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Best Practices for Anxiety Treatment | Dr. Dawn Elise Snipes

May 31, 2021
This episode is pre-recorded as part of a live, on-demand continuing education webinar. CEUs are still available for this presentation by registering them at allceus.com. stripe counselor toolbox. I would like to welcome everyone to today's presentation on

best

practices

for treating

anxiety

. I am your host dr. Dawn Elise Snipes, not long ago we did a presentation on strengths-based biopsychosocial approaches to addressing

anxiety

, and while that's great, I thought maybe we should look to you, who know the current research, so I went to PubMed . I don't know if this is a playground for me; that's where a lot of journal articles are found, and you can sort them, and I sorted by articles that were done and meta-analyses that were done in the last five years, which gives us an idea about the current research.
best practices for anxiety treatment dr dawn elise snipes
I mean, there are a lot of things that remain the same, as some of the drugs that were known to work ten years ago are still good first-hand

treatment

s, but there are also some newcomers that we will talk about, and there are also some changes Let's talk, so we'll explore some common causes of anxiety symptoms to treat them. We really need to do it and of course it plays a role in the biopsychosocial aspect. We really need to understand what causes it, because anxiety is caused by someone. Someone who has a racing heart, for example, may be different from the anxiety caused by someone who has abandonment issues.
best practices for anxiety treatment dr dawn elise snipes

More Interesting Facts About,

best practices for anxiety treatment dr dawn elise snipes...

We're going to treat the two things differently, so we want to look at some of the common causes. We look at some common causes of anxiety. You know what these common themes are in practice and I would ask you to share some of the themes that you see underlying or underlying the anxiety of many of your clients and identify current

best

practices

for anxiety management, including counseling interventions , medications, physical interventions and active

treatment

s that's why we worry because anxiety can be crippling and a large proportion of our clients have anxiety a large proportion of our clients have anxiety comorbid with depression and they're looking come on, how can I feel anxious and stressed? and how can I not? sit still and at the same time know that when you are depressed a lot of times you want to sleep, people who have both problems really want to sleep but they can't, so I want to help clients understand that sometimes.
best practices for anxiety treatment dr dawn elise snipes
Also anxiety, if people are anxious for a long time, the body starts to hold on to cortisol, which the body recognizes at a certain point, it's a losing battle, I'm not going to put any more energy into it, so it starts using up. some of their exciting neurotransmitters, so to speak, and people start to feel depressed, the brain has already said that there is no remedy; It's that you can't change the situation, and then people start to feel desperate and helpless. is kind of the definition, if you will, of chronic low-grade depression, stress and anxiety, people's energy and ability to focus came up, so if we're going to help them become themselves, we have to help them become discover how to overcome anxiety by addressing not only the overwhelming generalization. debilitating anxiety, but also panic in social anxiety and minor anxieties that occur, which may not meet the threshold for a diagnosis;
best practices for anxiety treatment dr dawn elise snipes
Anxiety is a major cause of addiction relapse if you have a client who has previously self-medicated or had an addiction. for some reason anxiety is one of the main causes increase in physical pain when anxiety increases people tend to tense their muscles when they tense their muscles they tend to feel more pain in their back and things that already hurt can hurt more because serotonin, one of our most important anxiolytic neurotransmitters, it is also one of our most important pain modulators. Serotonin levels are too low because anxiety is high, so our perception of pain will be more acute and people can have trouble sleeping if they feel stressed, and their body thinks there's a threat that it can't go as deep.
If you're getting restful sleep, you may be getting a lot of sleep, but it's probably not quality sleep, which means your neurotransmitters can leave your body and your body will start to be in a constant state of stress when we're exhausted. , the body knows that we are possibly the weakest link in the pack, so it continues to secrete cortisol to keep you a little alert so you can rest again like when you have a new baby at home. For the first few months, my children's house was from the hospital. I slept. but I didn't sleep well I mean the slightest noise and I was awake and I looked around and you know what I felt I was exhausted and very new pair And makes the causes of anxiety abandonment and rejection, and we Let's talk about the ways in that we want to deal with these things, but some of the underlying issues that I've seen with a lot of clients and when I do research, a lot of the issues that come up include low self-esteem if someone has low self-esteem. esteem, seek external validation, often look for someone else to tell them that you love, that you are fine, which can lead to anxiety because people shouldn't tell them they are fine, which makes their relationships weak and dysfunctional, irrational thoughts and cognitive distortions.
It can make people believe that if I'm not perfect, I'm not worthy of being loved, for example. Looking at some irrational thoughts and cognitive distortions, social support and unhealthy relationships. If you're in a relationship, it takes two to tango, and even if your client is relatively healthy mentally and physically, if he's not functional, he can't be in a relationship. They fear abandonment and rejection if the other person always says if you don't do it The relationship and social exile lead if our clients are in relationships, even if they are not completely dysfunctional, if our clients cannot ask for what they need and set appropriate boundaries and manage conflict effectively because conflict occurs in every relationship, They may start to argue more, which can lead to fear, which can lead to relationships ending in the past, and okay, every relationship I have ends, which means I shouldn't love, so they start fearing abandonment and rejection, so there are four areas that we can make look at another that clients rate, another problem is the unknown and the loss of control many times negative self-talk and cognitive distortion c a contribution to the fact that if I do not have control over everything , all this is a disaster -The negative will be, apart from dating clients or dating negative people, it wears you out a little, if you notice that people who tend to be more negative, the pessimistic conspiracy tends to date people who are also negatively pessimistic. and conspiratorial, so when you're with someone who tends to be anxious, the anxiety can be palpable and it can permeate physical complaints and it can make people feel anxious because they don't know what's causing it, like I said before, if your heart starts to beat.
If you don't know what's causing it, you might start thinking I'm having a heart attack or that I'm going to die when people have panic attacks, for example, they really think they're having a heart attack, and I've had it. , but they are very unpleasant experiences, but if people start to have physical discomfort, you might know that they have a strange rash that they can't go away, or whatever, but if they don't, they don't know what it is and they can't control it, They can't make it go away, they start thinking about worst-case scenarios and they go online and go to WebMD, which usually offers worst-case scenarios, so Physical complaints are important, we need to normalize the fact that no one is pain-free everything. time and you know that you may have pain or soreness or a lump or lump or if you have a cough, you probably know that if We're looking at the probability, the probability that it's something significant is pretty small, you probably want to have it looked into, but you know that the likelihood that it is something to worry about is relatively small and a feeling of helplessness can lead to fear of the unknown and Causes of loss of control for someone who does not feel they have agency in their life, if they have an external locus of control or If you feel like a victim your whole life, then you may not be afraid to be in control, you can hold on and say, "Okay, this is it." the only area of ​​my life I can control growing up you know I grew up in a very chaotic environment I have no control I was sent into the foster care system yadda yadda yadda now that I'm an adult you know I can control these things, and I'm left with white knuckles, and if I can't control everything, it's a terrifying death and loss, and it causes another kind of anxiety.
They can be people or pets and pets are important. I don't want to put pets down because you know they are small parts of many of our families. now I think and you know she is healthy we took her to the vet and the vet said yes she has a small heart murmur but that is expected for a 14 year old dog but if it comes out if she doesn't come back when I call her, I had this anxiety for a moment, oh my god. Oh, I hope it wasn't the day, so anxious about losing people, and you know when she crosses the bridge, and you know I'm okay with that.
I find it harder to deal with my daughter's emotional turmoil when this happens and because she grew up with this dog, so you know, these are the types of things we want to talk to our clients about, what things are weighing on you, how about Maybe you don't even think. because I know in the back of my mind that there is always concern for one of our donkeys and her dogs; work and promotions can cause anxiety when people are afraid of losing their jobs when they are always afraid that you know they are coming in. and get a pink slip or get fired, you know we want to help them see how realistic it is: are you doing what you need to do to get and keep your job?
And sometimes it's not easy to answer. I mean the first thought. That thing that a lot of us have is good, you know if you do the right thing, so I don't, but there are bosses out there and I had a lot of amazing bosses, and I had two terrible bosses, and I could never get them. the feeling that I could do anything well and there was always an anxiety about who I am, so I'm going to get in trouble today, so you want to be with people talking, your job causes anxiety, what can you do to moderate the anxiety? the same?
Promotions can make people feel anxious or they promote safety and security, which you know when you lose safety and security, you can feel very anxious, so if the house next door gets robbed or there's a shooting in the walk or if you go to watch the news can make you feel unsafe and insecure very quickly, so we want to help people find out how safe and protected you are, and a lot of that goes back to the events when people lose their dreams and hopes or they fear they will leave. lose their dreams and hopes, they may start to get anxious, you know they have a dream of being a doctor, or I just finished the presentation on how to help high school students go to college, and many high school students, for example , they start college with these big eyes and hope to save the world, and they want to be doctors and engineers, and this and that, and they get into it and realize it's a lot harder than they thought.
Or they realize you know what I don't really do like that, but I've already committed to it, what should I do, or I want to help people, but I can't do it? going to medical school because I wouldn't pass calculus and it caused me a lot of anxiety, it was like what am I going to do now, do you know what career I should choose so people can help you figure out if you have dreams that maybe crashed? and burned, and you have to find new ones that you know well, one that we have to accept, you have to find out that that is not going to happen, and what can you do now, people can also have dreams about relationships that they are in relationships and they look forever with this person, and then this relationship ends or starts to get difficult and they say, but this is my dream it happens when it has to happen because this is my dream, I don't do it. knowing how it doesn't work, if it goes away we want to help people rewrite their story and then diseases, spiders and other phobias often go with death, many times when people get sick they start to get anxious, oh God, when they finally is, what would it be?
You know that it is incurable if a spider bites me it will kill me and what is strange you know that there are very few spiders that are actually the same poisonous as the snakes that pass over the bridges that I shared with you, this is not one of my irrational fears, You know, I'm just afraid that you know something is going on. Appen and I'm going to get rid of pushing myself off the side of the bridge, which is completely irrational, but we have to do it. help people look at the door and identify the thoughts they are saying to themselvesthemselves now about these phobias and dealing with anxiety, failure is another anxiety trigger, especially in this culture, our culture in American culture largely places a high premium on success and perfectionism. and when people realize that they're not perfect, they can get anxious because they feel like I'm not perfect, so I can, I'm a failure, you know the cognitive distortions of all or nothing thinking and they start with the negative self-talk, you know. that you can't do anything right, so these are some of the problems that you know we often see in counseling sessions, so what do we do?
You know someone comes in and I can't. It seems to live like that but anxiety, depression, and substance disorders, as well as a variety of physical disorders, often coexist, so that's the first thing we need to realize. If we realize that we are rarely faced with a very simple diagnosis, you know that if someone comes in, we have to find out that if they come in and they are depressed, let's talk about it, and then we start to realize that their depression started to appear after a long period where they were very anxious, so we have To deal with that, but we also have to help them with their sense of hopelessness and helplessness, we need to develop the sense of empowerment and then substance disorders.
We know that substance use is often a form of self-medication, but we also know that they are monkeys with the neurochemicals in the brain, and can contribute to anxiety and depression, as well as physical problems, due to mental disorders. physical, anxiety about having physical disorders. If we take physical disorders, they can all contribute to anxiety, so we have to look at the person as a whole and do everything that contributes to anxiety and what are all the things that contribute to anxiety, so we start with a big list of things that need to be addressed, and then we can start to figure out where we start, so we can know if these things are comorbid, and that helps researchers investigate pathways to mental disorders, so they can start to find out , you know, what rope can we pull to untangle this cloak of anxiety so that it doesn't suffocate anyone and for us as doctors it gives us important opportunities to intervene, you know, sometimes clients come in and start talking, start talking about their anxiety and physical problems.
You may know about their anxiety from their palpitations and because they are frequent, we may want to encourage them to see the doctor to rule out anything to do with hormonal imbalances or know about heart conditions or anything else. that can contribute to That can help them address it and if that's the case. If you have physical disorders, let's go with hormonal imbalances that contribute to palpitations, then they can start treating it. If they don't start it, they don't treat it, the amount of psychotherapy. We do it, it's not going to give them the quality of life that they're looking for because they're still going to feel it, so we want to make sure that we address it holistically: Anxiety disorders should be treated with psychological therapy, pharmacotherapy, or a combination of both and what they found, and no surprise it's old news that counseling plus pharmacotherapy tend to have the best results but in two cases they have similar results but it's just to look at and I hate to call simple anxiety but we're just looking at anxiety symptoms here not We're looking at the entire quality of life and we want to make sure that we also include medical issues, which is the behavioral therapy that is considered the psychotherapy with the most evidence because there are a variety of cognitive-behavioral approaches. ranging from acceptance and commitment therapy to dialectical behavioral therapy and CBT, to know that anyone who deals with thoughts and cognitions falls into that area, and is effectively in the current The conceptualization of etiology of anxiety disorders includes an interaction between psychosocial factors such as childhood adversity or stressful events, and a genetic vulnerability, so psychosocial factors, and these are other things when we do our evaluation, that we want to pay attention to, because our Treatment approach is different for each case.
For people, for example, who have brain changes related to trauma, maybe then for someone who doesn't, we want to look at childhood adversity and the stressful events that caused it, basically what I tell clients is rewire the brain. There are trauma-related brain changes in soldiers and especially in children or people who have been exposed to extreme trauma that is intended to protect them, but can also cause complications later in managing anxiety. Coping skills that have been learned that are ineffective, you know, sometimes people grow up in a home or an environment or a situation where they don't learn effective coping skills, so we need to help them learn them and help them learn. new ones to build on their strengths and traumatic issues that they may still need to deal with, like domestic violence, which you know, if they grew up with a lot of domestic violence, they may think you know I'm out of the situation, that's over, I don't want to. think about it.
That, it no longer bothers me, or I am absent because of the father, and I put absence, because it could be death, it could be a father who could only be a child who can be adopted, no matter what happens. The child has the position of feeling as if he has been rejected by one of his parents, he can be very traumatic and harassing, but there are many traumatized people who, if they are out of the situation, usually say that you know I am out of it. the situation. If someone has a lot of current stressors, it's no big deal, let's move on, and they don't realize all the consequences and how it contributes to their current anxiety and their current self-talk and cognitions.
It also has an impact on whether they develop generalized anxiety, you know, we're stacking the deck here and the current availability of social support if they don't. If you have effective current social support, they will have trouble keeping everything up to date. They carry it on their own shoulders, so we want to look at all of these psychosocial factors when we do our assessment and now come back to the trauma issues if you've taken the trauma courses. With all CEUs, you know that some people aren't ready to admit that the trauma is still bothering them or they're working on the trauma, and it's nice that we can educate them that it can be a problem and then let them choose how to address it, but we want Keep in mind that you know it can be a problem.
It may be an underlying force that motivates some of the current cognitions and genetic vulnerability, so if you take any three people and put them or 300 people and subject them to roughly the same psychosocial situations, they're probably going to react a little bit differently. From their past experiences, but also because of their genetic makeup, there are certain permutations and they found four that we will talk about later that make the brain respond more or less to stress and more or less to serotonin, which is its substance. calming chemistry. , then brains that respond less to serotonin don't know how to send as much or send serotonin as easily that people can stay tense and connected.
It's a very simplified explanation, but that's all you really need for now. Susceptibility is so vulnerable that genetic vulnerability affects people to the effects. and the development of dependence on certain substances that can increase anxiety when people detox from alcohol when detox from benzos when detox from opiates may feel high levels of anxiety when taking opiates some find that opiates have wonderful anti-anxiety properties , not that I am advocating the use of opiates. I have only shown client experiences that this may be true, such that some people will be more susceptible to the anti-anxiety effects of certain substances, and that some people will become dependent on substances where others cannot, and that some of this is genetic. vulnerability and estimate that around 30% of the predictability of developing anxiety disorders is genetic and genetics also affects which medications are effective if you have a genetic makeup, then SSRIs may be helpful if you have a genetic makeup, then atypical antipsychotics may be more effective and SSRIs can't do anything, that's why many of our clients have it.
I'm so frustrated because you know there's no way to know exactly. I think there are genetic tests now, but up until then it was harder to figure out which medication to start taking, and most doctors don't really know any doctors who start by saying, "okay, let's do a genetic profile" to see what medications can help. start more frequently, we start events, such as with an SSRI or other anti-anxiety medication, a type of benzo that in my experience, so we possibly want to encourage clients to consider genetic testing if they are having trouble finding a regimen. of medication that works for them and they feel they must have genetic vulnerability also influences what will make someone more vulnerable.
From all of you in today's class, you know that thinking about sleep, but that sleep is not a big problem for some. of you; I know people who can spend days or weeks sleeping four or five hours, it's not a big deal. I need eight or nine hours of sleep, so genetically, for some reason, I'm programmed to sleep a lot, so if I don't sleep as much, I tend to have a harder time. deal with life on life's terms, and I know this makes me more vulnerable to irritability, so genetic vulnerability affects who can become addicted, what drugs work best, and what situations tend to make someone more vulnerable to anxiety, so our medications and I know the guy here is small, but we're going to make it.
The first line medications are selective serotonin reuptake inhibitors SSRIs and SNRs are selective norepinephrine reuptake inhibitors, now the names are a little misleading because selective norepinephrine reuptake inhibitors also increase available serotonin but the mechanism of action is different, the mechanism of action for each SSRI is also 'a little bit different, so you can give someone Prozac and they have a terrible experience, and you can give them Zoloft, and they have a much better experience, like I said before, A lot of research was done. done five years ago with medications and zoloft paxil luvox lexapro celexa and its generic products have been found to be effective in treating anxiety in certain people, that no medication works for everyone in the last five years, but effexor has appeared on the radar, and is effective according to the Hamilton Rating Scale for Anxiety.
Clients do not have success or do not get the treatment effect they need with some of the other medications, but none of us are probably prescribers, but we must educate clients why the first medication or even the third medication the doctor tries does not It doesn't work so that you don't start to feel helpless and hopeless, as I said before, there are at least four different genetic variations associated with the development of general and anxiety disorder and different medications are more or less effective depending on genetic makeup. In the case of the person, there is a high rate of death after two benzos, the recommendation has actually moved to the use of benzos because some doctors prescribe an SSRI and for the first four weeks, while the SSRI builds up in the system , they will also prescribe it. prescribing a benzo to take as needed to moderate anxiety and you know you can argue both sides of that if someone has a history of substance use or substance dependence.
Benzos are really a bad idea because they are highly dependent, but the other reasons What they are now warning against using benzodiazepines is that there is a higher mortality rate among benzodiazepine users than non-users. risk of dependence if you use it for more than six months, and that is a long time to use a benzo and when we talk about dependence and six months, we are talking about someone who uses it every four hours or every eight hours, depending on their benzo every day , not a PRN user, if someone uses it at night to help them sleep or knows three or four times a week when anxiety really increases, the risk of dependence is relatively low, but many people with anxiety, because when they find the right benzo, they feel much better and don't want to get off it, and for many people, when the benzo reaches the middle of its life and starts to leave even more of the system, their anxiety increases.
Know that you have anxiety and want to cure yourself with more benzos, which will be a problem that you should discuss with your doctor. There is also an increased risk of dementia: benzodiazepine users again, this is for people who use them, every day forsix months or relatively every day for six months or more, and it doesn't matter if they know we're talking about someone. not someone who is 65 years old or someone who is 35 who uses benzos because you know six months a year two years, the risk of dementia in adulthood increases considerably according to research, benzodiazepines also do not treat depression, so if someone has co - Anxiety and depression that occur, there is a much higher risk of suicide if they use benzodiazepines, so if you are aware that the risk of suicide is a result of a benzodiazepine overdose, but you are not always aware of other treatment options other than benzodiazepines. something that people want to touch you know they scare the hell out of me and SSRIs and SNRIs don't seem to work so you can try tricyclic antidepressants, the older generation seroquel antidepressants are used a lot and there is research that shows that it can really be effective with anxiety like some of the antidepressants, and depending on the person, seroquel benzos can make you very sleepy, so you know that weight gain and fatigue are not the side effects of seroquel, and you know that drowsiness can be side effects unacceptable. for some clients and increase peron, the third option, boost barone works more as an antidepressant serotonin reuptake inhibitor and you should know that around four weeks, for some buildup in the system, studies have shown that there is not much time . -Term benefit, but six months to eighteen months of use is effective for talking to clients, and many clients find it improves.
If they take it, it doesn't necessarily help them be anxious like a benzodiazepine, but it helps them not go from zero to 200 in 2.3 seconds, but you know they can't freak out every time something goes wrong, which a lot of clients find It helps because they feel more stable during the next day. remission - the medication should be continued for six to twelve months and for the last six months the first six months last like the last six months, you know they say it is best to taper off; It's best not to quit cold turkey, but it's definitely important for people once they're in remission, not to suddenly feel better, I feel better.
You don't need it anymore; They need to work on it and make sure they have developed the skills and tools they need to deal with anxiety that will happen in life, so physical signs and symptoms of anxiety can include fatigue, irritability, muscle tension or muscle pain, try to continue to feel nervous. Easily scared, trouble sleeping, nausea, diarrhea, irritable bowel syndrome, headache, so the first thing we want to do with clients when we talk to them well, the second thing, the first thing is to say: get a physical exam, rule out physiological causes for this, but we can also help clients observe. you know what could be causing these things you can do to mitigate them what could be contributing to your fatigue what could be contributing to your irritability and your muscle tension or your muscle aches I mean, let's look at the economy, did you recently get a new bed or do you need a new bed, what about your desk chair?
I know you know I have more muscle tension and soreness when I use the mouse a lot because I have terrible posture, being aware of that helps me and then I'm like, well, I know what caused it, it's unfortunate, it's unpleasant, but it's no big deal. , shaking or feeling nervous, you know, it can be caused by low blood sugar, it can be caused by anxiety, it can also be caused by early-onset Parkinson's symptoms, you know. You know it can be the worst case scenario or it can be something really benign, so we want people to notice, you know, when you start shaking or feeling nervous, there's something to that, you know, I know when my son gets excited. a lot. he just sits there and you can see him almost shaking because he's so excited about something, so we want people to avoid misidentification, we don't want them to jump to the worst case scenario, we don't want them to go to WebMD. and wow, my God, I have cancer, I have this debilitating disease and I'm going to die in six months, probabilistic Lee talks, it's not going to happen, yeah, get a doctor's opinion, I'm certainly not going to tell you, that's all.
In your head, I definitely want them to get an evaluation, but in the meantime I want to help them really think about the likelihood that this and other things are causing headaches, and this is another one that can be frustrating as we get older. My eyesight starts to fail and you know, there was a period where I was doing well and then after I reached 45, my eyesight started to steadily and rapidly like in my mind, so I have to change the prescription of my glasses every two years. and that can cause headaches, so instead of starting to worry about it, oh my gosh, I have a headache all the time, maybe I have a brain tumor, you know, I know it's probably my glasses or I'm grinding. my teeth so other biological interventions that have been evaluated there is something called a float rest system reduced environmental stimulation therapy reduces sensory input to the nervous system through the act of floating in a supine position that is face up in a puddle of saturated water with Epsom salt I know I'm looking at this which sounds really good and you can't have the same experience in a bathtub because you're not floating, you have pressure points and you're still hearing things that clients can classify or simulate. with, you know, earplugs or whatever, but if you can access this, it's been shown to be really effective, the floating experience is calibrated so that the sensory signals from the visual, auditory, olfactory, gustatory channels , thermal, tactile or vestibular, gravitational and preceptive, are minimized, which means that I don't see here taste, touch, smell, I don't feel anything, as with most movement and speech, so you want make people stand completely still and not speak, which can be difficult for some people with anxiety in the studio.
The study I analyzed with fifty participants reported significant reductions. on stress, muscle tension, pain, depression and negative affect, and was accompanied by a significant improvement in mood characterized by an increase in relaxation, happiness and well-being. I read the study. I wonder where I can register? You know, it sounds like when you look at some of the research it was actually more effective at addressing anxiety than something like a massage. Tai Chi also produced significant reductions in anxiety. There was approximately a 20% treatment effect. 25% treatment effect in patients with anxiety and fibromyalgia who practiced twice a week for one year.
You know we want to get things confusing here: is it Tai Chi itself or is it learning to control your muscles and being more in tune with your body and learning to control your breathing that helps people reduce their anxiety either way? ? Tai Chi helps people do that and it was shown that after a year after the first six months there was a significant treatment effect, but after a year you know it continued to grow and after a year it was about 25%. , so Tai Chi can be really effective. An acupuncture on the HT 7 median meridian can attenuate anxiety-like behavior induced by withdrawal from chronic morphine treatment through meditation of the GABA receptor system, what does that mean?
If acupuncture is performed in very specific places where anxiety occurs. Behavior of GABA, a receptor system. GABA is your main calming relaxation neurochemical that activates and causes your body to flood that receptor system and this research was done on people who were detoxifying from morphine treatment, but we can generalize the results. and I would be interested in seeing more studies on pain. Other things we should do to help people with anxiety. When people have chronic pain, they often have anxiety. Oh my god, this is getting worse or it will never get better. They just can't take this pain anymore or they may feel anxious about being rejected because they can't do some of the things they used to do because they are in a lot of pain, so there is a lot of guilt and anxiety that can revolve around the pain, what can we do? to help customers?
Guided imagery is usually very helpful if we can help them imagine, you know, if that pain in their shoulder imagine that pain is like the color red and it flows out of their arm or another focus on mindfulness so you know when you think about something, you know when they give me a shot, if I don't think about it, it doesn't hurt as much, if the nurse says "okay, now one, two, three" and you know it's counting down. and I am preparing and I am very focused on it. I once had another nurse who was talking to me and you know, she put the alcohol on my arm and kept talking, she didn't tell me that she was getting ready. to give me a shot and before I knew it she had given me a shot and she said, "Okay, we're done." I'm like you didn't give me a shot, but she said yes, I did it.
It's like "oh, so you didn't focus on me." and the next time you have an itch, for example, if you've ever been driving on the interstate and you can each with your foot, sometimes I get those on the bottom of my foot and I'm like, okay, I'm not going to go. stop at each foot if you focus on something besides the itch it will eventually go away. I'm not saying the pain will go away completely, but the more people focus on it, the more it hurts. Physical therapy can help, so encourage them to do it. a reference and encourage them to do a self-assessment of at least the ergonomics in their car at work, where they watch TV and spend most of their time at home and sleep, so those are the four places they spend their time. most of his time. time, what its ergonomics are like, and that it can help many people alleviate a lot of pain.
Hormones are another thing we need to look at. Estrogen and testosterone imbalances can contribute to anxiety symptoms. Heart palpitations. Fatigue. Irritability. Have people have a physical exam. As doctors, we can't do anything about it, but doctors can speed up the heart rate, sweating, palpitations are not uncommon in women in perimenopause or menopause, so many women start to feel like they are developing generalized anxiety and/or that something is wrong when they start to hit that zone in their 40s and 50s and start having some of these symptoms again. We're not going to diagnose them, but we want them to recognize that it may not be anything catastrophic, this is something that many women experience and help them figure out how to biologically deal with that supportive care.
Now you know this isn't going to address anything, but we can help them minimize their vulnerabilities. Help them create a sleep routine so their brain and body can rebalance. This can help repair. any adrenal issues that may be going on and improving energy level, people with anxiety don't sleep well, so helping them figure out how to sleep well is important. Nutrition, minimizing caffeine and other stimulants will be a great help because that makes people feel anxious, encourage them to work with a nutritionist to try to prevent spikes and drops in blood sugar, which can trigger the response. to stress.
When your blood sugar goes up or down too much, you can start to feel a little shaky and weird, and that can cause people anxiety because they might think, Oh my God, I'm having a stroke or a heart attack or you know, I don't know what these tremors are, so it's important to keep identifying the symptoms and encourage them to drink enough water. Dehydration can lead to toxic Ardea, which increases heart rate, sunlight, vitamin D deficiency is implicated in both depression and anxiety, mood problems. Vitamin D has been found in the main areas where serotonin receptors are located.
Vitamin D receptors are found, so we know that serotonin and vitamin D have something that happens with sunlight causes the skin to tell the brain to produce neurotransmitters and establish circadian rhythms that impact the release of serotonin, its neurochemical. calming, melatonin, which is produced from the breakdown of serotonin and helps you sleep and gaba, so sunlight actually helps increase the release. from gaba when it's time to start calming down and go to sleep exercise studies have shown that exercise can have a relaxing effect clients are encouraged to start slowly there isn't much new research on exercise and anxiety aromatherapy It has been used a lot, especially in other countries in the treatment of people with anxiety people with hospital anxiety people women who are giving birth and have some anxiety at birth there essential oils have been found to be really effective in many of those studies for anxiety include lavender rose Bedevere ylang and lang bergamot, chamomile,Frankincense and clary sage encourage customers to go to a health food store and you know, smell some of these to see if it makes them feel happy, calm and content.
Aromatherapy molecules enter the nasal membranes and will begin to trigger neurochemicals. reactions, so you don't need to apply it, you don't need to ingest it, all you need to do is encourage clients, if they're open to it, to think about this because aromatherapy can be integrated into your bedroom, for example with a spray bottle. or a mr. It can be incorporated in many different places where they do not apply it or ingest it in any way, all they do is smell it. They have used it to turn off aromatherapy in hospital emergency rooms and found that it reduces stress and irritability for people in emergency rooms and I have been in enough emergency rooms over the years to know that people Those who are hospitalized are generally not in the best mood, so if you can help those people, then it will probably have some kind of effect in psychologically helping clients realize that their body thinks there is a threat for some reason, so activated the threat response system, which is what they call anxiety, so they need to figure out why a threat actually exists. sometimes it's like the fire alarm going off in my house it just means the windows are open and there is a strong breeze there is no fire there is no problem there is just a malfunction it is a false alarm many times customers receive this threat they have this reaction of stress and it's not a big deal right now, so you can start to modify what your brain responds to and again those basic fears that a lot of people worry about about failure, rejection, loss of control, the unknown and death and loss, distress tolerance is one of those cognitive interventions that has taken center stage in anxiety research and it's not about managing anxiety, you know, helping people recognize their anxiety, acknowledge it and say : okay, I'm anxious, that's what it is, how can I improve the next one? moment instead of saying I'm anxious I shouldn't be anxious I hate being anxious and the lingo with that anxiety let it go just accept it it is what it is have the client learn to start saying I feel anxious it's okay so don't get distracted they react because they I explain the whole notion that feelings peak and go away in about 20 minutes, it's like a wave, so once they recognize their feelings, if they can distract themselves for twenty or thirty minutes, they obviously realized that they don't there is nothing real. threat to them if they can distract themselves for twenty or thirty minutes those emotions can subside and then they can deal with it in their wise mind.
Encourage them to use distancing techniques instead of saying I'm anxious or terrified or whatever. Have them say I'm having the thought that this is the worst thing in the world I'm having the thought that I can't handle this because the thoughts come and go and that comes from acceptance and commitment therapy functional analysis allows you to specify where, when, how often, with what intensity and under what circumstances anxiety arises. The response is triggered, so it's important that we help clients develop the ability to do functional analysis on their own, so that when they start to feel anxious they can stop and say, "Okay, where am I?" what's going on, how intense it is, what the circumstances are and they actually start." Try to figure out what is causing this for them so that they can identify any common themes from their psychoeducation about cognitive distortions and techniques can be provided to prevent those circumstances or mitigate them, so if the client knows that they get anxious before going into a meeting with their boss and it's usually high intensity anxiety, that's fine, then we can educate them, help them identify what fears may be related to techniques to slow down their breathing and calm their stress reaction and help them discover times in the past where they've managed to walk in and talk to their boss and it really wasn't the end of the world.
You know, there are a lot of different things we can do for them, but the first key gives them a great sense of empowerment to start with. Become detectives in your own life and do well now. In what situations does this happen? positive writing this was another really interesting study every day for 30 days the experimental group and these were high school aged youth in China, but you know, the experimental group engaged in 20 minutes of writing about the positive emotions they felt that day, so they write about anything positive that makes them happy, that excites them, that gives them hope, any long-term expressive writing about positive emotions, so after 30 days it seemed to help reduce test anxiety by helping them develop insight and using positive emotion words, so he got them out of the habit of using words of destruction and doom and encouraged them to get into the habit of looking at positive things and being more optimistic.
It's a really cool activity. which clients can try, it won't do any harm if you have them journal every day for 30 days. Mindfulness also came up in research and was shown to be really effective in a meta-analysis. Six articles on mindfulness-based stress reduction. Four on mindfulness-based stress reduction. Cognitive therapy and three on fear of negative evaluation and emotion regulation were reviewed. All of these showed that mindfulness was an effective strategy for the treatment of mood and anxiety disorders and is effective in therapy protocols with different structures, including virtual modalities, so you know if you are doing it through a teleconference.
Mindfulness can still be helpful. Mindfulness helps people begin to learn to observe what is happening and become aware of what is happening. More aware of those circumstances, which will help them complete their functional analysis, but also helps them become aware. of vulnerabilities and avoid things from the past and if they take better care of themselves and live more consciously, they may not experience as many situations that trigger their anxiety. Mindfulness also encourages clients to learn acceptance, to embrace radical acceptance. it is what it is I'm not going to fight it I'm angry right now I'm anxious right now whatever I feel right now is how I feel and that's okay and it's hard for clients to get to that, but once they get a grab that and they really believe it and they can say okay, okay, I'm not going to feel like this forever.
I'll do something else until the feeling passes, it helps and that's where labeling and letting go come in in mindfulness. Also help them identify triggering thoughts. What were you thinking just before you started feeling anxious? If people are aware or let's start again when people are not aware, they often notice or don't notice that they are getting anxious until they get super. super anxious when people are aware they become more aware of subtle cues address unhelpful thoughts when they say or believe that it is an extreme need for adults to be loved by their loved ones because almost everything they do is always going to happen why is it a need?
What I encourage them to do is focus on their own self-respect, on gaining approval for practical purposes, you know, for promotions or whatever, but it's not about me being lovable, it's about me getting a promotion and making more money. and I focused on loving instead of being loved because when we give love, we usually receive love in return. Useless thought number two. People feel like they can't handle it if things aren't the way they want them to be or if they aren't under their control, so encourage clients to focus on the parts that are. in their control and other things in life that are going well and to which they are committed number three, misery is invariably caused externally and imposed on us by external people and events.
Just reading that makes me feel disempowered, so I encourage clients to focus on the The fact that reactions like misery or happiness are largely caused by people's view of the conditions, so If you see it as a tragedy and devastating, then it will probably produce misery, if you see it as an opportunity and a challenge, then it will probably produce a different emotional reaction. If something is or can be dangerous or fearful, people should be terribly upset and infinitely upset by it. obsessing about it a lot of people with anxiety get stuck in this, you know, if I feel like it's scary, I need to worry about getting on a plane, for example, if I fear that it's dangerous, I need to think about it and worry because that won't help. nothing, so encourage clients to figure out how to deal with it and make it harmless if and when possible.
That's not possible, accept the inevitable, so looking at planes that you know face means doing research to find out how dangerous it really is and realizing that it's actually not that dangerous, which helps make it a little harmless in your own mind. Tell them that it's not as dangerous as it could be and that when you can't accept the inevitable, you know you've got a fly, so move on and figure out how you're going to get through it. Hurricanes are the same way as people, especially in places like Texas, Louisiana. Florida can become obsessed as soon as hurricane season starts to arrive or if a hurricane is seen in the Atlantic somewhere, they start checking the weather every hour or more, wondering what the path will be and you know what you can't. change the hurricane's path so that all you can do is board up your house, evacuate if necessary, and deal with the consequences.
Child driving is just another example I'll give you, my kids are learning to drive and that's a little scary and scary. you know what's going to happen when they're out there you know you see crashes all the time we're going to make it harmless by making sure they have good training on how to drive making sure they're good drivers and then accepting that some things are just not in my control , it is easier to avoid it than to face life's difficulties and responsibilities. Running away from fear is often much more difficult in the long term, so encourage clients to look back at times when they have avoided difficulties and responsibilities and the end result, you know what? happened there, people believe that they must be completely competent to achieve in every way possible or they will be isolated, rejected, and failures.
We need to encourage clients to accept themselves as imperfect, with human limitations and flaws, and focus on what makes them lovable human beings. Qualities like courage, intelligence and creativity and those things that cannot be taken away from them. What inherent qualities do they have that make them wonderful people? Because something once strongly affected people's lives. They should fear it indefinitely if you get lost. You know, when little kids turn around. Lost is scary when you grow up, if you get lost you turn on the GPS and discover the way, but some people you still know get scared of getting lost if they got lost once, so we want to help people look back at the past. episodes that may be contributing to the current anxiety and compare the situation.
You know, are you the same person or is it no big deal now that you're older, you're wiser, stronger, encourage them to learn from past experiences, but don't get too attached or prejudiced. for them, yes, maybe you could have gotten lost in the past and it was a horrible experience, well, you were six years old. I can see how that would be terrifying and a horrible experience, but it doesn't have to continue to impact you that way now that you know? 26 getting lost, you know, it could be an opportunity to try a new restaurant or something that people should have complete control over things.
Well, this doesn't happen, so encourage clients to remember that the past and future are uncontrollable, we can't. changing the past is what it is, we can learn from it so that it does not repeat itself, but we cannot change it and the future is largely uncontrollable. I mean, there are a lot of things I can do to keep moving toward a rich and meaningful life. Life, but sometimes it's going to throw me curveballs and there's nothing I can do to plan or control that we can control our actions in the present to stay on our preferred path and generally develop general skills to deal with adversity in in case it arises.
We want to help clients develop those general problem-solving skills and general support system so that when a curveball is thrown at them, you know it doesn't hit them over the head. People have virtually no control over their emotions and can't help but feel disturbed by things. Well, encourage them to think about the fact that they have real control over destructive emotions. If you choose to work to improve the next moment and change the inaccurate thoughts, then you will not experience the destructive emotions as much.intensely or as frequently when they feel an emotion. emotion, you feel how you feel, but again, you don't have to fight it, fight it and cover it, you can say this is how I feel, how can I improve the next moment when it comes to cognitive distortions?
Encourage them to find alternatives when I start to personalize things, if someone laughs when you leave the room, then the person starts to get anxious thinking, oh, they were making fun of me. I wonder what they thought. I wonder if I had something stuck to the back of my dress. they start to panic about it, that's no use, encouraging them to think that you know what our three alternative explanations are that had nothing to do with you for why they laughed, magnification of the worst thing you know, take something and say that If this happens then it will be a catastrophe and minimization goes hand in hand with that many times when people magnify and see a catastrophe they minimize not only their own strengths and resources but all the other things they have going for them.
All they are seeing is this catastrophe, so encourage them to focus on the facts, what is really happening and what the high probability event is and encourage them to get information and look at the bigger picture. You know, yeah, you were in a car accident and your car is totaled and that's unfortunate, you know it really sucks, but you know that won't make you lose your job and then be homeless and penniless and yadda-yadda, it might cause Your insurance goes up, but okay, so I don't have a car, but what resources do you have? Who can?
Who do you work with? Maybe I can take it to work? You know, let's look at the resources you have and solve the problem so that troubleshooting helps. magnification and also focusing on you know, let's be grateful for what didn't happen, you know they could have killed you, but they didn't, the car was totaled, it's replaceable, all or nothing, thinking again, make them think about what else could have been happening. Brittney suggested finding the exceptions instead of saying she always does this, look for exceptions, when hasn't she done it? What else have you done instead of this selective abstraction and filtering is when people look for the good, the bad and the ugly, a selective abstraction means that you?
You kind of see what you expect to see, so if you expect something to be devastating, you only see the devastating aspects of it, which goes with magnifying and minimizing, you filter things out a lot of times when people are in a bad mood or they're anxious. , they see the negative because that's the mood they're in, so encourage people to fill in the picture. Okay, there are all these bad things. What are the good things? Encourage them to look at the good, the bad, and the ugly so you get a broad view of exactly what is happening and encourage them to remember that hindsight is twenty-twenty when people have something embarrassing happen or they get anxious about something that happened , they look back and say: I should have done it or I could have done it oh I wish I hadn't done it when you were in that situation, you did what you did and you know that maybe you had a reason for it or maybe you didn't have other options or That it was just stupid. do it, but okay, so you made a fog.
In retrospect, it's 2020, that mistake will stand out like the big letter on the eye chart because you're thinking back and you're looking at it and that's all you see, but it's encouraging. clients to remember that other people are too busy worrying about themselves to really remember what you did jump to conclusions encourage clients to remember to get all the facts If your partner comes home and smells like perfume, don't jump to the conclusion that such Maybe he was cheating on you, he went to the mall to buy a new tie and he walked by the perfume area and sprayed himself or he bought you some perfume or who knows, maybe the person sitting next to him at work sprayed his perfume on you. desktop and part of it was leaked.
There are different reasons why this could happen, so encourage people to get all the data for mind reading. We can not do it. You know you can't read someone's mind. You don't know what he's thinking, so ask him what are you doing? If you think about this, don't assume anything and emotional reasoning encourages people to take a step back from a situation and ask themselves, am I feeling anxious about this because I'm feeling anxious and I'm looking for reasons why it should be scary? I feel anxious about this because it is so scary, for some reason there are real facts to back up my anxiety.
A lot of times when we're faced with new situations, we can feel anxious because it's a new situation, but when we take a step back we say, you know, there's really nothing to do. Worry about this, you know, it's no big deal, I understood this and I'm moving on, so instead of moving on and trying to figure it out, okay, I feel anxious, so there must be a reason, not necessarily a very likely one. false alarm, other psychological interventions. Relaxation skills encourage people. To learn to relax not only physically but also mentally, diaphragmatic breathing is helpful, encouraging them to breathe through their stomach and to put their hand on their belly and feel their belly expand and contract, slowing down their breathing, which triggers the reaction. of rest and digestion in the brain, which is Calming meditation can be helpful for some people.
Some people find it too frustrating to try to calm their mind because they have too much monkey mind, which may be later or maybe never. For some people we do not want to increase their anxiety with interventions. Cute Progressive Muscle Relaxation also has a lot of research backing and remember with Cute Progressive Muscle Relaxation we are Sakura telling you to attach an AK signal, you word how to relax or breathe with the relaxation response so that you tense your muscles and then relax your muscles. . and as they relax their muscles they say their q word as relaxed and work from head to toe or head to toe tensing and relaxing different muscle groups so that they become more aware of what a tight muscle feels like versus a tight muscle. relaxed reactive. muscle, there are great scripts online that people have already recorded that can guide people in walking clients through CPM.
I highly recommend it because once you get used to it, you can think about that cue, you can think, relax, and as you breathe out, you'll start to feel your whole body relax because it's trained when you hear that, just like when you hear the word pop quiz. When you were in high school, you had a stress reaction, well, we want to use it the other way around and train, train the body. So when you hear a keyword, you relax. Help them develop their self-esteem. Because the fear of failure and rejection often comes from the need for other people's approval.
Help them develop a rational idea of ​​their real self. Develop compassion. I'm an idiot or I'm stupid or I'll never measure up to anything, encourage them to talk to themselves as they would to their child or, hopefully, their best friend, and encourage them to highlight their strengths whenever they feel like they have them. an imperfection identify these three strengths that they have so that you know how to balance imperfections and strengths cognitive restructuring reframing challenges in terms of current strengths, not past weaknesses, so if you are going to give a presentation in front of 60 people and you hate public speaking instead of thinking about you.
You know this is scary because the last time I stood up in front of people I forgot everything I was going to say and dropped my cards. Well, that's a weakness of the past. What is your current strength? prepared, you know your material, yada-yada, so encourage people to look at all the strengths and resources they currently have and have them develop an attitude of gratitude and optimism because, as I said with that, the positive writing exercise when the people find themselves in an optimistic and grateful framework. mentally they tend to see more good things, they also see bad things, but they can also see more good things and some of the bad things they see opportunistically instead of seeing them as devastation.
Acceptance and commitment therapy says that some One of the reasons we are miserable is fear, we merge with our thoughts, we think I'm terrified. Well, if I'm terrified, then I can't, I mean, if I am, I can't get rid of anything. Having the thought that I am terrified Well, I can get rid of a thought I can forget things easily Encourage people to evaluate their experience and empower them to see things as challenges and opportunities rather than difficulties. Encourage them not to avoid their experiences. That's scary, the gradual exposure and the search for exceptions, like in my case, bridges.
You know, I love public speaking, so that doesn't happen, but when I go to a bridge, you know, when I drive to the bridge, you know, when I'm on the bridge, someone else is. driving I get used to doing that when I drive over a bridge and then when I drive over one of those bridges it opens up I hate those bridges um I know you all are like oh my gosh yeah it's an irrational fear I realize that , but instead of going straight to the bridge that opens, go to the small bridges first and then remember the times I went over bridges and there was no problem, you know, there are exceptions, nothing happened, it was no big deal, sometimes I did it.
I didn't even realize until someone pointed it out to me. Hey, look at that beautiful water and I'm like, oh, we're on a bridge, so encourage people not to avoid their experiences, get used to them, embrace them and learn that they have the power. to deal with them and stop giving reasons for behavior that you know use challenging questions if something is fearful let's look for evidence for and against instead of making excuses social interventions improve their relationship with themselves, which goes with self-esteem-enhancing people will feel less anxious about getting their needs and wants met if they know what they are, so part of that is becoming aware because many of our clients don't know what they need and what they want, they just .
They want to feel better but they don't know how they don't know what they need to feel better, so help them identify their needs and wants, encourage them to be your best friend, you know, when they get a promotion, take them out to dinner. giving yourself a pat on the back, whatever it is, not trusting other people to do it because other people don't care, but other people are often very involved in thinking about their own things and may not be aware of it. realize it, encourage them to do it. develop a method of internal validation so that they can feel like they are nothing and realize why they are lovable human beings and accept the fact that not everyone will like them and no one will like them all the time. time and that's okay, you know my kids don't like me all the time, my husband doesn't like me all the time.
I'm fine with that. I know I can be a challenge, but you know most of the time you know they like me. and that's okay and there are some people you know who don't like me at all and that's okay there's nothing I can do about it, helping our clients develop and being okay with that helps alleviate a lot of anxiety because a lot of people feel that everyone has to like them and if someone doesn't like them it's like what did I do wrong? Dear God, encourage them to develop healthy supportive relationships with good boundaries.
Develop assertiveness skills so they can ask for help when they need it. anxiety. a lot of times you know it's the body saying there's a threat, well if there's a threat maybe you need help, you know how to deal with it so people have to be willing and able to ask for help and not feel that that will lead them to be. rejected and allow them a certificate, this will allow them to say no to the requests again without feeling that it will result in a complete rejection. Describe the ideal healthy supportive relationship and encourage them to separate the ideals from the real ones you already know, let's see.
If you had the best relationship, what would it be like? Well, you know, Warden June Cleaver, we get it. Now, how realistic is it, you know, let's see, let's rephrase this a little bit to make it less extreme. You know, Warden June Cleaver never fought with her sons. They were perfect, you know all those extreme words, let's look at what's real, what happens in real relationships, encourage people to identify who would be a good partner in supportive relationships. I don't necessarily mean romantic, I mean friends and where you can find them. I know where you would find people you could be friends with and encourage them to play.
What does it mean when you play? Because many times this goes with mine. You know what it means when your friend doesn't text you back. right away, what does it mean when your friend cancels dinner on Friday night? What does it mean when you see where I'm going with this? And many times clients with anxiety, rejection and low self-esteem problems will go to the worst. case scenario so encourage them to find the exceptions again what else could have been happening what else could bewhat caused this and it's not about you then anxiety is a natural emotion that serves a survival function excessive anxiety can develop from lack of sleep nutritional problems neurochemical imbalances inability to develop adequate coping skills cognitive distortions low self-esteem and a variety of other things Ambala recovery involves improving health behaviors making sure your body functions and produces the neurotransmitters you need and you know how to release them as needed identify and develop them Current coping strategies address cognitive distortions and develop a healthy supportive relationship with yourself himself and with others.
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