250 Using a Strengths-Based Approach to Addressing Panic Disorder
Counselor Toolbox

 
 
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Question
~ What are some common issues or thoughts that trigger panic in people?
Strengths Based Biopsychosocial Approach to Recovery from Panic
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC
Executive Director, AllCEUs
Objectives
~ Define panic
~ Examine how the fight or flight reaction can be corrupted to prompt panic attacks
~ Examine the cognitive, emotional, behavioral, biological sources of the stress reaction
~ Explore a variety of interventions that may assist people in counterconditioning the panic response

How It Impacts Recovery
~ Panic attacks can feel overwhelming
~ Panic attacks are exhausting and can leave people feeling out of control of their own body
~ People can avoid things they have phobias of, but panic attacks seem to come out of the clear blue
~ People with panic attacks often restrict what they do (superstitiously) to avoid panic triggers
~ Awareness of what a panic attack is and what triggers them for each individual is crucial to recovery.

The Body’s Response to Anxiety/Panic
~ We have a primitive response system that protects us from danger “Fight-Flight-Freeze”
~ To prepare to take on the threat, the body sends out “excitatory” signals
~ Increase in heartrate
~ Increase in respiration
~ Numbness or tingling in hands (blood to the core)
~ Sweating (temperature and slipperiness)
~ Pupil Dilation (blurred vision/spots/brightness)
~ Muscle Tension
The Mind’s Response to Panic
~ Oh CRAP!
~ Something bad is going to happen or I wouldn’t be feeling this way
~ Catastrophic thinking— I’m going to
~ Pass out
~ Die
~ Throw up
~ ???
The Panic Cycle
Track Panic Symptoms: Anxiety Log
~ Log your anxiety episodes (not just panic)
~ What were your symptoms
~ Physical
~ Cognitive
~ Emotional
~ What triggered it
~ Why did that trigger it
~ What may have made you more vulnerable to your triggers
~ How can you prevent those in the future?
~ What have you done in the past that might have helped in this situation?
~ Review your log each week to
~ Identify particular situations that might trigger panic and begin to address those
~ Identify times when you are not panicky and increase those
Life Through Panic Colored Glasses
~ If you are hypervigilant about panic triggers, you will find them (Emotional reasoning)
~ Review your Anxiety Log
~ Identify your triggers
~ Make a plan to deal with them
~ Identify vulnerabilities
~ Make a plan to prevent them
Body Awareness | Physical Mindfulness
~ Body Scan
~ What am I experiencing
~ What might be causing it
~ Blood Sugar
~ Stimulants
~ Adrenaline Rush
~ Orthostatic Hypotension
~ Hormones
~ Excitement or Panic
Its only a False Alarm
~ Mindfully attending to panic
~ Feel the sensations (ride the wave)
~ Focus on breathing
~ Use positive self-talk
~ Distract
~ Keep a list of 3 things you can do to distract yourself
~ Pray
~ Sing
~ Call someone
~ Listen to music

Exercise
~ When the body is on high alert because it is getting stress signals, but you are sitting still, there is a disconnect which causes:
~ An increase in stress chemicals
~ May trigger catastrophic thinking
~ One way to get the mind and body back in synch is to move
~ Providing a reasonable explanation for the increased heartrate and respiration
~ Using the stored energy that has been released to fuel the fight or flight reaction
~ Exercise also releases serotonin (a calming effect)
Nutrition
~ Stimulants, medications and certain supplements can trigger a stress response.
~ Caffeine
~ Decongestants
~ Guarana
~ Hot peppers can trigger indigestion and a stress response (sweating, increased heart rate, difficulty breathing/chest tightness)
~ Low blood sugar can trigger
~ Cold hands
~ Dizziness
~ Trembling
Nutrition
~ Keep your blood sugar steady by minimizing processed sugars/carbohydrates and if appropriate, having a protein with your carbs
~ Drink enough water
~ Explore decaffeinated green tea which is thought to have anti-anxiety effects
Breathing, Meditation and Guided Imagery
~ Interventions
~ Mindful Breathing
~ Combat breathing
~ Aware breathing
~ Body Scan
~ R – Recognize what is happening
~ A – Allow life to be just as it is
~ I – Investigate inner experience with kindness
~ N – Non-Identification
Relaxation
~ Practicing relaxation techniques and biofeedback can reduce stress symptoms by:
~ Slowing your heart rate and respiration
~ Lowering blood pressure
~ Reducing activity of stress hormones
~ Increasing blood flow to major muscles
~ Reducing muscle tension and chronic pain
~ Improving concentration and mood
~ Lowering fatigue
~ Reducing anger and frustration
~ Provide a sense of control over your bodily responses

Physical Conditions that Increase Anxiety
~ Exhaustion
~ Diabetes/hypoglycemia
~ Hypertension
~ Hyperthyroid
~ PMS
~ Pregnancy
~ Postpartum
~ Anemia
~ Bronchitis/Emphysema
~ Cardiac Issues
~ Side effects of medications including SSRIs
Question
~ What are some common issues or thoughts that trigger panic in people?
Challenging Questions Worksheet
~ What are the facts for and against this belief?
~ Is your belief a habit or based on facts?
~ In what ways is your belief based on feelings rather than facts?
~ In what ways is your belief not including all of the information?
~ Does the belief use all-or-none, extreme or exaggerated terms (i.e., always, never, need, should, must, can’t, and every time)?
~ In what way is your belief focused on just one piece of the story?
~ Are you confusing something that is possible with something that is likely?
~ How does this belief protect you or help you move toward what is truly important in your life?
~ How does holding on to this belief keep you from doing those things that are important in your life?
Thinking Patterns That Increase Anxiety
~ All-or-nothing
~ Egocentric/center of attention
~ Catastrophic thinking
~ Need for approval

~ Activity
~ Write down 5 things that cause you anxiety
~ Annual evaluations, going to the doctor, going to a new place (especially a big city)
~ Identify the underlying thoughts that trigger your anxiety
~ Dispute those thought patterns
Emotions That Increase Anxiety
~ Shame/Embarrassment
~ Inadequacy
~ Going Crazy
~ Anxious Anticipation

~ Activity
~ For each of the above, identify
~ What causes the emotion, or what the emotion means about you (Look for themes of loss of control, rejection and failure)
~ Dispute it
Behaviors That Increase Panic
~ Poor Time Management
~ Taking on too much
~ Procrastination
~ Type-A Personality
~ Perfectionist
~ Overachiever
~ Conscientious
~ Phobia of wasting time/Lack of time perspective
~ Difficulty falling asleep

Stress and Time Management
~ You can feel time-stressed because
~ You are over committed
~ You procrastinated
~ Sometimes procrastination is caused by anxiety (Philosophy 101)
~ Activity
~ Make a list of all the things you have to do (I use index cards)
~ Separate the lists into 3 categories: Must do, Need to do soon, Like to do
~ Prioritize and delegate the must dos
~ Simplify where possible
~ Combine where possible

Relationships and Panic
~ Fears of failure, rejection and abandonment can trigger high anxiety or even panic for many people
~ Panic can be triggered if people feel like their needs are not going to be met or if they engage in mind-reading
~ Develop effective assertiveness skills
~ Stop mind reading
~ Stop looking for the other shoe to drop
~ Address abandonment issues
~ Develop self-esteem and self-acceptance
~ Nurture supportive relationships
~ Use challenging questions
Apply It Question for the End of Group
~ Identify 3 ways you could have used this information in the past week.
~ What was the situation?
~ What did you do?
~ How effective was that for you?
~ Short term
~ Long Term
~ If you would have had this new information, what could you have done differently?
~ How would that have changed the outcome?
~ How can you start integrating this knowledge into your routine
Summary
~ Panic is caused by the fight or flight reaction
~ Many things (mostly benign) may cause symptoms of the stress reaction
~ Cognitive interpretations of these symptoms can cause a full blown panic attack.
~ Body scan and breath awareness help some people
~ RAIN and Distraction may work better for others
~ Eliminating vulnerabilities can also eliminate low-grade chronic stress which can increase the likelihood of a panic attack.

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