• It combines mindfulness techniques such as meditation with elements of CBT
• It teaches people how to notice and allow thoughts and feelings without fixing, changing, or avoiding them

• These experimental designs are not very useful in measuring social variables or trends

• A therapist tells his client they can date two years after she stops treating him.

• You just don't approve of what your client is telling you

• Therapist wishes to engage in a relationship with client's family

o   Apply results of animal research to the acquisition and elimination of anxiety in humans

• Mentalism of Freud, psychiatric pigeon holing of Kraepelin
• Ignore inner world/focus on behavior – reaction to mentalism of psychoanalysis
• Then Rotter, motivation-reinforcement approach coupled with cognitive-expectancy approach
• Learning theory and cognitive theory
• Also application of Albert Bandura’s social learning theory – modification of behavior

• Deemphasize role of ‘inferred’ variables
• Stimulus response rather than variables thought to mediate
• Ignore inner world/focus on behavior – reaction to mentalism of psychoanalysis
• The expectancy that reinforcements would occur following the behavior in question

broad spectrum of treatment/variety of specific techniques/complementary

• educational
• collaborative 
• patient goals

• ongoing assessment, beginning AND end of treatment and often during treatment

  pre- and post test

• work towards generalization

• skill development – behavioral deficits AND reciprocal inhibition

• Modify or change thinking believed to contribute to patient’s problem

• Active

• Operant (instrumental) and Classical Conditionining Classical Conditioning of fears, operant conditioning of fear behaviors

• Systematic desensitization, imagine fear inducing situations while in heightened state of relaxation, 

• relaxation: progressive, breathing, imagery and more

• exposure therapy, expose self to situations previously feared or avoided

  in vivo, in imagino

• hieararchy, increasingy complex skills/demanding situations

• behavioral rehearsal – role play

• assertiveness training

• Identify automatic thoughts

• assertive training – reciprocal inhibition, can’t be anxious and assertive
• systematic desensitization, reciprocal inhibition, counter conditioning, expose to anxiety provoking stimuli in relaxed state, gradually increasing series of anxiety provoking stimuli, eventually desensitized, training in relaxation, anxiety hierarchy – work together to construct hierarchy; spatial-temporal lines

identifying automatic thoughts

• Social Learning theory – behavior joint product of reinforcement and expectations (expectations about a goal or outcome of some value)
• motivation-reinforcement approach coupled with cognitive-expectancy approach

• Therapist should be accepting
• Collaborative

• Should be long rather than short
• Repeated until all fear/anxiety is eliminated
• Gradual
• Patient must attend to feared stimulus and interact w it as much as possible
• Must provoke anxiety

• For acquiring new behaviours
• Discuss why the new skill is needed
• Make a plan for the rehearsal
• Actually go through the situational role play
• Assertiveness training

• different methods (time outs, contracts) to increase good behaviours and get rid of bad ones
• Token economies

• Something is done to provoke an undesirable response and that response is them paired with an undesirable stimulus, with the assumption that the association of the response with the undesirable stimulus will fade out the behaviour
• Aversion agents can be elctrical shock or drugs
• Covert stimulation is when the patient imagine their bad response and then imagine something aversive happening
• 
  

• Reaccuring, random panic attacks
• 4 or more physiological symptoms and/or irrational fears
• Treatments: Relaxation training, panic-control therapy, interoceptive desensitization, SSRI antidepressants, lifestyle and personality changes

• fear of open spaces/fear of having a panic attack in a difficult to escape from place
• anxiety of being away from safe place/person
• anxious anticipation of possible panic attack
• Treatment: relaxation training, panic control therapy, introceptive desensitization, exposure, cognitive therapy, SSRI or tranquilizer medication, assertiveness training, group therapy

• Extreme fear of embarassment or humiliation in public
• Specific i.e. fear of public speaking, fear of blushing, fear of using public toilet, but can be general
• Treatment: Relaxation training, Cognitive therapy, Exposure, Focus/Stay on task, SSRI/low-dose tranquilizers/MAO-inhibitors, Social skills training, Assertiveness training

• Strong fear and avoidance of a specific object/situation
• No panic attacks except sometimes w/ direct exposure
• Common: Animals, Heights, Elevators, Airplanes, Doctors, Weather, Blood/Injury, Disease
• Treatment: Relaxation, Cognitive therapy, Exposure

• Chronic anxiety that persists for 6 mo, no panic attacks, phobias, or obsessions
• Anxiety/worry focuses on 2+ stressful circumstances a majority of days in a 6 mo period
• Basic fears (death/failure/etc) and some physiological symptoms
• Treatment: Relaxation, Cognitive therapy, Worry Exposure, Reducing Worry Behaviours, Problem Solving, Distraction, SSRI/SNRI/Benzodiazepine, Mindfulness Practice, Lifestyle & Personality Changes

• Obsessions-recurring ideas/images/thoughts/impulses that intrude the brain
• Compulsions-behaviours/rituals that you perform to dispel the anxiety of obsessions
• Obsessions can occur w/o compulsions; often accompanied by depression
• Treatment: Relaxation, Cognitive therapy, Exposure and response prevention, SSRI/low-dose antipsychotics, Lifestyle & personality changes

• Disabling psychological symptoms following a traumatic event; last longer and stronger when the trauma is personal
• Must last more than a month and cause significant distress
• Treatment: Relaxation training, cognitive therapy, Exposure, SSRI/tranquilizers, Support groups, EMDR/Hypnotherapy

• Increase serotonin levels by preventing reabsorption by the synapses
• Number of serotonin receptors can decrease in the first few months called downregulation
• Downregulation allows the nerve cells in the serotonin receptor system to become less sensitive to change caused by stress, therefore leading to less dramatic mood change and less anxiety vulnurability.

• Helpful for any anxiety disorders; easily tolerated by medically ill and elderly; not addictive; no long term problems; most do not lead to weight gain
• Some side effects (jittery, restless, headache, nausea, etc); reduced sexual motivation and/or sexual dysfunction; take some time to show benefits; expensive

• High-potency tranquilizers
• Often used w/ SSRIs for panic disorder
• Depress the activity of the central nervous system; higher doses are like sedatives, lower doses reduce anxiety
• Differences btwn brands are how long they last in your body

• Good: Work quickly; can be taken on an as-needed basis; generic versions are available; less bothersome side effects; good for people who can't take anti-depressants
• Bad: addictive; abrupt withdrawl is dangerous; can experience rebound anxiety if go off too quick; only effective as long as you take them; can dull emotions and experiences

• Block the reuptake of serotonin and norepinephrine
• Tried when SSRI not enough; block two things not one

• Good: Block two things at once
• Bad: Can cause withdrawl if abruptly ended; same physiological side effects

• Used to treat panic attacks; reduce both intensity and frequency; can reduce accompanying depression

• Good: No physical dependence; beneficial for depression on top of anxiety/panic; block panic attacks; inexpensive
• Bad: Dry mouth, blurred vision, dizziness; weight gain; sexual dysfunction; anxiety can increase for the first few days; take a while to work; 30-50% relapse rate on panic symptoms

•  Good: potent panic blocking; helpful for social phobia; can help severe depression
• Bad: last resort; weight gain; near fatal rise in blood pressure when combined w certain things; hypotension; sexual dysfunction; fatigue; insomnia; critical dietary restrictions

• Heredity
• Childhood (parents communicate anxiety, overly critical parents, emotional insecurity/dependence, parents supress expression of feelings/self-assertiveness)
• Cumulative stress over time

• The physiology of panic
• Panic Attacks (overly sensitive nervous system)
• GAD (low amounts of GABA/low GABA activity)
• OCD (low GABA, low serotonin, improperly functioning anterior cingulate gyrus)
• Medical Conditions that can cause panic attacks/anxiety (hyperventilation syndrome, hypoglycemia, hyperthyroidism, mitral valve prolapse, PMS, Inner Ear Disturbances)

• Stressors that Precipitate Panic Attacks (significant personal loss/life change, stimulants/recreational drugs)
• Conditioning (associate phobic thing w bad stuff OR avoid phobic thing and learn to be phobic of it)
• Evolutionary Origins of Phobias
• Trauma, Simple phobias, PTSD

• Avoidance of phobic situations
• Anxious self-talk
• Mistaken beliefs
• Withheld feelings
• Lack of assertiveness
• Lack of self-nurturing skills
• Muscle tension
• Stimulants/dietary factors
• High-stress lifestyle
• Lack of meaning/sense of purpose

1. Be familiar w relevant anxiety material
2. Help the phobic come up w specific goals for each session
3. Communicate w phobic beforehand what is expected of you during
4. Help break problems down into small steps
5. Be cooperative instead of assuming the initiative
6. Be familiar w partner's early signs of anxiety
7. Create list of coping statement & relaxation procedures w partner
8. Don't let distress rattle you, but do take it seriously
9. Hug or offer hand rather than lecture
10. Be reliable and be where you're supposed to be
11. Don't push the person!
12. Encourage them to make the most of each session
13. Don't do everything for them,they're responsible for their recovery
14. Try to see things from their POV
15. Be sure to give praise for every small achievement
16. Express confidence in the phobic
17. Encourage with rewards
18. Accept their bad days & that they won't have a perfect session every time
19. Be willing to adjust your schedule for your commitment to them
20. Know your own limits & forgive yourself if you're not perfect

• Normal fears: concrete external fear, within realm of possibility, something that will actually harm you
• Anxiety: usually not a specific fear, more internal, vague/distant/unrecognized danger, vague anxiety of "something bad" happening, interferes w your life and functioning

1. Internal or External Initiating Circumstances
2. Slight increase in unusual/unpleasant bodily symptoms
3. Internalization (increased focus on symptoms magnifies)
4. Catastophic Interpretation (the symptom is dangerous)
5. Panic

• Increased heart rate
• Increased respiratory rate
• Tensing of muscles
• Sweat
• Dizziness
• Choking sensations
• Heart palpatations

• Practice abdominal breathing
• Repeat positive coping statements
• Combine those
• Talk to a supportive person
• Physical activity
• Stay in the present
• Distract yourself
• Get angry at your anxiety
• Do something immediately pleasurable

• Nonstriving
• Acceptance 
• Nonjudgemental
• Patience
• Letting go
• Commitment & Self-Discipline

• By constantly avoiding something you become more sensitive to it
• You're so sensitive that you react w anxiety when confronted w it, then avoid it more

• Exsposure to the anxiety causing thing desensitizes you
• You get used to it and it doesn't cause the same anxious response bc you experienced the aftermath and nothing bad happened

• There is no one cause of anxiety
• They all interact

• A. Activating events in people's lives, which people have
• B. Beliefs (often irrational) about, and lead to
• C. Consequences/behavioral disturbances bc of the intermingling of A and B
• D. Dispute the irrational beliefs and there will be a
• E. New emotional consequence or effect

• A. I binge eat a lot of chocolate
• B. I believe that I am a terrible glutton with no self-control and I will never be thin because I'll keep screwing up by eating
• C. I feel self-hatred and depression
• D. Why can't I just start eating healthy again tomorrow? Why will one slip up negate all my progress?
• E. I am disappointed but hopeful.

1. The idea that you must have sincere love & approval all the time from everyone you deem significant
2. You must prove yourself competant, adequate, and acheiving or at least have some talent or competence
3. People who harm you/commit misdeeds are generally bad/wicked & you must severly blame/damn/punush them
4. Life is awful/catastrophic when things do not go your way
5. Emotional misery comes from external pressures and you have little ability to rid yourself of depression/hostility
6. If something seems dangerous/fearsome you must become occupied w/upset about it
7. You will find it easier to avoid life's self-responsibilities thanto undertake some rewarding forms of self-discipline
8. Your past remains all-important & has to keep determining your feelings/behaviours today
9. People/things should turn out better than they do; you have to view it as terrible/awful if you don't quickly find solutions to probs
10. You can find happiness through inertia/inaction and just 'enjoying yourself'
11. You must have a high degree of order/certainty to feel comfortable or must rely on some supernatural entity
12. You give yourself a global rating as a human & your general worth relies upon the goodness of your performance/degree that people approve of you