Brief Behavioral Skills: CBT for Anxiety (CBT-A)

Summary

This webinar by Kari Stephens and Patrick Raue, clinical psychologists at the University of Washington, introduces Cognitive Behavioral Therapy for Anxiety (CBT-A). They outline the CBT model of anxiety, emphasizing exposure as the primary treatment and discussing anxiety management strategies. The presenters guide through creating exposure hierarchies, addressing safety behaviors, and utilizing cognitive restructuring to challenge anxious thoughts. The session includes practical examples and techniques to apply in therapy for various anxiety conditions.

Takeaways

• 📚 The training focuses on Cognitive Behavioral Therapy for Anxiety (CBT-A), teaching how to understand and treat anxiety using a modular approach applicable to various anxiety conditions.
• 🧠 The CBT model of anxiety is represented by a triangle involving physical sensations, thoughts, and behaviors, which interact and can reinforce anxiety over time.
• 👩‍⚕️ Clinicians need to distinguish between realistic threats and unfounded anxieties, and determine the client's willingness to engage in exposure therapy, a key component in treating anxiety.
• 👉 The 'treatment pitch' involves explaining the benefits of exposure and anxiety management strategies to patients, emphasizing the importance of setting clear treatment goals.
• 🌟 Exposure therapy is the most effective treatment for anxiety, as it helps patients confront and reduce fear responses to situations they avoid.
• 🛠 Anxiety management strategies, such as deep breathing and relaxation, are useful for tolerating anxiety but are less effective in eliminating it compared to exposure.
• 📈 Developing an exposure hierarchy is crucial, involving the patient in creating a list of anxiety-provoking situations, ranked from least to most distressing.
• 🔍 The case example of 'TC' illustrates the application of CBT-A, emphasizing the importance of identifying specific triggers and the patient's subjective experience of anxiety.
• 🏋️‍♀️ For patients like TC, whose anxiety revolves around physical pain, exposure exercises involve gradually engaging in activities that provoke anxiety, such as physical exertion.
• 🚫 Safety behaviors, while providing temporary relief, can maintain anxiety by reinforcing the connection between a situation and perceived danger.
• 🤝 The therapist's role in exposure therapy includes encouragement, helping the patient maintain focus on the trigger, assessing reactions, and providing validation and reinforcement.

Q & A

What is the main focus of the training presented by Kari Stephens and Patrick Raue?

The main focus of the training is cognitive behavioral therapy for anxiety, also known as CBT-A.

What are the learning objectives for the training on CBT-A?

The learning objectives include understanding the CBT model of anxiety, describing how to pitch treatment to patients, discussing the difference between exposure and anxiety management strategies, developing an exposure hierarchy with patients, and describing anxiety management strategies using physical and cognitive approaches.

Why is treating anxiety challenging for clinicians?

Treating anxiety is challenging because it often requires patients to expose themselves to situations that scare them the most, and clinicians must distinguish between unfounded anxieties and realistic threats.

What is the importance of developing a clear treatment pitch for patients?

A clear treatment pitch is important to ensure that both the client and therapist understand the treatment plan and goals, which helps them feel energized and enthusiastic about the anxiety treatment.

What is the significance of exposure in the treatment of anxiety according to the training?

Exposure is significant because it is the most effective treatment component for anxiety, resulting in a reduction of patient anxiety by allowing the brain to unlearn what it perceives as overly dangerous.

How does the modular approach to treatment benefit clinicians and patients?

The modular approach allows clinicians to apply strategies regardless of the specific anxiety condition, providing them with basic pieces to customize treatment plans with their patients, ensuring flexibility and adaptability.

What is the role of anxiety management strategies in the context of CBT-A?

Anxiety management strategies, such as relaxation and cognitive restructuring, help patients manage or live with their anxiety better. However, they are not as powerful as exposure in actually reducing anxiety severity.

Can you explain the '3 Bs' model used to educate patients about anxiety?

The '3 Bs' model refers to Body, Brain, and Behavior. It helps patients tune into what they feel in their body, what thoughts go through their head, and what actions they take when they experience anxiety.

How does the concept of safety behaviors relate to the effectiveness of exposure exercises?

Safety behaviors can maintain anxiety by providing temporary relief but reinforcing the connection between perceived danger and the anxiety trigger. This can undermine the effectiveness of exposure exercises, which aim to retrain the brain to recognize that the alarm is unnecessary.

What is the process for creating an exposure hierarchy for patients?

The process involves working with the patient to create a list of situations they are avoiding and would like to face, ordered from least to most anxiety-provoking. This hierarchy guides the exposure exercises, starting with less distressing situations to build up the patient's confidence and tolerance to anxiety.

How can relaxation skills, such as diaphragmatic breathing, assist in managing anxiety?

Relaxation skills target the physiological reactivity to anxiety, helping to reduce acute panic reactions and chronic muscle tension. Diaphragmatic breathing, in particular, involves slow, controlled breaths that engage the diaphragm, promoting a sense of calm and helping to make anxiety more tolerable.

What is the goal of cognitive restructuring in the context of CBT-A?

The goal of cognitive restructuring is to help patients identify, evaluate, and change unhelpful and maladaptive thoughts, generating more balanced, accurate, and less anxiety-provoking coping thoughts that are still believable to the client.