SA01 Understanding and
Treating Anxiety Disorders
Dr. David A Russ
Licensed Psychologist
www.turnaroundanxiety.com www.carolinas-counseling.com
Notes and Powerpoint can be
downloaded from:
www.turnaroundanxiety.com/documents
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Identifying the Core Elements of Anxiety
Types of Anxiety Disorders
Explanation of Treatment
Example of Treatment
Question and Answer
Outline for this Workshop
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False Alarm
Anxiety Sensitivity
Rapid and General
Memorized/Learned
Normal problem solving backfires
Core Elements (Causes)
Disorder - Reaction significantly
incongruent with circumstances
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Intensity
Frequency
Interference
Persistence
What Makes it a Disorder?
Panic
OCD
GAD
Phobia
Shared Elements
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Physiological Arousal
Cognitive Distortion
Avoidant Coping
Reinforcing Cycle
Specific Shared Elements
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Autonomic Nervous System
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Sympathetic and Parasympathetic
big issue, often becomes part of
disorder
Can be triggered by event, multiple
stressors, biology, etc
Fight or Flight trumps everything
Real Experience + Imagined Fear
Loss of predictability
Physiological Arousal
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Physiology “demands” focus on danger
Problem is mental invention (What if?)
Common Distortions
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Over-estimate danger
Feel over-responsible - guilt
All or nothing
Filter out positive
Intolerance of uncertainty
Mind-Reading
Cognitive Distortions
Attempt to solve “invented” problem
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Primary: Avoidance/Escape –
literal or imagined
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Secondary: If can’t avoid then
make it as safe as possible –
symptoms get more extreme and
less functional – partially effective
(huge problem)
Avoidant Coping
Trigger
Primary
Secondary
Getting a shot
don’t go
distract self, don’t look
at needle, request extra
anesthesia
Racing heart
Don’t exert self
Check pulse, have safe
person with you,
relaxation
Food that could cause
choking
Don’t eat
Have water, chew extra,
eat soft food
Interacting with people
Avoid social situations
Keep topic easy, avoid
eye contact, take
talkative friend, have
excuse to leave
Examples
Trigger
No
Correction
View as
Threat
Avoidant
Coping
Anxiety
Reinforcing Cycle
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Panic
Separation
GAD
Social/Selective Mutism
Phobias
Trauma
OCD and spectrum
Types of Anxiety
Fear of Fear
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Severe Distress
Out of blue
Fear of fear
Agorophobia
Panic Disorder
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palpitations
sweating
trembling or shaking
sensations of shortness of breath or smothering
feeling of choking
chest pain or discomfort
nausea or abdominal distress
dizziness or lightheadedness
derealization or depersonalization
fear of losing control or “going crazy"
fear of dying
paresthesias
chills or hot flushes
Symptoms
Fear of loss of protection/security
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Characterized by extreme fear/distress when
faced with separation - home or attached
adults
Worry about safety of self and caregivers
School refusal
Body complaints
Being alone/sleep
Separation Anxiety
Fear of things going bad
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Pattern of exaggerated worry that is
characterized by attention to negative or
threat related information
Must last 3 -6 months
About multiple issues
Physical complaints: pain, nausea, fatigue
Generalized Anxiety Disorder
Fear of embarrassment or judgment
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Fear acting in way that is humiliating
Fear of judgment
Fear reaction can be panic
Performance Anxiety
Selective Mutism
Social Phobia
Fear of clearly discernible object or situation.
Types
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Phobias
Natural
Animal
Blood/Shots/Injury
Situational
Other - Emetophobia
Anxiety resulting from Trauma
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Physical or Natural
Re-experienced (flashbacks, dreams,
etc.
Avoidance
Numbing
Hyper-arousal
Trauma related
Fear of loss of core value
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Obsessions – thoughts in focus in spite of and
contrary to desire of person. Thoughts cannot be
suppressed even though not characteristic of self.
Great distress as result
Compulsions – urges to perform behavior or
thinking actions to reduce anxiety or possible
harm.
Obsessive-Compulsive Disorder
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Treatment for Core Elements:
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Physiological Arousal Calming
Cognitive Distortion Accuracy
Avoidant Courageous Coping
Core error: Reacting to
something that is bothersome as
dangerous
Treatment
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Educational
Directive
Structured
Symptom Reduction rather than
insight oriented
More coach, less therapist
Approach
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Medication
Skill Training – somatic
management
Distress tolerance
Change Lifestyle
Physiological Calming
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Teach thinking about thinking
Tracking thoughts
Identification of problem thinking
Cognitive Restructuring
Cognitive Accuracy
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What is the evidence?
Are there other ways to think
about the situation?
What is the worst that could
happen?
What is the effect of believing
idea?
Keys to Disputing Thoughts
ERP
• Exposure
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Deliberately evoking anxiety
Remaining in distress
Response Prevention
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Prevent normal coping response
Not doing anything to reduce distress
before, during and after exposure
Don’t employ Safety Behaviors
Courageous Coping
Exposure
• Types
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Thought
Interoceptive
Virtual
In situation
Create Hierarchy
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SUDs
List of triggers and core fears
Put in 3 categories - Easy, Medium, Hard
Create an exposure for them
Treatment - Exposure
1.Words
2.Short sentences
3.Paragraphs
4.Simple cartoon illustrations
5.Photos of sick people (no vomit)
6.Pictures of vomit
7.Pictures of people vomiting
8.Animated videos of vomit
9.Videos of people vomiting
10.Fake vomit and smell
Emetophobia Hierarchy
Safety Behavior
Response Prevention
Don’t look at words
Stare at words, write the word
Only do exposure with safe person or Exposure in places where might get
in safe place
sick (nurses office)
Mental change to make story safe (just Describe story as scary as possible
looking for something in toilet)
Say words fast or mutter them
Slow down speaking, enunciate
Subtle actions (flick, spit, swallow,
change posture)
No flicking, fidgeting, spitting
Example Response Prevention
Turnaround
www.turnaroundanxiety.com