Strengths Based Tools for Anxiety Relief | CBT Counseling Skills

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs. Register@Allce.com Counselortoolbox you I'd like to welcome everybody to today's presentation using a strengths based biopsychosocial approach to addressing anxiety. So that's a mouthful. We're going to start out by looking at what a strengths based approach is. And I'm going to try not to say that too many times because I always get tongue tied. But it's one of those things that we started talking about, golly, probably 15 years ago. But. But we don't necessarily do a wonderful job of implementing it. So we'll look at ways that we can incorporate more strengths based interventions in our treatment. Define a biopsychosocial approach that's a lot older than strengths based. We'll talk about that. Explore the symptoms of anxiety and you're like, well I know how to diagnose anxiety. Yes you do. But let's look at why those symptoms are there and what function they serve. Because that'll help us help the clients understand why they might be experiencing them. And then we'll identify potential causes of and biologic of and biological and psychological and social interventions for those symptoms. Because not everybody's going to want to use the same interventions. I found over the many years I've been working with clients, some clients really like a cognitive approach. Some clients prefer a more holistic biomedical approach with a little bit of counseling in there. So we really want to talk with the client about and here's a clue about strengthspace, what works for them. So why do we care? Well, anxiety can be debilitating. Even if you're seeing a client who maybe recently was diagnosed with a chronic illness or a chronic pain condition or something, they may have some anxiety. And that constant revving, if you will think about when you're anxious, you're kind of feeling like you're revved up. You're sitting in the driveway with a car in park, just kind of revving that gas. This low grade chronic stress erodes your energy and your ability to concentrate, which means that anxiety can be a major trigger for addiction relapse because people just want to escape it for a while. They want to be able to rest. Increased physical pain. We know that anxiety increases the stress reaction. We know that stress reaction reduces serotonin because serotonins are comm chemical. And when we're stressed, we don't need to be calm. We need to be Doing something. So, you know, through the HPA axis, we know that anxiety triggers the stress reaction and may lead to an increased perception of physical pain. It can also lead to actual increased pain. I mean, think about it. When you get stressed, when you get anxious, do you carry some of that stress in your neck, in your back, and your belly? I do. So thinking about how you experience anxiety can give you a little bit more sympathy and empathy for what your clients may be going through. And anxiety triggers sleep problems when you are anxious, especially generalized anxiety. You know, your body is perceiving that there's a threat and it can't really put its finger on what that threat is. So it's staying on alert most of the time, which means when you go down to lay down to sleep, you may be sleeping, but you're probably not getting into that deep quality sleep because your body wants to make sure that you can wake up and be alert at a moment's notice. And when you're in deep sleep, you wake up and you're hard to wake up. But then it takes a minute to kind of get your bearings. So a lot of times we find with people with chronic anxiety, they're not sleeping well. So what does strengths based mean? It's easier and more effective to build on something that already works to some extent. So I'll ask clients, what do you do that helps you feel less anxious? What do you do that helps you sleep better, even if it's not a panacea? It may not fix everything, but I want to know what they're building on. What are they using right now that works? 10%. I'll settle for 10%. I'm cool with that because we can build on that. If it works a little bit, then they're going to be more, more likely to be treatment compliant with trying to strengthen that intervention than if I just threw something at them that they'd never heard of before? And they might try it and it might work, but there's a whole learning curve with it. If they're already doing something, they've gotten that initial learning curve out of the way and we're just going to have gradual improvements. Strengths based approaches help people identify how they're already trying to cope. So I want to empower them to realize that you've already started doing something. It's not me. I'm not going to wave a magic wand and make you less anxious. You've already started trying to figure out what to do, and it's within your power to keep building on that. And there are two types of strengths, and this is kind of important. Prevention and resilience strengths or vulnerability prevention. If you think about dbt, what you do on a daily basis to stay healthy and happy and prevent vulnerabilities, think about times when you've been more susceptible to getting anxious, irritable, angry, any of those dysphoric feelings. What was going on? Were you already stressed out? Were you not eating well? Were you not sleeping well? Were you, did you have too many irons in the fire, so you felt like you were pulled in 15 different directions? So we're going to talk about prevention and resilience strengths in terms of just in general, what you do to keep yourself on your A game. And then we're going to talk about specific intervention coping strengths by asking them in the past, when you have felt this way, whatever this way is, what helped when you've experienced this symptom, maybe feeling like they can't breathe because it feels like an elephant sitting on their chest, what's helped what? What do you do? And you know, oftentimes we don't go here, what made it worse, because we don't want to do that. But if you can help them start sorting between this helps, this makes it worse, this helps, this makes it worse, we can start seeing themes and trends in what works for that person, which can also help the rest of the diagnostic team get a better handle on what might be causing the anxiety. And we're going to talk a little bit in this presentation about differential diagnosis, because there's a lot of stuff, for lack of a better term, that can cause symptoms of generalized anxiety, besides just cognitive stuff. Hormone imbalances, thyroid hormone imbalances, all those sorts of things may trigger those sorts of feelings. Also, blood sugar, when your blood sugar drops, your body secretes cortisol and adrenaline in order to cause your liver to put more glucose into the system. So if people have unstable blood sugar, hypoglycemia, diabetes issues, anything like that, they may feel symptoms of anxiety. So if we're starting to look at the interventions they're using, then we can get a better picture of what might be triggering it, what might be causing it, and make referrals if they're not already seeing other multidisciplinary providers. So a biopsychosocial approach. I'm not going to spend a lot of time here because I think it's pretty, pretty well known, but your biological interventions include balancing those neurochemicals. And that doesn't necessarily mean medication. It can mean making sure that they are getting adequate nutrition. And we're not nutritionists, we're not, not going to make that prescription for what they should eat. But we do want to educate our clients that what you eat has a direct effect on whether your body has the building blocks to make the neurochemicals that help you feel calm and happy. We're also going to talk about nutrition and how things like caffeine and nicotine not only rev up the system and can cause symptoms of anxiety, but they can also impair sleep, which can intensify symptoms of anxiety. Which brings us to sleep. You see how all this just kind of feeds in on itself. Sleep is important because that's when the body rebalances all the neurotransmitters or at least that's what they think. But think about a time when you've been sleep deprived. And I mean DBT looks at this as one of those vulnerability prevention things. And just common sense would tell you when you're feeling fatigued and foggy headed and however you want to describe it, when you're sleep deprived, a lot of times you can get anxious. It's harder to deal with life on life's terms, as I say, because you don't have the energy. All of your energy reserves are kind of being stretched thin because you didn't rest and recharge overnight. And sunlight and circadian rhythms, this is one people don't think about very often. But is not just seasonal affective disorder leading to depression if people are not getting enough sunlight and their circadian rhythms are out of whack. And there's a lot of reasons that can happen, including taking too many naps during the day and other things like that. But if they are not getting their circadian rhythms in whack, they may start not sleeping well. And if they're not sleeping well, they, they can have some side effects. So we do want people to note from a prevention those things that you do every day to keep yourself happy and healthy. How are you maintaining and making sure your body machine is operating well? Psychological. Now this is right up our alley. We want to help them identify mindfulness techniques. What can you do and how can you do it so you can remain mindful of what your needs and wants are. And I talk about anchored mindfulness. So at every meal, before they eat or after they eat, I usually prefer before, they just kind of do a quick scan and go, how am I feeling? What am I thinking? What am I needing? It's not super in depth but it's a start. It's a start to get people paying attention to kind of where they're at instead of operating on autopilot and ignoring something until it makes the entire system break down. Distress tolerance skills. A lot of our clients with anxiety issues are plagued or use distress intolerant thoughts. I cannot deal with this. I cannot tolerate this. So we want to teach them distress tolerance. We want to teach them about urges and how they come in and go out like waves. We want to teach them the improve and accept acronyms from DBT to help them figure out, you know, when there's something that happens that you can't control. And I use these examples a lot. This Saturday, my daughter's dog had this major anxiety attack. And yeah, it's a dog, but it's my daughter's pride and joy. And she's older, so it kind of freaked me out a little too. But there was nothing we could do. The vets were closed. There was nothing that I really could identify that said need to go to the emergency vet. But we had to wait until Monday morning to get her into the vet. So helping my daughter use distress tolerance skills and myself to get through the weekend so we didn't perseverate on. Is Raina okay? Is Raina okay? Is Raina okay? So distress tolerance skills can be really helpful to providing clients tools to get through something that they just can't change at the moment. We'll talk about other coping skills and cognitive restructuring techniques. And then the social part of biopsychosocial a lot of times, again, we forget is talking about improving their self esteem and their relationship with their self. Oh, new concept. Never knew where that belonged. Exactly. Well, think about it. In order to have a good relationship with others, probably important to at least like yourself some. Otherwise it's probably gonna. You're probably gonna form more dysfunctional relationships based on external validation. Sometimes in general, I find that to be true. So helping clients improve their sense of self worth and do for themselves what they would want a best friend to do for them empowers them to start moving forward. And it empowers them to make friends and friendships that are based on mutual respect and all that kind of stuff instead of just needing somebody to validate and fill a void. And then we talk about improving relationships with healthy, supportive others. This doesn't necessarily mean biological family. It can. So we want to ask, who are your healthy, supportive others? And. And how can we help you get them involved in your life? Support groups are another great place to find supportive others who kind of understand this Whole anxiety thing. So if there are good support groups in your area and your person doesn't have a lot of social support, that might be one place to make a referral. So it's another avenue, another strength that they can build upon if they've already got one or two friends. But they might need some people who understand a little bit better what's going on. That's one way to do it. So what is anxiety? It is half of the fight or flight response. It's an excitatory response, which means it's going to get you revved up. Your heart rate is going to go up, your breathing is going to go up, you may start to sweat. Its function is to protect you from danger. For some reason, your body thinks there's a threat and it's saying you either need to fight or get the heck out of here. Well, cool. I'm glad my brain's looking out for me. It becomes a problem when it's overgeneralized, though. So every bump in the night makes you jump up and have an anxiety reaction, or every time you hear sirens going by, you start to have an anxiety reaction. It can be a problem if it's overly intense or uncontrollable. And this is kind of more your panic attacks, but falls under that anxiety umbrella. And that can be debilitating. And it can become a problem when it's constant due to, and I use the term brain injury pretty loosely. They find that there are similar brain changes, or injuries, if you will, in people who have PTSD as well as people who have, you know, traumatic brain injury from, you know, a concussive sort of force. There are actual changes in the brain when there's exposure to extensive trauma related stuff. So these people may experience more anxiety. Okay, well, we got to accept where the client is at and what they're dealing with, and then we can start figuring out what might be most helpful. Like depression. Anxiety can be caused by excess serotonin. Yeah, who knew? Some of the research has indicated that too much serotonin may actually serve to trigger more depression. And serotonin has also been linked to some anxiety. It's also been linked to reducing some anxiety. So the question is, well, when is an SSRI helpful? And my short answer is ask the psychiatrist. But the long answer is that the neurochemicals in our brain are always operating in a balance. So it's not as easy as just going, oh, you've got that symptom. That means there's too little of this could be too much of Something else. So it's kind of like developing a warm bath. You got to kind of figure out what the balance is for that person. And that's obviously going to be something the psychiatrist is going to handle. But helping them understand that our feelings are a direct result from the balance of neurochemicals in our brain. So our symptoms, generalized anxiety, can vary. They may include persistent worrying or obsession about small or large concerns that is out of proportion to the impact of the event. Okay, so fine. Most of our clients who present with generalized anxiety are going to have this symptom. What do we do about it? Well, my first question is, what helps you know, when you are worrying? What helps you change gears? What helps you get a breather, even if it's just for 30 minutes? What helps you stop worrying or at least not think about it for that small period of time? And do you have tools that you use to help rein it in and consider the proportion they may or they may not? Some people are like, yeah, I start to worry, and then I realize that I'm really making a mountain out of a molehill, blah, blah, blah. And I'm like, okay, great. How do you do that? What skills do you use? It doesn't mean that the anxiety is not a problem. It's still coming up frequently. But they at least have a couple of things that they're doing when it happens. Inability to set aside or let go of worry. So as soon as they stop worrying, they get worried because they're not worrying. So acceptance and commitment therapy. We'll talk in a little while about the acronym fear and unhooking from emotions. Realizing that we don't have to act on them, we'll talk about some challenging questions that we might encourage clients to ask. But again, starting out with when you notice that you're worrying and you try to ignore it and it keeps coming back, what do you do when you have an inability to relax? You feel keyed up or on edge? Is there anything you can do that helps you relax? A bubble bath, Going on a walk, pulling weeds. You know, y' all know pulling weeds is mine. If I go out and I get outside, I'm too focused on the little weeds that keep popping up, mocking me, and I forget about whatever it was that was bothering me for that period of time. So we want to ask clients if they have anything like that. Difficulty concentrating or the feeling that your mind just goes poof blank. Well, you know, we know that lack of sleep can do that too. So as we're listening to these symptoms, we also want to identify when did this start? Is there anything that it's related to? Do you have episodes where it's worse and where it's better, which could indicate that there's a relationship to hormones or blood sugar or something else? Distress about making decisions for fear of making the wrong decision. When you have to make decisions, and we all do, how do you get past this fear? How do you go ahead and make that decision anyway? And what happens if it's wrong? How do you deal with that? Those are the things I want to know. Because we're going to be encouraging people to make decisions, and if it happens, sometimes we want them to have the skills to be able to deal with that as well as if it's a right decision. Carrying every option in a situation all the way out to its possible negative conclusion. So I was getting ready to go to this job interview. I didn't really know what I was walking into, and I did poorly in the job interview. So that means that I'm probably not going to get the job. And if I don't get the job, then in three months I won't be able to pay my rent. So I'm probably going to be homeless. And then I'm not going to know what to do with my kids, and I'm going to lose my kids. And I'm just like, dude, take a breath. So sometimes people can go all the way out to the catastrophic sky is falling conclusion. Okay, so then we want to talk with them about what's the probability that it's going to get to that point. And, you know, generally they come back with, you know, not real probable, and they can give explanations for that. And difficulty handling uncertainty or indecisiveness goes back to that fear of making the wrong decision and fear of rejection, fear of not being what somebody else wants them to be, necessarily. Other signs that we want to pay attention to fatigue. Okay, well, there are like a bazillion different things that cause fatigue and a lot of medical diagnoses. Not that I'm going to start throwing this out at clients because that'll just increase their anxiety. Well, it could be Lyme disease, it could be this, it could be that. No, no, no, no, no, no. But in my mind, I'm listening for what they do when it started, how they deal with it, if the fatigue predated the anxiety. You know, that's something I'm going to ask about. Irritability. How do they handle that? What makes it worse and better? Muscle tension or muscle aches, trembling and feeling twitchy. This is one of those signs, potentially that blood sugar is low. It may have nothing to do with cognitive stuff and maybe the brain going, I need more fuel. So we want to explore this and talk with clients about, you know, family history of diabetes and, you know, what they think may make it worse or better. Being easily startled can be a sign of ptsd. Can also just be anxiety, trouble sleeping, sweating, nausea, diarrhea, irritable bowel syndrome, and headaches. Like I said, when we get stressed, we tend to feel it systematically. Our body sends out cortisol, norepinephrine, turns everything kind of up, so everything starts running faster and you can just take that image all the way to the end for yourself. In kids. And I don't often talk about kids, but kids present a little bit differently with anxiety. They may have a lot of worry about performance at school or sporting events, being on time and punctuality. Earthquakes, nuclear war, or other catastrophic events that, you know, unless there has recently been one. If you live in California, then earthquakes are something that could be a prominent concern and could cause generalized anxiety. Sure. And it's important to look at the probability of these things happening, what to do in those cases. A child or teen with generalized anxiety disorder may also feel overly anxious to fit in. What teen do you know that doesn't? I mean, there are periods of anxiety. How frequently and how debilitating is this anxiety? They may be a perfectionist, lack self confidence, strive for approval, or require a lot of reassurance about performance. So just paying attention to this in kids, does it mean that if kids show any of these symptoms, they need to be seeing a psychiatrist and on medications and da, da, da. No. But if we see these signs, the earlier we see them, the easier it's going to be for us to say, present them with some other intervention based coping skills and look at what they're doing preventatively. You know, are they getting enough sleep, Are they eating a healthy, healthy diet? Or are they eating a pop tart on the bus on the way to school? And I ate pop tarts on the bus on the way to school. I'm not knocking it. I'm just saying every morning might not be the best thing. Okay, so biological interventions. Let's start at the beginning. When you feel anxious, your body thinks there's a threat. Figure out why is there a threat? Is there something biologically going on that could cause you harm? Are you harm's way? You know, if you're walking through a parking garage at 1 o' clock in the morning by yourself and you feel anxious. Well, you know what, that's probably pretty spot on. You know, anxiety serves a purpose. It is there to tell you something might be going a little bit wonky. So figure out why. If you feel anxious and you realize, you know, I haven't eaten in a while, hey, you tuned into a clue. And part of helping people with anxiety is to help them realize their body's trying to tell them something. And it doesn't mean there's necessarily a problem. It could be over generalized. But let's check in and rule out the biggies first. Do you need to eat? Do you need to get something, some water to drink? Kind of. What's going on? Have you had too much caffeine? We've all had. Well, maybe not all of us. Many of us have had those days where we've had just a little bit too much of the full calf or we've gone to Starbucks and yeah, and you can feel like this anxiety or revved up sensation kind of coursing through your veins. So being aware of what's going on. If you went to Starbucks and all of a sudden you feel like a chihuahua that's been drinking Starbucks, be aware of it. You may not need to do anything. You know, it may not be. It's something that's probably going to pass in four to six hours. Other things for biological interventions, you know, obviously have people see their physician, get a blood workup, make sure everything's normal, and rule out what I call the easy stuff. You know, if they have a thyroid imbalance that's easier to treat, and then long standing cognitions that, you know, we're going to deal with. Supportive care. Encourage people to make sure that they're preventing vulnerabilities by creating a sleep routine. Quality sleep helps the brain and body rebalance. It can help repair adrenal fatigue or chronic fatigue. Any of those symptoms of, you know, I wake up and I just can never actually feel, feel energized. And it improves energy level and concentration and a whole bunch of other things. So sleep routines, roughly the same time each night, you want to go to bed. You know, don't be too rigid with it. Make sure you do the same two to three things just like you would with a little kid. You know, with kids, they eat dinner, go take a bath, get a story, read, get tucked in, go to bed. That sets their body up. As soon as they start eating dinner, their brain's going, it's starting to be time to wind down. Let me make that melatonin. We want to do that for ourselves. Nutrition, minimize caffeine and other stimulants. I'm realistic. People who drink caffeine are probably not going to just be like, oh, that's not helpful, no problem, I'm going to cut it out. They like their coffee, so help educate them about the effect of caffeine and nicotine and other stimulants, including pre workout supplements. If they're avid athletes and let them make a decision, an educated decision, with their healthcare provider. Encourage them to prevent spikes and drops in blood sugar which can trigger the stress response and shakiness and just a sense of kind of dizziness and not feeling well. And drink enough water. Water is required for all of those electrical impulses and everything to go through our body. If we're dehydrated even 1%, we start feeling foggy headed and have difficulty making decisions. Make sure they get sunlight, vitamin D. They've actually implicated in mood issues, but they're not sure why. They know the areas of the brain that are responsible for depression and anxiety have a lot of receptors for vitamin D, but they're not sure how it all works together. Sunlight prompts the skin to tell the brain to produce neurotransmitters, which sets circadian rhythms and impacts the release of serotonin, melatonin and gaba. Now, your natural serotonin typically is your antianxiety antidote and GABA is too. So when serotonin levels are low, people tend often when their natural serotonin levels are low, people tend to experience some more anxiety. But as I said in the beginning of the presentation, the research is somewhat conflicting on this, which is why I encourage patients to advocate for themselves. And if they start on an SSRI or something because they think that's going to help them and it doesn't. Talk to their doctor if it makes their symptoms worse, talk to their doctor because there are other medications if they need that. But we also want to look at what can you do, lifestyle wise, to help your body function efficiently. Think about your body as a car. You know, think about whatever really nice car you want, but you wouldn't run that car on the same oil for 15 years with 100 pounds of dog food in the trunk and expect it to operate efficiently and effectively. Well, stress is kind of like that hundred pounds of dog food in the trunk and not getting enough sleep is like putting in really bad gas. And if you will. So we want to help people make sure their body machine is doing as much as it can and then we can figure out where to go from there. Exercise does have a relaxing effect, but start slowly. I'm not saying go to the gym and bust hump for 40 minutes three times a week. I'm saying walk around the block a couple of times with your dog. That is, you know, doing something is better than nothing, obviously. Have them clear it with their physician first. Other supportive care things, medication, As I said, SSRIs, selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors have been used in interventions with anxiety. And benzodiazepines have, as well as bus bar, which doesn't nicely fit anywhere else. Benzos typically are, you know, your Valium, your Xanax, highly addictive. So I personally make sure I educate clients about benzos, especially if they have a history of addiction in their family. But, you know, that's obviously going to depend on the individual client and be between them and their prescribing physician. Aromatherapy can help. And think about a time when you've walked into somewhere and like the mall and you've walked past Cinnabon and you've just been like, oh, my gosh. And you just kind of feel this wave of relaxation go over your entire body. And then you realize you probably don't want to eat that many calories. But before that happens, you have a feeling, you have a sensation. Smells are some of our greatest triggers for memories, encouraging people to find smells that they find relaxing. And we all have certain smells, and it may take some playing to figure out what they are, but we all have certain smells that can help us feel more relaxed or at ease than, you know, other smells. Smells that remind me of, you know, certain places tend to stress me out more than smells that remind me of my grandmother's house, which is Pine Sol. So, you know, I can just clean with Pine Sol and I'm good. But they found that Clary Sage is a great essential oil for anti anxiety, as well as lavender rose, vetveer, Ylang ylang, bergamot, chamomile, and frankincense. You can go to davidwolf.com, draxe.com to read more about those. Now, remember aromatherapy, especially essential oils. Clients don't want to put those directly on their skin, especially without working with a licensed aromatherapist. But smelling them can have a similar effect. I sprinkle Clary Sage on my pillow every night, but that's me. So figuring out what works for that client, we also use on our dogs. I don't like to give them actual oral supplements, Valerian. And I put it on their collars before there's a thunderstorm. And it helps. I've done an AB test, and there's definitely a difference in their mood and their. Their shakiness and everything when a thunderstorm comes. For the two that have thunderstorm anxiety. So do some exploration or encourage your clients to do exploration. They don't have to buy these right away. They can go down to the local health food store. Most of them have essential oils. Have them sniff them. If they sniff it and they go, oh, that's disgusting. Well, that's probably not going to work for them, but they might find some that they smell and they're like, I like this. It could be a scent that's not even related to a prior memory. They found, you know, these essential oils here aren't necessarily related to a memory when they help calming, which is why lavender and chamomile are in a lot of baby baths and baby shampoos. Well, babies certainly don't have any point of reference for that, but there is something about those oils that can be soothing. So psychological interventions. Anxiety equals threat. Threat equals activation of one or more of those basic fears. So what are they? And this is where we get into the practical. And I like to help clients understand that their brain is trying to tell them something. And if we can step back and go, you're right or you're wrong, they're going to be more empowered to take control of their anxiety. So what are these basic fears? Failure. None of us likes to fail, but some people perceive failure as a road to rejection. And if they need external validation, then rejection is scary as crap. Because if somebody else isn't there to tell them they're okay, then who's going to tell them they're okay? Rejection and isolation can be huge for people, which is, you know, we have whole diagnosis of social anxiety. Some people feel very threatened by other people's opinion of them and not being accepted. Loss of control. You know, if you're not in complete control of a situation, well, you know what? If you're not in complete control, you have a greater risk, possibly failure. You know, if you have perfect control over it, then you assume that you will be able to come out victorious or whatever. The unknown. Some people love it. They like spontaneity. Some people hate it because they like to be in control all the time. And then the last one is death, loss. And depending on how you want to characterize it, death, obviously of a person or of Yourself. If you're afraid to fly in an airplane because you're afraid it's gonna crash, yeah, that's a fear of death. If you are facing a situation where you're afraid, you're nervous about going into a job interview, you know, you may be fearing failure, but you also may fear loss of self concept. If you don't get that job, what does that say about you? You can lose dreams. If you're applying for a college that you want to get into really, really desperately and you don't get into that college, that's a loss. You've got to accept that that dream you had since you were knee high to a grasshopper isn't going to happen. So that's something that needs to be grieved and dealt with. But leading up to it, there is probably, probably going to be some anxiety about, well, if this happens, is my life going to fall apart? So we can help clients start understanding and identifying the sources of their anxiety. Then I move on to mindfulness and acceptance. All right, so you know what the categories are. Observe yourself when you get anxious. Accept that you feel angry or anxious and just be like, okay, stressed out right now, or I'm anxious, I'm panicky, whatever word they use, okay, radical acceptance, Label it and let it go. Which takes some practice for people in order to not fight with it and go, well, I shouldn't feel anxious right now. There's nothing to be stressed about. I don't know why I'm anxious. They can talk to themselves for an hour about that, or they can just say, you know what, I'm anxious. Let me let that go and figure out what I can do to improve the next moment. Encourage them to identify trigger thoughts. When they're being mindful. They're going to tune in more to that internal critic. That's probably telling them you're going to fail. Or if you don't get this, you're going to be rejected. So tuning into those trigger thoughts, that internal critic, and telling him to shut the heck up. Distress tolerance. It isn't always about controlling your anxiety. Anxiety comes, it's just a warning signal. You know, if you've ever had a fire alarm malfunction in your, in your house, kind of like the anxiety. Sometimes it's telling you there's smoke and there's a problem. Other times it's telling you that there's smoke because I forgot something was in the oven or nothing at all. I've had fire alarms go off for no apparent reason. So it's about Identifying that there might be a threat and then addressing it if there's nothing there, you know, or nothing you can put your finger on. Sometimes it's better to distract, not react. You don't have to get yourself all wound up wondering, you know, what should you be worried about? Just say, you know what, I'm feeling anxious right now. I don't see anything around that's going on. I'm going to take a breath and redirect my attention and use distancing techniques. When clients start getting stressed, encouraging them to put the phrase, I'm having the thought that in front of instead of saying, I am freaked out about this upcoming interview. Saying, I'm having the thought that I'm freaked out about this upcoming interview. Why? Because then we can say, well, what are you going to do with that thought? What else can you do? Can you let it go? Is there anything you can do to change that thought? Encourage clients to relax. This is preventative as well as interventive. My new word for the day, diaphragmatic breathing can help people slow down their heart rate and slow down that stress response. What I learned to call combat breathing, you may call it something else. You breathe in for a count of four, you hold for a count of four, and then you exhale for a count of four. By slowing your breathing, your heart rate automatically slows. So people who are having a panic attack, who are having an anxiety moment can calm themselves down. If you get cut off in traffic and you have that panic moment, slowing breathing will help get you back to baseline more quickly. If you're in the place where you can and you're willing to do it, Meditation can help. Meditating can help you focus on your breath and really focus on what the energies in your body are doing. Another relaxation skill. And I always tell you guys that there are all kinds of resources on the Internet for it, but you know, I don't usually show you so. And of course that's not going to come up the way I wanted it to. Well, I'll do that at the end of class so we get through it. But I googled, forgive the verb, progressive muscular relaxation videos and I found a bunch that were on YouTube. I'm not recommending any particular one because I haven't watched them all. Obviously you're going to watch it before you recommend it to a client, but this way they can lay down on their bed and just let a video walk them through the progressive muscular relaxation and help them relax. Self esteem interventions. You know, I keep talking about this fear of failure, fear of rejection, wanting to make sure that you are your own best friend, to improve social relationships with others, yada, yada. Well, they need to figure out how their self esteem is right now. So what's the difference between their real self, who they are right now, or how they think about themselves right now versus who they think they should be? I have my clients write that down and then we look at the should be's and we cross out the things that are just completely unreasonable. You know, I'm never going to be 5, 10, and redhead. That's just. Well, I guess I could be redhead, but naturally no. So cross those off. That's not what's going to ever happen. So what's important in my ideal self? What things do I want to leave that are important and then go back and compare it to the real self. And if there are differences, then set goals to start improving and becoming the person they want to be. I mean, it's a pretty academic exercise. Encourage compassionate self talk. Too often our clients are just nasty to themselves. They hold themselves up to this standard and they hold everybody else to this standard down here. And I'm like, well, if you're not going to hold anybody else to the standard, why do you hold yourself there? You're just creating a situation where you reject yourself and you feel like a failure. Hmm. There's a concept. Encourage them to spotlight strengths. What strengths do you have? What do you bring to the table? What is awesome about you? And a lot of times they hate answering this question, so I'll have them write it down in a journal, add to it over a couple of weeks, and then we look at it together and encourage them to accept imperfections. I present to them the concept of Yin and Yang. Everybody has their strengths and everybody has their weaknesses. And that kind of is what balances everything out. If everybody had the same strengths, then the weaknesses would go untended and everything would be chaos. So it's great if you've got these strengths and somebody else has opposite strengths because you can assist each other and make a more balanced project or relationship or whatever it is. So accepting imperfections and going, yep, that's not my strong suit is important. But helping clients look at it in terms of not a rejection or a failure, but just as a statement of what is cognitive restructuring. We want to help them address and identify irrational thoughts and cognitive distortions. This is something they probably already do a little bit on their own and we can build on it. But once they understand, especially the cognitive distortions, the all or nothing, thinking, the catastrophizing, etc. They can start sorting their thoughts and it empowers them to go, yep, I can see where that was kind of extreme. I can see a different way to restate this, where it's more middle of the road or more empowering. Reframe challenges in terms of current strengths, not just past weaknesses. Instead of saying, I failed at every relationship I've been in, look and say, look at everything I've learned from all the relationships I've been in that I can bring to this new relationship. And encourage them to create an attitude of gratitude and optimism, focusing on what they do have and what they can do. And I should have put empowerment there too, because as they develop those. Those fears, that threat goes down. You can't be empowered and scared to death at the same time. Most of the time. Most of the time, they balance themselves out. So I talked about ACT earlier, the fear acronym Fusion with your thoughts. If clients fuse with their thoughts and they feel like they have to act on every feeling and thought they have, then they're going to be stuck in that anxiety roller coaster. If they can separate and going, I'm having the feeling that I'm anxious. Or if they can view their anxiety as a bubble and let it float up, there are a lot of different unhooking or diffusion exercises that they can do so they can let go of that anxiety and focus on what is in the moment. Evaluate their experience in a way that empowers them instead of disempowers them. Instead of looking at it as a failure, looking at something as evidence of courage to step out of their comfort zone and try something that they wouldn't necessarily succeed at, and a learning opportunity. So I encourage them to look at, how else could you restate this? That would be empowering and positive. If they want to avoid their experiences, a lot of us don't go headlong into fear. That's just not what we want to do. So gradual exposure is one of those things. And finding exceptions. I worked with a client who was terrified of driving. She got to the point where she could hardly drive from her house to my office without having a panic attack. So we would talk about, as you came here, what happened. Were there any threats? Was it safe? Was there anything that could have harmed you? And found exceptions to her belief that driving was just the most dangerous thing in the world. Gradual exposure. You know, I'm not telling her, well, you just need to get over it and go out and drive. No, that would be cruel. However, you know, the things that she did do, we talked about, okay, how can you do this in a way that minimizes your anxiety? Maybe getting on the interstate at rush hour isn't the best route to take. To go from point A to point B, you have to get there, so how else could you do it? Getting her used to making workarounds and feeling confident and comfortable with driving, and then reason giving for behavior. When clients start explaining why they're anxious and why they're avoiding doing something, we want to ask challenging questions. You know, the thought that this is dangerous or this is fearsome, okay, what is your evidence for and against? You know, let's look at it rationally. Let's look at it like, like an attorney and argue both sides of the case. Let's figure out if this is based on feeling or fact. If you're feeling scared, so you tell yourself it must be dangerous, that's different than knowing it's dangerous and then feeling scared. The challenging questions worksheet. We've gone over in a bunch of activities, so I'm not going to belabor that one. Too much recreation and relaxation. There's always stuff you can do. But a lot of our clients with anxiety disorders don't take time to relax. So we want to encourage them to do that, but they need to make a list of fun things to do because a lot of times when they do have a moment, they're like, I don't know what to do because they haven't rested and relaxed for so long. Encourage them to make a list, maybe a little bucket list of fun things they want to do this month. Social interventions encourage them to identify their needs and wants with mindfulness, preferably anchored mindfulness. So they're doing it at least three times a day. Encourage them to be their own best friend. If they start thinking, I wish somebody would, well, do it for yourself. Yeah, it's not quite the same, but as you start doing it for yourself, you realize you deserve it. Which creates stronger, healthier other relationships. Help them understand the difference between internal validation, the ability to say I'm okay, and external validation, needing others around solely for the purpose of telling you that you are worthy of breathing the air. And encourage them to be compassionate with themselves. We already talked about that. Help them develop healthy, supportive relationships and learn about boundaries and develop assertiveness skills. In dbt, this falls under those interpersonal effectiveness skills. The biggest one that I find with people who have anxiety is asking for help and being able to say no to requests without fearing that they're going to be rejected or somebody's going to get mad at them. So those are skills that we can work on so people can ask for help when they need it. So they don't feel isolated, but they can also set boundaries so they don't feel pulled in 18 different directions. Have them describe the ideal healthy, supportive relationship and then separate the real from ideals. Because a lot of times tv, media, Disney gives us a really skewed perception of what a healthy real relationship looks like. Like we never fight. Oh, okay. Anyway, so encourage them to look at relationships more realistically. Identify who these persons that they know are that they might be able to develop these relationships with that are currently in their life. You know, instead of starting from ground zero, start with what they've got. The other technique I like is playing the what does it mean Game. What does it mean when your boyfriend girlfriend doesn't respond to your text right away? What does it mean when your significant other calls and says you know what, I can't go out tonight? A lot of times the way they answer this will help us understand and help them understand some of their fears of abandonment and anxiety reactions and be able to come up with three alternatives to well, why didn't she return your text right away? Resources the Anxiety and Phobia Workbook really like that one. Act for Anxiety Disorders Anxiety Food Solution. I like this one just because it really educates clients about how what they put in their body is important in terms of the building blocks for health and happiness. Coping with anxiety 10 simple ways to Relieve Fear and Worry. It's a good book. And the 30 minute therapy for Anxiety Now Neu Harbinger has a lot of resources on anxiety. These are my five favorites. You may hate them. You know we all have our different preferences you can look them up on. They have the Google previews so you can read some of them and figure out if it's something that you like. Oops, I went too far. Summary Anxiety is a natural emotion that serves a survival function. Excessive anxiety can develop from lack of sleep, nutritional problems, other causes of neurochemical imbalances, failure to develop adequate coping skills so you can't deal with that threat, cognitive distortions, low self esteem and a need for external validation. Recovery involves improving health behaviors, identifying and building on current coping strategies, addressing cognitive distortions, developing healthy supportive relationship with self and others. So then let's go real quickly here to if I can get it to come up Course exam so strengths based, you know just to kind of review means identifying what the client is already doing that's helping them. It doesn't necessarily mean using a best practice. I mean, best practices are great, but we don't know if that's going to work for the client or if the client's already even engaged in those. We know, for example, that acupuncture is a best practice for treatment of certain disorders. However, some clients may be like, oh heck no, not going near the needles. Well, that may not work. So strengths based means identifying what the client client is already using and building upon that. Biopsychosocial means addressing the physical, mental and interpersonal mitigating and exacerbating factors for the person's current problems. We can't deal with everything that's ever existed. We want to look at this particular problem in context. Your anxiety right now. What's causing it, what makes it worse, what makes it better. But we do want to look at the person as a complex entity, not just as a psychological phenomenon. And anxiety is there for a purpose. It tells the body, tells the person, check it out. You know, like I said, it's like the smoke detector. Could mean there's a problem, may just be a false alarm. But anxiety is there to help protect people. And a variety of skills, including distress tolerance and relaxation skills, can be very helpful in helping people deal with anxiety. Because when they start to feel that anxiety reaction, when their heart starts to race, they might start to feel like they're spiraling out of control. By giving them tools to be able to kind of get their heart rate under control, get their breathing under control, deal with some of those distress intolerant thoughts that are prompting the stress reaction, we can empower them to take control of their current situation. Are there any questions? Let me see if I can find that. Let me bring if you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceus.com counselortoolbox this episode has been brought to you in part by allce.com, providing 24. 7 multimedia continuing education and pre certification training to counselors, therapists and nurses since 2006. Use coupon code counselortoolbox to get a 20% discount off your order this month.