SECTION V: ANXIETY

Therapist’s Overview

IT’S US AGAINST THE ANXIETY

GOALS OF THE EXERCISE

1. To increase non-anxious family members’ understanding about anxiety.
2. To increase ways non-anxious family members can be supportive.
3. To reduce anxious family members’ sense of isolation.

ADDITIONAL HOMEWORK THAT MAY BE APPLICABLE TO ANXIETY

• My Safe Place Page 19
• Acting as If Page 52
• What Am I Thinking When I Am Depressed? Page 115

ADDITIONAL PROBLEMS IN WHICH THIS EXERCISE MAY BE USEFUL

• Depression
• Anger

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH CLIENT

Anxiety can be quite debilitating. Oftentimes, it is our thought patterns that reinforce that feeling of dread. When we are anxious, we are frequently stuck in our heads worrying about something or someone. These thoughts of worry can be overpowering. Family members can try to be supportive but can too often become frustrated with the anxious family member. The anxious family member may then feel depressed and isolated. The following exercise is designed to help the non-anxious family members to become more understanding and in tune with what the anxious family member experiences in their heads. By doing this exercise as a family, the hope is that the anxious member may feel less isolated and more supported.

EXERCISE V.A

IT’S US AGAINST THE ANXIETY

1. As a family unit, each member is to think of a time when they felt anxious. Each member is to write down this memory in as much detail as possible.
a. I felt anxious when (describe when):
089
b. I was with: ______________________________
c. We were (describe where you were):
090
2. In describing the situation take time for each family member to write out several anxious thoughts s/he may have had.
091
3. As a family, each member is to read aloud their situations and anxious thoughts.
4. Family should then brainstorm in order to generate calming, reassuring, encouraging types of thoughts to replace the anxious thoughts. (What else can I think about?)
5. Each family member can record the replacement thoughts on index cards, or a designated family member can record all of them on a sheet of paper for any member to review at any time.

Therapist’s Overview

MY/OUR DAUGHTER IS AFRAID TO GO TO SCHOOL

GOALS OF THE EXERCISE

1. Develop a basic understanding as to why the fear exists.
2. Develop alternative self-talk when feeling afraid to attend school.
3. Identify role of each family member in enabling or compounding the fears of the anxious child.

ADDITIONAL HOMEWORK THAT MAY BE APPLICABLE TO ANXIETY PROBLEMS

• My Safe Place Page 19
• A Picture Is Worth a Thousand Words (just pictures 1−3) Page 215
• Creating a Positive Outlook Page 227

ADDITIONAL PROBLEMS FOR WHICH THIS EXERCISE MAY BE USEFUL

• Low Self-Esteem5

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH CLIENT

When a child is afraid of attending school, it is important to elicit what specific fears he/she has and why they may have developed. This can be accomplished directly in sessions (i.e., by Socratic questioning). Very often parents try to help a fearful child by giving him/her reassuring statements. However, very often this can actually maintain the anxiety. What is needed is for the child to develop self-assurance and some coping skills. To accomplish this, have the child list the various statements s/he makes when feeling frightened. Alongside of each fearful statement, have her/him write a reassuring or countering statement. Copy this or just the counterstatements on an index card. Whenever the child is feeling scared, direct her/him to take out the list and read it. These are referred to as coping cards. Whenever the child expresses fear to her/his parent(s), the parent(s) respond by saying, “Remember what you wrote on your coping card.” Then have them rate the outcome of their response to the card (e.g., it helped some, a lot, did not help).

EXERCISE V.B

MY/OUR DAUGHTER IS AFRAID TO GO TO SCHOOL

FOR PARENTS AND FEARFUL CHILD

Being a parent is the most difficult job in the world. When one of our children is hurting, our initial response is to take care of them, to fix the hurt. When that hurt is a fear of attending school, our natural response is to reassure our child that “everything will be fine” and “you are okay.” This usually helps to some degree, but the anxiety returns once you stop the reassurance. To overcome this, your child/adolescent must learn to make self-reassuring statements. This allows them to take control. To accomplish this, have your child/adolescent list the various statements s/he makes when feeling frightened. Alongside of each fearful statement, have them write a reassuring or countering statement. Copy this or just the counterstatements on an index card. Whenever your child/adolescent is feeling scared, direct her/him to take out the list and read it to herself/himself. These are referred to as “coping cards.” Whenever your child/adolescent expresses fear to you, respond by saying, “Remember what you wrote on your coping card.”
Fearful Self-Talk Strong Self-Talk Rate the Outcome
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Therapist’s Overview

WHEN I FEEL ANXIOUS IT IS LIKE . . .

GOALS OF THE EXERCISE

1. Help the anxious member identify times and situations when/where s/he feels anxious. Use physical examples as much as possible (e.g., butterflies in my stomach).
2. Have family understand the impact that anxiety has on the anxiety-ridden individual.
3. Anxious family member identifies automatic thoughts that accompany anxious feelings as well as the behavior that s/he engages in.
4. Anxious family member learns to practice cognitive restructuring techniques as well as behavioral rehearsal.
5. Family members learn to coach anxious family member in cognitive restructuring techniques and the use of new behaviors.

ADDITIONAL HOMEWORK THAT MAY BE APPLICABLE TO ANXIETY PROBLEMS

• My Safe Place Page 19
• A Picture Is Worth a Thousand Words (just pictures 1−3) Page 215
• Creating a Positive Outlook Page 227

ADDITIONAL PROBLEMS FOR WHICH THIS EXERCISE MAY BE USEFUL

• Anger
• Depression

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH CLIENT

When a person feels anxious, one of their main concerns is a fear of losing control. By helping them identify when and in what situations they feel anxious, as well as what they think about and what they do when anxious, you can help them regain a sense of control. It is also important for you to help the other family members who are struggling with feelings of frustration and helplessness over dealing with the anxious family member. Teaching the other family members ways to be helpful and effectively supportive will help in changing how the family as a unit interacts with the anxious member.

EXERCISE V.C

WHEN I FEEL ANXIOUS IT IS LIKE . . .

If you are feeling anxious, you most likely want to learn ways to regain control and overcome that fear of losing control. Figuring out the cues or situations in which you tend to feel anxious, as well as what goes through your mind and what you do in those circumstances will give you and your therapist a better understanding of what you need to do differently.

FOR THE ANXIOUS FAMILY MEMBER

Over the next week identify the times/situations, your thoughts/images, emotions, and behaviors when experiencing anxiety.
1. I felt anxious when:
092
a. Describe what went through your mind (e.g., thoughts, images) when you were feeling anxious.
093
b. Describe what you did when you were feeling anxious.
094
2. I felt anxious when:
095
a. Describe what went through your mind (e.g., thoughts, images) when you were feeling anxious.
096
b. Describe what you did when you were feeling anxious.
097
3. I felt anxious when:
098
a. Describe what went through your mind (e.g., thoughts, images) when you were feeling anxious.
099
b. Describe what you did when you were feeling anxious.
100
4. I felt anxious when:
101
a. Describe what went through your mind (e.g., thoughts, images) when you were feeling anxious.
102
b. Describe what you did when you were feeling anxious.
103
Share this with the other family members.

Therapist’s Overview

MY MOTHER’S ANXIETY MAKES ME FEEL. . .

GOALS OF THE EXERCISE

1. Have family members identify what it is like for them when their parent(s) is/are anxious.
2. Have family members express their feelings regarding living with an anxiety-ridden person.

ADDITIONAL HOMEWORK THAT MAY BE APPLICABLE TO ANXIETY PROBLEMS

• My Safe Place Page 19
• A Picture Is Worth a Thousand Words (just pictures 1−3) Page 215
• Creating a Positive Outlook Page 227

ADDITIONAL PROBLEMS FOR WHICH THIS EXERCISE MAY BE USEFUL

• Anger Problems
• Depression

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH CLIENT

Very often family members are not given a forum to discuss their own thoughts and feelings regarding what it is like for them to live with someone who is frequently anxious. The following exercise is intended to create such a forum.

EXERCISE V.D

MY MOTHER’S ANXIETY MAKES ME FEEL . . .

FOR FAMILY MEMBERS

Identify two or three situations in which you observed your parent or spouse being anxious, and then describe how you knew that s/he was anxious.
1. 104
a. 105
b. 106
2. 107
a. 108
b. 109
3. 110
a. 111
b. 112
4. 113
a. 114
b. 115
5. 116
a. 117
b. 118
6. 119
a. 120
b. 121