Anxiety

Sarah

G: Due to a lack of effective coping skills, client uses illicit substances to self-treat her anxiety.

G: As a result of her mental illness, client experiences episodes of severe anxiety that interfere with her ability to function normally.

G: As a result of her mental illness, client experiences excessive and unrealistic worry that is difficult to control.

G: Due to excessive anxiety, client avoids situations that require a degree of interpersonal contact and spends most of her time isolating. As a result, she is unable to work and has almost no social support network.

G: Client uses illicit substances to self-treat her anxiety. This leads to repeated relapses and ongoing impairments in multiple areas of functioning. I met with her today to continue teaching her more effective techniques for managing her anxiety.

G: As a result of her mental illness, client experiences high levels of anxiety that interfere with her ability to function normally. I met with her today to continue teaching her how to control her anxiety without the use of drugs and alcohol.

I: Began teaching clt how to use relaxation skills. Explained progressive muscle relaxation and the value it can have in reducing anxiety. Modeled progressive relaxation, showing her how to tense different muscle groups and then release the tension. I then encouraged her to try, which she did. Practiced tensing and relaxing several basic muscle groups, providing coaching and feedback. 

I: Continued work on teaching progressive muscle relaxation.  Reviewed the skill of tensing and relaxing that clt learned last week, then took her through a more complete version of the exercise, starting with the head and moving to the toes. Provided coaching and feedback, encouraging her to visualize a wave of relaxation flowing over her as she released the tension in each muscle group.

I: Reviewed the skill of progressive relaxation that we've been working on over the past two weeks. Then introduced clt to techniques she can use in the presence of others without drawing unwanted attention to herself (i.e., things she can do once she is already sitting in a crowded room or in an anxiety-provoking situation around other people). Modeled deep breathing for her and explained that I was trying to focus only on the physical sensations of breathing, how it felt, and keep my mind clear of other thoughts. I invited her to do it with me and talked her though it as we did it together.

I: Reviewed the technique of deep breathing as a way of managing anxiety in the presence of others, without drawing unwanted attention. Then introduced another technique that can be used for this purpose -- calming mental imagery (imagining herself in a relaxing location). Modeled this for her, explaining what I was imagining, then invited her to do it with me, using a scene that she found relaxing.

I: Continued discussion of things clt can do to manage her anxiety in social situations, where more involving techniques like progressive relaxation are not practical. After reviewing the technique we practiced together last week (positive mental imagery), I introduced her to the use of positive affirmations -- reassuring things she can repeat to herself. Demonstrated this for her. Pointed out that she can do this almost anywhere, whenever she feels the need to relax and center herself, without anyone noticing.

I: Reviewed the relaxation skill we practiced together last week -- positive affirmations. Then introduced the idea of carrying something with her, like a small round stone, that represented being calm and in control. Suggested she hold it firmly in her hand in situations that caused her to feel anxious, maintaining an awareness of its texture and shape, and what it represented.

I: Last week I introduced clt to the idea of carrying a "calming stone" with her -- anything tangible that represents being calm and in control. Today I asked clt to hold her "calming stone" in her hand, then coached her through a series of deep-breathing and progressive relaxation exercises which she learned to do in prior sessions. I then asked her to continue breathing slowly and deeply while imagining herself in an anxiety-provoking situation. I praised her for trying something new and explained she could do this exercise by herself, whenever she wanted, and that it could help reduce the discomfort that prevents her from spending time with other people and living life the way she wants to.

R: Client was responsive and engaged, and agreed to practice using the coping skills she learned today between now and our next meeting.

R: Client expressed interest in learning how to reduce her anxiety, but was distracted and required continual prompting to stay focused.

R: Client is able to perform the anxiety-reduction techniques she learns during our sessions together, but says she doesn't use them consistently on her own.

R: Client said, "______________".

P: Plan is to continue working with client on learning to manage her anxiety.

P: Will continue teaching client how to manage her anxiety without the use of drugs and alcohol.

James

G: Due to a lack of effective coping skills, client uses drugs and alcohol to self-treat his anxiety.

G: James uses illicit substances to self-treat his anxiety. This leads to repeated relapses and ongoing impairments in multiple areas of functioning. I met with him today to continue teaching him more effective ways of controlling his anxiety.

G: Due to a lack of effective coping skills, client previously used drugs and alcohol to control his anxiety. Now that he is sober, he is experiencing high levels of anxiety that he does not know how to manage, and is at risk of relapse.

G: Due to excessive anxiety, client avoids social situations and spends most of his time isolating. As a result, he has few friends and almost no social support network.

G: As a result of his mental illness, client experiences episodes of severe anxiety that interfere with his ability to function normally.

G: As a result of his mental illness, client experiences excessive and unrealistic worry that is difficult to control.

G: As a result of his mental illness, client experiences high levels of anxiety that interfere with his ability to function normally. I met with him today to continue teaching him how to control his anxiety without the use of drugs and alcohol.

I: Introduced clt to breathing exercises as a way of managing his anxiety. Explained the value of this technique. Modeled deep breathing, then encouraged clt to join in, which he did. Instructed him to think only about his breathing and how it felt. He had trouble slowing things down at first, so I did the exercise along with him as a way of pacing him. Explained that this technique is especially useful for dealing with acute attacks of anxiety and returning himself to a calmer state. Provided feedback afterwards and praised clt for his willingness to try something new.

I: Began teaching clt how to use progressive muscle relaxation. Explained the value it can have in reducing anxiety. Demonstrated the technique by sitting in a chair, tensing different muscle groups, and then releasing the tension. After modeling the technique I invited clt to try. Practiced tensing and relaxing several basic muscle groups together, providing coaching, feedback, and praise.

I: Continued work on teaching progressive muscle relaxation. Reviewed the skill of tensing and relaxing that clt learned last week, then took him through a more complete version of the exercise, starting with his toes and moving upwards to his head. Provided coaching and feedback, encouraging him to visualize a wave of relaxation flowing over him as he released the tension in each muscle group. Encouraged him to breathe slowly and deeply when using this technique.

I: Introduced clt to guided imagery as a way of reducing his anxiety. Explained the value of the technique and how it works. Sat with him in an area free of noises and other distractions. Asked him to think of a place he would feel very relaxed in, then describe things he saw, heard, smelled, and felt there. Directed him to keep his eyes closed and focus all his attention on the place he was describing.

I: Continued working with clt on managing his anxiety. Explained that regular physical exercise and a healthy diet can also help people feel less anxious. Unlike the techniques we have covered so far, they can provide a calming effect even when we are doing something else and thinking about other things. Reducing his intake of sugary snacks and caffeinated beverages, for example, could help him maintain a more stable blood-sugar level throughout the day and sleep better at night. Explained that lack of sleep is a major contributor to feelings of anxiety.

I: In prior sessions I observed that clt spends a lot of time on his phone reading stories and following links that are forwarded to him, and accepting most of what he reads at face value. I explained to clt that social media often exaggerates negative events, distorts our view of the world, and creates the impression that others are more successful than we are. This can cause us to feel unsafe and insecure. I suggested he reduce his exposure to social media and spend more time engaging in healthy activities he enjoys, such as going to the gym and listening to music.

I: Engaged clt in a discussion of prior experiences to identify situations in which he has successfully dealt with anxiety in the past. Then explored each situation with him, asking questions and using reflective listening to help him find common features or themes. By the end of the session, clt recognized that sharing his feelings with others was a common feature in most situations where he felt he had successfully managed his anxiety. I encouraged him to increase his use of this coping skill (sharing) as it was seems to be effective.

I: Reviewed coping skills we identified last week as being effective in helping client manage his anxiety, with the goal of reinforcing and internalizing them. Then we began a discussion of the role unresolved problems play in maintaining anxiety. Taught clt a basic problem-solving strategy for addressing the multiple issues he ruminates over. The strategy involves specifically defining each problem, generating options for addressing it, evaluating these options, implementing a plan, and re-evaluating and refining the plan. Clt agreed to choose a problem he currently has and try applying the strategy to resolve it.

I: Introduced client to the technique of "urge surfing". Explained that struggling to suppress or avoid cravings can actually make them stronger and longer-lasting. Urges come in waves and eventually pass; suggested to client that instead of trying to control or escape from his urges, he should just sit and experience them, breathing slowly and deeply, describing to himself the thoughts and sensations he is having until the urge subsides. Informed client that the more he practices this, the easier it will become to ride the wave of his cravings as they peak and recede. 

R: Client expressed interest in learning how to reduce his anxiety, but was distracted and required continual prompting to stay focused

R: Client was skeptical about his ability to experience urges without trying to control them, but agreed to try.

R: Client was responsive and engaged, and agreed to practice using the coping skills he learned today between now and our next session.

R: Client is able to perform the anxiety-reduction techniques he learns during our sessions together, but doesn't use them consistently on his own.

R: Client said, "______________".

P: Plan is to continue working with client on learning to manage his anxiety.

P: Will continue teaching client coping skills for managing his anxiety without the use of illicit substances.

P: Will continue reviewing and reinforcing anxiety-reductions techniques client learns until they become second nature for him.