agendas, setting session 26–9, 256
American Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 9, 16, 405
American Psychiatric Association (APA) 9
anxiety (general) xiv–xvi, 120–1,
catastrophizing 39, 41–2, 46, 76
depression and low mood 403–8, 414
development of 49–52
diagnosing disorder 9–10, 13–15
disturbing images 81
helpful and unhelpful 7–8
maintaining factors 19, 50, 51–2, 54
misinterpretation of situations 32–3, 41–2
behavioural experiments 62
cognitive biases and errors 38–40, 69–71
cognitive methods of tackling 69–76
questioning/ tackling directly 78
taking a new perspective 79–80
relationship problems 408–15
risk aversion 77
self-monitoring 55–61
symptoms of disorder 11
overview of categories 43, 44, 45, 46
recognizing interconnections 46–8
see also case studies; CBT; generalized anxiety disorder; health anxiety; obsessive compulsive disorder; panic disorder; Post Traumatic Stress Disorder; social phobia; specific phobia
Anxiety and Depression Association of America (ADAA) 443
Anxiety Disorders Laboratory 444
Anxiety UK 442
applied tension technique 111–13, 114, 190
arachnophobia 88–9, 93–5, 103–8, 118, 124–7, 131
avoidance behaviour 11, 46, 47, 67–8, 404
generalized anxiety disorder 208–9, 232–4, 238
health anxiety 253–4, 259–60, 278–84, 297
obsessive compulsive disorder 329–40, 353, 355, 358–9, 380–1
panic disorder 149, 168–9, 174–8, 188
relationships 411
social phobia 248–9, 253–4, 259–60, 278–84
specific phobias 90–3, 96, 120, 128
behavioural experiments 20, 60, 62, 64, 67–9
health anxiety 314–20
obsessive compulsive disorder 63, 368–83
panic disorder 63, 71–2, 175–9
social phobia 264, 265–6, 268–71, 281–5
specific phobias 102–17, 118–19
worksheets (general) 65–7
behavioural symptoms (general) 43, 44, 45, 46
birds, fear of 118
black and white thinking 39, 308
blood pressure, dropping 111–13, 114, 190, 191
see also fainting
blood-injury, fear of 111–13
breathing difficulties 4, 11, 41–2, 45, 63, 73, 130, 135, 152, 153, 171–2, 189, 192–3, 195, 306
breathing, controlled 173
British Association for Behavioural and Cognitive Psychotherapies (BABCP) 442
case studies 4–5, 12, 25, 29, 56–7, 66–7, 72, 80
anxiety formula 74–5
generalized anxiety disorder 5, 12, 41, 44, 197, 211
health anxiety 289, 299, 307, 312, 315–17, 321–2, 330
obsessive compulsive disorder 347–8, 349, 351, 353–4, 361, 362–3, 367–9, 374, 375, 378, 379, 380, 382, 383, 385
panic disorder 4, 12, 41–2, 44, 45, 47, 131, 137–8, 150, 163–4, 166–7, 171–2, 176, 178, 181
PTSD 387–9, 393–4, 396, 397, 398
relapse prevention 417–27
social phobias 245–6, 257–8, 259, 268, 283–4
vicious cycle of symptoms 45–6, 47, 52
catastrophizing 39, 41–2, 46, 76
Centre for Anxiety Disorders and Trauma 443, 445
checking behaviour 379–80
children with specific phobias 88
Citizens Advice Bureau (CAB) 76
classifying disorders 9–10, 13–15
claustrophobia 94–5
Cognitive Behavioural Therapy (CBT) xiii–xiv, xv, xvii, xviii–xix, 13
behavioural experiments 20, 60–9, 71–2
cognitive biases and errors 38–40, 69
cognitive methods 69–76
dealing with aversion to risk 77
dealing with catastrophizing 76
disturbing images 81
goal setting 24–5
interruptions to therapy 24
key principles summarized 17–18
maintaining factors of anxiety 52
measuring progress 23, 25, 26–7
misinterpretation of situations 32–3, 37
changing anxious interpretations 73–5
formulating a new perspective 78–80
questioning/tackling directly 78
reducing attention to perceived threats 71–2
monitoring anxiety 55–60
moving forward in sessions 26, 28
psychoeducation/fact-finding 61–2, 72
questionnaires 26–7
setting agenda for sessions 26–9
skills for life 21–2
structure of sessions 18–20, 23–30
symptoms of disorder
categorizing 43–4
recognizing interconnections 46–8
see also anxiety (general); generalized anxiety disorder; health anxiety; obsessive compulsive disorder; panic disorder; Post Traumatic Stress Disorder; social phobia; specific phobia
cognitive biases and errors 38–40, 69–71
see also misinterpretations of situations; individual disorders
cognitive symptoms 43, 44, 45, 46
see also individual disorders
compassion fatigue 411–12
compulsions defined 348
coping abilities, your 75–6
cycles of anxiety see individual disorders; vicious and virtuous cycles
Depression Alliance 446
depression and low moods 11, 202, 215, 255, 403–8, 414, 415
development of anxiety 49–52
diagnosing disorders 9–10, 13–15
generalized anxiety disorder 199
PTSD 389–91
social phobia 258
specific phobia 89–90
see also obsessive compulsive disorder; panic disorder
diary keeping 140–1, 162–3, 165, 186–7, 218, 226, 229
see also note-taking; worksheets
diet, effects of 305, 384, 404, 497
doctors xviii, xix, 23, 108, 114, 140, 385, 390–1, 399, 400, 407, 408, 428
health anxiety 289, 309, 341–2
see also therapists, professional
doubters’ disease 349
dyslexia 59
emotional reasoning 276
emotional symptoms 43, 44, 45, 46
see also individual disorders
evolution, human 6
exercise levels 305
exposure treatment 68, 100–5, 332–41, 344
facing fears see exposure treatment
fact-finding/psychoeducation 61–2, 72, 264, 304, 365
fainting 111–13, 114, 135, 150, 152, 153, 169, 189–91, 195
family and friends xvii, 23, 75, 407
effects of insecure environment 49–50
impact of health anxiety 293–4
relationship problems 408–14, 415
revealing your difficulties to 381–2
see also supporters
fight or flight response 5–6, 61, 136, 157
filtering thoughts 40
fortune telling behaviour 40
see also predicting outcomes
freeze response 6
generalized anxiety disorder (GAD) 10, 12, 13, 29, 36, 62, 70
age and causes of 213–14
avoidance behaviour 208–9, 232–4, 238
beliefs about worry 238–41
case studies 5, 12, 41, 44, 197, 211
commonality of 212–13
coping ability 208
diagnostic questionnaire 199
diary keeping and note-taking 200, 208, 216, 218, 226, 229, 236–7
distraction and avoidance 208–9, 232–4, 238
distraction and worries 233
disturbing images 233–4
excessive and everyday worry 214–15
feelings after bout of worry 210
goal setting 219–20
hypothetical event worry 232–3, 235–7
negative beliefs about worry 206–7, 212, 240, 241
overview of disorder 198–9
positive beliefs about worry 204–6, 212, 241
quality of life 210
real event worry 226–31
related psychological problems 215
relationship problems 209, 410
subjects of worry 214
suppression of worries 233
tolerating uncertainty 220–5
uncertainty questionnaire 221–2
understanding worry 199–200
beliefs about worry 204–5
real and hypothetical events 202–4, 212, 226
understanding uncertainty 200–2, 212
worry spiral diagram 211, 216–17
your supporters 215, 225, 231, 238, 241, 242
goal setting 24–5, 219–20, 258–9, 304, 327–8, 338
GPs see doctors; therapists, professional
activity levels 305–6
anxiety framework 299–300
approach to self-help 301–2
attention to media or internet information 294, 295, 316–17
avoidance and safety behaviours 297, 299, 300, 329–41
behavioural experiments 314–20, 328
beliefs about health and medical services 295, 299, 309
case studies 289, 299, 307, 312, 315–17, 321–2, 330, 336
challenging negative thinking patterns 309–10
checking and reassurance seeking 291, 296–7, 299, 300, 320–9
alternative behaviours 326–8
costs and benefits of 324–6, 328
costs and benefits of self-help 302–3
diet 305
disqualifying evidence 309
evidence for and against health concerns 310–11
exposure treatment 332–41, 344
focus on bodily sensations 296, 299, 300
genetic vulnerability 293
if – then statements 315
impact on quality of life 291–2
intolerance of uncertainty 308
minor ailments 306
misinterpretation of bodily sensations 294–5, 299, 300, 305–6, 308
model of disorder 298
negative assumptions 295, 308–9
overview of disorder 287–8
parents with condition 293–4
people with diagnosed medical conditions 292–3, 342
predicting outcomes 308, 315–16
psychoeducation 304–5
relapse prevention strategies 343
relationship problems 410
reviewing treatment 342–3
setbacks and high-risk situations 344–5
sleeping patterns 305
thought patterns 308, 310, 311
thought records 309–13
treating checking and reassurance behaviours 320–9
what keeps health anxiety going? 294–8
when to seek medical attention 341–2
witnessing serious illness in others 293
worksheets and note taking 299–300, 303, 309, 313, 317–18, 326, 331, 336–7
your supporters 301, 303, 304, 306, 314, 320, 326, 340, 342, 343, 345
heart rate, accelerated 11, 35, 131, 135, 136, 157, 158, 159, 163–4, 169, 192–3, 335
see also panic attacks
heights, fear of 119
help and support see doctors; family and friends; online resources; supporters; therapists, professional
hoarding behaviour 349
see also obsessive compulsive disorder
homework, CBT 20, 26, 27, 28, 29
hypochondriasis see health anxiety
imagery in CBT 398
images, disturbing 81, 143, 149, 181–2, 233–4, 347
imaginal exposure 334
Improving Access to Psychological Therapies (IAPT) 67, 128, 399, 446
inheritance of anxiety 49–50, 51
injections, fear of 113–17
insanity, fearing see madness, fearing
interoceptive exposure 334–5
interpretation of situations see misinterpretation of situations
interruptions to therapy 24
Intolerance of Uncertainly scale 29
intrusive thoughts 11, 36, 61, 63, 70
see also images, disturbing; obsessive compulsive disorder; PTSD
labelling behaviour 40
lifts, fear of 119
low moods see depression
madness, fearing 68–9, 70, 74, 131, 169, 209, 240, 370, 372–3
see also panic attacks
maintaining factors of anxiety 19, 50, 51–2, 54
health anxiety 294–8
obsessive compulsive disorder 350–4, 358, 359–60
PTSD 389–91
social phobia 261–3
specific phobias 90–1
measuring progress 23, 25, 26–7, 29
see also individual disorders
medication xviii–xix, 407, 428
memories, intrusive 11, 386, 388
mind reading behaviour 39
misinterpretation of situations 33–8, 41–2, 46, 47, 54
ability to cope and receive help 75–6
Anxiety Formula 73–5
behavioural experiments 62, 71–2
catastrophizing 39, 41–2, 46, 76
challenging risk aversion 77
changing patterns of interpretation 73–5
cognitive biases and errors 38–40, 70–1
formulating a new perspective 78–80
questioning/tackling directly 78
reducing attention to perceived threats 71–2
see also individual disorders
monitoring anxiety 55–61
see also diary keeping; note-taking; worksheets
National Health Service (NHS) 89, 385, 441, 443, 446
National Institute for Health and Clinical Excellence (NICE) xix, 444
note-taking 24, 55–9, 76, 140–1, 151–2, 167, 172, 175, 183–4, 191, 193, 200, 208, 216, 218, 256, 258, 269–76, 281
see also diary keeping; worksheets
obsessions defined 347–8
obsessive compulsive disorder length of treatment 356
obsessive compulsive disorder (OCD) 10, 12, 13, 36, 61, 70, 131, 409
avoidance behaviour 349–50, 353, 355, 358–9, 380–1
behavioural experiments 63, 368–83
case studies 347–8, 349, 351, 353–4, 361, 362–3, 367–9, 374, 375, 378, 379, 380, 382, 383
checking behaviour 379–80
controlling your thoughts 373–4
dealing with attention to threat 374–5
disturbing images 347
doubters disease 349
eating and sleeping patterns 384
fate of past obsessions 368–9
fear of going mad/ losing control 370–3
maintenance model 352–3, 359–60, 365
note-taking 361–5, 376, 377, 382–3
obsessions/intrusive thoughts 347–8, 370
commonality of 365–8
personal interpretation/significance of 350–2, 354, 355, 356, 358, 368, 385
rethinking personal interpretation/significance of 382–3, 384
overview of disorder 346–50
Personal Significance Scale 358
personally relevant evidence 354, 355, 357, 361, 366–9
predicting outcomes 374
real-time record keeping 361–5
relapse prevention 384–5
relationship problems 410
responsibility for harm 378
revealing your difficulties 381–2
self-assessment 357–60
structure of sessions 356–7
testing your biased thinking 375–7
thought-action fusion 376–7
unique approach CBT treatment 357
what keeps your OCD going? 350–4, 358, 359–60
your supporters 355, 365, 367, 369, 373, 377, 378, 380, 381, 382, 383
Obsessive Compulsive Disorder Inventory 357
OCD UK 445
online resources xix, 385, 445
Oxford Centre for Anxiety Disorders and Trauma 444, 445
panic disorder 9, 13, 35, 61, 70, 71, 184–5
avoidance and safety seeking behaviour 149, 168–72, 173, 174–8, 188
behavioural experiments 63, 175–9
belief in underlying health problem 130, 140, 150, 152, 155–61, 163–4, 192–3, 195
controlled breathing 173
overview of disorder 131–2
panic attacks 12, 45, 61, 70, 74, 128, 129–32
case studies 4, 12, 41–2, 44, 45, 47, 131, 137–8, 150, 163–4, 166–7, 171–2, 176, 178, 181
disturbing images 143, 149, 181–2
emotional reactions 166–8
examining your attacks and related fears 133–4, 140–7, 150–62, 165, 170–1, 172
feeling faint 135, 152, 153, 169, 189–91, 195
heart rate 135, 136, 157, 158, 159, 163–4, 169, 192–3
misinterpretation of bodily sensations 130, 140, 148–50, 152, 156–62, 163–4, 165–6, 167–8, 189, 192–5, 196
panic diagrams 137, 145–6, 148
shimmering/moving objects 153, 196
tremors and shaking 153, 169, 171, 194–5
triggers and vicious cycles 136–8, 140–7, 149, 159–60, 165–8
panic diary 140–1, 162–3, 165, 186–7
predicting outcomes 175, 176–8
relapse prevention 183–4
relationship problems 410
unique approach of CBT 139
what keeps your panic going? 135–7, 148–9
work sheets and note-taking 140–1, 151–2, 156, 159, 162–3, 165, 167, 170, 172, 175–7, 178, 180, 183, 185, 186–7, 191, 193
your supporters 134, 140, 146, 147, 152, 155, 160, 172, 173, 180
Personal Significance Scale 358
physical symptoms 11, 43, 44, 45, 46, 70, 71–2
see also individual disorders
Post Traumatic Stress Disorder (PTSD) xix, 12, 36, 62, 70, 81
alcohol and drug use 399
avoidance and precautionary behaviour 387, 392, 394, 397–8
case studies 387–9, 393–4, 396, 397, 398
concentration difficulties 387
diagnosing disorder 389–91
discrimination training 397
feelings about the trauma 395–6
flashbacks and nightmares 387
imagery in CBT 398
length of treatment 399
memories
triggers 397
updating 396–7
over-alertness 387
overview of disorder 387–9
panic attacks 399
professional therapists 386–7, 394–6, 397–8
PTSD Cycle 391–3
relationship problems 410
reliving your trauma 395, 396–7
sleeping difficulties 387
suppressing thoughts and memories 393, 398
writing about your trauma 395
predicting outcomes 64–5, 175, 176–8, 252, 268, 283–4, 308, 315–16, 374
predisposing factors and anxiety 49–50, 51
psychoeducation 61–2, 72, 264, 304, 360, 365
psychotherapists see therapists, professional
questionnaires 26–7
diagnosing GAD 199
diagnosing specific phobias 89–90
GAD – cost of uncertainty 221–2
health anxiety 290
safety seeking behaviour 188
spider phobia 124–7
relapse prevention strategies 120–1, 183, 286, 343, 384–5, 416–28
relationship problems 408–15
repetitive behaviour 349
rituals, neutralizing 349
safety behaviours 11
panic disorder 149, 168–72, 173, 174–8
social phobias 246, 247, 248–9, 253–4, 259–60, 278–84
see also avoidance behaviours
Samaritans 442
scientific approach of CBT 22, 30
self-consciousness 247, 248, 250–1, 257, 264, 265–7, 286
shimmering/moving objects 153, 196
situational exposure 334
sleeping patterns 305, 384, 387, 403, 404, 407
social phobia 3, 10, 13, 35, 36, 39, 62, 68, 70, 72, 128
anxiety flowchart 262–3
attention switching – internal to external 265–7, 276
avoidance/safety behaviours 246, 247, 248–9, 253–4, 259–60, 278–84
behavioural experiments 264, 265–6, 268–71, 281–5
case studies 245–6, 257–8, 259, 268, 280, 283–5
commonality of 246
conducting surveys 284–5
conversing and expressing opinions 245–6, 257–8, 259, 280, 283
depression or low mood 255
diagnosing disorder 258
emotional reasoning 276
facing your fears 278–84
negative assumptions 252–3
note-taking 256, 258, 269–76, 281
overly high standards 277
overview of disorder 243–7
patterns of thinking 247, 248, 252–3, 264, 267–78
physical and cognitive effects on 244, 245, 248, 268, 280, 281, 284
post-mortems of social experiences 254–5
predicting outcomes 252, 268, 283–4
psychoeducation 264
relapse prevention strategies 286
relationship problems 410
self-consciousness 247, 248, 250–1, 257, 264, 265–7, 286
sexual attraction 245, 258, 260, 268, 280, 281, 284
shyness 246
Social Phobia Rating Scale 258
taking too much responsibility 276
thought records 269–76
types of 245–6
unique approach of CBT 257
what keeps your phobia going? 261–3
worksheets 249–50, 262–3, 272–5
your supporters 247, 256, 260, 267, 269–70, 271, 278, 280, 282, 285
specific phobias 9, 62, 68, 71
applied tension technique 111–13, 114
avoidance and safety behaviour 90–3, 96, 120, 128
behavioural experiments 102–17, 118–19
facing fears/ exposure treatment 92–3, 100–19
fear of birds 118
fear of blood-injury 111–13
fear of heights 119
fear of injections 113–17, 119
fear of lifts 119
fear of snakes 109–11
fear of spiders 88–9, 103–8, 118, 124–7, 131
fear of vomiting 119
fear of wasps 118
IAPT phobia scales 128
length of treatment 97–8, 101, 112
overview of 87–8
physical symptoms 90, 111–12, 114
post-treatment session 120
relapse prevention 120–3
relationship problems 410
strength of beliefs 95–6
worksheets 122–3
your supporters 97, 98, 100, 101, 102, 103–11, 113, 114–17, 120
spiders, fear of 88–9, 103–8, 118, 124–7, 131
SPRS 258
structure and style of CBT sessions 18–20, 23–4, 30
see also individual disorders
Subjective Units of Disturbance scale (SUDs) 101
suicidal thoughts 408
supporters xxi, 16, 20–1, 24, 31, 42, 48, 53, 83, 415, 428
generalized anxiety disorder 215, 225, 231, 238, 241, 242
health anxiety 301, 303, 304, 307, 314, 320, 340, 342, 343, 345
obsessive compulsive disorder 355, 365, 367, 369, 373, 377, 378, 380, 381, 382, 383
panic disorder 134, 140, 147, 152, 155, 160, 173, 180
social phobias 247, 256, 260, 267, 269, 278, 280, 282, 285
specific phobias 97, 101, 103–11, 113, 120
see also family and friends; therapists, professional
suppression, worry 233
surveys in therapy 63, 284, 367–8
symptoms of anxiety disorders 11, 43–8
see also individual disorders
Theory A vs Theory B 37–8
therapists, professional xvii, xix, 18–21, 23, 24, 343, 407, 428
see also doctors; Post Traumatic Stress Disorder; supporters
thought records 269–76, 309–12
thought-action fusion 376–7
tremors and shaking 153, 169, 171, 194–5, 268, 280, 284
uncertainty, understanding and tolerating 200–2, 212, 220–5
vicious and virtuous cycles
creating vicious 44–8, 50, 51–2
creating virtuous cycles 47, 54
see also individual disorders
vomiting, fear of 119
wasps, fear of 118
behavioural experiments (general) 63–4, 65
blank 448–93
finding a new perspective 79–80
generalized anxiety disorder 217, 237–8
health anxiety 299–300, 303, 313, 317–18, 331, 336–7
obsessive compulsive disorder 362–4, 371
panic disorder 140–1, 156, 159, 162–3, 165, 170, 176–7, 178, 180, 186–7
relapse prevention 416–17
social phobias 249–50, 262–3, 272–5
specific phobias 122–3
standard record sheet 56–8
World Health Organization 9
see also GAD; individual disorders