Therapy: Anxiety Management & Relaxation,Psychological techniques for managing anxiety Frank McDonald Consultation-Liaison Psychologist The Townsville Hospital Queensland Australia,Edvard Munch, 1896 - Anxiety,Overview,Aim & Objective General comments on psychological management General considerations in medically managing anxiety Psychological strategies for mx anxiety brief survey Class exercise on instant strategies Common anxiety disorders what technique goes best with what condition? Evidence for psychological treatments Resources for practical applications Optional self-test References,Some degree of acute anxiety is normal in most medical presentations. More chronic, Anxiety Disorders are the most common psychiatric condition, affecting 25% of adults at some point in their lives & 5%+/- of hospital pts1.,Aim & Objective,Aim To briefly survey some psychological strategies for mx of anxiety (Some easily acquired or a natural part of medical roles that youll develop soon, if havent already. Others need further training or referring on) Objective Students will be more aware of psychological methods of managing common anxiety presentations,General comments on psychological mx,Anxiety is a normal emotion in response to threat & a powerful motivator Mild to moderate levels of anxiety improve the ability to cope, reactions become faster, understanding is better & responses are more appropriate On balance, acute moderate fear/anxiety a good thing However, chronic high levels of anxiety reduce capacity to plan, make accurate judgments, carry out skilled tasks, & comprehend useful information they can paralyze thinking & action,After Yerkes & Dodson 2,General comments on psychological mx,Psychological treatments (especially cognitive-behavioural therapies) can help restore mental health of anxious people & overcome debilitating effects of excessive anxiety Anxiety disorders are manageable, given skilful practitioner & hard-working patient However, chronic & diffuse disorders like GAD are more difficult to treat successfully,General comments on psychological mx,Two main psychological interventions for anxiety disorders are the cognitive & the behavioural 1. Cognitive Therapy (termed Cognitive-Behaviour Therapy or CBT when, as is usual, combined with behavioural techniques) Cognitivists: “To feel differently, think differently. Distorted beliefs & other cognitive processes, like attention bias, contribute to psychopathology. Change internal processing of events.” Therapist & pt challenge & re-structure cognitive distortions & other unhelpful cognitions (specific thoughts, schema, spontaneous images, fantasies etc.) and/or modify attention e.g. via meditation,Feelings & behaviour depend on interpretation of events,General comments on psychological mx,2. Behaviour Therapy Behaviourists: “To feel differently, act differently. Change behaviour or manipulate environment.” - They apply principles of 3 main theories of learning Classical conditioning (Ivan Pavlov) learning by association Relaxation & exposure (systematic desensitisation, flooding & response prevention) are behavioural anxiety mx methods based on classical conditioning,Previously neutral stimuli can, by association, evoke the same response as the original powerful one e.g. panic driving a car after an m.v.a Repeated, graded exposure to the newly fearful stimulus without the acquired association (of an accident), extinguishes the learning,General comments on psychological mx,Operant conditioning (B F Skinner) learning by operating on the environment & its subsequent responses No anxiety conditions treated by this alone. But rewards (positive reinforcement) & ending aversive experiences (negative reinforcement) help other approaches E.g. more social assertion (less anxious withdrawal) brings pleasing responses from others & reduces loneliness. Increases chances of less anxious behaviour,Natural example of operant cg,Operant conditioning gone wrong! You positively & negatively reinforce childs anxiety with such solicitousness,General comments on psychological mx,Social (or observational) learning (Albert Bandura) Learning by experiences in social relationships via negative & positive modelling Observing respected or significant others, & whether they are rewarded or punished, sets up expectations in observer, & results in behaviour changes Bridges cognitive & behavioural theories. Learning can occur faster - by observation alone without changes in behaviour first, nor direct modification of cognitions,Assertiveness training, social skills training, communication skills training, & problem-solving training - all used in behavioural & cognitive anxiety mx - rely heavily on modelling (& rehearsal+ to aid recall of the behaviour),General considerations in medically managing anxiety,Treating anxiety part of mx of most medical conditions. Improves compliance and Q o L, reduces disability, decreases service reliance, improves ou