SOLUTION FOCUSED ANXIETY MANAGEMENT

Transcription

1 SOLUTION FOCUSED ANXIETY MANAGEMENT Ellen Quick, Ph. D. 1 Welcome! Inviting and celebrating courage Anxiety concerns our clients bring 4 session anxiety management class General SF frame and introducing specific techniques Generating SF questions that elicit courage and coping Looking to the future 2 1

2 Goals 1. Adding ideas, tools, techniques 2. Inviting tapping the courage, resources, and appropriate caution clients already have 3. Excitement about the power of a SF perspective 3 Anxiety management class 4 sessions can begin at any one Significant others welcome Class, not a group Open to anyone interested Management, not elimination! 4 2

3 Session 1: Physical sensations and relaxation techniques Physical reactions can be adaptive (survival!) Things the body does under stress and fears Stressor physical reaction danger (cycle) Body reactor (and mind reactor ) Some coping techniques: Belly button breathing, the wave, autogenic training, just because, mindfulness Homework: sample techniques, and notice how you ride through sensations differently! 5 Session 2: Behavioral techniques Exposure and habituation Courage ladder (in vivo densensitization) for phobias and other symptoms Commonsense and counterintuitive Panic: exposure to sensations (intereoceptive exposure) OCD: delay, response prevention, and do something different GAD: exposure to uncertainty, discomfort; write, read, and shred For things you can t face a little at a time: imagine coping Homework: practice exposure, and notice how you already tolerate distress! 6 3

4 Session 3: Thinking coping techniques Events/ Automatic Feelings Sensations Thoughts Behavior 2-part formula: 1. Accepting: reality, feelings 2. But decreasing danger, probability, helplessness Common automatic thoughts and some alternatives 7 Exercise: Automatic Thought Accepting Reality/Feelings But Difference in this perspective Homework: noticing your thoughts, experimenting with changing them, and noticing how that makes a difference 8 4

5 Session 4: Life issues and anxiety Pros / Cons of managing anxiety A third column: How I would deal with each con I can t vs. I don t want to (or Part of me doesn t want to ) Ambivalence 101: mixed feelings are normal! Assertiveness: interface with anxiety Stages of adulthood, seasons of life, Eric Erikson s central issues independent of anxiety Bumps on the road of life may lead to body reactions and coping Homework: What issues am I facing? How would I deal with those with normal anxiety? What does that tell me about how I might deal with them even with my anxiety? 9 What s normal anxiety, appropriate caution? Robbie: 60s, heart attack history, fears another Used to be afraid of airplanes Used to? How?! Really wanted to go! Movie, music Reassured someone (protector) Flying home, and again soon Wait for breath to get regular 10 5

6 List: Ingredients of solution Exposure/ habituation Desensitization Focus on goal Distraction Apply to current fear 11 Exercise: Interviewing for Appropriate Caution Interview your partner about some area where other people freak out but he or she has an appropriate degree of concern. How do you do that? How do you take appropriate caution in that area? How do you make sure you take real good care of yourself? Wow! 12 6

7 General SF Approach to Anxiety What does client want? How might I best help? What will it look like? Any pieces of this already happening? A general SF frame Add techniques when needed -- those from the class Evidence based treatment 13 Pressure for evidence based treatment Specific techniques vs. common factors (meta analysis results) 14 7

8 Client Variables 40% 15% Specific Techniques 30% 15% Therapist Alliance Hope 40% Client factors (before enter therapy room!) 30% Relationship 15% Hope or expectancy 15% Model (less than expected!) 15 SFT creates, enhances common factors: Therapist Alliance Client Variables 40% 30% Enhanced by Solution- Focused Approach 15% 15% Hope Specific Techniques 16 8

9 Client factors: Nonproblem areas tremendously important Change may appear here first; from client, not therapist Start where client is Chance events respect power, weave into therapy 17 Relationship factors: We know how powerful and EBTA. Beyebach s research Spanish therapists are just so nice! Collaborative solution focused approach strengthens therapeutic alliance 18 9

10 Hope and expectancy factors: Miracle question / solution focused inquiry Pieces happening? How did you do that? Wow! Compliments highlight strengths, on the road to solution Creates hope 19 When create common factors, sometimes sufficient and sometimes more needed Consistent with SF practice to add other things? Insoo: Just because you re solution focused doesn t mean you get stupid. Building on what works WHAT to add: pieces from the class 20 10

11 HOW to add: 1. Add to basic approach 2. Incorporate into the approach (similar and different -- like cookie dough ) ADDING: A possibility /perspective Collaborative spirit; client expert Beginning of session or later Terry Trepper s approach and variations 21 Refer to the literature Lesson Picture Acknowledge this is different Input from conference If one way mirror Experiment Adjunct /resource Weave thread back with future-oriented inquiry, compliments, building on it 22 11

12 INCORPORATING: Questions informed by knowledge of problem and techniques Basic SF questions and variations tailored to specifics of anxiety and tools for it E.g.: multiple choice intensity of symptoms 23 Sometimes what s already working IS technique build on it Or if not, slide into technique as alternative 24 12

13 Incorporating Solution focused approach Miracle question Scaling Compliments Wow! (what else?) Specific tools for anxiety Courage ladder Mindfulness Education Cognitive tools (what else?) Anxiety problems Generalized anxiety Phobias OCD Panic attacks (what else?) 25 Exercise: Creating solution focused questions (and other thoughts) These were created in our discussion of incorporating! Scaling questions using client s language-e.g., 0=paralyzed; 10=absolutely no fear. Especially invite describing the positive state (calm, relaxed, etc.) -- in client s own words. 2. How were you able to stop obsessing? 3. How did you manage to increase your calm? 4. What will it look like when you re comfortable? 5. Tell me about a time when you were calm. Wow! How did you do that? 6. Tell me about a time when anxiety wasn t a problem. 7. Tell me about a time when you had some anxiety and got through it. 8. Tell me about a time when the anxiety was a little less. 9. Tell me about a time when you were starting to move into panic but didn t. 10. How did you keep panic from happening? 11. When you are comfortable, what will your body be telling you that s different? 12. When you are relaxed, what will you be saying to other people? What will they notice about you? 13. What will you be doing instead? 14. How will the realization that anxiety is a common reaction help you? 15. Tell me about a time when being energized helped you to be at your best. How did it help you do exactly what you needed to do? Wow! 26 13

14 Envision a miracle SF perspective has become an integral component of evidence based practice with anxiety disorder. What will be different? What will you continue? What will you add? What will clients and colleagues notice? How did you make this happen? Pieces already happening? 27 A multi-center study? SF therapists and/or clients document scaling question changes of clients using SFBT for anxiety concerns. Similar to Doing What Works Group study (quantitative, qualitative) 28 14

15 When you first called for help with your anxiety Your degree of concern or caution is appropriate, not excessive. Anxiety isn t so much a problem any more How did you make your changes happen? What do you want to continue, because you know it works for you? 29 This might go along with information from the therapist on these things: Client age Client gender Presenting complaint Session # Modality (individual, couple, family, group, etc.) Type of practice (private practice, inpatient, community mental health, outpatient clinic, student health, etc.) Treatment (SFBT, SFBT plus specific techniques which?, any other details therapist wants to provide) 30 15

16 Anyone who collects scaling question numbers and/or written comments (or other data) from clients who participate in solution focused anxiety management is invited to forward any data (with all identifying personal information removed) to for possible use in a multicenter study! 31 Detailed notes for running a solution focused anxiety management class Some more detailed materials may become available over the next few months. If you would like a copy when/if these are ready, you may me at ellenkquick@gmail.com For detailed materials on conducting a solution focused group (useful for anxiety, depression, and other concerns), including handouts and full transcripts of 5 miracle question visualizations, see Chapter 10, Doing What Works in Brief Therapy: A Strategic Solution Focused Approach, Second Edition, E. Quick, Academic Press/Elsevier,