Lesson - 07 CBT

Cognitive Behavioural Therapy
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.
1
Although it can be uncomfortable, anxiety is not always a negative thing.
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.
Understanding and working with Anxiety Disorders
How to know if the client is presenting with an anxiety disorder
If the client can answer “yes” to any of the following questions, they may
well have an anxiety disorder:
Are they constantly tense, worried, or on edge?
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 avoid everyday situations or activities because they make them

anxious?
Do they experience sudden, unexpected panic attacks?
Do they feel that danger and misfortune are around every corner?
The Signs and Symptoms of Anxiety Disorders
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.
2
One person may struggle with a disempowering fear of driving or

uncontrollable, intrusive thoughts and another may live in a constant state of
fear and trepidation and worry about absolutely everything.
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.
Emotional Symptoms of Anxiety
In addition to the main symptoms of irrational and excessive fear and

worry, the other common emotional symptoms of anxiety include:
Feelings of apprehension
Restlessness
Feelings of unexplained tension
Always waiting and expecting the worst to happen
Looking out for warning or danger signs or portents
Difficulty maintaining concentration and focus
Irrational irritability
Periods of mental void
Physical Symptoms of Anxiety
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.
Because of the numerous physical symptoms, anxiety sufferers can frequently

mistake their disorder for a medical illness and this can then further add to their
fears and worsen the condition.
3
They may find themselves visiting numerous medical professions before their
anxiety disorder is discovered and correctly diagnosed.
The most common physical symptoms of anxiety include:
Fatigue
Exhaustion
Sweating
Over body muscle tension
Headaches
Nausea
Tremors and unexplained twitching
Insomnia
Frequent urination
Loose bowel movements and IBS like symptoms
Dizziness
Stomach upsets
Flu like symptoms
There is also a recognised medical link between anxiety and depression.

Many people with anxiety disorders also suffer from depression at some point.
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.
As depression exacerbates anxiety it is vital to seek treatment for both

conditions.
4
Anxiety Attacks and their Symptoms
Anxiety attacks are also known as panic attacks and are episodes of intense
panic or fear.
Anxiety attacks usually occur suddenly and without warning.
Sometimes there is an obvious trigger— getting stuck in a lift, or thinking about

the important work function that is due to be attended. However, in many cases,
the attacks come without any reason or all.
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.
The Symptoms of an Anxiety Attack can include:
Hyperventilating
Nausea
Hot flashes
Chills
Heart Palpitations
Chest Pains
Trouble Breathing
5
Choking sensations
Feelings of losing control
Shaking
Trembling that cannot be controlled
Overwhelming surge of panic or fear
Feelings that unconsciousness is imminent
Uncontrollable urge to urinate or defecate
Types of Anxiety Disorders
There are six main recognised categories of anxiety disorders and each has
their own distinct symptoms and these are:
Generalized anxiety disorder
Obsessive-compulsive disorder
Panic disorder
Phobia
Post-traumatic stress disorder
Social anxiety disorder
Generalized Anxiety Disorder
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.
6
Clients presenting with GAD are chronic worriers who feel anxious most of the
time, though they may not even know why.
Anxiety related to GAD often shows up as physical symptoms like insomnia,

stomach upset, restlessness, and fatigue.
Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is characterized by unwanted thoughts or

behaviours that seem impossible to stop or control.
If a client has OCD, they may well be troubled by obsessions, such as a

recurring worry that they forgot to turn off the oven or water in the house before
they left the house or that they might hurt someone. They may also suffer from
uncontrollable compulsions, such as excessive cleaning rituals to their
surroundings and to themselves.
Panic Disorder
Panic disorder is characterized by repeated, unexpected panic attacks, as well as

fear of experiencing another episode.
Panic disorder can also be frequently accompanied by agoraphobia, which is a

fear of being in places where escape or help would be difficult in the event of a
panic attack.
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
A phobia is an unrealistic or exaggerated fear of a specific object, activity, or

situation that in reality presents a minimal to no danger.
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.
7
E.g. not going into a park or open green space for fear of seeing or being
attacked by birds.
Unfortunately, avoidance only strengthens the phobia.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur in

the aftermath of a traumatic or life-threatening event.
Symptoms of PTSD include flashbacks or nightmares about what happened,

hyper vigilance, startling easily, withdrawing from others, and avoiding
situations that remind the client of the event and talking about the event.
Social Anxiety Disorder
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.
How CBT works for Anxiety Disorders
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.
Behavioural and thinking techniques are implemented in the following

order within CBT treatment:
A complete range of relaxation training, including breathing, progressive

muscle relaxation, imagery and distraction techniques.
8
Educational training in the relationship between negative thoughts, feelings, and

behaviour the challenge and reinterpret thinking in a more balanced way.
Behavioural experiments to test feared situations, and by experiencing these

fears of the worst happening reduce their sense of danger and threat.
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.
Anxiety Symptom Questionnaire. Client:

Please answer yes or no for each of
the symptoms listed below to Date:
determine your levels of anxiety.
1. Do you have a fear or sense of Yes/ No
losing control? Give details:
2. Do you feel a sense of dread in Yes/ No

everyday life? Give details:
3. Are you afraid of dying? Yes/ No

Give details:
4. Do you find yourself unable to Yes/ No

relax? Give details:
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5. Do you often feel nervous for no Yes/ No

apparent reason? Give details:
6. Do you experience trouble with Yes/ No

breathing and experience shortness Give details:
of breath?
7. Does your heart feel like it is Yes/ No

racing or pounding very fast Give details:
without you engaging in aerobic
exercise?
8. Do you suffer from frequent Yes/ No

indigestion? Give details:
9. Do you experience frequent hand Yes/ No

tremors or body twitching? Give details:
10. Do you frequently imagine the Yes/ No

worst things happening to yourself Give details:
or family members?
11. Please list any other symptoms

you are experiencing currently?
10
Anxiety/ Panic Attack Client:

Questionnaire.
Please answer yes or no for each of Date:
the statements listed below to
determine your levels of anxiety
attack.
1. I have had an anxiety/panic Yes/ No
attack. Give details:
2. I have had anxiety/panic attacks Yes/ No

when I have been away from home Give details:
or a safe environment.
3. I feel that if I have another Yes/ No

anxiety/panic attack, I will die. Give details:
4. I feel that as I have already Yes/ No

experienced at least one panic Give details:
attack that I will definitely have
another one.

anxiety/panic attack that I will Give details:
definitely lose control and everyone
will look at me.

anxiety/panic attack that people Give details:
will laugh at me or lose respect for
me or see me as weak and
vulnerable.
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anxiety/panic attack that I will lose Give details:
my sanity and be locked up.
8. I feel that I am unable to function Yes/ No

when I am alone and have an Give details:
anxiety/panic attack.
9. I feel that I must be with my Yes/ No

partner or friend to be safe from Give details:
experiencing another anxiety/panic
attack.
10. When I have an anxiety/panic Yes/ No

attack I cry or scream. Give details:
11. Please list any physical or

emotional symptoms you have
experienced whilst having an
anxiety/panic attack?
12
Post Traumatic Stress Disorder Client:

Symptom Questionnaire.
Please answer yes or no for each of Date:
the symptoms listed below to
determine your levels of PTSD.
1. Do you get many headaches? Yes/ No
Give details:
2. Are you experiencing regular Yes/ No

insomnia or sleep disturbance? Give details:
3. Do you feel sad frequently? Yes/ No

Give details:
4. Are you crying frequently? Yes/ No

Give details:
5. Are you experiencing constant Yes/ No

tiredness or exhaustion? Give details:
6. Are you able to relax? Yes/ No

Give details:
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7. Have you lost pleasure in your Yes/ No
usual activities or hobbies? Give details:
8. Are you experiencing frequent Yes/ No

worry or anxiety? Give details:
9. Are you finding it difficult to Yes/ No

concentrate or focus for any length Give details:
of time?
10. Are you experiencing poor Yes/ No

appetite? Give details:
11. Are you experiencing poor Yes/ No

digestion or frequent IBS like Give details:
symptoms?
12. Are you having difficulty Yes/ No

maintaining your normal working Give details:
practices?
13. Are you experiencing Yes/ No

irritability? Give details:
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14. Are you finding it difficult to Yes/ No
make decisions currently? Give details:
15. Have you lost interest in your Yes/ No

life/family/friends? Give details:
16. Have you experienced a Yes/ No

traumatic event recently? Give details:
17. Do you have nightmares about Yes/ No

the event? Give details:
18. Do you experience flashbacks Yes/ No

about the event? Give details:
19. Are you experiencing unwanted Yes/ No

thoughts about the event? Give details:
20. Are you experiencing feelings Yes/ No

of hopelessness about your future? Give details:
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21. Are you or have you been Yes/ No
contemplating ending your life? Give details:
22. Do you feel or think that your Yes/ No

life is not worth living? Give details:
23. Do you feel or think that your Yes/ No

family and friends would be better Give details:
off without you?
24. Are you feeling afraid Yes/ No

currently? Give details:
25. Please list any other physical or

emotional symptoms you are
currently experiencing?
16
Social Anxiety Questionnaire. Client:

Please answer yes or no for each of
the symptoms listed below to Date:
determine your levels of Social
Anxiety.
Do you feel these symptoms whilst
in social situations?
1. Pain in the chest Yes/ No
Give details:
2. Difficulty in breathing Yes/ No

Give details:
3. Hyperventilating Yes/ No
Give details:
4. Choking Yes/ No
Give details:
5. Sweating/ Extreme perspiring 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:
9. Very scared Yes/ No

Give details:
10. Terrified Yes/ No

Give details:
11. Fear of dying Yes/ No

Give details:
12. Fear of loss of sanity Yes/ No

Give details:
13. Pounding speeding heart rate Yes/ No

Give details:
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14. Nauseous Yes/ No
Give details:
15. Partial loss of control Yes/ No

Give details:
16. Complete loss of control Yes/ No

Give details:
17. Loss of speech or vocal ability Yes/ No

Give details:
18. Please list any other physical or

emotional symptoms you have
experienced in a social situation or
setting?
When you are in the following

social situations, do you feel or
think that other people are watching
you, criticising or judging you?
1. Dining out. Yes/ No
Give details:
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2. In general social situations Yes/ No
Give details:
3. At work meetings Yes/ No

Give details:
4. In a job interview Yes/ No

Give details:
5. Using a public toilet Yes/ No

Give details:
6. On a date situation Yes/ No

Give details:
7. Meeting someone for the Yes/ No

first time Give details:
8. Speaking in public Yes/ No

Give details:
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9. Dealing with authority figures Yes/ No
Give details:
10. On the stage, performing Yes/ No

Give details:
11. At a hobby event Yes/ No

Give details:
12. Confronting someone Yes/ No

Give details:
13. Saying no to a close friend or Yes/ No

family member Give details:
14. Out with friends or family Yes/ No

members Give details:
15. In public changing facilities Yes/ No

Give details:
16. Please list any other places
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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.
Clients and the therapist are then focused on:
What the diagnosis is.
What means the therapist will use to achieve these results.
Recognising when these goals have been achieved.
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.
NEETA TRAINING & CONSULTING SERVICES WWW.NEETATCS.COM

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.
Dealing with Obsessions and Compulsions
What is Obsessive Compulsive Disorder?
Obsessive Compulsive Disorder (OCD) is the name given to a condition in

which people experience repetitive and upsetting thoughts and/or behaviours.
OCD has two main features: obsessions and compulsions.
Obsessions are involuntary thoughts, images or impulses.
Common obsessions include:
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.
As with obsessions, there are also many types of compulsions.
It is common for people to carry out a compulsion in order to reduce the anxiety
they feel from an obsession.
Common compulsions include excessive washing and cleaning, checking,

repetitive actions such as touching, counting, arranging and ordering, hoarding,
ritualistic behaviours that lessen the chances of provoking an obsession (e.g.
putting all sharp objects out of sight), and acts which reduce the obsession (e.g.
wearing only certain colours).
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.
A client can have some or all of these symptoms.
Almost everybody experiences some type of thoughts that individuals with

OCD have (e.g., wanting to double-check the front door or the gas or cooker).
However, most people are able to dismiss these thoughts.
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
therefore OCD has often been called the 'secretive disorder'.

It is important to remember that severity of OCD differs markedly between
people but each person's distress is very real.
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.
Psychological factors such as susceptibility to stress or exposure to an

emotionally traumatic experience are also likely to be in evidence.
Other examples of OCD are:
Trichotillomania is a compulsive urge to pluck out hair, resulting in noticeable

hair loss.
It is also referred to as 'compulsive hair pulling' and Compulsive Skin Picking

(CSP) is the repetitive picking at one's own skin to the extent of causing
bleeding or damage to the skin to relieve anxiety or urges.
In the first stage of assessment, diagnostic tests are used to look at the areas of:
Checking, Washing, Doubting and noticeable slowness in tasks.

Both an analysis of the symptoms of obsession and personality traits are

measured as well as levels of anxiety and depression.
Clients are also encouraged to self-monitor the frequency and duration of their
obsessive thoughts as well as the intensity this distress has caused.
Also, the nature and frequency of ritualistic behaviour is monitored and

recorded in the CBT diary or work log.
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.
Exposure needs to be done without performing a compulsion (a process called

'response prevention') and in this way allow the client to tolerate the discomfort
that occurs.
If a compulsion is performed, then the exposure should be repeated in order to

'undo' the compulsion.
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.
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.
In research trials, about 25% of patients either refuse to take part in a

programme of exposure and response prevention or fail to adhere to a
programme.
Of those that do adhere, about 75% are helped significantly after 10-20 sessions
as an outpatient. The risk of relapse after treatment is about 25%, when the
person may require additional treatment.
CBT suggests that OCD results when an individual misinterprets intrusive
thoughts or urges as a sign that not only will harm occur, but that they may be
responsible for it through what they do or what they fail to do.
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.
When a person is receiving CBT, the most important ingredient is the

homework that must be done between the sessions.
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.
© Sue Etherden 2008

The right of Sue Etherden to be identified as the author of this work has
been asserted by her in accordance with the Copyright, Designs and
Patents Act 1988.

QUESTIONS ON LESSON SEVEN
Q1. Briefly, what is your understanding of Anxiety?
Q2. Give 6 physical symptoms of anxiety?
Q3. State the 6 main recognised categories of anxiety disorders?
Q4. Explain your understanding of OCD?
Q5. Give examples of common compulsions within OCD?
Q6. Design a Post Traumatic Stress Disorder Symptom Questionnaire?
Q7. Describe some of the methods that may be used within CBT for the
treatment of Anxiety disorders?
Q8. Describe 2 other OCD conditions?
Q9. What percentage of the UK population has or is experiencing some

form of OCD?
Q10. Describe your understanding of a Phobia and give an example?

Return your answers to either:
Dr.neetaparate9@gmail.com
Do not send any attachments; just type your answers into the body of the
email, some formatting required.
Please complete the subject box of every email exactly as follows
(This has to be machine read and is Case Sensitive):
Your Name – CBT (tutored) – Lesson Number
Leave at least one blank line between each answer.
Don’t forget to keep a copy for your own records

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Cognitive Behavioural Therapy

Although it can be uncomfortable, anxiety is not always a negative thing.

Understanding and working with Anxiety Disorders

How to know if the client is presenting with an anxiety disorder

Are they constantly tense, worried, or on edge?

Do they avoid everyday situations or activities because they make them

Do they experience sudden, unexpected panic attacks?

The Signs and Symptoms of Anxiety Disorders

One person may struggle with a disempowering fear of driving or

Emotional Symptoms of Anxiety

In addition to the main symptoms of irrational and excessive fear and

Feelings of unexplained tension

Always waiting and expecting the worst to happen

Looking out for warning or danger signs or portents

Difficulty maintaining concentration and focus

Periods of mental void

Physical Symptoms of Anxiety

Because of the numerous physical symptoms, anxiety sufferers can frequently

The most common physical symptoms of anxiety include:

Over body muscle tension

Tremors and unexplained twitching

Loose bowel movements and IBS like symptoms

Flu like symptoms

There is also a recognised medical link between anxiety and depression.

As depression exacerbates anxiety it is vital to seek treatment for both

Anxiety Attacks and their Symptoms

Anxiety attacks usually occur suddenly and without warning.

Sometimes there is an obvious trigger— getting stuck in a lift, or thinking about

The Symptoms of an Anxiety Attack can include:

Feelings of losing control

Trembling that cannot be controlled

Overwhelming surge of panic or fear

Feelings that unconsciousness is imminent

Uncontrollable urge to urinate or defecate

Types of Anxiety Disorders

Generalized anxiety disorder

Post-traumatic stress disorder

Social anxiety disorder

Generalized Anxiety Disorder

Anxiety related to GAD often shows up as physical symptoms like insomnia,

Obsessive-compulsive disorder (OCD) is characterized by unwanted thoughts or

If a client has OCD, they may well be troubled by obsessions, such as a

Panic disorder is characterized by repeated, unexpected panic attacks, as well as

Panic disorder can also be frequently accompanied by agoraphobia, which is a

A phobia is an unrealistic or exaggerated fear of a specific object, activity, or

Unfortunately, avoidance only strengthens the phobia.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur in

Symptoms of PTSD include flashbacks or nightmares about what happened,

Social Anxiety Disorder

How CBT works for Anxiety Disorders

Behavioural and thinking techniques are implemented in the following

A complete range of relaxation training, including breathing, progressive

Educational training in the relationship between negative thoughts, feelings, and

Behavioural experiments to test feared situations, and by experiencing these

Anxiety Symptom Questionnaire. Client:

2. Do you feel a sense of dread in Yes/ No

3. Are you afraid of dying? Yes/ No

4. Do you find yourself unable to Yes/ No

5. Do you often feel nervous for no Yes/ No

6. Do you experience trouble with Yes/ No

7. Does your heart feel like it is Yes/ No

8. Do you suffer from frequent Yes/ No