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Brief Interventions for Anxiety Disorders with Children and Adults
Anxiety Disorders continuing education Psychologist CEU

Manual of Articles Sections 18 - 24
Section 18
Anxiety... the Attention Getter!

CEU Question 18 | CEU Answer Booklet | Table of Contents | Anxiety CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, MFT CEU

sadness-socialworkceuThe main problem in Anxiety Disorders is not in the generation of anxiety, but in the overactive cognitive patterns or frames of reference relevant to danger that are continually creating external and/or internal experiences as a sign of danger.

Symptoms and Functions
According to Beck, the symptoms that indicate an anxiety disorder can be divided into cognitive, affective, behavioral, and physiological. These are based upon the four functional systems that are coordinated to produce adaptive responses to situations of danger. Anxiety disorders represent a malfunction of the system for activating and terminating a defensive response to a threat, thus causing prolonged anxiety. This is a response that can be understood as inappropriate domination by a primal mechanism, such as flight, freeze, or collapse... rather than a more adaptive way of behaving, like social competency. The activation of the primal response to a threat such as possible rejection by an audience in public speaking undermines your client's more mature functioning. Thus, the threat is increased. Your client's symptoms are expressions of the excessive functioning of his or her systems, or of an interference with the function of a particular system.

Below is a list of many of the "cognitive symptoms" associated with Anxiety Disorders. It will be apparent that many of these symptoms are intensified versions of normal function; for example, self-consciousness or hypervigilance. Other symptoms appear to be the result of inhibition of normal functions -- for example, loss of concentration or blocking. Still other symptoms denote erosion of voluntary control over processes ordinarily under your client's control, such as loss of objectivity. Please note the list is in a checklist format for your convenience, and reproduction to use for further client assessment.

Cognitive Symptoms in Anxiety Disorders

1. Sensory-Perceptual
"Mind" haze, cloudy, foggy, dazed
Objects seem blurred/distant
Environment seems different/unreal
Feeling of unreality
Self-conscious
Hypervigilant

2. Thinking Difficulties
Can't recall important things
Confused, Unable to control thinking
Difficulty in concentration
Distractibility, Blocking
Difficulty in reasoning
Loss of objectivity and perspective

3. Conceptual
Cognitive distortion, Repetitive fearful ideation
Fear of losing control
Fear of not being able to cope
Fear of physical injury/death
Fear of mental disorder, negative evaluations
Frightening visual images

The sensory-perceptual symptoms appear to be caused by an interference with normal cognitive function. This interference is possibly a result of cognitive strain. Thus, the integration of visual impressions with the cognitive schemas is unbalanced. The individual experiences perceptual aberrations. These aberrations are readily recognized as such and have an "as if" quality. Your client may state, "Things seem to be different, but I know they aren't." Many agoraphobic clients report, for instance, that after they have been looking at the broad fluorescent light in the supermarket, objects seem to be split horizontally and the separate parts are dissociated.

These conceptual problems are related to changes in the cognitive processes by the primal mode. These changes reflect preoccupation with the sense of vulnerability and danger. The focus on fears, loss of control, and inability to cope are an expression of the cognitive frame of reference. This frame of reference is one of "danger" and "vulnerability."

As you know, the types of symptoms of anxiety will vary according to the nature of the problem. If it is immediate and severe, the person may experience panic. If the problem is chronic, he or she is more likely to experience uneasiness or a "wound-up" feeling. Use the following checklist to assess and provide insights into interventions with past or future clients.

Typical Affective Adjectives

Anxious
Nervous
Fearful
Terrified
Scared
Frightened
Alarmed
Jittery
Jumpy
Edgy
Impatient
Uneasy
Tense
Wound-up

The behavioral symptoms, as we will discuss later, generally reflect either the hyperactivity of the behavioral system or else its inhibition. Tonic immobility is an expression of the freeze reaction, whereas restless behavior and tremors represent the body's mobilization for action. The shaking and trembling may represent the preparation for survival behavior prior to the formulation of a clear-cut strategy.

Behavioral Symptoms

Inhibition
Tonic immobility
Flight
Avoidance
Speech dysfluency
Impaired coordination
Restlessness
Postural collapse
Hyperventilation

The physiological symptoms reflect a readiness of the total organism for self-protection. The sympathetic branch of the autonomic nervous system facilitates an active coping strategy. Thus, increased heart rate and blood pressure help a person defend himself actively or to escape. The parasympathetic symptoms, in contrast, facilitate the strategy of collapse. They ultimately may result in your client feeling he or she is helpless and has no active coping strategies for dealing with a threat. Some physiological symptoms result from behavioral reactions; for example, numbness and tingling sensation in the extremities and faintness may be caused by over-breathing or hyperventilation syndrome.

Symptoms According to Physiological Symptoms

Cardiovascular

Palpitations
Heart racing
Increased blood pressure
Faintness (P)
Actual fainting (P)
Decreased blood pressure (P)
Decreased pulse rate (P)

Respiratory

Rapid breathing
Difficulty in getting air in
Shortness of breath
Pressure on chest
Shallow breathing
Lump in throat, Gasping
Choking sensation
Spasm of bronchi (P)

Neuromuscular

Increased reflexes
Startle reaction
Eyelid twitching
Insomnia
Spasm
Tremors
Rigidity
Fidgeting
Pacing
Strained face
Unsteady
Generalized weakness
Clumsy motions

Urinary Tract

Pressure to urinate (P)
Frequency of urination (P)
Gastrointestinal
Abdominal pain (P)
Loss of appetite
Revulsion toward food
Nausea (P)
Heartburn (P)
Abdominal discomfort
Vomiting (P)

Skin

Face flushed
Face pale
Localized sweating (palm region)
Generalized sweating
"Hot and cold spells"
Itching


Note: (P) Represents parasympathetic symptoms that facilitate the strategy of collapse

Major Reactions: Mobilization, Inhibition, Demobilization
Your Client's response to a threat can be discussed in terms of three major types of reaction. Mobilization prepares him or her for active defense. Inhibition can be expressed by the freezing reaction. Inhibition is designed to curtail "risky behavior" and to buy time to determine an appropriate strategy. Demobilization denotes deactivation of the motor apparatus and reflects a sense of helplessness in the face of an overwhelming threat.

Mobilization may be represented physiologically by activation of the systems for purposes of action. This pattern may be observed as follows in the various systems.
a. Cognitive. The individual is hypervigilant for any cues relevant to danger. The threshold for unexpected or loud stimuli is lowered. The content of ideation deals with dangerous events past, present, and future and may take the form of repetitive automatic thoughts. Your client has frequent visual images with a content of personal adversity. Your client is also likely to have nightmares.
b. Affective. The emotional symptoms may vary from edginess and tension to terror.
c. Behavioral. There is an increase in muscular activity even when sitting. This may be manifested by grimacing, by continuous movements of hands and often the rest of the body, and by chain smoking, sighing, shaking, tremors, and pacing back and forth.
d. Physiological. The organ systems show increased sympathetic activity; for example, increased heart rate and blood pressure, and sweating.

Inhibition involves active interference with normal cognitive and behavioral functions.
a. Cognitive. There is selective blocking of various functions, especially when an activity is being evaluated or challenged. There may be interference with recall of vital information, for example, the content of a speech, a response to a test, people's names, or phone numbers. Reasoning, concentration, objectivity, and perspective are impeded. The blocking and impediments may be varied over time as though a switch is being turned on and off. The "clouding of consciousness," "mental blurring," and sense of "passing out" may also be attributed to cognitive inhibition. This constriction of consciousness may intensify to the point that your client believes that he or she is about to faint.
b. Behavioral. There is inhibition of spontaneous movements, especially of facial muscles, so that the person may present a blank face. Some rigidity of facial muscles is apparent. There is also general muscle rigidity, so that movements are jerky and clumsy and activity requiring skill, such as playing a musical instrument, is impeded. There is often a problem with phonation and with dysfluencies such as stuttering, choking on words, or even partial mutism.

Demobilization. The symptoms of collapse occur most obviously in an overreaction to blood and injury but may appear in other reactions as well. The main symptoms are weakness and faintness. The main parasympathetic symptoms that are most prominent in the blood injury phobias are a lowering of the blood pressure and heart rate that may result in fainting.
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Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 350 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #1
The preceding section contains Checklists to fine tune your assessment of clients who may have Anxiety Disorders. Write three case study examples regarding how you might use the content of this section of the Manual in your practice.

Online Continuing Education QUESTION 18: What are three types of reactions your client may have to a threat? To select and enter your answer go to CEU Answer Booklet.

 
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The article above contains foundational information. Articles below contain optional updates.
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