Professional Documents
Culture Documents
Critical incident Schemas activated Negative automatic thoughts Behavioral response Anxiety symptoms Cognitive biases
Disorder
Cognitive themes
Panic disorder
Social phobia
Misinterpretation of anxious symptoms Concern about the consequences of panic Concern about appearing anxious before other, embarrassment in public Concern about consequences of obsessive thoughts/compulsive acts. Of no reduction of distress by compulsions. Excessive and Concern about the uncontrollable worry uncontrollability and about many events (6m) danger of worrying
4. When you noticed that emotion what sensations did you have? 5. When you had those sensations what thought went through your mind? 6. How much did you believe (insert catastrophic misinterpretation) those thoughts at that time? 7. What happened to your anxiety when you thought that? 8. Did you do anything to lower anxiety? What was that? 9. Since you have developed panic do you focus attention on your body/thoughts?
1. Trigger
Psycho education Exposure to internal cues (spinning in the chair, hyperventilating, swaying head from side to side) Cognitive restructuring decatastrophizaton Graded exposure to feared events (or usual activities that were being avoided) Practice in as many contexts as possible Talk about safety behaviours/ counters
Behavioural (or largely behavioural) techniques Relaxation Imagery Breathing exercise Others
Cognitive restructuring
Travelling two stops in an over-ground train, quiet time of day Travelling two stops in an over-ground train, peak hour Travelling one stop in an underground train, quiet time of day Travelling two stops in an underground train, peak hour Travelling five stops in an underground train, quiet time of day Travelling five stops in an underground train, peak hour
Use the progressive muscle relaxation, isometric or slow breathing exercises if possible before you go out. Perform all activities in a slow and relaxed manner. Give yourself plenty of time. Mentally rehearse your activity. For example, if you are traveling by train, mentally rehearse some coping statements to say to yourself as the doors close, as more people get on and so on. Monitor your breathing rate at regular intervals e.g., once every 5-10 minutes. You may use your slow breathing exercise to reduce your breathing rate if it is higher than it should be.
Do not leave a situation until you feel yourself to be calming down. Never leave the situation out of fear - face it, accept it, let it fade away and then either move on or return. If you do not do this you may interpret it as a failure and lose confidence. The longer you remain in a situation the calmer you will become and the faster you will overcome your fears e.g., staying for two hours in a shopping centre is better for you than going here for a total of two hours on four occasions. Congratulate and reward yourself for attempting or completing exposure tasks
Social phobia
Graded exposure
Contamination
Physical violence to self and others Images of loved ones dead Impulse to shout out an obscenity
Wash, check body for symptoms of disease. Ring doctor. Wont be alone with baby, seeks reassurance, hides knives. Counter imagination of same people alive Avoids social situations, asks others whether behaviour was acceptable in particular situation.
3. Do you believe these thoughts mean something? What is the worst they could mean? How much did you believe that at the time? 4. Did you do anything to stop from happening? Did you do anything to stop yourself doubting? Did you try to prevent feeling anxious? (what did you do?) 5. Do you believe that you must behave in certain ways in order to remain safe and stop bad things from happening?
1. Trigger thought/image/impulse What does the trigger personally mean to the patient?
*ERP
Exposure with positive self talk No bland reassurance Ask patient to treat this as a behaviour experiment. Usually lasts two hours. Modelling
Principles of ERP
Limits will be set on your ritualized behaviour Graded exposure You will not use counters Family members will not be enlisted to carry out your rituals.
Ask yourself Where is the evidence? Even if internal self talk appears logical and accurate, are the feared consequences really as awful or catastrophic as the OCD is trying to make them out to be? Reduce all or nothing thinking. Do a cost benefit analysis.
But beware
Is the CT turning into one big repetitive self reassurance ritual? Then throw the CT out of the window. Use of CT strategies during flooding style ERP tasks can dilute the intensity of the exposure task and thereby reduce potential for habituation gains. Is your self talk becoming another obsession? Then abandon it. The same questions have been raised about thought stopping also, though it is still used effectively by many therapists.
Imaginary exposure
Relaxation therapy
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