Coping with anxiety

Janelle

Session 1 (for client with schizophrenia): Educated clt on the role stress can play in the severity of someone’s symptoms, particularly for people diagnosed with a thought disorder. Helped her identify unnecessary sources of stress in her life that she might be able to reduce or eliminate, as these could be making her voices louder and more frequent, and her paranoia more pronounced. These are the symptoms that contribute to clt’s reluctance to go places where lots of people will be around her, especially strangers.

Session 2: 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. 

Session 3: 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.

Session 4: 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.

Session 5: 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.

Session 6: 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.

Session 7: 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.

Session 8: 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.

Carol

Session 1: Introduced clt to breathing exercises as a way of managing her anxiety. Explained the value of this technique. Modeled deep breathing, then encouraged clt to join in, which she did. Instructed her to think only about her breathing and how it felt. She had trouble slowing things down at first, so I did the exercise along with her as a way of pacing her. Explained that this technique was especially useful for dealing with acute attacks of anxiety and returning herself to a calmer state. Provided feedback afterwards and praised her for her willingness to try something new.

Session 2: 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.

Session 3: 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 our toes and moving upwards to our heads. Provided coaching and feedback, encouraging her to visualize a wave of relaxation flowing over her as she released the tension in each muscle group. Encouraged her to breathe slowly and deeply when using this technique.

Session 4: Introduced clt to guided imagery as a way of reducing her anxiety. Explained the value of the technique and how it works. Asked her to think of a place or situation she would feel most relaxed in. She identified “somewhere deep in the forest” as a place she would feel least anxious. I then sat with her in an area free of noises and other distractions and began a “forest” narrative, directing her to keep her eyes closed and try to focus only on what I was saying, and the images that came to her mind. After a while, I asked her to join in and help me describe things that might be seen, heard, smelled, or felt.

Session 5: Continued working with clt on managing her 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 her intake of sugary snacks and caffeinated beverages, for example, could help her 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.

Session 6: In prior sessions I observed that clt spends a lot of time on her phone reading stories and following links that are forwarded to her, and accepting most of what she 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 she reduce her exposure to social media and spend more time engaging in healthy activities she enjoys, such as gardening, listening to music, and spending time with her family.

Session 7: Engaged clt in a discussion of prior experiences to identify situations in which she has successfully dealt with anxiety in the past. Then explored each situation with her, asking questions and using reflective listening to help her find common features or themes. By the end of the session, clt recognized that sharing her feelings with others, especially her mother and sister, was a common feature in most situations where she felt she had successfully managed her anxiety. I encouraged her to increase her use of this coping skill (sharing) as it was clearly effective.

Session 8: Reviewed coping skills we identified last week as being effective in helping her manage her 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 she 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 she currently has and try applying the strategy to resolve it.