assessment of anxiety impact what occupational/financial ... · microsoft word - cappp cbt for...

AndrewGrimmerwww.bristolcbt.co.uk

Assessmentofanxiety

5Ws

• What

• When

• Where

• Why

• Withwhom

Impact

• Occupational/financial

• Domestic/self-care

• Social

• Personalinterests

• Relationships

FIDO

• Frequency

• Intensity

• Duration

• Onset

Features

• Physiological

• Cognitive

• Behavioural

• Affective

Fight Or Flight Response

Thoughts racing

Breathing becomesquicker and

shallower

Heart beats faster

Adrenal glandsrelease adrenaline

Bladder urgency

Palms becomesweaty

Muscles tense

Dizzy or lightheaded

When faced with a life-threatening danger it often makes sense to run away or, if that is not possible, to fight.The fight or flight response is an automatic survival mechanism which prepares the body to take these actions.All of the body sensations produced are happening for good reasons – to prepare your body to run away orfight – but may be experienced as uncomfortable when you do not know why they are happening.

Quicker thinking helps us toevaluate danger and make rapiddecisions. It can be very difficult to concentrateon anything apart from the danger (or escaperoutes) when the fight or flight response is active

Quicker breathing takes in moreoxygen to power the muscles.

This makes the body moreable to fight or run away

The adrenaline quickly signalsother parts of the body to get

ready to respond to dangerA faster heart beat feedsmore blood to the musclesand enhances your abilityto run away or fight

When in danger the body sweatsto keep cool. A cool machine is an

efficient machine, so sweating makesthe body more likely to survive a

dangerous event

Changes to visionVision can become acute sothat more attention can be paid todanger. You might notice ‘tunnelvision’, or vision becoming‘sharper’

Dry mouth

Muscles in the bladdersometimes relax in response

to extreme stress

Muscles all over the body tensein order to get you ready to run awayor fight. Muscles may also shakeor tremble, particularly if you staystill, as a way of staying ‘ready for action’

Hands get coldBlood vessels in the skincontract to force bloodtowards major musclegroups

PSYCHOLOGYT LS http://psychology.tools

The mouth is part of thedigestive system. Digestionshuts down during dangeroussituations as energy is divertedtowards the muscles

Nausea and ‘butterflies’in the stomachBlood is diverted away fromthe digestive system whichcan lead to feelings of nauseaor ‘butterflies’

If we don’t exercise (e.g. run away or fight)to use up the extra oxygen then we can

quickly start to feel dizzy or lightheaded


Anxietydiary

Day Time Anxiety(0-10)

Thoughts,concernsorworries

Behaviour(avoidance&safety-seeking)

Consequences(+&-)

Anxietyfeedbackloops

1ryappraisal:threat2ryappraisal:vulnerability

Situa;on/trigger

PhysicalEmo;onalCogni;veeffectsBehaviour

Gene

ralises Sensi;ses

FocusesConfirms

Amplifies


Anxietyequation

Anxiety=ProbabilityxAwfulness

Coping+Rescue


Exposurehierarchy

Brieflydescribetheanxious/avoidedsituation,object,sensationorintrusivethought/imageAnxiety

(0-100)


Exposurediary

Day/time ExposuretaskDuration.

(mins)

Start

(anxiety

0-100)

Mid

(anxiety

0-100)

End

(anxiety

0-100)


Behaviouralexperiment

Thoughttobetested:“If…then…”

(Ratecredibilityofbelief:0-100%)

Experiment(what,when,where,withwhom)

Prediction(ifbeliefistrue)

Obstacles/barrierstoovercome Solutions/strategiestoovercomebarriers

Whathappened? WhatdidIlearn(aboutthethoughttobetested)?


TheoryAvs.TheoryB

TheoryA TheoryB

Theproblemis… TheproblemisIworrythat…

EvidenceforTheoryA EvidenceforTheoryB

Implications:whatdoIneedtodoifTheoryAis

correct?

Implications:whatdoIneedtodoifTheoryBis

correct?


P3RPlan(afterChristinePadesky)

Whathaveyoubeenavoiding?

Howanxiousdoesthethoughtofdoingitmakeyoufeel(0-10)?

Predict:whatbadthingsmighthappenifyoudidthis?

Preparecopingresponses:whatcouldyoudowhenthishappens?

Practiseyourresponses(when,where,how,withwhom)

Reflect:whathaveyoulearnedaboutyourvulnerability?


Uncertaintyandchangeinbehaviour

Date:

Descriptionoftheactionchosen:

Discomfortduringtheaction

Thoughtsduringtheaction

Observationsafterperformingtheaction

(Dugas)

(Dugas)

(Dugas)

(Dugas)

(Dugas)

(Dugas)

(Dugas)

(Dugas)


WorryquestionsWhatareyouworryingabout?

Whatisitaboutitthatconcernsyou?

Whatistheveryworstthatcouldhappen?

Andwhatmakesthatsoawful?

Whatistherealisticlikelihoodofitoccurring?

Howmuchwouldyoubetonit?

Makeaspecificprediction(worryhatesspecifics)

Howconfidentareyou(outof10)?

Howanxiousdoesthatmakeyoufeel(outof10)?

Ifyourpredictioncametrue,whatcouldyoudotodealwithit?

Howwoulditlookin5years?

Whocouldyouturntoforhelp?

Howpracticallywouldtheyhelpyou?

Isthereanythingyoucanorshoulddoaboutyourconcern?

Ifyes,whenshouldyoudoit?

assessment of anxiety impact what occupational/financial ... · microsoft word - cappp cbt for...

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