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Section 1
Anxiety Diagnosis

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In this section, we will discuss detecting and exposing anxiety.  In your practice, how many of your clients arrive for their first session already aware and accepting of their anxiety?  Probably not many.  Therefore, the purpose of this section is to provide three CBT techniques you can use to help your client detect and expose anxiety.  The three techniques in this section are analyzing and attacking anxiety by discussing the costs of anxiety, cognitive therapy, and clearing roadblocks to change.  As you read this section, you might consider playing it for a client you are treating for anxiety. 

♦ Analyzing and Attacking Anxiety
First, let’s discuss analyzing and attacking anxiety.  Even when unaware clients talk about their feelings, some of the words in these examples are clear indications of anxiety.  Rob, age 31, stated, "I can’t come up with the words to describe my feelings.  It’s like dread and doom but a thousand times worse.  I want to scream, cry for help, but I’m paralyzed.  It’s the worst feeling in the world."  Clearly, Rob suffered from panic attacks. 

Another client, Haley, age 22, stated, "I’m lonely.  I’ve always been painfully shy.  I want friends, but I’m too embarrassed to call anyone.  I guess I feel like anyone I call will think I’m not worth talking to."  As you know, Haley was experiencing symptoms of social phobia or social anxiety disorder.  What type of anxiety does your client indicate that he or she may have?

Technique:  Discussing the Costs of Anxiety and Cognitive Behavioral Therapy
After analyzing a client’s anxiety, it is time to attack.  This course will provide a number of therapeutic interventions for anxiety, but I find that a good initial technique for getting clients to face anxiety is to simply discuss the costs of anxiety. 

Obviously, clients with anxiety feel, as they put it "lousy."  I have found that it can be productive to inform clients of some of the other ways they can be affected by anxiety.  Think of your Rob or Haley.  Could he or she benefit from considering costs of anxiety such as the physical toll, damage to children, weight gain and other health problems, or relationship problems? 

Or do you have a client like Leah who could benefit from an immediate cognitive therapy intervention?  Leah, a college sophomore, got physically ill before every exam.  Leah threw up, had diarrhea, and experienced mild tachycardia.  Leah stated, "I’m so worried I’m going to fail each and every test I take.  Then l would get kicked out of school.  What would happen to me then?" 

Clearly, a cognitive, CBT, approach to Leah would involve helping her capture the negative predictions and catastrophic outcomes that run through her mind.  I asked, "What is your typical test grade?"  After Leah answered, I followed up by asking her about her lowest test grade.  Leah reported a B average with her lowest grade being a B minus. 

Think of your Leah.  How might you guide your client to search for evidence about her true performance and a more realistic appraisal of the chances of her actually failing?  More information on cognitive therapy interventions for anxiety will be discussed later in this course.

♦ Clearing the Roadblocks to Change
In addition to analyzing and attacking anxiety initially, another productive technique in the early stages of therapy may be clearing the roadblocks to change.  Would you agree that this may prove to be an ongoing technique with some of your anxiety clients?  As you know, three major causes of anxiety are genetics, parenting, and trauma.  Regarding parenting, three parenting styles appear to foster anxiety in children.  These include overprotective, overcontrolling, and inconsistent parenting.  After identifying your client’s cause of anxiety, perhaps you might try to help him or her clear the roadblocks to change by moving from self-abuse to self-acceptance. 

♦ Causes of Rob's Anxiety
Rob, whose anxiety was the result of a panic disorder, also felt deep shame that someone like him was experiencing anxiety.  Rob stated, "A real man would never have this kind of problem."  In order to help Rob be more self-forgiving, I first asked him to write down the three major causes of his anxiety.  Over the course of several days, Rob reviewed his life and came up with as many possible contributors to his worries as he could. 

Examples of possible genetic influences that Rob identified were several family members, including a short description of associated behavior. 
1. Rob described parenting as a contributing factor when he identified his father’s unpredictable temper. 
2. Rob also described his mother as "moody." 
3. The third major cause of anxiety Rob listed were events in his life.  For example, Rob listed a traumatic car accident when he was 6, his first marriage ending in divorce due to his wife’s unfaithfulness, and his recent diagnosis of diabetes. 

Next, Rob and I reviewed his finished list.  I asked, "Do you think you are to blame for your worries?"  Rob stated, "After making this list, I realize a lot has happened to me.  But I don’t want to play the victim."  I asked Rob to be realistic and consider what percentage of his anxiety belonged to him and what percent could be attributed to genes, parenting, and past events.  Do you find that your clients, like Rob, become more willing to move from self-abuse to self-acceptance after clearing the roadblocks to change?

In this section we have discussed detecting and exposing anxiety.  The purpose of this section was to provide three CBT techniques you can use to help your client detect and expose anxiety.  The three techniques in this section were analyzing and attacking anxiety by discussing the costs of anxiety, cognitive therapy, and clearing roadblocks to change.

Peer-Reviewed Journal Article References:
Barlow, D. H., & Kennedy, K. A. (2016). New approaches to diagnosis and treatment in anxiety and related emotional disorders: A focus on temperament. Canadian Psychology/Psychologie canadienne, 57(1), 8–20.

Battalio, S. L., Huffman, S. E., & Jensen, M. P. (2020). Longitudinal associations between physical activity, anxiety, and depression in adults with long-term physical disabilities. Health Psychology, 39(6), 529–538.

Brewer, J. A., Roy, A., Deluty, A., Liu, T., & Hoge, E. A. (2020). Can mindfulness mechanistically target worry to improve sleep disturbances? Theory and study protocol for app-based anxiety program. Health Psychology, 39(9), 776–784.

Ossola, P., Gerra, M. L., De Panfilis, C., Tonna, M., & Marchesi, C. (2018). Anxiety, depression, and cardiac outcomes after a first diagnosis of acute coronary syndrome. Health Psychology, 37(12), 1115–1122.

Ruscio, A. M. (2010). The latent structure of social anxiety disorder: Consequences of shifting to a dimensional diagnosis. Journal of Abnormal Psychology, 119(4), 662–671. 

QUESTION 1
What are three CBT techniques for detecting and exposing anxiety? To select and enter your answer go to Test.

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