Читать книгу Adult Psychotherapy Homework Planner - Arthur E. Jongsma Jr. - Страница 29
ОглавлениеSECTION 3 ANXIETY
Therapist's Overview ANALYZE THE PROBABILITY OF A FEARED EVENT
GOALS OF THE EXERCISE
1 Develop an awareness of the irrational nature of the fear and anxiety.
2 Examine the probability of the negative expectation occurring and its consequences.
3 Identify distorted self‐talk that mediates the anxiety response.
4 Recognize that the feared outcome will not terminate the ability to function.
5 Resolve the core conflict that is the source of the anxiety.
ADDITIONAL PROBLEMS FOR WHICH THIS EXERCISE MAY BE MOST USEFUL
Dependency
Depression—Unipolar
Low Self‐Esteem
Obsessive‐Compulsive Disorder (OCD)
Phobia
Social Anxiety
Suicidal Ideation
SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH THE CLIENT
Support the client in taking the risk of looking boldly and fairly at the basis for anxiety. Help the client to acknowledge the irrational basis for anxiety and reinforce rational outcomes of feared situations that will not devastate the client's life. Pay special attention to the distorted cognitions that feed the fear and suggest realistic positive self‐talk to counteract this strong mediation effect.
EXERCISE 3.A ANALYZE THE PROBABILITY OF A FEARED EVENT
Many of our fears grow in their intensity without us ever stopping to analyze their exact nature, their causes, their probabilities of occurrence, the amount of control we might have over the situation, and the very real outcomes that are possible if our fears were realized. This exercise will help you thoroughly review your fears. As you rationally analyze the nature and cause of your fear and its real outcome, the fear will dissipate and your ability to cope will increase. Take this step‐by‐step approach in looking at two of your greatest fears and then bring this analysis to your counselor for a thorough processing and reinforcement of coping skills.
1 My First Fear isWhat is the fear or anxiety about?What is the possibility on a scale of 1 (very unlikely) to 10 (inevitable) that the feared outcome will actually happen? Circle one number.12345678910What self‐talk messages do you give yourself that make the fear grow?What are the very real consequences if the feared outcome did occur?What can you do to control the outcome of the situation that you fear?What is the worst possible real outcome if your fear was realized?How would your life be affected if your feared outcome actually happened? How would you cope or continue to function?
2 My Second Fear isWhat is the fear or anxiety about?What is the possibility on a scale of 1 (very unlikely) to 10 (inevitable) that the feared outcome will actually happen? Circle one number.12345678910What self‐talk messages do you give yourself that make the fear grow?What are the very real consequences if the feared outcome did occur?What can you do to control the outcome of the situation that you fear?What is the worst possible real outcome if your fear was realized?How would your life be affected if your feared outcome actually happened? How would you cope or continue to function?
Therapist's Overview PAST SUCCESSFUL ANXIETY COPING
GOALS OF THE EXERCISE
1 Identify successful coping strategies used in the past.
2 View yourself as a capable, resourceful person who has been successful at overcoming fear.
3 Apply successful coping strategies from the past to current anxieties.
4 Enhance ability to effectively cope with the full variety of life's anxieties.
ADDITIONAL PROBLEMS FOR WHICH THIS EXERCISE MAY BE MOST USEFUL
Impulse Control Disorder
Obsessive‐Compulsive Disorder (OCD)
Panic/Agoraphobia
Phase of Life Problems
Phobia
Social Anxiety
Suicidal Ideation
SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH THE CLIENT
This solution‐focused assignment attempts to get the client to recognize their resourcefulness in the past in dealing with anxiety. Helping the client clarify and refine the coping skill that they used is the most difficult part of the assignment. Clients are often not aware of what coping mechanism they relied on to deal with their fear. After the successful coping skills have been identified and refined, help the client to apply these successful skills from the past to current anxieties. Monitor and modify the solution as required.
EXERCISE 3.B PAST SUCCESSFUL ANXIETY COPING
This assignment leads us to focus on resources and successes that we have demonstrated throughout our past. We tend to forget about our ability to cope when our anxieties and fears seem so real and debilitating. However, all of us have had fears that we have overcome or that we have functioned with in spite of their presence from childhood right into adulthood. We may have feared attending kindergarten, but learned ways to cope with that fear as a child and eventually the fear was eradicated. We may have feared talking to teenagers of the opposite sex but eventually learned to speak to them in spite of our anxiety. We may have feared going on a job interview but pressed forward and presented ourselves in the best manner possible. In other words, we learn to cope and to function and to overcome anxiety. We cannot allow our anxieties to cripple us or cause us to avoid circumstances. We must face our anxieties head on. We may have coped by just “taking a deep breath” or by getting encouragement from our friends or by rehearsing what we were going to do or say so often that it became almost automatic. Whatever coping skill we used, we have been successful in the past and now we must rediscover those coping skills and apply them to the current anxieties.
1 Identify three fears or anxieties that you experienced in the past.Fear #1:Fear #2:Fear #3:
2 Identify what you did to cope with, or continue to function in spite of, the anxiety.Fear #1:Fear #2:Fear #3:
3 How do you know your coping mechanism identified in question 2 was successful?Fear #1:Fear #2:Fear #3:
4 What other coping skills have you relied on in the past to help you overcome fears?
5 How can you use each of the coping skills identified in question 2 to help you with your current fears?
Therapist's Overview WORRY TIME
GOALS OF THE EXERCISE
1 Reduce overall frequency, intensity, and duration of the anxiety so that daily functioning is not impaired.
2 Learn and implement a strategy to limit the association between various environmental settings and worry, delaying the worry until designated “worry time.”
3 Stabilize anxiety level while increasing ability to function on a daily basis.
4 Enhance ability to effectively cope with the full variety of life's anxieties.
ADDITIONAL PROBLEMS FOR WHICH THIS EXERCISE MAY BE MOST USEFUL
Depression—Unipolar
Low Self‐Esteem
Obsessive‐Compulsive Disorder
Panic/Agoraphobia
Phobia
SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH THE CLIENT
Clients with a Generalized Anxiety Disorder often spend an excessive amount of time worrying. Furthermore, they have trouble “letting go” of their worries. The goal of this exercise is to decrease the amount of time spent in worrying by restricting worry to a specific time and place. Instruct the client to designate a specific time and place to worry. Teach the client how to recognize, stop, and delay worry to the agreed‐upon “worry time” by using techniques such as deep breathing, deep muscle relaxation, thought‐stopping, and refocusing. The client should be trained in the use of these various techniques before implementing the “worry time” intervention. The client is asked to complete a daily “Worry Time” Log to identify how successful the client was in restricting the amount of time spent in worrying each day.
EXERCISE 3.C WORRY TIME
CLIENT'S INSTRUCTIONS
People with generalized anxiety spend a great deal of time worrying about various problems. They have trouble with “letting go” of their worries. Excessive worrying can be draining, both physically and emotionally. It can take away one's energy and interfere with the ability to relax and enjoy life. It is not uncommon for people who experience anxiety to have problems with both falling and staying asleep. High levels of anxiety and excessive worrying can make it difficult to concentrate on one's schoolwork and other tasks in life. Furthermore, people who worry to excess often do not enjoy their time spent with family and friends because they are so focused on their problems.
The purpose of this exercise is to reduce the amount of time you spend each day worrying. The first step in this exercise is to identify the specific stressor or issue that you are worried about in your current life. Next, you will select a specific time and place where you can focus or concentrate on your worries. You are asked to set aside a specific “worry time” for 15–20 minutes each day. Your therapist can help you select a specific time and place. The idea behind this exercise is to limit your worrying to a specific time and place. After your “worry time” has ended, you are instructed to use the strategies or interventions (i.e., deep breathing, relaxation, thought‐stopping, or refocusing that you have been taught in the therapy sessions) to manage your anxiety and worries for the remainder of the day. You may find it helpful to engage in some leisure/recreational activity to take your mind off your worries (this is called “refocusing”). Talk with your therapist about which specific strategy you feel is most helpful in limiting the amount of time you spend worrying outside of the “worry time.” We realize that this is easier said than done, but with regular practice of these techniques (i.e., deep breathing, relaxation, thought‐stopping, or refocusing), the hope is that you will be able to manage your anxiety more effectively. Please fill out the Daily “Worry Time” Log at the end of each day to let your therapist know how successful you have been in limiting the amount of time you spent worrying each day.
DAILY “WORRY TIME” LOG
Date and Time:Place:
1 What were you worried about today:
2 Rate the degree of your anxiety and worry on a scale from 0 to 10 (circle the appropriate number).012345678910
3 What strategy did you use to try to restrict the amount of time you spent worrying? (Please check all that apply.)______ Deep breathing______ Relaxation______ Positive self‐talk______ Thought‐stopping______ Refocusing______ Other (please list)
4 How successful were your strategies in limiting the amount of time you spent worrying?
5 If the strategies were not helpful in limiting the time you spent worrying today, what factors or stressful events interfered with your ability to “let go” of your worries?
