{"id":150228,"date":"2023-01-17T01:16:22","date_gmt":"2023-01-17T06:16:22","guid":{"rendered":"https:\/\/effectsofanxiety.net\/?p=150228"},"modified":"2023-01-17T16:53:03","modified_gmt":"2023-01-17T21:53:03","slug":"best-practices-for-anxiety-treatment-cognitive-behavioral-therapy","status":"publish","type":"post","link":"https:\/\/effectsofanxiety.net\/archives\/150228","title":{"rendered":"Best Practices for Anxiety Treatment | Cognitive Behavioral Therapy"},"content":{"rendered":"<div class=\"jetpack-video-wrapper\"><iframe loading=\"lazy\" title=\"Best Practices for Anxiety Treatment | Cognitive Behavioral Therapy\" width=\"660\" height=\"371\" src=\"https:\/\/www.youtube.com\/embed\/ZT5-TNqUg-w?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/div>\r\n\r\nthis episode was pre-recorded\r\nas part of a live continuing\u00a0\u00a0 education webinar on-demand CEUs are\r\nstill available for this presentation\u00a0\u00a0 AllCEUs.com\/Anxiety-CEU I’d like to welcome everybody to today’s\r\npresentation on best practices for the\u00a0\u00a0 treatment of anxiety I am your host, Dr. Dawn Elise Snipes now not too long ago we did\r\na presentation on strengths-based biopsychosocial\u00a0\u00a0 approaches to addressing anxiety while\r\nthose are wonderful you know I thought maybe\u00a0\u00a0 we ought to look at you know what’re some of the\r\ncurrent research so I went into PubMed which is\u00a0\u00a0 I don’t know it’s a playground for me it’s where\r\nyou find a lot of journal articles and you\u00a0\u00a0 can sort I sorted by articles that were\r\ndone and meta-analyses that were done within\u00a0\u00a0 the past five years so that gives us an idea\r\nabout current research I mean there’s a lot\u00a0\u00a0 of stuff that is still the same like some of\r\nthe medications that were known to work ten\u00a0\u00a0 years ago are still known to be you know good\r\nfirst-line treatments but there are also some\u00a0\u00a0 newcomers that we’ll talk about and there are\r\nalso, some changes that we’re going to talk about so we’re going to explore some common causes\r\nfor anxiety symptoms to treat, we need to and of course, this does play into\r\nthe biopsychosocial aspect we need to\u00a0\u00a0 understand kind of what causes it because anxiety\r\nthat’s caused by for example somebody having a\u00a0\u00a0 racing heart may be different than anxiety that’s\r\ncaused for somebody who has abandonment issues so\u00a0\u00a0 we’re gonna treat the two things differently so\r\nwe want to look at some of the common causes we’re\u00a0\u00a0 gonna look at some common triggers for anxiety\r\nDo you know what are some of these common themes that\u00a0\u00a0 we see in practice I will ask you to share\r\nsome of the themes that you see that underline\u00a0\u00a0 or underlie a lot of your client’s anxiety and\r\nidentify current best practices for anxiety\u00a0\u00a0 management including counseling interventions\r\nmedications physical interventions and supportive\u00a0\u00a0 treatments so we care because anxiety can\r\nbe debilitating and a lot of our clients\u00a0\u00a0 have anxiety a lot of our clients have anxiety\r\ncomorbid with depression and they’re looking at\u00a0\u00a0 us going how can I feel anxious and stressed out\r\nand like I can’t sit still and be depressed at the\u00a0\u00a0 same time you know when you’re depressed you’re\r\nsupposed to want to sleep well a lot of times\u00a0\u00a0 people who have both issues want to\r\nsleep but they can’t so I want to help clients\u00a0\u00a0 understand that also sometimes anxiety when\r\npeople are anxious for long enough the body\u00a0\u00a0 starts kind of holding on to the cortisol the body\r\nrecognizes at a certain point this is a\u00a0\u00a0 losing battle I’m not going to put energy into\r\nthis anymore so it starts withdrawing some of\u00a0\u00a0 its excitatory neurotransmitters so to speak and\r\npeople will start to feel depressed the\u00a0\u00a0 brain has already said this is hopeless this is\r\nyou’re helpless to change the situation so\u00a0\u00a0 then people start feeling hopeless and helpless\r\nwhich is sort of the definition if you will of\u00a0\u00a0 depression low-grade chronic stress and anxiety\r\narose energy and people’s ability to concentrate\u00a0\u00a0 so if we’re going to help them become their uber\r\nselves we need to help them figure out how to\u00a0\u00a0 address anxiety not just generalized overwhelming\r\ndebilitating anxiety but also panic social anxiety\u00a0\u00a0 and those minor anxiety triggers that come along\r\nthat may not meet the threshold for diagnosis\u00a0\u00a0 anxiety is a major trigger for addiction relapse\r\nif you have a client who is self-medicated before\u00a0\u00a0 or had an addiction for some reason anxiety is a\r\nmajor trigger increased physical pain when anxiety\u00a0\u00a0 goes up people tend to tense their muscles when\r\nthey tense their muscles they tend to feel more\u00a0\u00a0 pain I mean think about when you’re stressed you\r\ntend to have more pain like in your neck your\u00a0\u00a0 back and things that already hurt may hurt more\r\nwhy because serotonin which is one of our major\u00a0\u00a0 anti-anxiety neurotransmitters is also one of our\r\nmajor pain modulators so when serotonin levels are\u00a0\u00a0 too low because anxiety is high then our pain\r\nperception is going to be more acute and people\u00a0\u00a0 can have sleep problems if they’re stressed out\r\nyour body thinks there’s a threat you’re not\u00a0\u00a0 going to be able to get into that deep restful\r\nsleep you may have you may sleep a lot but it’s probably not quality sleep which\r\nmeans your neurotransmitters may get out of whack\u00a0\u00a0 your hormones make it out of whack and your body\r\nis going to start perceiving yourself in a\u00a0\u00a0 persistent state of stress when you’re exhausted\r\nthe body knows that we may be the weakest link\u00a0\u00a0 in the herd so it continues to secrete cortisol\r\nto keep you on alert a little bit so you\u00a0\u00a0 may again you may be resting kind of like when\r\nyou have a new baby at home those first couple\u00a0\u00a0 of months that my children were home from the\r\nthe hospital I slept but I didn’t sleep well I mean\u00a0\u00a0 the slightest little noise and I was awake and I\r\nwas looking around and you know I felt it I felt\u00a0\u00a0 exhausted and a lot of new parents do so triggers\r\nfor anxiety abandonment and rejection and we’re\u00a0\u00a0 going to talk about ways we might want to deal\r\nwith these things but some of the underlying\u00a0\u00a0 themes that I’ve seen in a lot of clients and when\r\nI do the research and a lot of what themes that\u00a0\u00a0 come out include low self-esteem if someone has\r\nlow self-esteem they’re looking to be externally\u00a0\u00a0 validated oftentimes they’re looking for somebody\r\nelse to tell them you’re lovable you’re okay so\u00a0\u00a0 that can lead to anxiety about not having\r\npeople to tell them you’re okay which makes\u00a0\u00a0 their relationships tenuous and can make them\r\ndysfunctional irrational thoughts and cognitive\u00a0\u00a0 distortions may lead people to believe that if I’m\r\nnot perfect for example I am not lovable so we’re\u00a0\u00a0 going to look at some irrational thoughts and\r\ncognitive distortions unhealthy social supports\u00a0\u00a0 and relationships when you’re in a relationship\r\nit takes two to tango and even if your client is\u00a0\u00a0 relatively mentally and physically healthy if they\r\nare in a dysfunctional relationship they can fear\u00a0\u00a0 abandonment and rejection if that other person\r\nis always saying if you don’t do X I’m going\u00a0\u00a0 to leave you or if that other person is always\r\ncheating on them or whatever so relationships\u00a0\u00a0 can trigger abandonment anxiety and ineffective\r\ninterpersonal skills can lead to relationship\u00a0\u00a0 turmoil and social exile if our clients are in\r\nrelationships even if they’re not completely\u00a0\u00a0 dysfunctional if our clients are not able to ask\r\nfor what they need and set appropriate boundaries\u00a0\u00a0 and manage conflict effectively because conflict\r\nhappens in every relationship then they may start\u00a0\u00a0 to argue more which may lead to fearing may lead\r\nto relationships ending in the past and them going\u00a0\u00a0 well every relationship I get into ends which\r\nmeans I must not be lovable so they start fearing\u00a0\u00a0 abandonment and rejection these are four areas\r\nthat we can look at one more assessing clients\u00a0\u00a0 another issue is the unknown and loss of control\r\na lot of times negative self-talk and cognitive\u00a0\u00a0 distortions can contribute to that if I don’t have\r\ncontrol of everything then it’s all going to be a\u00a0\u00a0 disaster negative others when clients hang out\r\nor when people hang out with negative people it\u00a0\u00a0 kind of wears on you after a while you notice\r\nthat people who tend to be more negative\u00a0\u00a0 pessimistic conspiracy-minded tend to hang out\r\nwith people who are also negatively pessimistic and\u00a0\u00a0 conspiracy-minded so if you’re hanging out with\r\nsomebody who tends to be anxious then the anxiety\u00a0\u00a0 can be palpable and it can kind of permeate\r\nphysical complaints can lead people to be\u00a0\u00a0 anxious because they don’t know what’s causing it\r\nlike I said earlier sometimes if your heart starts\u00a0\u00a0 to race if you don’t know what’s causing it for you\r\ncan start thinking I’m having a heart attack or\u00a0\u00a0 I’m gonna die when people have panic attacks for\r\nthe example they truly think they’re having a heart\u00a0\u00a0 attack and it’s I’ve had them they are very\r\nvery unpleasant experiences but when people\u00a0\u00a0 start having physical complaints and it can be you\r\nknow they have a weird rash that they can’t get to\u00a0\u00a0 go away or whatever but when they don’t know\r\nwhat it is and they can’t control it they can’t\u00a0\u00a0 make it go away they start thinking about all\r\nthe worst-case scenarios and going online and\u00a0\u00a0 getting on WebMD which usually gives you all the\r\nworst-case scenarios um so physical complaints\u00a0\u00a0 are important we need to normalize the fact that\r\nnobody’s pain-free all the time and you know the\u00a0\u00a0 fact that you may have an ache or a pain or a lump\r\nor a bump or you know a cough most likely you know\u00a0\u00a0 when we look at probability the probability of it\r\nbeing something significant is pretty small now\u00a0\u00a0 do you want to get it checked out probably but\r\nyou know the probability that is anything to be\u00a0\u00a0 worried about is relatively small and a sense\r\nof powerlessness can trigger fear of the unknown\u00a0\u00a0 and loss of control for somebody who doesn’t\r\nfeel like they have any agency in their life\u00a0\u00a0 if they have an external locus of control or\r\nif they felt victimized all of their life then\u00a0\u00a0 they may fear not being in control they may be\r\nholding on and saying okay this is the one area\u00a0\u00a0 of my life I can control when I grew up you know\r\nI grew up in a very chaotic environment I had no\u00a0\u00a0 control I was bounced around in the foster system\r\nyadda yadda yadda now that I’m an adult you know I\u00a0\u00a0 can control these things and I am going to hold\r\non with white knuckles and if I can’t control\u00a0\u00a0 everything then that terrifies me to death and\r\nloss are other triggers for anxiety and it can\u00a0\u00a0 be people or pets and pets are important I don’t\r\nwant to minimize pets because you know they are\u00a0\u00a0 little parts of a lot of our families so making\r\nsure we check that my daughter’s dog for example\u00a0\u00a0 is it’s getting old she’s getting older she’s 14\r\nnow I think and you know she’s in decent health\u00a0\u00a0 we took her to the vet and the vet said yeah she’s\r\ngot a little heart murmur but that’s expected for\u00a0\u00a0 a 14-year-old dog and but when she goes out if she\r\ndoesn’t come back when I call her I have this rush\u00a0\u00a0 of anxiety for a second oh my gosh I hope this\r\nwasn’t the day so anxious around losing people\u00a0\u00a0 and you know if she when she crosses the bridge\r\nshe will and you know I’m okay with that I’m\u00a0\u00a0 I have a harder time dealing with my daughter’s\r\nemotional turmoil when that happens and because\u00a0\u00a0 she’s grown up with this dog so you know those\r\nare the types of things that we want to talk about\u00a0\u00a0 with our clients what things are weighing on you\r\nthat you may not even be thinking about because I\u00a0\u00a0 know in the back of my mind there’s always that\r\nworry about one of our donkeys and her dog jobs\u00a0\u00a0 and promotions can trigger anxiety if people are\r\nafraid they’re gonna lose their job if they’re\u00a0\u00a0 always afraid that you know they’re gonna walk in\r\nand get a pink slip or get fired you know we want\u00a0\u00a0 to help them look at how realistic they are\r\nyou doing what you need to do to achieve\u00a0\u00a0 and keep your job and sometimes it’s not easy to\r\nthe answer I mean the first thought that a lot of us\u00a0\u00a0 have is well you know if you’re doing the right\r\na thing so just do it but there are those bosses\u00a0\u00a0 out there and I’ve had some amazing bosses\r\na lot of them and I’ve had two horrendous\u00a0\u00a0 bosses and those two bosses I could never I\r\nnever felt like I was able to do anything right\u00a0\u00a0 and so going to those jobs there was always this\r\nanxiety about what I’m what am I going to get in\u00a0\u00a0 trouble for today so you want to talk with people\r\nabout does your job cause anxiety what can you\u00a0\u00a0 do to moderate that anxiety the same thing with\r\npromotions people may get anxious about whether\u00a0\u00a0 they’re going to get promoted to safety and security\r\nyou know when you lose safety and security you can\u00a0\u00a0 feel anxious so if there’s a break-in at\r\nthe house next door or shooting down the road\u00a0\u00a0 or you start watching the news you can feel very\r\nunsafe and insecure quickly so we want to\u00a0\u00a0 help people figure out how safe and secure are you\r\nreally and a lot of it goes back to looking\u00a0\u00a0 at facts when people lose their dreams and hopes\r\nor fear that they’re going to lose their dreams\u00a0\u00a0 and hopes they can start to get anxious you know\r\nthey have this dream that they’re going to be\u00a0\u00a0 a doctor or I just finished the presentation on\r\nhelping high school students transition to college\u00a0\u00a0 and a lot of high school students for example\r\nstart college with these wide eyes and hopes\u00a0\u00a0 to save the world and they want to be doctors\r\nand engineers and this and that and they get\u00a0\u00a0 into it and they realize that it’s a lot harder\r\nthen they thought or they realize that you know\u00a0\u00a0 what I don’t like this but I’ve already\r\ncommitted to it so what do I do I want to help\u00a0\u00a0 people but I can’t I can’t cut it doing this you\r\nknow for me I figured out in my second year that\u00a0\u00a0 I wasn’t going to medical school because I wasn’t\r\ngoing to pass calculus and that caused a lot of\u00a0\u00a0 anxiety it was like okay what am I gonna do now\r\nDo you know what career should I choose to help people figure out do they have dreams that have\r\nmaybe kind of crashed and burned and you have to\u00a0\u00a0 find new ones you know okay that one we’ve got to\r\naccept it figure out that it’s not going to be and\u00a0\u00a0 what can you do now people may also have dreams\r\nabout relationships they get into relationships\u00a0\u00a0 and see themselves with this person forever\r\nand then this relationship ends and or starts to\u00a0\u00a0 get rocky and they’re like but that’s my dream\r\nwhat happens if that’s got to happen because\u00a0\u00a0 it’s my dream I don’t know how to function if\r\nthat goes away we want to help people be able to\u00a0\u00a0 rewrite their narrative and then sickness spiders\r\nand other phobias kind of go in with death a lot\u00a0\u00a0 of times when people get sick they start getting\r\nanxious that oh my gosh what if this is terminal\u00a0\u00a0 oh my gosh what if this is you know incurable\r\nif I get bit by a spider it’s gonna kill me and\u00a0\u00a0 which is rare you know there are very few spiders\r\nthat is actually that poisonous same thing with\u00a0\u00a0 snakes going over bridges I’ve shared with you all\r\nthat is not one of my irrational fears you know I\u00a0\u00a0 am just terrified that you know something’s going\r\nto happen and I’m going to get pushed off the side\u00a0\u00a0 of the bridge which is completely irrational but\r\nwe need to help people look at those and identify\u00a0\u00a0 the thoughts that they’re telling themself about\r\nthose phobias and dealing with that anxiety failure\u00a0\u00a0 is another –trigger for anxiety especially in\r\nthis culture our culture American culture is large part puts a high premium on success\r\nand perfectionism so when people realize that\u00a0\u00a0 they’re not perfect they may start to get anxious\r\nbecause they feel like if I’m not perfect then I’m\u00a0\u00a0 a failure you know those cognitive distortions of\r\nall-or-nothing thinking and they start with that\u00a0\u00a0 negative self-talk you know you can’t do anything\r\nright so those are some of the issues that you\u00a0\u00a0 know we often see in counseling sessions so what\r\ndo we do you know somebody comes in and is like\u00a0\u00a0 I can’t live this way doc anxiety depression and\r\nsubstance disorders as well as a range of physical\u00a0\u00a0 disorders are often comorbid so this is the first\r\nthe thing we need to realize is that\u00a0\u00a0 we’re very rarely dealing with a very simple\r\nthe diagnosis you know when somebody comes in we need\u00a0\u00a0 to figure out you know if they come in and they’re\r\npresenting with depression all right let’s talk\u00a0\u00a0 about that and then we start realizing that there\r\ndepression started to occur after a long period\u00a0\u00a0 of being anxious okay so we need\r\nto deal with that but we also need to help them\u00a0\u00a0 with their sense of hopelessness and helplessness\r\nwe need to develop that sense of empowerment and\u00a0\u00a0 then substance disorders we know that substance\r\nuse is often a way of self-medicating but we also\u00a0\u00a0 know that it monkeys with the neurochemicals\r\nin the brain and can contribute to anxiety and\u00a0\u00a0 depression the same thing to physical issues pain\r\nfrom physical disorders anxiety about having\u00a0\u00a0 physical disorders medications you’re taking for\r\nphysical disorders can all contribute to anxiety\u00a0\u00a0 so we need to look at the person as a whole and go\r\nwhat are all the things that are contributing to\u00a0\u00a0 the anxiety and what are all the things that the\r\nanxiety is contributing to so we have started having this big list of stuff that needs to be\r\naddressed and then we can start figuring out okay\u00a0\u00a0 where we start so knowing that these things\r\nare comorbid helps researchers explore pathways\u00a0\u00a0 to mental disorders so they can start figuring\r\nout you know what little string can we pull to\u00a0\u00a0 unravel this blanket of anxiety so it doesn’t\r\nsuffocate somebody and for us, as clinicians, it\u00a0\u00a0 provides us key opportunities to intervene in you\r\nknow sometimes clients will come in and start talking about their\r\nanxiety and their physical issues you\u00a0\u00a0 know maybe their anxieties about you know heart\r\npalpitations and because that’s a common one we\u00a0\u00a0 may want to encourage them to go see the doctor to\r\nget that ruled out you know rule out anything that\u00a0\u00a0 has to do with hormone imbalances or you know\r\nheart conditions or anything else that might be\u00a0\u00a0 contributing to it which can help them address\r\nit and if they do have physical disorders let’s\u00a0\u00a0 go with hormone imbalances that are contributing\r\nto the heart palpitations then they can start to\u00a0\u00a0 treat that if they don’t start to treat that then\r\nno amount of talk therapy we do is going to get\u00a0\u00a0 them to the quality of life that they’re looking\r\nfor because they’re still gonna feel those so\u00a0\u00a0 we want to make sure that we’re addressing them\r\nholistically anxiety disorders should be treated\u00a0\u00a0 with psychological therapy pharmacy therapy or a\r\ncombination of both and what they found and this\u00a0\u00a0 is no surprise this is kind of old news is that\r\ncounseling Plus pharmacotherapy tends to have the\u00a0\u00a0 best outcomes but separating the two have\r\nsimilar outcomes in many cases but that’s just\u00a0\u00a0 looking at and I hate to call it simple anxiety\r\nbut we’re just looking at anxiety symptoms here\u00a0\u00a0 we’re not looking at the full quality of life and we\r\nwant to make sure that we’re also including any\u00a0\u00a0 medical issues behavioral therapy is regarded\r\nas the psychotherapy with the highest level\u00a0\u00a0 of evidence, there are a variety of cognitive\r\nbehavioral approaches ranging from acceptance\u00a0\u00a0 and commitment therapy to dialectical behavior\r\ntherapy to CBT to debt you know any of those that\u00a0\u00a0 deal with the thoughts and the cognitions that fall in\r\nthat realm and it is effective in the current conceptualization of the etiology\r\nof anxiety disorders includes an interaction of\u00a0\u00a0 psychosocial factors such as childhood adversity\r\nor stressful events and a genetic vulnerability\u00a0\u00a0 so the psychosocial factors and these are other\r\nthings when we do our assessment we want to pay\u00a0\u00a0 attention to because our approach to treatment\r\nis going to be different for people for example\u00a0\u00a0 who have trauma-related brain changes maybe\r\nthen for somebody who doesn’t so, we want to\u00a0\u00a0 look at childhood adversity and stressful events\r\nthat it may have caused basically what I tell clients is like rewiring of the brain there\r\nare trauma-related brain changes in soldiers and\u00a0\u00a0 especially in children or in people who’ve been\r\nexposed to extreme trauma that is designed to\u00a0\u00a0 protect them but it also can cause complications\r\nkind of later on in dealing with anxiety coping\u00a0\u00a0 skills that were learned that are ineffective you\r\nknow sometimes people grow up in a household or an\u00a0\u00a0 environment or a situation where they don’t learn\r\neffective coping skills so we need to kind of help\u00a0\u00a0 them unlearn those and learn new ones build on\r\ntheir strengths and trauma issues that may still\u00a0\u00a0 need to be dealt with such as domestic violence\r\nyou know if they grew up a lot around a lot of\u00a0\u00a0 domestic violence they may think you know I’m\r\nout of that situation it’s over I don’t want to\u00a0\u00a0 think about it it’s not bothering me anymore or a\r\nparental absence and I put absence because it can\u00a0\u00a0 be death it can be a parent that just packed up\r\nand left it could be a child that got put up for\u00a0\u00a0 adoption whatever put the child in a position of\r\nfeeling like they were rejected by a parent can\u00a0\u00a0 be very traumatic and bullying among other things\r\nbut there are a lot of trauma issues that people\u00a0\u00a0 once they’re out of that situation often say you\r\nknow I’m out of it it’s not a big deal I dealt\u00a0\u00a0 with it let’s move on and they don’t realize the\r\nfull ramifications and how that’s contributing to\u00a0\u00a0 their current anxiety and their current self-talk\r\nand cognitions of current stressors if somebody has\u00a0\u00a0 a lot of current stressors that are also going to\r\nimpact whether they develop generalized anxiety\u00a0\u00a0 you know we’re kind of stacking the deck here and\r\nthe current availability of social support if they\u00a0\u00a0 don’t have effective current social support then\r\nthey’re gonna have difficulty bearing the weight\u00a0\u00a0 of everything on their shoulders so we want\r\nto look at all these psychosocial factors when\u00a0\u00a0 we do our assessment now going back to the trauma\r\nissues if you’ve taken the trauma courses at\u00a0\u00a0 all CEUs you know that some people are not ready\r\nto acknowledge that the trauma is still bothering\u00a0\u00a0 them or work on the trauma and that’s okay we\r\ncan educate them that it might be an issue and\u00a0\u00a0 then let them choose how to address it but\r\nwe want to bear in mind the fact that you\u00a0\u00a0 know this could be sort of an underlying force\r\nmotivating some of the current cognitions and genetic vulnerability so you take any three\r\npeople and you put them or 300 people and you\u00a0\u00a0 put them through roughly the same psychosocial\r\nsituations they’re all probably going to react\u00a0\u00a0 a little bit differently based on their prior\r\nexperiences but also because of their genetic\u00a0\u00a0 makeup there are certain permutations and they\r\nfound four we’ll talk about later that make the\u00a0\u00a0 brain more or less responsive to stress and\r\nmore or less responsive to serotonin which\u00a0\u00a0 is your calming chemical so brains that are less\r\nresponsive to serotonin isn’t going to you know\u00a0\u00a0 send out as much or send out serotonin as easily\r\nso people can stay kind of tensed and wired that’s an oversimplified explanation but that’s\r\nall you need for right now so genetic\u00a0\u00a0 vulnerability impacts people’s susceptibility\r\nto the effects and development of dependence\u00a0\u00a0 on certain substances which can increase anxiety\r\nwhen people are detoxing from alcohol when they’re\u00a0\u00a0 detoxing from benzos when they’re detoxing from\r\nopiates they can feel high levels of anxiety when\u00a0\u00a0 they take opiates some people find that opiates\r\nhave wonderful anti-anxiety properties not that\u00a0\u00a0 I am advocating for the use of opiates I’m\r\njust client experiences have shown that that\u00a0\u00a0 can be true so some people are going to be\r\nmore susceptible to the anti-anxiety effects\u00a0\u00a0 of certain substances and some people are going\r\nto be Cerrone to become dependent on substances\u00a0\u00a0 where others may not and that part of that is\r\ngenetic vulnerability and they estimate about\u00a0\u00a0 30% the predictability of the development\r\nof anxiety disorders is genetic and genetics\u00a0\u00a0 also impact which medications are effective\r\nif you have genetic makeup then SSRIs might\u00a0\u00a0 be helpful if you have genetic makeup be then\r\natypical antipsychotics may be more effective\u00a0\u00a0 and SSRIs might not do anything which is why\r\na lot of our clients get so frustrated because they know there’s no way to figure out exactly what I\r\nguess there is now that there’s genetic testing\u00a0\u00a0 out there but up until then it was harder to\r\nfigure out which medications to start with and\u00a0\u00a0 most physicians matter of fact I don’t know of\r\na single physician that starts by\u00a0\u00a0 saying well let’s do a genetic profile to see\r\nwhat med to start you out with most we’ll start with events as with an SSRI or some other\r\nanti-anxiety medication some sort of benzo\u00a0\u00a0 that’s been my experience so we may want\r\nto encourage clients to consider genetic\u00a0\u00a0 testing if they’re having difficulty finding a\r\nmedication regime that works for them and they\u00a0\u00a0 are feeling like they have to have medication\r\ngenetic vulnerability also affects what’s going\u00a0\u00a0 to make somebody more vulnerable now than all of you\r\nin class today you know thinking about sleep you\u00a0\u00a0 know sleep may not be a big deal for some of you\r\nI know people who can go days or weeks with four\u00a0\u00a0 or five hours of sleep and they feel fine it’s\r\nnot a big deal, not me I need eight or nine hours\u00a0\u00a0 of sleep so genetically for whatever reason I am\r\nprogrammed to need a lot of sleep so when I don’t\u00a0\u00a0 get that much sleep I tend to be it tends to be\r\nharder for me to deal with life on life’s terms\u00a0\u00a0 and I know that that makes me more vulnerable to\r\nbeing irritable so genetic vulnerability affects\u00a0\u00a0 who can become addicted and affects what medications\r\nwork best and affects what situations are going\u00a0\u00a0 to tend to make somebody more vulnerable to\r\nanxiety so our medications and I know the type\u00a0\u00a0 on here is small but we’re going to go through\r\nthe first-line drugs are the SSRIs selective\u00a0\u00a0 serotonin reuptake inhibitors and SNRs is\r\nselective norepinephrine reuptake inhibitors\u00a0\u00a0 now the names are a little bit deceptive because\r\nselective norepinephrine reuptake inhibitors also\u00a0\u00a0 increase available serotonin but the mechanism\r\nof action is different the mechanism of action\u00a0\u00a0 for each SSRI is a little bit different as well\r\nwhich is why you can put somebody on Prozac and\u00a0\u00a0 they have an awful experience and you can put them\r\non Zoloft and they have a much better experience like I said earlier a lot of the research pre\r\nfive years ago had been done on medications and\u00a0\u00a0 Zoloft Paxil luvox Lexapro Celexa and their\r\ngenerics have all been found to be effective\u00a0\u00a0 at treating anxiety in certain people no one\r\nthe medication works for everybody in the last five\u00a0\u00a0 years Effexor has come on the radar and it has\r\nbeen found effective according to the hamilton\u00a0\u00a0 rating scale for anxiety so that’s another one to\r\nconsider if clients are not successful or getting\u00a0\u00a0 the treatment effect that they need for on some\r\nof the other medications obviously, none of us\u00a0\u00a0 probably are prescribers but we do need to educate\r\nclients about why the first drug or even the third\u00a0\u00a0 drug that the doc tries may not work so they\r\ndon’t start feeling helpless and hopeless like\u00a0\u00a0 I said earlier there are at least four different\r\ngenetic variations which are correlated with the\u00a0\u00a0 development of generalized anxiety disorder and\r\ndifferent medications are more or less effective\u00a0\u00a0 depending on the genetic makeup of the person\r\nthere’s a high mortality rate moving on to two\u00a0\u00a0 benzos the recommendation has switched\r\nto back off from the use of benzos now for\u00a0\u00a0 some doctors will prescribe an SSRI and for the\r\nfirst four weeks while the SSRI is building up\u00a0\u00a0 in the system they will also prescribe a benzo\r\nto be taken as needed to moderate the\u00a0\u00a0 anxiety and you know you could argue on either side\r\nof that, if somebody has a history of substance\u00a0\u00a0 use or substance dependence benzos are really\r\na bad idea because they do have a high rate of\u00a0\u00a0 dependence but the other reasons that they are now\r\ncautioning against the use of benzodiazepines is\u00a0\u00a0 that there’s a higher mortality rate among benzo\r\nusers compared with non-users there’s an increased\u00a0\u00a0 risk for dependence with use for more than six\r\nmonths and that’s a long time to be using benzo\u00a0\u00a0 and when we’re talking about dependence and six\r\nmonths we’re talking about somebody who uses it\u00a0\u00a0 like every four hours or every eight hours\r\ndepending on your benzo every single day not\u00a0\u00a0 a PRN user if somebody’s using it at night to\r\nhelp them go to sleep or you know three or four\u00a0\u00a0 times a week when the anxiety gets high\r\nthe risk of dependence is relatively low but a\u00a0\u00a0 lot of people with anxiety because if they find\r\nthe right benzo makes them feel so much better\u00a0\u00a0 they may not want to be off of it and for a lot of\r\npeople when that benzo reaches its half-life and\u00a0\u00a0 starts getting out of the system even more their\r\nanxiety spikes you know they have rebound anxiety\u00a0\u00a0 which they want to medicate with more benzos\r\nthat’s gonna be an issue for them to discuss\u00a0\u00a0 with their doctor there’s also an increased risk\r\nof dementia identified in long-term benzodiazepine\u00a0\u00a0 users again this is for the people who use you\r\nknow throughout the day every day for six months\u00a0\u00a0 or relatively every day for six months or more\r\nand it doesn’t matter if it’s you know we’re\u00a0\u00a0 talking about somebody who’s 65 or somebody\r\nwho’s 35 who’s been using benzos for you know\u00a0\u00a0 six months a year two years the risk of later\r\nlife dementia is greatly increased according\u00a0\u00a0 to the research benzodiazepines also don’t treat\r\ndepression okay so if you’ve got somebody who has\u00a0\u00a0 concurrent anxiety and depression there’s a much\r\nhigher suicide risk if they’re on benzodiazepines\u00a0\u00a0 so being aware and generally that suicide risk\r\ncomes from overdosing on benzodiazepines but\u00a0\u00a0 not always other treatment options you know if the\r\nbenzos aren’t something that people want to touch\u00a0\u00a0 you know they scare the living daylights out of\r\nme and SSRIs and SNRIs don’t seem to be working\u00a0\u00a0 then tricyclic antidepressants can be tried on those\r\nyour older generation antidepressant Seroquel\u00a0\u00a0 is used a lot and there are some there’s some\r\nresearch that shows it can be effective\u00a0\u00a0 with anxiety like some of the antidepressants and\r\ndepending on the person the benzos Seroquel can\u00a0\u00a0 make people very very very sleepy so you know\r\nit may not be the side effects of the Seroquel\u00a0\u00a0 the weight gain and the fatigue and you know\r\nsleepiness may be an unacceptable side effect for\u00a0\u00a0 some clients and boosts per\u00f3n is the third option\r\nboost Barone works more like an anti-depressive\u00a0\u00a0 serotonin reuptake inhibitor and that it takes\r\nyou know four weeks or so to kind of build up in\u00a0\u00a0 the system studies have shown that there’s really\r\nno long-term benefit to taking it but after six months\u00a0\u00a0 to eighteen months of use it has been shown to\r\nbe effective in talking with clients a lot of\u00a0\u00a0 clients report that boost bar when they take it\r\ndoesn’t necessarily help them stop being anxious\u00a0\u00a0 like a benzodiazepine does but it helps them not\r\ngo from zero to 200 in 2.3 seconds it kind of you\u00a0\u00a0 know keeps them from having this gush of a freak\r\nout reaction every time something goes wrong which\u00a0\u00a0 a lot of clients report helps because they feel\r\nmore stable throughout the day after remission\u00a0\u00a0 medication should be continued for six to twelve\r\nmonths and during that last six months first six\u00a0\u00a0 months keep it as is last six months you know\r\nthey say that tapering is best it’s best not\u00a0\u00a0 to stop somebody cold turkey on any of these but\r\nit’s important for people once they’re\u00a0\u00a0 in remission to not just suddenly go okay I feel\r\nbetter I don’t need any of this anymore they need\u00a0\u00a0 to work into it and make sure they’ve developed\r\nthe skills and tools that they need to deal with some of the anxiety that is going to\r\nhappen in life so physical signs and symptoms\u00a0\u00a0 of anxiety may include fatigue irritability muscle\r\ntension or muscle aches try laying feeling twitchy\u00a0\u00a0 being easily startled trouble sleeping nausea\r\ndiarrhea irritable bowel syndrome headaches so the\u00a0\u00a0 first thing we want to do with clients when we’re\r\ntalking to them well second thing first thing is to say get a physical to let’s rule out physiological\r\ncauses of this but we can also help clients\u00a0\u00a0 look at you know what might be causing these\r\nthings that you can do to mitigate it what might\u00a0\u00a0 be contributing to your fatigue what might be\r\ncontributing to your irritability and your muscle\u00a0\u00a0 tension or your muscle aches I mean let’s look at\r\neconomics did you recently get a new bed or do you\u00a0\u00a0 need to get a new bed what about your desk chair I\r\nknow you know I get more muscle tension and muscle\u00a0\u00a0 achy when I do a lot of mousing because I have\r\ndeplorable posture being becoming aware of that\u00a0\u00a0 helps and then I’m like okay well I know it caused\r\nunfortunately, it’s unpleasant but it’s not a\u00a0\u00a0 big deal trembling or feeling twitchy you know\r\nthat can be caused by low blood sugar that can\u00a0\u00a0 be caused anxiety that can also be caused\r\nby early onset Parkinson’s symptoms you know\u00a0\u00a0 there’s you know it can be worst case scenario\r\nor it can be something benign so we want\u00a0\u00a0 to have people figure out you know when you start\r\ntrembling or feeling twitchy is there something\u00a0\u00a0 that it’s related to you know I know when my\r\nson gets excited he’s he just sits there\u00a0\u00a0 and you can see him almost shake because he’s so\r\nexcited about something so we want to have people prevent misidentification we don’t want them\r\nto jump to that worst-case scenario we don’t\u00a0\u00a0 want them to go onto WebMD and go oh my gosh I’ve\r\ngot cancer I’ve got this debilitating disease and\u00a0\u00a0 I’m going to die in six months probabilistic Lee\r\nspeaking it’s not gonna happen yes get a doctor’s\u00a0\u00a0 opinion I’m certainly not going to tell them it’s\r\nall in your head I want them to get an\u00a0\u00a0 evaluation but I do want to in the meantime\r\nhelp them think about how likely is\u00a0\u00a0 this and other things for headaches and this is\r\none another one of those that can be frustrating\u00a0\u00a0 as we get older our eyesight starts to go and\r\nyou know there was a period there I did fine\u00a0\u00a0 and then after I hit 45 my eyesight just started\r\nto like steadily and kind of rapidly in my mind\u00a0\u00a0 decline so I have to get my eyeglass prescription\r\nchanged every couple of years and that can cause\u00a0\u00a0 headaches so instead of starting to worry\r\nabout oh my gosh I’ve got a headache all the time\u00a0\u00a0 maybe I’ve got a brain tumor you know I know that\r\nit’s probably my glasses or I’m grinding my\u00a0\u00a0 teeth so other biological interventions that\r\nhave been evaluated there’s something called\u00a0\u00a0 the floatation rest system that reduced environmental\r\nstimulation therapy reduces sensory input into\u00a0\u00a0 the nervous system through the act of floating\r\nsupine which is on your back in a pool of water\u00a0\u00a0 saturated with Epsom salt you know I’m looking at\r\nthis going sounds good and you can’t\u00a0\u00a0 quite get the same experience in a bathtub because\r\nyou’re not floating you’ve got pressure points and\u00a0\u00a0 you’re still hearing stuff clients can sort of\r\nsimulate it with you know earplugs or whatever\u00a0\u00a0 but it’s if they can access this it’s been shown\r\nto be effective the float experience is\u00a0\u00a0 calibrated so that sensory signals from visual\r\nauditory olfactory gustatory thermal tactile or\u00a0\u00a0 tactile vestibular gravitational and preceptive\r\nchannels are minimized which means you don’t see\u00a0\u00a0 here taste touch smell feel nothing as is most\r\nmovement and speech so you want people to lay just\u00a0\u00a0 like completely motionless and not talk which can\r\nbe hard for some people with anxiety in the study\u00a0\u00a0 the study I looked at fifty participants\r\nreported significant reductions in stress muscle\u00a0\u00a0 tension pain depression and negative effects and it\r\nwas accompanied by significant improvement in mood\u00a0\u00a0 characterized by increases in relaxation happiness\r\nand well-being I read the study I’m like where can\u00a0\u00a0 I sign up you know it sounds in looking at some of\r\nthe research this was more effective for\u00a0\u00a0 addressing anxiety than something like a massage\r\nTai Chi also produced significant reductions in\u00a0\u00a0 anxiety there was approximately a 20% treatment\r\neffect 25% treatment effect in patients with\u00a0\u00a0 anxiety and fibromyalgia who practiced twice a\r\nweek for a year now you know we want to look at\u00a0\u00a0 the confounding things here is it the Tai Chi\r\nitself or is it learning to control the muscles\u00a0\u00a0 and becoming more in tune with your body and\r\nlearning to control your breathing helps\u00a0\u00a0 people reduce their anxiety either way you know\r\nTai Chi helps people do that and it was shown that\u00a0\u00a0 after a year after the first six months, there was\r\na significant treatment effect but after a year\u00a0\u00a0 you know it kept growing and after a year it was\r\nabout 25% so Tai Chi can be effective acupuncture at the HT 7 median Meridian can\r\nattenuate anxiety-like behavior induced by\u00a0\u00a0 withdrawal from chronic morphine treatment through\r\nthe meditation of the GABA receptor system\u00a0\u00a0 what does that mean that means if you if the\r\nacupuncture is done in very certain places the anxiety behavior the GABA a receptor\r\nsystem GABA is your main calming relaxation\u00a0\u00a0 neurochemical that is triggered and causes your\r\nbody to sort of flood that receptor system and\u00a0\u00a0 this research was done on people who were detoxing\r\nfrom morphine treatment but we can look at\u00a0\u00a0 generalizing the results and I would be interested\r\nto see further studies on it pain other things we\u00a0\u00a0 need to do to help people with anxiety when people\r\nare in chronic pain they often have anxiety that\u00a0\u00a0 oh my gosh this is getting worse or it’s never\r\ngonna get better or I just can’t take this pain\u00a0\u00a0 anymore or they may get anxious that they’re going\r\nto be rejected because they can’t do some of the\u00a0\u00a0 things they used to do because they’re in so much\r\npain so there’s a lot of guilt and anxiety that\u00a0\u00a0 can kind of revolve around pain what can we do\r\nto help clients guided imagery is generally very\u00a0\u00a0 helpful if we can help them imagine you know if\r\nthat pain in their shoulder imagine the pain is\u00a0\u00a0 like the color red flowing out of their arm\r\nor other focus mindfulness so you know when you\u00a0\u00a0 think about something you know when you get a shot\r\nif I don’t think about it it doesn’t hurt near as\u00a0\u00a0 much as if the nurse says okay now one two three\r\nand you know she’s counting down and I’m getting\u00a0\u00a0 prepared and I’m focused on it I had\r\nanother nurse one time who she was just talking\u00a0\u00a0 to me and you know put the alcohol on my arm\r\nand just kept on talking and didn’t tell me she was\u00a0\u00a0 getting ready to give me a shot and before I knew\r\nit she had given me a shot and she was like okay\u00a0\u00a0 we’re done I’m like you didn’t give me a shot yet\r\nshe said yes I did it’s like oh so not focusing\u00a0\u00a0 on it and next time you have an itch for example\r\nif you’ve ever been driving on the interstate and\u00a0\u00a0 you can reach on your foot I get those on\r\nthe bottom of my foot sometimes and I’m like okay\u00a0\u00a0 I’m not going to pull over to each my foot if you\r\nfocus on something besides the itch eventually it\u00a0\u00a0 goes away I’m not saying the pain is gonna completely\r\ngo away but the more people focus on it the more\u00a0\u00a0 it hurts physical therapy can help so encourage\r\nthem to get a referral and encourage them to do a\u00a0\u00a0 self-evaluation if nothing else of ergonomics in\r\ntheir car at work where they watch TV and spend\u00a0\u00a0 most of their time at home and they’re sleeping\r\nso those are the four places that they spend most\u00a0\u00a0 of their time what do their ergonomics look like\r\nand that can help a lot of people mitigate\u00a0\u00a0 a lot of pain hormones are another thing that\r\nwe need to look at imbalances of estrogen and\u00a0\u00a0 testosterone can contribute to anxiety symptoms\r\nheart palpitations fatigue irritability having\u00a0\u00a0 people get a physical we can’t as clinicians do\r\nanything about it but doctors can rapid heart\u00a0\u00a0 weight rate sweating palpitations are not uncommon\r\nin women in perimenopause or menopause so a lot\u00a0\u00a0 of women start feeling like they’re developing\r\ngeneralized anxiety and\/or something’s going wrong\u00a0\u00a0 when they start reaching that mid-40s to mid-50s\r\narea and they start having some of these symptoms\u00a0\u00a0 again we’re not going to diagnose it but we do\r\nwant them to recognize that it may not be anything\u00a0\u00a0 you know is catastrophic this is something that a\r\na lot of women experience and help them figure out\u00a0\u00a0 how to deal with that supportive care biologically\r\nnow you know this isn’t gonna treat anything but\u00a0\u00a0 we can help them minimize their vulnerabilities\r\nhelp them create a sleep routine so their brain\u00a0\u00a0 and body can rebalance this can help repair any\r\nadrenal issues that may be going on and improve\u00a0\u00a0 energy levels people with anxiety don’t sleep well\r\nso helping them figure out how to get some quality\u00a0\u00a0 sleep is important nutrition minimizing caffeine\r\nand other stimulants are going to be a big help\u00a0\u00a0 because those make people feel anxious and encourage\r\nthem to work with a nutritionist to try to prevent\u00a0\u00a0 spikes and drops in blood sugar which can trigger\r\nthe stress response when your blood sugar goes way\u00a0\u00a0 up or way down you can start getting kind of shaky\r\nand feel weird and that can cause people anxiety\u00a0\u00a0 because they might think oh my gosh I’m having a\r\nstroke or a heart attack or you know I don’t know\u00a0\u00a0 what these tremors are so it’s important that\r\nthey don’t miss identify symptoms and encourage\u00a0\u00a0 them to drink enough water dehydration can lead\r\nto toxic Ardea which is increased heart rate\u00a0\u00a0 sunlight vitamin D deficiency is implicated\r\nin both depression and anxiety mood issues\u00a0\u00a0 vitamin D has been found in those main areas where\r\nserotonin receptors are found vitamin D receptors\u00a0\u00a0 are found so we know the serotonin and vitamin D\r\nhave something going on sunlight prompts the skin\u00a0\u00a0 to tell the brain to produce neurotransmitters and\r\nset circadian rhythms which impact the release of\u00a0\u00a0 serotonin your calming neurochemical melatonin\r\nwhich is made from breaking down serotonin and helps you sleep and GABA so sunlight actually\r\nhelps increase the release of GABA when it’s\u00a0\u00a0 time to start calming down and going to sleep\r\nexercise studies have shown that exercise can\u00a0\u00a0 have a relaxing effect and encourage clients to start\r\nslowly there’s not a whole lot of new research\u00a0\u00a0 on exercise and anxiety aromatherapy has been\r\nused a lot, especially in other countries in\u00a0\u00a0 the treatment of people with anxiety people with\r\nhospital anxiety people women who are giving birth\u00a0\u00a0 and they have some birth anxiety there they’ve\r\nbeen found to be effective in a lot of\u00a0\u00a0 those studies essential oils for anxiety include\r\nlavender rose Bedevere ylang ylang bergamot\u00a0\u00a0 chamomile frankincense and Clary sage encourage\r\nclients to just go to a health food store and\u00a0\u00a0 you know sniff some of these and see if it makes them\r\nfeel happy and calm and content the aromatherapy\u00a0\u00a0 molecules enter the nasal membranes and they\r\nwill start triggering neurochemical reactions\u00a0\u00a0 and so you don’t need to apply it you don’t need\r\nto ingest it all you need to do is so encourage\u00a0\u00a0 clients if they’re open to it to think about this\r\nbecause aromatherapy can be integrated into their bedroom for example with an atomizer or a Mr.\r\n\r\nIt\r\ncan be incorporated in a lot of different places\u00a0\u00a0 again where they’re not applying it or ingesting\r\nit in any way all they’re doing is smelling it\u00a0\u00a0 they’ve used it in defusing aromatherapy in\r\nhospital emergency rooms and they found that it\u00a0\u00a0 reduces stress and irritability the people in\r\nemergency rooms and I’ve been to enough emergency\u00a0\u00a0 rooms over the years to know that\r\npeople who are in ers typically are not in the\u00a0\u00a0 best mood so if it can help those people then\r\nit’s probably going to have some sort of an\u00a0\u00a0 effect so psychologically helping clients realize\r\nthat their body thinks there’s a threat for some\u00a0\u00a0 reason that’s why it triggered the threat response\r\na system which is what they call anxiety so they\u00a0\u00a0 need to figure out why is there a threat\r\nyou know sometimes it’s like the fire alarm going\u00a0\u00a0 off in my house it just means that the windows are\r\nopen and there’s a strong breeze there is no fire\u00a0\u00a0 there is no problem there’s just a malfunction\r\nit’s a false alarm a lot of times clients get this threat reaction they get this stress\r\nreaction and it’s not a big deal right now so they\u00a0\u00a0 can start modifying what their brain responds to\r\nand again those basic fears that a lot of people\u00a0\u00a0 worry about failure rejection loss of control the\r\nunknown and death and loss distress tolerance is\u00a0\u00a0 one of those cognitive interventions that have\r\ntaken center stage in anxiety research and\u00a0\u00a0 it isn’t about controlling your anxiety you know\r\nhelping people recognize their anxiety acknowledge\u00a0\u00a0 it and say okay I’m anxious it is what it is\r\nhow can I improve the next moment instead of\u00a0\u00a0 saying I’m anxious I shouldn’t be anxious I hate\r\nbeing anxious and slang with that anxiety let it\u00a0\u00a0 go just accept it is what it is have the client\r\nlearn to start saying I am feeling anxious okay so\u00a0\u00a0 distract don’t react because I explain to them\r\nthe whole notion of feelings comes in the crest and goes out\u00a0\u00a0 in about 20 minutes it’s like a wave so once they\r\nacknowledge their feeling if they can distract\u00a0\u00a0 themselves for twenty or thirty minutes you know\r\nthey figured out there was no real threat if they can distract themselves for twenty or\r\nthirty minutes those emotions can go down and then\u00a0\u00a0 they can deal with it in their wise mind and encourage\r\nthem to use distancing techniques instead of\u00a0\u00a0 saying I am anxious or I am terrified or whatever\r\nhave them say I am having the thought that this\u00a0\u00a0 is the worst thing in the world I am having the\r\nthought that I cannot handle this because thoughts\u00a0\u00a0 come and go and that comes from acceptance and\r\ncommitment therapy functional analysis makes it\u00a0\u00a0 possible to specify where and when with what frequency\r\nwith what intensity and under what circumstances\u00a0\u00a0 the anxious response is triggered so it’s\r\nimportant that we help clients develop the\u00a0\u00a0 ability to do functional analyses on their own so\r\nwhen they start feeling anxious they can stop and\u00a0\u00a0 say okay where am I what’s going on how intense\r\nis it what are the circumstances and they start trying to figure out what causes this for\r\nthem so they can identify any common themes from\u00a0\u00a0 their psychoeducation about cognitive distortions\r\nand techniques to prevent those circumstances or\u00a0\u00a0 mitigate them can be provided so if the client\r\nknows that they get anxious before they go into\u00a0\u00a0 a meeting with their boss and it’s usually a high\r\nthe intensity of anxiety okay so we can educate them and help them identify what fears may be related\r\nto techniques to slow their breathing and calm\u00a0\u00a0 their stress reaction and help them figure out\r\ntimes in the past when they’ve handled going in\u00a0\u00a0 and talking to their boss and it wasn’t\r\nthe end of the world you know there’s lots of\u00a0\u00a0 different things we can do there for them there\r\nbut the first key and it gives them a lot of\u00a0\u00a0 a huge sense of empowerment to start becoming\r\ndetectives in their own life and going okay now\u00a0\u00a0 under what situations does this happen positive\r\nwriting this was another cool study each\u00a0\u00a0 day for 30 days the experimental group and this\r\nwas high school-aged youth in China but you know\u00a0\u00a0 the experimental group engaged in 20 minutes of\r\nwriting about positive emotions they felt that\u00a0\u00a0 day so they’re writing about anything positive\r\nthat make them happy that made them enthusiastic gave them hope whatever long-term expressive\r\nwriting positive emotions so after 30 days it\u00a0\u00a0 appeared to help reduce test anxiety by helping\r\nthey develop insight and use positive emotional words so it got them out of the habit of using\r\nthe destruction and doom words and encouraged them\u00a0\u00a0 to get in the habit of looking at the positive\r\nthings and being more optimistic it’s a cool activity that clients can try it’s not gonna\r\nhurt anything if you have them journal each day\u00a0\u00a0 for 30 days mindfulness also came up in the\r\nresearch and was shown to be effective in\u00a0\u00a0 a meta-analysis of six articles about mindfulness\r\nbased stress reduction four about mindfulness-based cognitive therapy and three about fear of\r\nnegative appraisal and emotion regulation was reviewed all of these showed that mindfulness\r\nwas an effective strategy for the treatment of\u00a0\u00a0 mood and anxiety disorders and is an effective\r\nin therapy protocols with different structures\u00a0\u00a0 including virtual modalities so you know if you’re\r\ndoing it via teleconference mindfulness can still\u00a0\u00a0 be helpful mindfulness helps people start learning\r\nhow to observe what’s going on and become aware of\u00a0\u00a0 what’s going on more aware of those circumstances\r\nwhich will help them complete their functional\u00a0\u00a0 analysis but it also helps them become aware of\r\nvulnerabilities and head off things in the past\u00a0\u00a0 and if they’re taking better care of themselves\r\nthat they’re living more mindfully then they may\u00a0\u00a0 not experience as many situations that trigger\r\ntheir anxiety mindfulness also encourages clients\u00a0\u00a0 to learn acceptance that radical acceptance of\r\nit is what it is I’m not gonna fight it I’m angry\u00a0\u00a0 right now I am anxious right now however I’m\r\nfeeling right now is how I feel and that’s okay it’s hard for clients to get to that but once\r\nthey get a hold of that and they truly believe it\u00a0\u00a0 and they can say all right it’s fine I’m not gonna\r\nfeel this way forever I’m gonna do something else\u00a0\u00a0 until the feeling passes it helps and that’s where\r\nthe labeling and letting go comes in mindfulness\u00a0\u00a0 can also help them identify trigger thoughts\r\nwhat thought were you having right before you\u00a0\u00a0 started feeling anxious if people are mindful or\r\nlet’s start back when people are not mindful they\u00a0\u00a0 often notice or don’t notice that they’re getting\r\nanxious until they’re like super anxious\u00a0\u00a0 when people are mindful they become more aware of\r\nsubtle cues address unhelpful thoughts when they\u00a0\u00a0 say or believe it’s a dire necessity for adults\r\nto be loved by significant others for almost\u00a0\u00a0 everything they do always running gonna happen\r\nwhy is it a necessity what we can encourage them\u00a0\u00a0 to do is concentrate on their self-respect\r\non winning approval for practical purposes you\u00a0\u00a0 know for promotions or whatever but it’s not about\r\nme being lovable it’s about me getting a promotion\u00a0\u00a0 and making more money and focusing on loving\r\nrather than being loved because when we give\u00a0\u00a0 love we generally get love back with unhelpful thought\r\nnumber two people feel they aren’t able to stand\u00a0\u00a0 it if things are not the way they want them to be\r\nor are not in their control so encourage clients\u00a0\u00a0 to focus on the parts that are in their control\r\nand other things in life which are going well and\u00a0\u00a0 to which they’re committed number three misery\r\nis invariably externally caused and is forced\u00a0\u00a0 on us by outside people and events just by reading\r\nthat makes me feel disempowered so encouraging\u00a0\u00a0 clients to focus on the fact that reactions such\r\nas misery or happiness are largely caused by the\u00a0\u00a0 view that people take of the conditions so if\r\nyou see it as a tragedy and devastating then\u00a0\u00a0 it’s probably going to produce misery if you\r\nsee it as an opportunity and a challenge it’s\u00a0\u00a0 probably going to produce a different emotional\r\nreaction, if something is or may be dangerous or fearsome people, should be upset and\r\nendlessly upset about obsessing about it a lot of\u00a0\u00a0 people with anxiety get stuck on this you know\r\nif I feel like it’s fearsome I need to worry about\u00a0\u00a0 it getting on a plane for example if I fear that\r\nthat’s dangerous that I need to think about it\u00a0\u00a0 and worry about it that’s not going to do any\r\ngood so encourage clients to figure out how to\u00a0\u00a0 face it and render it harmless if possible and\r\nwhen that’s not possible accept the inevitable\u00a0\u00a0 so looking at airplanes you know facing it means\r\nresearching to figure out how dangerous\u00a0\u00a0 is it really and realizing that it’s not\r\nthat dangerous so that helps render it a little\u00a0\u00a0 bit harmless in their mind it proves to them\r\nthat it’s not as dangerous as it could be and when\u00a0\u00a0 it’s not possible accepting the inevitable you\r\nknow you got a fly so getting on there figuring\u00a0\u00a0 out how you’re gonna get through it hurricanes\r\nare the same way people especially in places\u00a0\u00a0 like Texas Louisiana Florida may obsess as soon\r\nas it starts coming to hurricane season or if a\u00a0\u00a0 hurricane is spotted out in the Atlantic somewhere\r\nthey start checking the weather every hour or more\u00a0\u00a0 wondering what the path is going to be and you\r\nknow what there’s you can’t change the path of the\u00a0\u00a0 hurricane so all you can do is board up your house\r\nevacuate if necessary and deal with the fallout child driving is just another example I’ll give\r\nyou know my children are learning how to drive and\u00a0\u00a0 that’s kind of scary and fearsome you know what’s\r\ngonna happen when they’re out there you know you\u00a0\u00a0 see crashes all the time well render it harmless\r\nby making sure they’ve got good training on how\u00a0\u00a0 to drive make sure they’re good drivers and then\r\naccepting that some things are just not within\u00a0\u00a0 my control it’s easier to avoid than face life\r\ndifficulties and responsibilities well running\u00a0\u00a0 from fear is usually much harder in the long run\r\nso encourage clients to look back at times when they’ve avoided difficulties and responsibilities\r\nand the eventual outcome you know what happened\u00a0\u00a0 there people believe they should be thoroughly\r\ncompetent in achieving in all possible respects\u00a0\u00a0 or they will be isolated rejected and failures we\r\nneed to encourage clients to accept themselves as\u00a0\u00a0 imperfect with human limitations and flaws and\r\nfocus on what makes them loveable human being\u00a0\u00a0 what qualities like courage and intelligence and\r\ncreativity and those things that can’t be taken\u00a0\u00a0 away what inherent qualities do they have that\r\nmake them awesome people because something once\u00a0\u00a0 strongly affected people’s lives they should\r\nindefinitely fear it if you got lost you know\u00a0\u00a0 when little kids get lost it’s terrifying when\r\nyou’re grown up if you get lost you turn on the\u00a0\u00a0 GPS and you figure out your way but some people\r\nstill, you know freaked out about getting lost if\u00a0\u00a0 they got lost once so we want to help people look\r\nback at past episodes that may be contributing to\u00a0\u00a0 the current anxiety and compare the situation’s\r\nyou know are you the same person or is this not\u00a0\u00a0 a big deal now that you’re older wiser stronger\r\nencourage them to learn from past experiences\u00a0\u00a0 but not be overly attached to or prejudiced by\r\nthem yeah you could have maybe got lost in the\u00a0\u00a0 past and it was a horrible experience well you\r\nwere six I can see where that would be terrifying\u00a0\u00a0 and a horrible experience but it doesn’t have to\r\ncontinue to impact you that way now when you’re\u00a0\u00a0 you know 26 getting lost you know could be an\r\nopportunity to try a new restaurant or something\u00a0\u00a0 people must have complete control over things\r\nwell this doesn’t happen so encourage clients\u00a0\u00a0 to remember that the past and the future are\r\nuncontrollable we can’t change the past it is what\u00a0\u00a0 it is we can learn from it so it doesn’t repeat\r\nbut we can’t change it and the future is largely\u00a0\u00a0 uncontrollable I mean there are a lot of things I\r\ncan do to stay moving toward a rich and meaningful\u00a0\u00a0 life but life is going to throw me curveballs\r\nsometimes and there’s nothing I can do to plan for\u00a0\u00a0 or control that we can control our actions in the\r\npresent to stay on our preferred path and general\u00a0\u00a0 develop general skills to deal with adversity\r\nshould it arise so we want to help clients\u00a0\u00a0 develop those general problem-solving skills and\r\nthe general support system so when they are thrown\u00a0\u00a0 a curveball you know it doesn’t knock them upside\r\nthe head people have virtually no control over\u00a0\u00a0 their emotions and cannot help feeling disturbed\r\nby things well encourage them to think about the\u00a0\u00a0 fact that they have real control over destructive\r\nemotions if they choose to work at improving the\u00a0\u00a0 next moment and changing inaccurate thoughts then\r\nthey’re not going to experience the destructive\u00a0\u00a0 emotions as intensely or as frequently when you\r\nfeel an emotion you feel how you feel but again\u00a0\u00a0 you don’t have to wrestle with it fight it and\r\nnurture it you can say this is how I feel how\u00a0\u00a0 do I improve the next moment when it comes to\r\ncognitive distortions encourage them to find\u00a0\u00a0 alternatives when they start to personalize things\r\nif somebody laughs when you walk out of the room\u00a0\u00a0 then the and the person starts getting anxious\r\nthinking oh they were making fun of me I wonder\u00a0\u00a0 what they thought I wonder if I had something\r\nstuck to the back of my dress and they start\u00a0\u00a0 getting all panicked about it that doesn’t do\r\nany good encouraging them to think you know what\u00a0\u00a0 our three alternate explanations that hadn’t but\r\nhad nothing to do with you for why they laughed\u00a0\u00a0 magnification of the worst thing you know taking\r\nsomething and saying if this happens then it’s\u00a0\u00a0 going to be a catastrophe and minimization going\r\nalong with that a lot of times when people magnify\u00a0\u00a0 and see a catastrophe they minimize not only\r\ntheir strengths and resources but all the\u00a0\u00a0 other stuff that they’ve got going for them all\r\nthey’re seeing is this catastrophe so encouraging\u00a0\u00a0 them to focus on the facts of what is actually\r\nhappening and what is the high probability\u00a0\u00a0 event and encourage them to get information\r\nand look at the broader picture you know yes you\u00a0\u00a0 got into a car crash and your car is totaled and\r\nthat is unfortunate you know it sucks but\u00a0\u00a0 you know that is not going to cause you to lose\r\nyour job and then become homeless and penniless\u00a0\u00a0 and yadda-yadda it might cause your insurance to\r\ngo up but okay so you don’t have a car but what\u00a0\u00a0 are the resources that you have who can who do\r\nyou work with that might be able to give you a\u00a0\u00a0 ride to work you know let’s look at the resources\r\nyou have and work around so problem-solving helps\u00a0\u00a0 with magnification and also focusing on you know\r\nlet’s be grateful for what didn’t happen you know\u00a0\u00a0 you could have been killed but you weren’t the\r\ncar was totaled it’s replaceable all or nothing\u00a0\u00a0 thinking again have them think about what else\r\ncould have been happening like Brittney suggested\u00a0\u00a0 finding the exceptions instead of saying she\r\nalways does this look for exceptions when has\u00a0\u00a0 she not done that what else has she done instead\r\nof this selective abstraction and filtering is\u00a0\u00a0 when people look for the good the bad and the\r\nugly a selective abstraction means you kind of\u00a0\u00a0 see what you expect to see so if you expect\r\nsomething to be devastating you see only the\u00a0\u00a0 devastating aspects of it which kind of goes with\r\nthe magnification and minimization you filter out\u00a0\u00a0 the stuff a lot of times when people are in a bad\r\nmood or are anxious they see the negative because\u00a0\u00a0 that’s the state of mind they’re in so encouraging\r\npeople to complete the picture alright there’s\u00a0\u00a0 all this bad stuff now what’s the good stuff you\r\nknow to encourage them to look at the good the bad\u00a0\u00a0 and the ugly so they get a wide view of exactly\r\nwhat’s going on and encourage them to remember\u00a0\u00a0 that hindsight is twenty-twenty when people have\r\nsomething embarrassing happens or they get anxious\u00a0\u00a0 about something that happened they look back\r\nand they go I should have or I could have or oh I\u00a0\u00a0 wish I wouldn’t have when you were in that\r\nthe situation you did what you did and you know\u00a0\u00a0 maybe you may have had a reason for it or you know\r\nyou may have not had other options or it may have\u00a0\u00a0 just been a bonehead thing to do but okay so you\r\nmade one mistake hindsight is 2020 that’s gonna\u00a0\u00a0 that mistake is gonna stand out just like the\r\ngreat big letter on the eye chart because you’re\u00a0\u00a0 thinking back and you’re looking at it and that’s\r\nall you see but encouraging clients to remember\u00a0\u00a0 that other people are too busy worrying about\r\nthemselves to remember what they did jumping\u00a0\u00a0 to conclusions encourages clients to remember to\r\nget all the data if your significant other male\u00a0\u00a0 significant other comes home and is smelling like\r\nperfume don’t just jump to the conclusion that he\u00a0\u00a0 was cheating on you maybe he went to the\r\nmall to get a new tie and walked through the\u00a0\u00a0 perfume area and got spritzed or bought you some\r\nperfume or who knows maybe the person sitting next\u00a0\u00a0 to him at work sprayed her perfume on the desk\r\nand some of it filtered on there are all different\u00a0\u00a0 reasons that that might happen so encourage people\r\nto get all the data mind reading we can’t do it\u00a0\u00a0 you know you can’t read somebody’s mind you don’t\r\nknow what they’re thinking so ask them what you think about this don’t assume anything and\r\nemotional reasoning encourages people to step back\u00a0\u00a0 from a situation and ask themselves am I feeling\r\nanxious about this because I’m feeling anxious and\u00a0\u00a0 I’m looking for reasons that it should be scary\r\nor am I feeling anxious about this because it’s\u00a0\u00a0 really scary for some reason there are facts\r\nsupport my anxiety a lot of times when we go into\u00a0\u00a0 new situations we may feel anxious because it’s\r\na new situation but when we step back we say you\u00a0\u00a0 know what there’s nothing to be worried\r\nabout here you know no big deal I got this and\u00a0\u00a0 move on so instead of rolling with it and trying\r\nto figure out okay I feel anxious so there must\u00a0\u00a0 be a reason not necessarily very likely a false\r\nalarm other psychological interventions relaxation\u00a0\u00a0 skills encourage people to learn how to relax\r\nnot only physically but mentally diaphragmatic\u00a0\u00a0 breathing helps encourage them to breathe\r\nthrough their stomach and put their hand on their\u00a0\u00a0 belly and feel their belly expand and contract\r\nslows breathing down which triggers the rest and digestion reaction in the brain which is calming\r\nmeditation can be helpful for some people some\u00a0\u00a0 people find trying to quiet their minds too\r\nfrustrating because they’ve got too much\u00a0\u00a0 monkey mind going on that can be later or maybe\r\nnever for some people, we don’t want to increase\u00a0\u00a0 their anxiety with interventions cute progressive\r\nmuscular relaxation also has a lot of research\u00a0\u00a0 support and remembers with cute progressive\r\nmuscular relaxation we’re Sakura get them\u00a0\u00a0 to attach a cue AK you word like relax or breathe\r\nwith the relaxation response so they tense their\u00a0\u00a0 muscles and then relax their muscles and as\r\nthey relax their muscles they say their “quack”-word\u00a0\u00a0 like relaxed and they work from head to toe or\r\nfrom toe to head tensing and relaxing different\u00a0\u00a0 muscle groups so they become more aware of what a\r\ntense muscle feels like versus a reactive relaxed\u00a0\u00a0 muscle there are great scripts that are online\r\nthat people have already recorded that can walk\u00a0\u00a0 people walk clients through CPM are I highly\r\nencourage it because once they get used to it\u00a0\u00a0 then they can just think that cue they can think\r\nrelax and as they exhale they will start to feel\u00a0\u00a0 their entire body kind of relaxing because it’s\r\ntrained when it hears that just like when you hear\u00a0\u00a0 the word pop quiz when you were in high school\r\nyou had a stress reaction well we want to use\u00a0\u00a0 it in reverse and train the body so that when\r\nit hears a cue word relaxes helps them develop\u00a0\u00a0 self-esteem because fear of failure and rejection\r\na lot of times come from needing other people’s\u00a0\u00a0 approval to help them develop a rational idea of\r\ntheir real self develops compassion self-talk\u00a0\u00a0 instead of saying I’m an idiot or I’m stupid or\r\nI’ll never measure up to anything encourage them\u00a0\u00a0 to talk to themself like they would talk to their\r\nchild or hopefully their best friend and encourage\u00a0\u00a0 them to spotlight strengths whenever they feel\r\nlike they’ve got an imperfection to identify these\u00a0\u00a0 three strengths that they have so they’re you know\r\nbalancing out the imperfections and the strengths of cognitive restructuring reframes challenges in\r\nterms of current strengths, not past weaknesses\u00a0\u00a0 so if you’re going to give a presentation in front\r\nof 60 people and you hate public speaking instead\u00a0\u00a0 of thinking about you know this is terrifying\r\nbecause the last time I went up in front of people\u00a0\u00a0 I forgot everything I was going to say and drop\r\nmy note cards well that’s a past weakness what\u00a0\u00a0 is your current strength you’re prepared to know\r\nthe material you ‘yoyo’ so encourage people\u00a0\u00a0 to look at all the strengths and resources they\r\ncurrently, have them develop an attitude of\u00a0\u00a0 gratitude and optimism because as I said with\r\nthat the positive writing exercise when people\u00a0\u00a0 are in a grateful optimistic frame of mind they\r\ntend to see more of the good stuff they see the\u00a0\u00a0 bad stuff too but they can also see more of the\r\ngood stuff and some of the bad stuff they see\u00a0\u00a0 opportunistically instead of as a devastation\r\nacceptance and commitment therapy says that some of the reasons that we’re miserable are\r\nfear we get fused with our thoughts we think I\u00a0\u00a0 am terrified well if I am terrified then I can’t\r\nI mean if I am I can’t get rid of anything I am\u00a0\u00a0 if I’m having the thought that I’m terrified\r\nwell I can get rid of a thought I can forget\u00a0\u00a0 things easily encourage people to evaluate their\r\nexperience and empower them to look at things as\u00a0\u00a0 challenges and opportunities instead of hardships\r\nencourage them not to avoid their experiences so\u00a0\u00a0 things that are scary gradual exposure and\r\nfinding exceptions like for me bridges you\u00a0\u00a0 know I love public speaking so that’s not a\r\nthing but when I go to a bridge you know when\u00a0\u00a0 I Drive to the bridge you know when I’m on the\r\nbridge somebody else is driving I get used to\u00a0\u00a0 doing that when I Drive over a bridge than when\r\nI Drive over one of those bridges that open up\u00a0\u00a0 I hate those bridges um I know y’all are just like\r\noh my gosh yeah it’s an irrational fear I realize\u00a0\u00a0 that but instead of going straight for the bridge\r\nthat opens up going for the little bridges first\u00a0\u00a0 and then thinking back over times that I’ve gone\r\nover bridges and there’s been no problem you know there are exceptions nothing happened it wasn’t a\r\nbig deal sometimes I didn’t even notice it until\u00a0\u00a0 somebody pointed out hey look down there at that\r\npretty water and I’m like oh we’re on a bridge so\u00a0\u00a0 encourage people to not avoid their experiences\r\nget used to them embrace them and learn that they\u00a0\u00a0 have the power to deal with them and stop reason\r\ngiving for the behavior you know use the challenging\u00a0\u00a0 questions if something is fearsome let’s look for\r\nat the evidence for and against it instead\u00a0\u00a0 of you know making excuses for social interventions\r\nimprove their relationship with their self which\u00a0\u00a0 goes with self-esteem improvement people are going\r\nto feel less anxious about getting their needs and\u00a0\u00a0 wants to be met if they know what their needs and wants\r\nare so part of that is becoming mindful cuz a lot\u00a0\u00a0 of our clients don’t know what they need and want\r\nthey just want to feel better but they don’t\u00a0\u00a0 know how they don’t know what they need to feel\r\nbetter so helping them identify their needs and\u00a0\u00a0 wants and encouraging them to be their own best friend\r\nyou know when they get a promotion take themselves\u00a0\u00a0 out to dinner pat themselves on the back whatever\r\nit is don’t rely on other people to do it because\u00a0\u00a0 other people it’s not that they don’t care but\r\nother people are often very involved in thinking\u00a0\u00a0 about their stuff and they may not notice\r\nencourage them to develop a method of internal\u00a0\u00a0 validation so they can feel like they are all\r\nthat ‘no bag of chips and they realize why they\u00a0\u00a0 are lovable human beings and they accept the\r\nthe fact that everybody is not going to like them\u00a0\u00a0 and nobody is gonna like them all the time and\r\nthat’s okay you know my kids don’t like me all\u00a0\u00a0 the time my husband doesn’t like me all the time\r\nI’m okay with that I know I can be challenging but\u00a0\u00a0 you know most of the time you know they like me\r\nand that’s okay and there are some people you\u00a0\u00a0 know who don’t like me at all and okay there’s\r\nnothing I can do about that helping our clients\u00a0\u00a0 develop an okayness with that helps relieve a lot\r\nof anxiety because a lot of people feel like they\u00a0\u00a0 have to be liked by everybody and if somebody\r\ndoesn’t like them it’s like what did I do wrong\u00a0\u00a0 oh my gosh encourage them to develop healthily\r\nsupportive relationships with good boundaries\u00a0\u00a0 develop assertiveness skills so they can ask for\r\nhelp when they need it anxiety a lot of times you\u00a0\u00a0 know that’s the body saying there’s a threat well\r\nif there’s a threat maybe you need some help you\u00a0\u00a0 know dealing with it so people need to be willing\r\nand able to ask for help and not feel like that’s\u00a0\u00a0 going to lead them to be rejected and allow them a\r\ncertify this will allow them to say no to requests\u00a0\u00a0 again without feeling like that’s going to result\r\nin them being fully rejected describe the ideal\u00a0\u00a0 healthy supportive relationship and encourage\r\nthem to separate the ideals from the reals you\u00a0\u00a0 know let’s look at if you had the best relationship\r\nwhat would it look like okay you know warden June\u00a0\u00a0 Cleaver we got that now how realistic is that\r\nyou know let’s look at you know rephrasing this\u00a0\u00a0 a little bit so it’s less extreme you know warden\r\nJune Cleaver never fought their kids were perfect\u00a0\u00a0 you know all those extreme words let’s look at\r\nwhat’s real what happens in real relationships encourages people to identify who would be\r\na good partner in supportive relationships\u00a0\u00a0 I’m not meaning necessarily romantic I’m meaning\r\nfriends and where they can be found you know where\u00a0\u00a0 would you find people that you could be friends\r\nwith and encourage them to play through what it means when gaming cuz a lot of times again this\r\ngoes with my reading you know what it means when your friend doesn’t return your text right\r\naway what does it mean when your friend cancels\u00a0\u00a0 dinner on Friday night what does it mean when\r\nyou see where I’m going with this and a lot of\u00a0\u00a0 times clients with anxiety and rejection issues\r\nand low self-esteem will go to the worst-case\u00a0\u00a0 scenario so encourage them to go back to finding\r\nthe exceptions what else could have been happening\u00a0\u00a0 what else could it be that caused this and it’s\r\nnot about you so anxiety is a natural emotion that\u00a0\u00a0 serves a survival function excessive anxiety can\r\ndevelop from lack of sleep nutritional problems\u00a0\u00a0 neurochemical imbalances failure to develop\r\nadequate coping skills cognitive distortions low\u00a0\u00a0 self-esteem and a variety of another stuff recovery\r\nAmbala involves improving health behaviors making sure your body’s functioning and making the\r\nneurotransmitters it needs and you know release\u00a0\u00a0 them as needed to identify and build on current\r\ncoping strategies address cognitive distortions\u00a0\u00a0 and develop a healthy supportive relationship with\r\nself and others if you enjoy this podcast please\u00a0\u00a0 like and subscribe either in your podcast player\r\nor on YouTube, you can attend and participate in our live webinars with dr.\r\n\r\n<img decoding=\"async\" src=\"https:\/\/images.pexels.com\/photos\/6693918\/pexels-photo-6693918.jpeg?auto=compress&amp;cs=tinysrgb&amp;h=650&amp;w=940\" \/>\r\n\r\nSnipes by subscribing\r\nat all CEUs comm slash counselor toolbox, this\u00a0\u00a0 episode has been brought to you in part by all\r\nCEUs calmly provide 24\/7 multimedia continuing\u00a0\u00a0 education and pre-certification training to\r\ncounselors therapists and nurses since 2006 have used coupon code consular toolbox to get\r\na 20% discount on your order this month.\r\n\r\n<a href=\"https:\/\/www.youtube.com\/watch?v=ZT5-TNqUg-w\" target=\"_blank\" rel=\"noopener\">As found on YouTube<\/a>\r\n\r\n<a href=\"https:\/\/3be35e-jxxlr2y0zm03m5u6vcl.hop.clickbank.net\">Animated Video Maker – Create Amazing Explainer Videos | VidToon™ #1 Top Video Animation Software To Make Explainer, Marketing, Animated Videos Online It\u2019s EASIER, PRODUCTIVE, FASTER Get Commercial Rights INCLUDED when you act NOW Get Vidtoon™<\/a>","protected":false},"excerpt":{"rendered":"<p>this episode was pre-recorded as part of a live continuing\u00a0\u00a0 education webinar on-demand CEUs are still available for this presentation\u00a0\u00a0 AllCEUs.com\/Anxiety-CEU I’d like to welcome everybody to today’s presentation on best practices for the\u00a0\u00a0 treatment of anxiety I am your host, Dr. Dawn Elise Snipes now not too long ago we did a presentation on &hellip; <a href=\"https:\/\/effectsofanxiety.net\/archives\/150228\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Best Practices for Anxiety Treatment | Cognitive Behavioral Therapy<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":150227,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[7],"tags":[38507,34232,696,35489,59888,37897,37895,35259,38513,38514,42335,38531,38510,37902,38039,37878,38508,38509,59884,59809,59885,59887,42326,35339,38520,37893,37894,38517,42329,37876,957,34002,38525,38526,42327,38532,38527,37906,59886,38528,35373,38506,35665],"class_list":["post-150228","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-getting-help","tag-adacb","tag-addiction","tag-anxiety","tag-anxiety-management","tag-best-practices","tag-cadc","tag-cap","tag-cbt","tag-ccapp","tag-ccdc","tag-ccm-ceus","tag-cebynet","tag-certification","tag-cheap-ceus","tag-cognitive-behavioral","tag-counseling","tag-counselling","tag-counsellor","tag-ctrs-ceus","tag-donnelly-snipes","tag-dr-dawn-elise-snipes-2","tag-evidence-based","tag-hpcsa","tag-kati-morton","tag-ladac","tag-ladc","tag-lcdc","tag-lcsw","tag-lcsw-ceus","tag-lpc-ceus","tag-mental-health","tag-mindfulness","tag-naadac","tag-nbcc","tag-nctrc","tag-online-ceu","tag-online-training","tag-quantum-units","tag-quickstart-guide","tag-relapse-prevention","tag-studies","tag-unlimited-ce","tag-ytccon"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/effectsofanxiety.net\/wp-content\/uploads\/2023\/01\/htmlF_IMG_63c59754498b7.jpg","_links":{"self":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150228","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/comments?post=150228"}],"version-history":[{"count":4,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150228\/revisions"}],"predecessor-version":[{"id":150243,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150228\/revisions\/150243"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media\/150227"}],"wp:attachment":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media?parent=150228"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/categories?post=150228"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/tags?post=150228"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}