Lesson - 07 CBT
Lesson - 07 CBT
Lesson - 07 CBT
Lesson 7
Anxiety
Understanding and working with Anxiety Disorders
Dealing with Obsessions and Compulsions
Anxiety
Our modern society has been called 'age of anxiety' and for the last four decades
almost a third of the population has reported anxiety symptoms at some point in
their lives.
As the human race are forced to constantly juggle work, home, and family
pressures, their ability to respond to these constant demands and recuperate
from each task has diminished and in some cases, vanished.
One of the main problems people have in managing these internal and external
stressors is how they deal with their stress and anxiety levels.
In the work population today the average man/woman is said to be working five
times as much as the average employee did in the 1970's.
In Britain today, on average, we work 46 hours per week, the longest hours in
the EU.
Anxiety can be defined as the difference between the physical, thinking and
feeling resources and the required individual response.
People feel they are under constant threat and that they may lose control and are
unable to cope with their life demands.
It is normal to worry and feel tense or scared when under pressure or facing a
stressful situation.
Anxiety is the body’s natural response to danger, the internal alarm that goes off
when an individual feels threatened.
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Anxiety can help an individual stay alert and focused, spur them into action, and
motivate them to solve problems and strive for better things in life. However,
when anxiety is constant or overwhelming and when it interferes with normal
relationships and activities this is when a normal acceptable level of anxiety
becomes an anxiety disorder.
If the client can answer “yes” to any of the following questions, they may
well have an anxiety disorder:
Does their anxiety interfere with their work, social, or family responsibilities?
Are they plagued by fears that they accept and know are irrational, but cannot
stop worrying about them?
Do they believe that something bad will happen if certain things are not done a
certain way?
Do they feel that danger and misfortune are around every corner?
Because anxiety disorders are a group of related conditions rather than a single
disorder, they can look very different from person to person.
One individual may suffer from intense anxiety attacks that strike without
warning, while another gets panicked at the thought of attending a social
gathering.
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But despite their different forms, all anxiety disorders share one major
symptom: persistent or severe fear or worry in situations where most people
would not normally feel threatened.
Feelings of apprehension
Restlessness
Irrational irritability
Anxiety is more than just a feeling; it is a product of the body’s stress or fight-
or-flight response and therefore involves a wide variety of physical symptoms.
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They may find themselves visiting numerous medical professions before their
anxiety disorder is discovered and correctly diagnosed.
Fatigue
Exhaustion
Sweating
Headaches
Nausea
Insomnia
Frequent urination
Dizziness
Stomach upsets
Anxiety and depression are believed to stem from the same biological factor,
which may explain why they are frequently both apparent within a client’s
presenting issues.
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Anxiety attacks are also known as panic attacks and are episodes of intense
panic or fear.
Anxiety attacks usually peak within ten minutes, and they very rarely last more
than a half hour.
But during that short period of time, the terror and fear can be so severe that a
client can feel as if they are going to die or totally lose control.
The physical symptoms are themselves so frightening that many people believe
they are experiencing a heart attack.
After an anxiety attack is over, the client may be very anxious and frightened
about having another one, particularly in public or in a place where help is not
readily available.
Hyperventilating
Nausea
Hot flashes
Chills
Heart Palpitations
Chest Pains
Trouble Breathing
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Choking sensations
Shaking
There are six main recognised categories of anxiety disorders and each has
their own distinct symptoms and these are:
Obsessive-compulsive disorder
Panic disorder
Phobia
If constant worries and fears distract the client from their normal activities or
they present as being troubled by a persistent feeling that something bad or
negative is going to happen, they may well be suffering from generalized
anxiety disorder.
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Clients presenting with GAD are chronic worriers who feel anxious most of the
time, though they may not even know why.
Obsessive-Compulsive Disorder
Panic Disorder
If a client is presenting with agoraphobia, they are likely to avoid public places
such as shopping centres, or confined spaces such as an airplane or lifts.
Phobia
Common phobias include fear of animals such as snakes and spiders, fear of
flying, and fear of heights.
In the case of a severe phobia, the client may well go to extreme lengths to
avoid the thing they fear.
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E.g. not going into a park or open green space for fear of seeing or being
attacked by birds.
If the client has a debilitating fear of being seen negatively by others and
humiliated in public, they may be suffering from social anxiety disorder, which
is also known as social phobia.
Social anxiety disorder can be thought of as extreme shyness and in very severe
cases, social situations are avoided altogether.
Performance anxiety which is also known as stage fright is the most common
type of social phobia.
CBT treatment for anxiety works by both improving those resources which help
the client to cope and, at the same time diminishing the sense of threat.
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In the first session a CBT practitioner will give a full individual assessment
using a specific diagnostic criteria, to determine the severity of symptoms
connected with anxiety.
Below are examples of some diagnostic questionnaires used within the CBT
process to ascertain the nature and severity of the presenting issue or
problem.
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7. I feel that if I have another Yes/ No
anxiety/panic attack that I will lose Give details:
my sanity and be locked up.
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7. Have you lost pleasure in your Yes/ No
usual activities or hobbies? Give details:
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14. Are you finding it difficult to Yes/ No
make decisions currently? Give details:
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21. Are you or have you been Yes/ No
contemplating ending your life? Give details:
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3. Hyperventilating Yes/ No
Give details:
4. Choking Yes/ No
Give details:
6. Dizzy Yes/ No
Give details:
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7. Faint Yes/ No
Give details:
8. Scared Yes/ No
Give details:
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14. Nauseous Yes/ No
Give details:
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2. In general social situations Yes/ No
Give details:
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9. Dealing with authority figures Yes/ No
Give details:
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where you have felt anxious in?
The client’s answers will determine the origin of the person’s life and anxiety
experience and give the therapist and client an extra formulation to work with
whilst deciding on the appropriate form of treatment for the presenting problem.
A problem list of 5-6 things the client wants to change as a result of CBT
treatment is collaboratively drawn up with the therapist and client and this acts
as the aims and objectives of the therapy.
Some methods that may be used within CBT for the treatment of Anxiety
disorders are:
Exercise
Exercise is a natural stress treatment and anxiety reliever.
Research shows that as little as 30 minutes of exercise three to five times a week
can provide significant anxiety relief. To achieve the maximum benefit, the
client needs to achieve at least an hour of aerobic exercise on most days.
Relaxation techniques
When practiced regularly, relaxation techniques such as mindfulness
meditation, progressive muscle relaxation, controlled breathing, and
visualization can reduce anxiety and increase feelings of relaxation and
emotional well-being.
Biofeedback
Using sensors that measure specific physiological functions—such as heart rate,
breathing, and muscle tension—biofeedback teaches the client to recognize the
body’s anxiety response and learn how to control them using relaxation
techniques.
Hypnosis
Hypnosis is sometimes used in combination with cognitive-behavioural therapy
for anxiety.
While the client is in a state of deep relaxation, the therapist uses different
therapeutic techniques to help them face their fears and look at them in new
ways.
Exposure therapy
In exposure therapy for anxiety disorder treatment, the client will confront their
fears in a safe, controlled environment.
Through repeated exposures, either in their imagination or in reality, to the
feared object or situation, they then gain a greater sense of control.
Basically as they face their fear without being harmed, their overall anxiety
gradually diminishes.
Fears about dirt, germs and contamination; fears of acting out violent or
aggressive thoughts or impulses; unreasonable fears of harming others,
especially loved ones; abhorrent, blasphemous or sexual thoughts; inordinate
concern with order, arrangement or symmetry; inability to discard useless or
worn out possessions; religion and fears that things are unsafe, e.g. household
appliances.
The main features of obsessions are that they are automatic, frequent, upsetting
or distressing, and frequently difficult or impossible to control.
It is common for people to carry out a compulsion in order to reduce the anxiety
they feel from an obsession.
Compulsions can be observable actions, for example washing, but they can also
be mental rituals such as repeating words or phrases at a set pace or tone,
counting or saying a prayer.
The main features of compulsions are they are repetitive and stereotyped actions
that the person feels forced to perform.
Individuals can have compulsions without having obsessed ional thoughts but
frequently they both occur together.
Therefore carrying out a compulsion reduces the person's anxiety at that time
and makes the urge to perform the compulsion again stronger each time.
Clients with OCD cannot ignore unpleasant thoughts and pay undue attention to
them and this then means that the thoughts become more frequent and
distressing and, over time, they can affect all areas of a person's life, often their
work, their family and social life.
A client with OCD can often appear to function completely normally despite
being greatly distressed.
Due to this it is often possible for people with OCD to hide their OCD and
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therefore OCD has often been called the 'secretive disorder'.
Clients experiencing OCD are not insane or dangerous and most never carry out
their unpleasant thoughts.
Most clients presenting with OCD know that their thoughts are excessive or
irrational but the anxiety they feel makes the thoughts difficult to ignore.
OCD is much more common than was previously thought. Recent research
suggests that between 1-2 per cent of the UK population has OCD.
One reason why the growth of OCD has been underestimated in the past is that
people with OCD are frequently wary of seeking help and support for their
condition.
They worry that others will think they are insane, and often do not know that
their disorder is a recognised condition with effective treatments.
Also, young people also suffer from OCD and often many adults with OCD had
presenting symptoms in childhood.
The cause of OCD is much debated but it is likely to result from a combination
of factors and the causes for one person may be different from those for another.
OCD can run in families and, in some cases, may be associated with an
underlying biochemical imbalance in the brain.
In the first stage of assessment, diagnostic tests are used to look at the areas of:
Clients are also encouraged to self-monitor the frequency and duration of their
obsessive thoughts as well as the intensity this distress has caused.
CBT works in the first part of the treatments to bring anxiety and depression
scores into the normative range.
Standard CBT is used to teach clients the relationship between their thoughts,
feelings and their OCD behaviours.
The preferred treatment is exposure when clients are prevented from performing
rituals and are exposed to the circumstances that caused their compulsive
behaviour. These rituals have come to be associated with safety and protection
and the clients are forced to face their worst fears.
For the treatment to be successful the exposure needs to be long enough for the
anxiety to subside and the fear needs to be constant and the exposure should be
repeated often.
Each individual has a different way of dealing with their situation and condition
and therefore this means that each person starts by confronting relatively easy
situations and then gradually works up to more difficult ones.
Facing up to each fear becomes easier and easier and the anxiety gradually
subsides.
The short-term side effects consist of anxiety and distress, but these will
gradually decrease and, in the long term, the fear will subside.
A client is never forced to confront their fears but they will be encouraged to
take responsibility for devising their own programme.
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A therapist does not have to be present, although it may help some individuals
at the start of their treatment programme and the tasks set need to be
challenging but not overwhelming.
CBT seeks to help the individual understand that their problem is one of anxiety
rather than danger and to react accordingly.
Individuals with OCD actively try to prevent harm and therefore the solution
becomes the problem.
The therapist can only act as a support or mentor and the more clients practise
on their own, the sooner they will get better.
When clients have completed a successful course of treatment for OCD, most
experts recommend follow-up visits for at least six months to a year.
Q7. Describe some of the methods that may be used within CBT for the
treatment of Anxiety disorders?
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