Topic 8b: Behavioral Exposure [Part 2] {by 3/30}

[Behavioral Exposure] – Practice an Anxious Patterns Record on yourself. Answer the following (you can be brief): (1) Were you able to get a clearer picture of the relationship between the triggering event, negative automatic thought, and physiological response? (2) What were your anxiety related behaviors (only share what you are comfortable with)? (3) How were these behaviors and the outcome reinforcing your thoughts and physiological response?

 

[Behavioral Exposure] – Watch PDA-9: Behavioral Techniques – Modifying Anxious Thoughts.  Practice a Decatastrophizing Worksheet on yourself. Answer the following (you can be brief): (1) Was it helpful starting with the worst-case scenario and ending with the most realistic scenario? (2) Did assessing the probably for each scenario provide supportive “data” to help modify your negative automatic thought? (3) Did this technique provide enough “convincing” information to develop an alternative thought?

 

[Behavioral Exposure – Watch PDA-11: Behavioral Techniques – In Vivo Exposure [PDA-10 is helpful, too].  (1) When the client was in the produce section, what was the most helpful technique to reduce her anxiety? (2) When having a panic attack in the aisle, how was it therapeutically beneficial for the client to try and “wait it out” for a few minutes rather than immediately leaving the grocery store? (3) What were some indicators after the in vivo exposure technique that it was effective for the client?

 

Your original post should be posted by 3/30.  Have your two replies posted no later than 4/1.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

38 Comments (+add yours?)

  1. Jessica Costello
    Mar 27, 2020 @ 14:50:23

    Behavioral Exposure 1
    1. Completing the anxious patterns record was helpful in clarifying the relationship between my triggering event and the physiological response that followed it, as well as my associated thoughts. Though I was aware of this relationship before the negative event, knowing it as the event was occurring helped modify my response and this has strengthened my belief that I would be able to guide a client through this process as well.

    2. I think being aware of this helped me reduce the anxiety behaviors that I would’ve otherwise engaged in.

    3. I was actually able to facilitate a more adaptive response because I was aware of the links between my thoughts, emotions, and behaviors.

    PDA-9: Behavioral Techniques – Modifying Anxious Thoughts

    1. As I worked on the decatastrophizing worksheet, I did find it helpful to think about both the worst-case and best-case scenario before the most realistic. Thinking about the two extremes helped me realize that these kinds of outcomes had happened in the past and were in the realm of possibility, but were not common enough to be the likely outcome in this case.

    2. Assessing the probability of each outcome did help modify my negative automatic thought into a more adaptive or realistic thought in terms of what I was capable of doing.

    3. Using this technique helped me realize how unrealistic the negative automatic thought was and how focusing on these hypothetical outcomes were maladaptive.

    PDA-11: Behavioral Techniques – In Vivo Exposure

    1. The client expressed that she really wanted to leave when she was experiencing lightheadedness, a racing heart, and other symptoms. Practicing deep breathing and reminding herself that these symptoms would pass as they had on other occasions were helpful in slightly reducing but not totally eliminating her anxiety.

    Having her wait out the symptoms was therapeutically useful in reducing the safety behaviors she previously engaged in, such as leaving the store. This experiment showed her that not only she would not have heart attack, but that she could withstand the symptoms, they would pass, and she could finish her shopping without running out of the store. Based on this experience and continued practice, she will most likely be able to continue entering feared situations and realizing that they do not pose a significant threat, which will subsequently reduce her distressing bodily symptoms and overall anxiety levels as well.

    2. The client was able to reduce her anxiety with the relaxation/deep breathing technique and the cognitive reminders that her symptoms would pass, even if the anxiety did not completely go away. In the parking lot, she was pleasantly surprised that she hadn’t run out of the store, and she felt like she could get her life back if she continued practicing these exposures. At the end of the video, she seemed willing to keep trying and improving.

    Reply

    • Monica K Teeven
      Mar 28, 2020 @ 14:45:03

      Hi Jess! Great job on your post! In your response to the second PDA-11 question, you mentioned two important factors about how therapeutically beneficial it was for Lindsey to wait it out in the aisle instead of leaving the grocery store that I did not mention in my blog post. You mentioned how it was therapeutically beneficial for Lindsey to wait it out because it helped her reduce one of the safety behaviors she previously engaged in (leaving the grocery store immediately). Furthermore, you mentioned how this particular experience of waiting it out and finishing her grocery shopping will be useful when continuing to practice entering situations that she perceives as a fearful. In addition, you mentioned how it will help to further decrease her believability that her current perceived fearful situation does not truly present a significant threat to her.

      Reply

    • Erin Wilbur
      Mar 29, 2020 @ 13:30:03

      Hi Jess,
      I agree that the therapeutic benefit of waiting out the anxiety helped Lindsey to realize she was capable of shopping and she wasn’t going to have a heart attack. Your point about how it will help her continue to enter stressful situations and realize that they don’t pose a significant threat to her is also really insightful. By recognizing that she was able to decrease the physiological symptoms she was having, she will hopefully remember that she can do it in the future when she faces similar situations, which really emphasizes the therapeutic benefit that behavioral exposure has for her.

      Reply

    • Taylor O'Rourke
      Mar 31, 2020 @ 10:28:35

      Hi Jess!

      I totally agree with how you discussed your experience with the decatastrophizing worksheet. I also found it extremely helpful to think of the worst-case and best-case scenarios first before the most realistic because it helped me realize how unrealistic I was thinking. Like you said, although these two extremes were not out of the realm of possibility, they simply were just not realistic and likely to occur. I also came to the conclusion that my hypothetical outcomes were very maladaptive and this propelled me to be able to come up with alternative, adaptive conclusions. Great job on the post!

      Reply

  2. Monica K Teeven
    Mar 28, 2020 @ 14:03:18

    Behavioral Exposure

    1. Yes, I was able to see a clearer picture of the relationship between the triggering event, negative automatic thought, and physiological response, especially my responses to the negative automatic thought questions.

    2. I avoided making eye contact when I was talking to my friend because when I am already anxious, seeing people’s reactions can increase my level of anxiety to the point where I get weepy.

    3. My negative automatic thoughts increased because I was not looking at my friends face while speaking. By not looking at my friend’s facial expressions, I imagined they were exhibiting the worst possible facial reaction based on what I said to them. This causes my physiological symptoms to increase.

    Behavioral Exposure

    1. Yes, I did find it helpful to start with the worst case scenario and progress through the realistic case to the best case scenario. If I had worked backwards starting with the best case scenario, my answers to the questions about the best case scenario and realistic case scenario would not have been as accurate. This is because my feelings and thoughts related to the worst case scenario were overpowering.

    2. Assessing the probability of each scenario did help me to modify my negative automatic thought. However, not as much as I think it would under normal circumstances (without the COVID-19 crisis). This is because my negative automatic thought is related to a particular event that could be altered or completely canceled due to the COVID-19 crisis. However, even though the probability levels were closer together than I would have liked, it did help me see that the realistic case scenario will most likely occur which helped decrease the level of negative automatic thoughts and my physiological symptoms.

    3. Yes, this technique provided enough convincing information to develop an alternative thought. This technique, as a whole, has helped me see that if this specific situation is affected by the COVID-19, my world will not be over. I could not have done anything differently to prevent this from happening. This is only a bump in the road, and looking at the big picture, I should not be complaining because compared to many people right now, I am one of the lucky ones. I rather have this particular event be altered by the virus compared to becoming ill, a loved one becoming ill, or needing to worry about money.

    Behavioral Exposure

    1. When Lindsey was in the produce section, the technique that helped her reduce her anxiety was the diaphragm breathing technique.

    2. It was beneficial for her to wait it out because it showed that by using a relaxation technique to help lower her anxiety, she does have some level of control over her feelings and thoughts. In addition, she even stated that after using the diaphragm breathing technique during the panic attack, she was able to lower her rate of anxiety from an 8 to a 6 or 7. Since she was able to reduce her level of anxiety, she was able to continue to finish her shopping and did not have to leave the store immediately.

    3. One of the indicators that the in vivo exposure technique was effective for her was that she was proud of herself for being able to continue shopping and not leaving when she did experience high levels of anxiety. Another indicator was that she had a couple of negative automatic thoughts that were not validated during this shopping trip which she discussed with Dr. V. In addition, at the end of the video she stated that she was closer to getting her life back.

    Reply

    • Erin Wilbur
      Mar 29, 2020 @ 13:35:29

      Hi Monica,
      Your event being altered due to COVID-19 sounds similar to what happened with my too, and why my worst-case scenario was so overwhelming for me. Although our negative automatic thoughts weren’t completely modified, it’s still important that we are self-aware and know that if this outcome weren’t due to coronavirus, our automatic thoughts may have been easier to modify. By recognizing this, at least we are aware that things are out of our control and this is a better alternative than becoming sick. It can definitely be more difficult to accept the realistic scenario when things are completely out of our hands. Thanks for reminding me to look at the positives!

      Reply

    • Melanie Sergel
      Mar 30, 2020 @ 19:35:37

      Hi Monica! For the Decatastrophizing Worksheet I had also found it very helpful to think about the worst case scenario first and then progress to the best scenario. If I was to do it the other way, I would probably not of had the responses that I did by working from worst to best. I’m happy to hear that assessing the probability of each scenario helped you modify your negative automatic thoughts. It had also helped me modify mine. I also was able to develop alternative thoughts from this technique because I was able to think more realistically and it sounds like that happened to you also. Great job!

      Reply

    • Mariah Fraser
      Apr 01, 2020 @ 23:29:35

      Hi, Monica!

      I liked how you said if you had done the best case scenario first, then the answers to the questions about best case and realistic case would likely have been weaker arguments because they wouldn’t have been as accurate. I agree, I think that talking about worst case first, and then comparing that with best case and realistic case scenario provides stronger evidence that may bring the client to ease. Also, it’s helpful because the therapist knows what direction to go in when asking about evidence that supports best/realistic case, or contradicts fears about worst case. This seems to be similar to what we’re learning in our addictions course — asking the client for reasons to use, and then reasons not to use, and in that order so that the therapist gains information that is useful in the counter-argument.

      Reply

  3. Melanie Sergel
    Mar 28, 2020 @ 16:59:49

    Anxious Patterns Record
    (1) After completing the Anxious Patterns Record, I was able to get a clearer picture of the relationship between the triggering event, negative automatic thought, and physiological response. I saw that my thoughts were very similar across the triggering events, which I haven’t noticed before.

    (2) Depending on the triggering event, my anxiety related behaviors consisted of separating myself from the situation that provoked my triggering event for a couple minutes so that I could gather myself together and to help calm myself down. Other times, I did the opposite where I was quick to get worked up and became emotional or angry. There were also times where I would just become silent and not talk to anyone.

    (3) These behaviors and the outcome were reinforcing my thoughts and physiological response because in some cases I was not doing anything to fix my anxious feeling. By not doing anything about it, I was reinforcing the thoughts and physiological response because my thoughts just continued which then continued my physiological response. There was one time where I did not avoid the triggering event and halfway through the event, I said to myself “I don’t know why I was so anxious about this” and it worked out in the end. This did not reinforce my thoughts or physiological response that I was having and instead switched to positive thoughts.

    PDA-9
    (1) I think it was helpful starting with the worst-case scenario and then ending with the most realistic scenario. By starting with the worst-case scenario, I was then only able to work myself up to the best. It did not give me any room to consider other worse scenarios that could occur. It helped me focus on more realistic scenarios.

    (2) Assessing the probability for each scenario did help provide supportive “data” to help modify my negative automatic thought. By doing this it really pointed out that my negative automatic thought was invalid. By processing how invalid it was it helped me move towards seeing a realistic scenario and what a best scenario could be. Although the probability for the best scenario was not as high it was still higher than the worst probability for the worst scenario. Therefore, both realistic and best were still higher probabilities than the worst was.

    (3) This technique helped provide enough “convincing” information to develop an alternative thought. It helped show me that the probability of the worst scenario happening was very unlikely, which was the first thing that helped me move towards developing an alternative thought. Thinking of realistic scenarios is helpful in developing alternative thought because it puts your thought into another perspective.

    PDA-11
    (1) When the client was in the produce section, she felt very anxious. The most helpful technique to reduce her anxiety was relaxation by diaphragm breathing. The client paused for a couple minutes and took some deep breaths to help with what she was feeling and thinking. After the second time she did it she felt that her anxiety was lowered a little bit and that she felt like it was not increasing.

    (2) When the client was having a panic attack in the aisle, it was therapeutically beneficial for the client to try and “wait it out” for a few minutes rather than immediately leaving the grocery store. It was beneficial for her to do this because instead of running out of the grocery store, she was able to take time to use her breathing exercises she learned. By having her relax and breathe she was able to acknowledge that this was going to pass. If she was to run out of the store without trying these techniques, then she would not learn that these techniques can help her. After completing the breathing technique, she was able to think through that she has never had a heart attack before, and she is not going to have one now. She was also able to see that it is all in her head.

    (3) Some indicators after the in vivo exposure technique that showed that they were effective for the client was that at the end when she is out in the parking lot, she said “I can’t believe I just did that”. This shows that the client realizes that she did something that she never thought she could do, and she was able to complete her goal of going to the grocery store without leaving by using these techniques. The client also rated her anxiety level at a 3 which is significantly lower than what it was rated before. The client also recognized that she was able to overcome the maladaptive behaviors that she really wanted to do like running out of the store. Lastly, the client felt very proud of herself in the end and said that she thinks that she will be able to get her life back together, this is sign to the clinician that she even recognized the progress she made and effectiveness of the technique.

    By the way, loved the cameo appearance in the video.

    Reply

    • Monica K Teeven
      Mar 28, 2020 @ 18:16:53

      Hey Mel! Great job on ur post! I wanted to mention a couple of important factors that I did not discuss in my post, but you did in your responses to the PDA-11 questions. First, in your response to the second question about PDA-11, you stated that using the diaphragm breathing technique helped Lindsey lower her anxiety level enough to continue shopping during a situation that she perceived as distressful. By using this relaxation technique instead of just leaving the store when she became anxious, it showed Lindsey that this technique helps her be able to finish her task even when she does experience anxiety. In your response to the third question from the PDA-11 video, you made a point to state that Lindsey rated her anxiety level in the parking lot after she finished her shopping at a 3. This information is important because when she was having high levels of anxiety in the store it was rated as an 8, then at a 6 or a 7 after she used the diaphragm breathing technique, and then to a 3 in the parking lot at the end. Seeing the levels decrease over time, helps to show both Lindsey and Dr. V, how successful this in vivo exposure was.

      Reply

    • Jessica Costello
      Mar 29, 2020 @ 14:20:19

      Hey Mel! First let me say that I’m glad you were able to get a clearer picture of the relationship between your thoughts, emotions, and physical responses and the recognition that you experienced similar thought patterns across different events. It’s good you were able to switch to more positive thoughts!

      You noted that the best-case scenario and realistic scenario were more likely than worst for your particular automatic thought. Noting the actual probability of the worst case scenario would be a good strategy to use with clients as they work on decatastrophizing their own thinking patterns.

      You also noted that the client in the video was able to practice her breathing in the aisle when she was having a panic attack. I agree that having this experience will probably increase her ability in the future to go into feared situations believing that she will be able to succeed. Good work on your post, Mel!

      Reply

    • Shelby Piekarczyk
      Mar 29, 2020 @ 16:45:10

      Hi Mel,

      I agree that the anxious patterns record helped me to see how triggering situations impacted my negative automatic thoughts and physiological arousal. I also like how you wrote that your response was different depending on what triggering situation you found yourself in. I agree with this because different situations provoke different automatic thoughts and behaviors for myself as well. Seeing how all of these factors correlated together gave me a better insight on how I handle certain situations. Great job!

      Reply

  4. Melanie Sergel
    Mar 28, 2020 @ 17:01:46

    Anxious Patterns Record
    (1) After completing the Anxious Patterns Record, I was able to get a clearer picture of the relationship between the triggering event, negative automatic thought, and physiological response. I saw that my thoughts were very similar across the triggering events, which I haven’t noticed before.

    (2) Depending on the triggering event, my anxiety related behaviors consisted of separating myself from the situation that provoked my triggering event for a couple minutes so that I could gather myself together and to help calm myself down. Other times, I did the opposite where I was quick to get worked up and became emotional or angry. There were also times where I would just become silent and not talk to anyone.

    (3) These behaviors and the outcome were reinforcing my thoughts and physiological response because in some cases I was not doing anything to fix my anxious feeling. By not doing anything about it, I was reinforcing the thoughts and physiological response because my thoughts just continued which then continued my physiological response. There was one time where I did not avoid the triggering event and halfway through the event, I said to myself “I don’t know why I was so anxious about this” and it worked out in the end. This did not reinforce my thoughts or physiological response that I was having and instead switched to positive thoughts.

    PDA-9
    (1) I think it was helpful starting with the worst-case scenario and then ending with the most realistic scenario. By starting with the worst-case scenario, I was then only able to work myself up to the best. It did not give me any room to consider other worse scenarios that could occur. It helped me focus on more realistic scenarios.

    (2) Assessing the probability for each scenario did help provide supportive “data” to help modify my negative automatic thought. By doing this it really pointed out that my negative automatic thought was invalid. By processing how invalid it was it helped me move towards seeing a realistic scenario and what a best scenario could be. Although the probability for the best scenario was not as high it was still higher than the worst probability for the worst scenario. Therefore, both realistic and best were still higher probabilities than the worst was.

    (3) This technique helped provide enough “convincing” information to develop an alternative thought. It helped show me that the probability of the worst scenario happening was very unlikely, which was the first thing that helped me move towards developing an alternative thought. Thinking of realistic scenarios is helpful in developing alternative thought because it puts your thought into another perspective.

    PDA-11
    (1) When the client was in the produce section, she felt very anxious. The most helpful technique to reduce her anxiety was relaxation by diaphragm breathing. The client paused for a couple minutes and took some deep breaths to help with what she was feeling and thinking. After the second time she did it she felt that her anxiety was lowered a little bit and that she felt like it was not increasing.

    (2) When the client was having a panic attack in the aisle, it was therapeutically beneficial for the client to try and “wait it out” for a few minutes rather than immediately leaving the grocery store. It was beneficial for her to do this because instead of running out of the grocery store, she was able to take time to use her breathing exercises she learned. By having her relax and breathe she was able to acknowledge that this was going to pass. If she was to run out of the store without trying these techniques, then she would not learn that these techniques can help her. After completing the breathing technique, she was able to think through that she has never had a heart attack before, and she is not going to have one now. She was also able to see that it is all in her head.

    (3) Some indicators after the in vivo exposure technique that showed that they were effective for the client was that at the end when she is out in the parking lot, she said “I can’t believe I just did that”. This shows that the client realizes that she did something that she never thought she could do, and she was able to complete her goal of going to the grocery store without leaving. The client also rated her anxiety level at a 3 which is significantly lower than what it was rated before. The client also recognized that she was able to overcome the maladaptive behaviors that she really wanted to do like running out of the store. She was also able to recognize that she was not going to have a heart attack. Lastly, the client felt very proud of herself in the end and said that she thinks that she will be able to get her life back together, this is sign to the clinician that she even recognized the progress she made and effectiveness of the technique.

    By the way, loved the cameo appearance in the video.

    Reply

  5. Erin Wilbur
    Mar 29, 2020 @ 13:08:32

    Anxious Patterns
    1. Yes, I was able to get a clearer picture of the relation between the event, my negative automatic thoughts, and my body’s response to them. Filling out the anxious patterns record helped me to recognize these thoughts and sensations related to the event.
    2. When I felt myself becoming anxious, I stopped doing my work and just looked around the room for a few minutes before picking up my phone. I texted my friends about the event and then researched the news that I had gotten, sometimes going back to the same page more than once to read the information again.
    3. My behavior didn’t decrease my anxiety or the distress I was feeling because I continued to ruminate on the information and then repeated it by texting my friends, my boyfriend, and talking to my coworker about it. Because I was at work, I wasn’t able to “leave” the situation which helped me to calm myself a bit because I still needed to be professional. However, I kept thinking about it and continued to ruminate when I left work, which reinforced the physiological response I had tried to stop while I was at work.
    PDA-9
    1. It was helpful for me to start with the worst-case scenario and work my way to the best-case, because I had been imagining the worst-case all day and needed to think of other alternatives. This allowed me to write down the worst possible outcome, but then also generate other options that I knew could happen and just hadn’t been considering.
    2. Assessing the probability helped me to decide to act on the most realistic scenario because although I believed the worst-case, this forced me to recognize the realistic scenario as possible. It didn’t completely modify my negative thought because I still believed it pretty strongly, but assessing the probability of it happening did help me realize that the realistic scenario was doable, and I was catastrophizing the event rather than finding an alternative.
    3. This technique did help me develop an alternative thought, and helped me to start making a plan to avoid the worst-case scenario rather than refusing to accept any other option except the worst possible outcome.
    PDA-11
    1. The most helpful technique for reducing Lindsey’s anxiety was diaphragmatic breathing and reminding herself that these feelings will pass.
    2. In the aisle when Lindsey had a panic attack, it was beneficial for her to wait it out rather than immediately leaving the store because she was able to focus on her breathing and remind herself that the symptoms she was experiencing would pass, rather than reverting back to her maladaptive safety behavior which was to immediately leave the situation rather than facing it. This helped her recognize that these symptoms were just her anxiety and that she wasn’t having a heart attack and shouldn’t believe that she was. This showed her that the techniques she learned in therapy could help her and that she is capable of facing the triggering event and controlling her reaction to it.
    3. Indicators after the event that the exposure was effective for the client were that her anxiety was down to a 3, she recognized that she didn’t have a heart attack or run out of the store like she predicted she would, and that she admits she feels very proud of herself for completing the grocery store trip. You can also see in her body language that she is feeling much more relaxed, she’s smiling and standing comfortably rather than very rigid and playing with her hands like she was before she entered the grocery store. A big indicator is also that Lindsey says “I feel like I can finally get my life back”. This shows that she is confident in her ability to face triggering events and use her coping skills to get through them.

    Reply

    • Jessica Costello
      Mar 29, 2020 @ 13:39:01

      Hi Erin! Good job with your post! I’m glad you were able to realize the negative impacts rumination had on your emotions and physiological responses. In your response to #2, I agree with your observations that Lindsey was able to remind herself that her symptoms would pass and this helped her wait out the panic attack in the story instead of reverting back to her old safety behavior of leaving. I think this practice experiment strengthened her belief that she could deal with these distressing situations. You also made some good observations about her body language and physical state after her anxiety went down at the end of the video, which I didn’t immediately catch. Good work!

      Reply

    • Shelby Piekarczyk
      Mar 29, 2020 @ 16:40:21

      Hi Erin,

      I agree that starting with worse-case scenarios and ending with the most realistic scenarios is extremely beneficial. I also tend to dwell on a situation for the entire day (sometimes maybe longer) so seeing a more realistic scenario would ultimately help me to realize how invalid my thoughts might have been. I also like how you wrote that writing down the realistic scenario did not completely get rid of your negative automatic thought but rather helped you establish alternative thoughts and ways that situation could play out. I feel the same that although my negative automatic thoughts did not disappear, thinking of alternative thoughts helped me to see that how I was thinking about the specific situation is invalid and could be looked at in a different way. Great job!

      Reply

    • Mariah Fraser
      Apr 01, 2020 @ 23:29:04

      Hi, Erin!

      I can relate to your post about ruminating, as my behaviors and cognitions have been on the events that are happening these days. Although sometimes talking about it is helpful, and expanding knowledge can sometimes provide some relief, I have also found that that is not the case. I find myself talking about things I’ve read or what I’ve heard, or things I would have done differently, and so on. As much as I don’t like this pandemic contaminating every aspect of my life, I reinforce it by feeding into the frenzy.

      Reply

  6. Shelby Piekarczyk
    Mar 29, 2020 @ 16:34:40

    1. Yes, I was able to get a clear picture between the triggering events, negative automatic thoughts, and my physiological arousal. I felt a strong connection between the event and my negative automatic thought to it.

    2. My anxiety related behaviors were different depending on the triggering event I found myself in. I either would be able to talk myself down and not let the triggering situation make me upset or I would become angry/upset with the situation. When I would become angry or upset it would be very difficult for me to get out of my own head. Because of this I would retract from everyone and want to just be alone in my own thoughts.

    3. These behaviors would have a large impact on my thoughts and physiological response. When I would get angry or upset about the situation, my negative automatic thoughts would heighten. Because of this I would want to be alone or not talk to anyone, leaving this pit within my stomach. Each factor has as large impact on one another.
    PDA-9
    1. Yes, I think it was helpful starting with the worse-case scenario and ending with the best-case scenario. At times I tend to think of the worst-case scenarios, even if they are not realistic. Ending with the most realistic situation helped me to see how invalid my thoughts can be about a certain situation. It also helped me see the vast difference between the worse-case scenario and the best-case scenario.

    2. Yes, assessing the probability did provide support ‘data’ for myself and these thoughts. When looking at the data it really showed me how invalid my thoughts are and how unrealistic some of the situations are. It also helped me to see that even though the most realistic situation may not have the most probability, it still proved to have more probability than the worst-case scenario. This data helped me to see how invalid my thoughts can ultimately be about a situation.

    3. Yes, this technique helped me develop an alternative thought. Using this technique, it opened my eyes to how invalid the worst-case scenario thought was and helped direct me towards a more appropriate thought. This technique also helped me view other scenarios that I was not thinking about before, leading me to an alternative thought about the situation.

    PDA-11
    1. When in the produce section the most helpful technique for the client was diaphragm breathing. After doing this twice she noticed that her anxiety symptoms were starting to decrease, and she was able to remind herself that this will pass and that she is okay.

    2. When the client was having a panic attack it was therapeutically beneficial for her to ‘wait it out’ because it showed her that these techniques, she had learned will help her during these situations. By staying in the grocery store she was able to use her breathing techniques and see that these helped her in the grocery store. The breathing techniques also showed her that her anxiety symptoms will pass and that she is not having a heart attack. If she had immediately ran out of the grocery store, she would have not seen how these tools can help her adaptively cope with her anxiety.

    3. Some indicators that the vivo experiment worked for the client was first, whenever she became anxious in the store, she could successfully calm herself down, ultimately completing her grocery shop. Another way you can see how the vivo experiment worked was the client’s reaction once they were out of the store. She was proud of herself and could not believe she accomplished this task. Lastly, after the experiment she was prepared and ready to start taking the next steps (e.g. going to the grocery store and having her husband stay in the car).

    Reply

    • Robert Salvucci
      Mar 31, 2020 @ 12:36:29

      Hey Shelby!

      It’s interesting how we tend to want to be alone and avoid people when we get anxious. I’ve noticed I have a tendency to do that with my Dad and Sister when I get home from a particularly stressful day at work or when I feel rushed. Usually this actually makes me feel more anxious and guilty, whereas engaging with people usually make me feel more open and calm. You mentioned how many of these thoughts can have a snowball effect and self-perpetuate, especially when we isolate and procrastinate. While doing some of these exercises, formally or in my head, I also noticed myself seeing how I could view other situations that I wasn’t even considering at the time.

      Reply

  7. Jenna Nikolopoulos
    Mar 29, 2020 @ 19:32:24

    Anxious Patterns Record

    1. Yes, I was able to get a clearer picture of the relationship between the triggering event, negative automatic thought, and physiological response. I was able to see the relationship sequentially as the event triggered my negative automatic thought, which then triggered my response.

    2. I started to ruminate on the event and think of the worst-case scenario. These behaviors started to affect my mood as I began to get upset over what I was thinking, which led me to distance myself from others because I wanted to be alone.

    3. Ruminating on what happened only increased my negative automatic thoughts, which lead to thinking of the worst-case scenario, which only reinforced my anxiety because I wasn’t doing anything productive to calm myself down. As I continued to ruminate, it reinforced my thoughts and physiological response even more because I not only became more anxious, but also became upset in general, which lead me to distance myself from others to be alone. By not doing anything and just letting myself become more anxious, I was reinforcing my thoughts and physiological response because it enabled the continuation of my negative thoughts, which caused the continuation of my response.

    PDA-9

    1. I think it was helpful starting with the worst-case scenario and ending with the most realistic scenario because I tend to immediately think of the worst-case scenario, which doesn’t allow me to recognize alternatives. By ending with the most realistic scenario, I was able to see how invalid my thoughts were surrounding the situation and how unrealistic my worst-case scenario was.

    2. Assessing the probability for each scenario did provide supportive “data” to help modify my negative automatic thought. It allowed me to visually compare the likelihood of each scenario happening, which helped me realize that my negative automatic thought is invalid and unrealistic. Because of this, I was able to look at the most realistic and best-case scenario in a more positive light, which made me feel better about my initial thought. Even though the probabilities for the most realistic and best-case scenarios weren’t very high, since they were higher than my worst-case scenario, it helped me realize that there is a greater likelihood of these two scenarios happening over the worst-case scenario.

    3. This technique did provide enough “convincing” information to develop an alternative thought because once I was able to see how unrealistic my worst-case scenario was I was able to view the situation in a new perspective. This new perspective allowed me to form an alternative thought that was more realistic and more positive compared to my initial negative automatic thought.

    PDA-11

    1. The most helpful technique to reduce her anxiety was diaphragm breathing. She became more anxious in the produce section and noticing a lot of people in the store didn’t help her anxiety. Once she began to take a few slow breaths it seemed to help reduce her anxiety enough to continue shopping.

    2. It was therapeutically beneficial for her to try and “wait it out” rather than immediately leave the grocery store because it allowed her to see how effective the techniques are in lowering her anxiety. By taking the time to do her breathing, she was able to see that she could gain control over her anxiety and acknowledge that what she was feeling was going to pass and not result in a heart attack. The longer she waited in the aisle, the more control she gained over what she was feeling and felt able to finish her shopping. If she had left immediately, this would have reinforced her anxiety because she would be engaging in the same maladaptive behaviors. Waiting it out in the aisle helped her realize that she can be in a grocery without having a panic attack.

    3. One indicator is that her anxiety level after leaving the grocery store was a 3 when it was originally a 6 or 7 before going inside. Another indicator is that she realizes that she didn’t have a panic attack when she predicted in the beginning that she would have a heart attack. Even though she really wanted to run out of the store, she didn’t, which made her feel really proud of herself for not only being able to go into the grocery store, but also stay and finish shopping even when her anxiety increased. Lastly, she said “I feel like I can finally get my life back”. This shows that the technique helped her recognize the progress that she has been making in therapy, which gives her more confidence in her ability to confront situations that trigger her anxiety and use the coping skills she has learned to effectively get through them.

    Reply

    • Renee Gaumond
      Mar 30, 2020 @ 14:11:29

      Hi Jenna,
      I relate with you when you said that ruminating only increased the negative thoughts that lead to thinking about the worst case scenario. Ruminating just seems to make people catastrophize events. Overthinking about the events bring up more and more negative thoughts, which eventually spiral downward. The spiraling allows for anxiety about the worst case scenarios and the constant rumination about them can lead to those scenarios appearing to be realistic.

      Reply

    • Melanie Sergel
      Mar 30, 2020 @ 19:45:18

      Hi Jenna! I’m glad that the anxious patterns record helped you get a clearer picture of the relationship between the triggering event, negative automatic thought, and physiological response. I had also found myself ruminating and distancing myself from others during certain anxious triggers. I like that you were able to notice that the ruminating reinforced the thoughts. When I was ruminating, I also noticed that I was not doing anything to fix the problem because I was too focused on thinking about the worst-case scenario. Good job on your post!

      Reply

  8. Taylor O'Rourke
    Mar 29, 2020 @ 20:48:16

    1. Were you able to get a clearer picture of the relationship between the triggering event, negative automatic thought, and physiological response? (Anxious Patterns Record)

    Yes, I was able to get a clearer picture of the relationship amongst these things.
    Seeing everything laid out as they flow from one to the next made it much easier to determine where I could intervene in the future to prevent maladaptive outcomes. I filled out the worksheet retrospectively, so it made it a little more difficult than if I had filled it out in the moment, but I was still able to get quite a clear picture by doing this worksheet. It gave me a lot of insight into how I may be able to respond if this situation were to happen again.

    2. What were your anxiety related behaviors?

    My anxiety related behaviors included racing heart, heavy breathing, and feel
    clammy/sweaty. The anxiety responses included doing some deep, slow breathing, positive self-talk, and laying/sitting down to try to relax. Doing anything to keep myself distracted from my anxieties was helpful.

    3. How were these behaviors and the outcome reinforcing your thoughts and physiological response?

    These behaviors and the outcome reinforced my thoughts and physiological
    response because the more I partook in a certain behavior, the more I would feel it physiologically and the more my thoughts would continue to race from one thing to the next. Although my outcome was that I should not be worrying and maybe I got myself worked up over nothing, it was still very real to me in the moment.

    4. Was it helpful starting with the worst-case scenario and ending with the most realistic scenario? (PDA-9 and Decatastrophizing Worksheet)

    I think it was helpful to start with the worst-case scenario because as I was filling
    things out on the worksheet, they became more positive and adaptive over time. I think working from worst to best would cause too many false hopes for the client, so working from worst, to best, to most realistic is most beneficial. This helped me see that the chances of something being truly as bad as what I had thought it would be is highly unlikely. On the other hand, chances are it would not work out perfectly like the best-case scenario. That is why ending in the middle with the most realistic box is beneficial. It gets all of the negatives and unrealistic, maladaptive thoughts out of the way first.

    5. Did assessing the probability for each scenario provide supportive “data” to help modify your negative automatic thought?

    Assessing the probability for each scenario did provide supportive data to help
    me modify my negative automatic thought. It helped me realize that the scenarios I was imagining based on my negative automatic thought were either more or less likely to occur than what I was truly thinking about. I think this is a great way to help clients notice that there is not much truth to their though (in most cases) and they should just focus on what is realistic.

    6. Did this technique provide enough “convincing” information to develop an alternative thought?

    This technique did provide enough convincing information to help me develop
    an alternative thought. This really came to me when I went through the section on how to cope with what I was thinking. The question that really stood out to me as important was what could work/was worth trying. I think this is very important because when we get stuck in our negative automatic thoughts, it is so difficult to focus on anything positive. However, there is oftentimes many different positive things we could do to help ourselves for next time this happens, and I think this question really tackles that well. By realizing how else I could cope with this thought, it inspired me to come up with a totally new, alternative thought instead.

    7. When the client was in the produce section, what was the most helpful technique to reduce her anxiety? (PDA-11 and PDA-10)

    The most helpful technique to reduce her anxiety was to be reminded of the
    coping skills she has worked on like slowing down her thoughts and working on her breathing. She was also reassured that these feelings are normal and they will pass. Just because she is thinking these things does not mean that they will necessarily happen. This helped her anxiety stay the same and not increase. She keeps doing the breathing exercises to help her be able to continue shopping.

    8. When having a panic attack in the aisle, how was it therapeutically beneficial for the client to try and “wait it out” for a few minutes rather than immediately leaving the grocery store?

    It was therapeutically beneficial for the client to try and wait it out for a few
    minutes because it counteracts the avoidant behavior. This also helps remind her that these symptoms and feelings will pass, they cannot last longer than about 10-15 minutes and she has never actually had a heart attack before. This helps ground her a bit and she feels better and okay to continue. This allows her to get past the hurdle of wanting to leave because now she feels just uncomfortable, and not that she wants to leave. She reminds herself that everything is in her head and she feels okay.

    9. What are some indicators after the in vivo exposure technique that it was effective for the client?

    Some indicators after the in vivo exposure that it was effective for the client are
    that the client feels a lot less anxiety than she did before entering the grocery store and she is very happy with herself that she was able to do it. She thought she would have a panic attack and never thought she could get through it, but she did without having to run out of the store or having a panic or heart attack. She had strong anxious and physiological symptoms that triggered some thoughts, but she was calm enough to wait it out for a few minutes which allowed her to continue shopping. She feels that she is getting her life back and knows only a few more sessions will occur. She will begin to start trying some of these exposures on her own with her husband outside or her coming by herself altogether.

    Reply

    • Renee Gaumond
      Mar 30, 2020 @ 14:21:11

      Hi Taylor,
      I agree that seeing everything laid out made it easier to find ways to intervene in the future. Seeing it clearly written out was helpful to see the relationship of the events, the negative thoughts, and then the outcomes. I also agree that filling out the worksheet in the moment is more effective than after the fact. When I did it after the fact, I was able to reflect and see where the thoughts took me, though when I did the exercise during the moment it allowed me to guide myself to a preferable outcome.

      Reply

    • Jenna Nikolopoulos
      Mar 31, 2020 @ 12:57:54

      Hi Taylor! I really liked your thought on the Decatastrophizing Worksheet about the question “what could work/worth trying”. When I have one negative automatic thought, it eventually leads to more, causing a cycle of negative thoughts in my head, which makes it very hard to look beyond them to try and see the situation from a positive perspective to generate positive thoughts that counteract those negative thoughts. But I think utilizing this question could be very helpful in these situations because it makes you take a step back from the situation to try and see it from a different perspective. Like you said, there is usually many different positive things that we can do to help ourselves, but being stuck in a negative mindset only causes us to focus on the negative. I think using this question can help people look for the positives in the situation and find alternative ways to help them cope with what they are feeling. I’m glad using this question was able to help you cope and generate an alternative thought!

      Reply

  9. Ashley Foster
    Mar 30, 2020 @ 13:22:40

    Behavioral Exposure

    1. After completing the anxious pattern record, I did find it easier to see the correlations of what was going on. Being able to write it down rather than rationalize the processes in my head, I found that it was a more concrete examination to explore for insight.

    2. As one of the biggest areas I struggle with is anxiety, I had many behavioral responses. These responses depend upon what triggers the anxiety or the response that I have recognized. I also realized I have both adaptive and maladaptive coping strategies associated with dealing with these anxieties. Overall, the big behaviors I noticed was avoidance and reinsurance I searched for in those times.

    3. These behaviors reinforced my negative automatic thoughts which lead to more maladaptive physiological responses. I could feel my anxiety rising as I did this assignment and looking over certain events and thoughts associated with them.

    PDA-9

    1. It was helpful in examining the worst- and best-case scenarios those opposite were easiest in coming up with realistic scenarios. I used the scenario of the anxious thoughts of the consequences of the corona virus and finishing my degree not having day care.

    2. Assessing the probability was helpful in challenging any irrational, emotional thoughts associated with this anxious thought.

    3. These techniques helped in breaking down the anxious thought for modification in the thought and building new alternatives for adaptive thoughts.

    PDA-11

    1. Using techniques such as deep breathing was extremely helpful and effective for the client to work through her panic. As it decreased the intensity of her symptoms, it also increases her motivation in herself to empower herself to move forward within the “session” even though she was still enduring symptoms.

    2. The client was able to find and use coping skills while having a panic attack in the aisle and was able to lessen the distress she was in and was able to finish her “session”. This empowering to the client that she was able to decrease her symptoms of panic. This is also beneficial to her as she can take this experience and use this “sitting with it” technique to work through her symptoms rather than avoiding/ running away from them.

    3. Some indicators that the vivo exposure was effective in the client involved in thoughts and behavioral express emotions. The client after the exposure was in disbelief that she was able to complete her “session” and proud of herself. She had a smile on her face, and she seemed more relaxed as she recapped with her therapist.

    Reply

  10. Renee Gaumond
    Mar 30, 2020 @ 13:56:15

    (1)
    The anxious patterns record did help me see a relationship between the triggering event, negative automatic thought, and physiological response. Usually the triggering event was a social interaction that triggered thoughts of awkwardness or incompetence.
    (2)
    My anxiety behaviors were staying quiet or social isolation. If the triggering event happened at work, I would refrain from talking during the conversation and afterward, I would avoid the person.
    (3)
    They reinforced my thoughts and physiological response because I would avoid situations and once when I would, I would feel a bit better that I removed myself from the situation. My response would also reinforce my core belief of being incompetent because I would try to fix whatever I was being criticized for and once I finished, I would avoid the person who criticized me. I feel like when I do this, it reinforces that what I did was incompetent enough that I had to fix it and then by avoiding further interactions with the co-worker, it would reinforce my social isolation.
    (1)
    It was helpful staring with the worst case scenario and ending with the most realistic scenario. I felt this way because the worst-case scenario is usually what I spend most time ruminating about, so getting those thoughts out first was helpful. Then ending with the most realistic scenario helped me focus more on since it was the last thing I focused on, making it the thing I spend more time thinking about afterward.
    (2)
    Assessing the probability for each scenario did provide supportive “data” to help modify my negative automatic thought. It helped me think about it as very unlikely to happen so I shouldn’t spend so much energy worrying about the worst case scenario.
    (3)
    It provided me convincing information to develop an alternative thought, though I still held onto the negative thought a little bit because it was in reference to a negative core belief. It did help in the moment though and helped me decide if there was any real validity to the thought to begin with.
    (1)
    The most helpful technique that Lindsey used to decrease her physiological responses was deep breathing.
    (2)
    It’s therapeutically beneficial for Lindsey to try and wait out the panic attack in the grocery store instead of leaving it in order to not continue to reinforce her avoidance behavior. Having Lindsey wait out her panic attack was beneficial so she can learn that she’s able to continue to shop without having to leave the store. It also helps her learn that she has control over her thoughts and feelings and can use techniques like deep breathing to alleviate her anxiety.
    (3)
    An indicator that the in vivo exposure technique was effective for her was that she was able to work through her panic attack without having to leave the grocery store. Another indicator was that she expressed that she was proud of herself for not leaving the store. She was able to take control over her anxiety attack by using deep breathing and was able to finish her shopping without leaving.

    Reply

  11. Robert Salvucci
    Mar 30, 2020 @ 14:10:10

    Anxious Patterns Record

    1. This exercise helped me get a more clear picture of the role uncertainty plays in relation to anxiety and automatic thoughts. When I don’t have a plan or a certain outcome in my mind, sometimes my brain will “fill in the gaps” as we talk about with Mark. When a series of catastrophic events come through my mind, this can create an artificial sense of urgency.

    2. When my willpower is low or anxiety is high, I tend to use music or browsing through my phone as means to distract myself from the anxiety. Sometimes these can briefly be useful, but these behaviors become problematic when I spend an extended period of time procrastinating or avoiding a responsibility as a result of avoidant or safety behavior.

    3. I think that reacting to triggering events and associated negative thoughts by engaging in avoidant behaviors can create a sense that the triggering event or stimuli is indeed something to be avoided, or that the associated anxiety is intolerable enough to warrant procrastination. This is why exposure and task persistence can be so important in managing anxiety. Also, if I’m anxious and repeatedly engage in avoidant behavior and procrastinate, my anxiety and self esteem slowly get worse as I fall behind on my responsibilities and see myself being inefficient.

    Decatastrophising

    1. I did find it helpful, As doing so helped me see my interpretation of my thoughts move from a more emotional place to a more reasoned and rational place. I was able to more clearly see how reframing or placing a thought in context affected my mood and sense of confidence or control over the situation. It also gave me the sense that I was progressing towards something.

    2. Seeing things in terms of probability served again to provide me with more of a sense of control, as well as an acceptance of uncertainty. I began to think more about how a range of terrible things could happen at any given moment, but all of them are incredibly unlikely. The framework was useful for the particular situation, and I think more generally practicing decastrophizing has made me feel more at peace with what I can’t control and able to focus more on what I can.

    3. This was definitely the case. I started seeing my worst case scenario examples as unhelpful given both their low probability and domain outside of my control. I noticed a sense of distance from the thought, feeling that it was silly, and also noticed other thoughts that stemmed from the original thought. Working on one scenario in particular carried over to related scenarios.

    In Vivo Exposure

    1. Lindsay was most helped by using deep breathing. She also seemed to respond well to Dr. V pointing out that it’s okay to be anxious, helping her have some acceptance of the discomfort she was feeling and willingness to persevere despite being anxious.

    2. Waiting out the panic symptoms helped Lindsay in a few ways. It brought her confidence up in the whole process of managing her anxiety. She noted that she felt proud of herself and that she is able to get her life back. It allowed her to practice restructuring and breathing techniques in the anxiety inducing situation. It also provided her with evidence that, even though she is anxious, she is still able to shop and that she won’t have a heart attack.

    3. Lindsay noted that her anxiety dropped down to a 3 afterwards, and that she felt confident and proud of herself. She noted that she feels like she can start getting her life back and was eager to continue with techniques. The shopping trip ended up being succesful

    Reply

    • Jenna Nikolopoulos
      Mar 31, 2020 @ 13:18:55

      Hi Bobby! I totally agree with your thought about uncertainty and how it relates to anxiety and automatic thoughts. I also tend to “fill in the gaps” when I don’t have all the pieces needed to rationally think through a situation. Especially when my mind goes to the worst-case scenario, I tend to fill in the gaps in a negative way because since I’m already catastrophizing the situation, my anxiety tends to fill those gaps with information that supports my worst-case scenario, which only increases my anxiety. I also agree with your thoughts on reacting to triggering events and related negative thoughts. I think by engaging in avoidant behaviors to these events and thoughts is what causes one to develop the avoidance patterns because it’s easier to just avoid the triggering event and related thoughts than to face them in the moment. The more avoidance is used to deal with one’s anxiety related to these events and thoughts, the more one will internalize that the only way to deal with their anxiety is to continue to engage in these avoidance behaviors.

      Reply

    • Madison Armstrong
      Mar 31, 2020 @ 13:24:46

      Hi Bobby,
      I also found the decatastrophizing worksheet to be a helpful tool to better understand my thoughts and emotions and shift them to a more rational place. My anxiety definitely led me to have a strong believability in the worst-case scenario outcome but looking at the best and realistic scenarios help me see that the probability of my “biggest fear” was not very likely to occur. I like how you mentioned that some things are just out of your control, that also resonates with me and it would be helpful to remind ourselves (and even some clients) of this often. I also felt very silly looking back at my original thought and it amazes me how powerful our negative automatic thoughts can be.

      Reply

    • Ashley Foster
      Apr 01, 2020 @ 20:02:27

      Hey Bobby!
      I like how you explain this how this assignment fills in the gaps who were looking at automatic thoughts in the relation to anxiety. When I was doing this assignment, I found that it would look at the thoughts I was having, And I was able to go back and see what I was missing rather than trying to do it in my head. I also think it’s helpful for in the moment breaking up that catastrophic thinking and putting it more in a gray matter thinking area. This way anxiety can be broken down the distress and better help the client at hand. It also opens the client’s eyes to taking a moment and reorganize thinking and putting it out on paper which can decrease the symptoms of anxiety as well. Great job with the posts!

      Reply

  12. Madison Armstrong
    Mar 30, 2020 @ 16:54:33

    [Behavioral Exposure]
    (1) I was able to get a clearer picture of the relationship between the triggering event, negative automatic thought and physiological response. Although, I was already somewhat aware of how these relate to one another, writing it down allowed me to make a clearer connection on how my anxious patterns impact my thoughts, behaviors and emotions.
    (2) My anxiety related behavior in this situation was total avoidance. Instead of facing the situation and using coping strategies to get through it, I allowed my negative automatic thoughts to talk me out of it. After this exercise I realized how my avoidance contributes to my negative automatic thoughts and how important it would be to implement some form of exposure to learn to cope with the negative automatic thoughts better.
    (3) Because my behavior was total avoidance of the situation, I never fully exposed myself to the full physiological response. The avoidance was reinforcing to both my thoughts and physiological response because my thoughts included being satisfied with the fact that I did not allow myself to feel the full physiological response. However, there was an undertone of disappointment in not being able to allow myself the exposure that I know I need to overcome this.
    [Behavioral Exposure] – Watch PDA-9
    (1) I did find it helpful to start with the worst-case scenario because this what I would to expect to happen even if it is very unlikely. Looking at the best-case scenario allowed me to see that the expectations I have for myself are too high and also unlikely to occur exactly how I desire them to. Ending with the more realistic scenario I was able to see that this would be what is most likely to occur, and it allowed this scenario to be fresher in my head and help ease the anxiety I was feeling previously from thinking about the worst-case scenario.
    (2) Assessing the probability of each scenario allowed me to see that the likelihood of the worst-case scenario is not what I make it out to be in my head. I often think that the worst-case scenario is a guarantee, but this allowed me to see that there are other outcomes than what I expected. The realistic scenario allowed me to become more aware that this is the more probable outcome and I should really set my expectation to this. I think that this exercise did help me gather supportive “data” to help modify my negative automatic thought and I am curious to see how this works for me the next time I am experiencing anxiety.
    (3)This technique did allow me to come up with an alternative thought, but it is hard to tell how convincing this new thought will be when I experience an anxiety response as I still feel a level of believability toward my negative automatic thought in the moment even though it is not believable otherwise.
    [Behavioral Exposure – Watch PDA-11
    (1) The most helpful technique to reduce her anxiety in the produce isle was her taking a moment to pause while doing some deep breathing techniques. Also Dr. V reminding her that her fight or flight response was a normal experience also seemed to help her.
    (2) It was therapeutically beneficial for the client to try and wait it out instead of immediately leaving because when she is by herself and she experiences the start of a panic attack she would immediately leave. It is helpful for her to try to wait it out to see that the outcome of having a hard attack is unlikely and would not occur. I would assume that the ultimate goal would be for her to be able to go to the grocery store by herself, so it is important for her to experience those symptoms and learn to cope with them in the moment instead of engaging in her safety behavior. She was able to learn that it is all in her head and that she has never had a heart attack before and likely will not have one now.
    (3) An indicator that shows that this was an effective technique for the client was when she said, “I can’t believe I just did that”. This shows that she was able to prove her initial prediction wrong that she was going to run out of the store and shows that she is feeling accomplished she was able to do this. Another indicator would be that she said, “I feel like I can get my life back”. This shows that she believes that this will work for her and she will be able to face this situation again and work through it in the future.

    Reply

    • Ashley Foster
      Apr 01, 2020 @ 20:07:21

      Hi Madi!
      I agree that it was therapeutic for the client to stay in the store and sit with her panic. Sitting with her Symptoms gave her the opportunity to problem solved and ultimately finish her session and her goal of finishing her grocery shopping. Although the main goal is to have her go alone and not have as much distress while doing this, she was able to use techniques like deep breathing to make it through the store. I think this is important as these individuals need to be challenged in their fear of exposure. Challenging this fear will give the client the sense of hope of overcoming the challenges of panic they experience. This also prepares the client to get to a spot where they can go and deal with their panic symptoms alone which is our ultimate goal as clinicians. Great job with the post!

      Reply

  13. Mariah Fraser
    Mar 30, 2020 @ 21:33:32

    Anxious Patterns Record

    I found that it was definitely helpful to fill out the anxious patterns record because I better understood how the triggering event, my negative automatic thought, and physiological response all related to one another.

    As a way to reduce my anxious feelings, I have the tendency to call or FaceTime my friends and talk with them about the situation. I look for reassurance or guidance, thinking that I will be told something that had never occurred to me before (which is rarely the case) or that afterwards I will feel relieved (another rare occasion). Sometimes, if that doesn’t work, or if everyone is too busy, I will engage in escaping behaviors, such as watching TV or going on social media, thinking that these are good sources of distraction.

    These behaviors were not at all helpful, although I already had this knowledge, but they are more from habit than from being effective in the past. If anything, I continued to swirl through those negative automatic thoughts and the physiological responses did not fade away because I just sat there thinking how much that FaceTime made it worse, and the TV/my phone wasn’t entertaining enough to take my mind off anything. Had I done something else to try to reduce the anxiety (socratic techniques/journaling), I probably would have felt a little better.

    Modifying Anxious Thoughts

    My opinion is that doing worst case scenario first is better because it gives the therapist information regarding the associated negative automatic thoughts, so that when the best case scenario is discussed, there is more evidence to counteract the feared worst case. Then, the client is given the opportunity to determine the happy-medium point, one that is likely to be somewhere in the middle of worst and best case. There is something beneficial and insightful in assessing the most extreme versions of the outcome, because it provides more of a rationale behind why the worst case is unlikely to happen.

    As I mentioned previously, looking at both extremes does provide data to the client and the therapist that is important when taking the step toward modifying the negative automatic thought.

    This technique is helpful because it helps the client to realize how unrealistic, far-fetched, and probably silly the negative automatic thought is. It also helps the client to realize that there is no value in believing these negative extremes, as it only perpetuates distress.

    In Vivo Exposure

    Deep breathing seemed to be the first important step in reducing her anxiety. Once she started practicing her deep breathing, she was encouraged to wait out her physiological symptoms and to calm her thinking a bit. After she was able to use this technique for a couple of minutes, she stated that her level of anxiety had gone down.

    It was helpful for her to wait out her panic attack because she was able to come to the realization that she was having a heart attack, by looking at the evidence (or lack thereof) of her history of heart attacks. Waiting it out helped to deter the client from engaging in her typical safety behaviors (running out of the store to her husband). She was able to remind herself that these symptoms would pass and she agreed to wait a minute or two, as she kept practicing deep breathing. This proved to the client that she is capable of riding out these situations, and that hopefully with more practice, she will be able to walk herself through a panic attack in the future.

    The client was very proud of herself for staying in the store and completing her grocery list. She kept saying how she couldn’t believe she had done it. The client was able to talk about her negative automatic thoughts, and with the help of the therapist, she came to the conclusion that these thoughts were not accurate, and if anything they were disproved.

    Reply

    • Madison Armstrong
      Mar 31, 2020 @ 13:10:22

      Hi Mariah,
      I also find myself engaging in escaping behaviors such as watching TV or scrolling through social media to avoid my anxious feelings. I think that it is important to recognize that these distractions are often things that our clients will engage in as well. This is helpful to be aware of because as the therapist you can target these areas with clients and encourage them to use more effective anxiety reducing coping skills, like you mentioned, either journaling or a Socratic technique.

      Reply

  14. Tim Keir
    Mar 30, 2020 @ 23:35:41

    1. Were you able to get a clearer picture of the relationship between the triggering event, negative automatic thought, and physiological response?

    Absolutely! In reality it feels like the anxiety response occurs practically spontaneously. Recognizing the antecedent of the automatic thought makes the physiological response more recognizable, and thus explains the anxiety response. While in the moment the actions seem to come from nowhere, their purpose becomes clear when the physiological response to them is considered.

    2. What were your anxiety related behaviors?

    Fear of assignments and failure is my name, and intense procrastination is my game. Specifically, I browsed the internet and played video games instead of confronting an ill-defined set of tasks before me.

    3. How were these behaviors and outcome reinforcing your thoughts and physiological response?

    Well, it is way easier to ignore your laundry list of chores when you simply don’t think about them in any capacity. The rapid pulse and constriction in the chest also eased during such times as well. The tension would only return once the obvious procrastination was labeled for what it was, however.

    4. Was it helpful starting with the worst-case scenario and ending with the most realistic scenario?

    Even if this worksheet only asked you to write down the worst-case scenario, there would be benefit to you. Beyond those who are experiencing very real concern, there is nothing more detrimental to an anxiety’s power than quantifying it. By writing down the worst-case scenario, the reality of it comes crashing into view, and one’s own investment into that belief begins to feel ridiculous. By then following it with the best case scenario (which may be equally ridiculous), the stage is set for people to discover that like most things, the actual result will lie somewhere in between.

    5. Did assessing the probability for each scenario provide supportive data to help modify your negative automatic thought?

    Absolutely! It obviously helps to have a basic understanding of probability, and it is likely that some clients would need a crash course. But if the likelihood of an event is considered and ultimately understood to be very low, then the number of alternative results has a bolstering effect. Even if something bad happens, the absolute worst case scenario requires so many bad rolls as to be practically impossible to achieve! Mediocrity is so much more mathematically possible!

    6. Did this technique provide enough convincing information to develop an alternative thought?

    It help set the groundwork for different thoughts to grow. The alternatives were seen in the myriad other outcomes devised as the “somewhere in the middle” realistic outcomes. Through repeated use of such decatastrophizing techniques, the more realistic outcomes will surely be brought up faster, and may eventually become the initial thoughts.

    7. When the client was in the produce section, what was the most helpful technique to reduce her anxiety?

    Using diaphragm breathing certainly helped the client halt the increasing anxiety momentarily, but what really seemed to help her regain control in the moment was a decatastrophizing thought from Dr. V. The idea that the heart attack the client was concerned over was unlikely, and that they had in fact gone over this sort of event before helped her come to a more rational conclusion of what she was experiencing was.

    8. When having a panic attack in the aisle, how was it therapeutically beneficial for the client to try and “wait it out” for a few minutes rather than immediately leaving the grocery store?

    Leaving the store is the client’s safety behavior – her maladaptive response to the anxiety. Avoidance of the store to prevent the feelings of light-headedness and heart palpitations are the entire reason that the sensations are so strong. By asking her to stay in the store and push through the moment of intense physiological stress, the client is exposing herself to the fact that her concern of the worst possible scenario did not in fact occur. Instead of leaving, the client was able to stay in place and allow the sensations to pass naturally. Leaving would only reinforce her feelings by removing the stressor. Sticking it out is how the anxiety is reduced.

    9. What were some indicators after the in vivo exposure technique that it was effective for the client?

    The client expressed significant decrease in her anxiety level on a number scale from the beginning and middle of the exposure. She seemed incredibly proud of herself for sticking through with the experiment and pushing past her own discomfort. The client was excited and willing to try even more intense version of the exposure in the future, and was feeling confident in her success and progress.

    Reply

    • Taylor O'Rourke
      Mar 31, 2020 @ 11:08:07

      Hi Tim!

      I completely agree with you when you said it would still be therapeutic and beneficial for clients to even just think about the worst-case scenario when it comes to the decatastrophizing worksheet. I think acknowledging the worst is super important in determining how unrealistic/highly unlikely it is to occur. So, as you mentioned, even if this is the only part of the worksheet that was filled out, it is still doing the client some good. Also, I like how you mentioned that quantifying one’s anxiety has a lot of power to it. This is a great way for people to get their thoughts/feelings out on paper so they can make more realistic judgments of them.

      Reply

  15. Robert Salvucci
    Mar 31, 2020 @ 12:29:10

    Hey Tim!

    I have similar experiences with anxiety, where I’ll be feeling a tightness in my chest and throat “for no reason” and then I realize that I was thinking about how I won’t have enough time to finish what I planned for the day, or worrying about my health. It was amusing but also spot on when you alluded to procrastinating on ill defined tasks, I find that when I break taks down it becomes much easier to start them, or even say that I’ll spend just 2 minutes starting on doing laundry. I had two baskets full of laundry sitting in my room that I finally put away this morning XD. Having a grasp on probability is very useful in combatting anxiety as you said. This engages our executive functions more and helps us feel in control.

    Reply

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Adam M. Volungis, PhD, LMHC

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