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SOLUTION FOCUSED
ANXIETY MANAGEMENT
Ellen Quick, Ph. D.
Welcome!
Inviting and celebrating courage
• Anxiety concerns our clients bring • 4 session anxiety management class • General SF frame – and introducing
specific techniques
• Generating SF questions that elicit courage and coping
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Goals
1. Adding ideas, tools, techniques
2. Inviting tapping the courage, resources, and appropriate caution clients already have
3. Excitement about the power of a SF perspective
Anxiety management class
• 4 sessions – can begin at any one • Significant others welcome
• Class, not a group
• Open to anyone interested • Management, not elimination!
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Session 1:
Physical sensations and relaxation
techniques
• Physical reactions can be adaptive (survival!) • Things the body does under stress – and fears • Stressor physical reaction danger (cycle) • “Body reactor” (and “mind reactor”)
• Some coping techniques: Belly button breathing, the wave, autogenic training, just because,
mindfulness
• Homework: sample techniques, and notice how you “ride through” sensations differently!
Session 2:
Behavioral techniques
• Exposure and habituation
• Courage ladder (in vivo densensitization) for phobias and other symptoms
• Commonsense and counterintuitive
• Panic: exposure to sensations (intereoceptive exposure) • OCD: delay, response prevention, and do something
different
• GAD: exposure to uncertainty, discomfort; “write, read, and shred”
• For things you can’t face a little at a time: imagine coping • Homework: practice exposure, and notice how you
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Session 3:
Thinking coping techniques
Events/ Automatic Feelings
Sensations Thoughts Behavior
• 2-part formula:
1. Accepting: reality, feelings
2. But…decreasing danger, probability, helplessness
• Common automatic thoughts and some
alternatives
Exercise:
• Difference in this perspective
• Homework: noticing your thoughts, experimenting with changing them, and noticing how that makes a
difference
But… Accepting
Reality/Feelings Automatic Thought
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Session 4:
Life issues and anxiety
• Pros / Cons of managing anxiety
• A third column: How I would deal with each con
• “I can’t” vs. “I don’t want to” (or “Part of me doesn’t want to…”)
• Ambivalence 101: mixed feelings are normal! • Assertiveness: interface with anxiety
• Stages of adulthood, seasons of life, Eric Erikson’s central issues – independent of anxiety
• “Bumps on the road of life” may lead to body reactions – and coping
• Homework: What issues am I facing? How would I deal with those with “normal” anxiety? What does that tell me about how I might deal with them even with my anxiety?
What’s “normal” anxiety,
appropriate caution?
• Robbie: 60s, heart attack history, fears another • Used to be afraid of airplanes
• Used to? How?! • Really wanted to go! • Movie, music
• Reassured someone (protector) • Flying home, and again soon • Wait for breath to get regular
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• List: “Ingredients of solution” • Exposure/ habituation
• Desensitization • Focus on goal • Distraction
• Apply to current fear
Exercise: Interviewing for
Appropriate Caution
• Interview your partner about some area where other people freak out but he or she has an appropriate degree of concern. • How do you do that?
• How do you take appropriate caution in
that area?
• How do you make sure you take real good care of yourself?
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General SF Approach to Anxiety
• What does client want? How might I best help?
• What will it look like?
• Any pieces of this already happening? • A general SF frame
• Add techniques when needed -- those from the class
• “Evidence based treatment”
• Pressure for evidence based treatment • Specific techniques vs. common factors • (meta analysis results)
15 • 40% Client factors
(before enter therapy room!) • 30% Relationship • 15% Hope or expectancy • 15% Model (less than expected!) 40% 30% 15% 15% Client Variables Specific Techniques Therapist Alliance Hope
SFT creates, enhances common factors:
40% 30% 15% 15% Enhanced by Solution-Focused Approach Client Variables Specific Techniques Therapist Alliance Hope
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Client factors:
• Nonproblem areas tremendously important • Change may appear here first; from client,
not therapist
• Start where client is
• Chance events –respect power, weave into therapy
Relationship factors:
• We know how powerful…and • EBTA. Beyebach’s research
“Spanish therapists are just so nice!” Collaborative solution focused approach strengthens therapeutic alliance
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Hope and expectancy factors:
• Miracle question / solution focused inquiry • Pieces happening? How did you do that?
Wow!
• Compliments – highlight strengths, on the road to solution
• Creates hope
• When create common factors, sometimes sufficient – and sometimes more needed • Consistent with SF practice to add other
things?
• Insoo: “Just because you’re solution focused doesn’t mean you get stupid.” • Building on what works
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HOW to add:
1. Add to basic approach
2. Incorporate into the approach
(similar and different -- like cookie dough…) ADDING:
• A possibility /perspective
• Collaborative spirit; client expert • Beginning of session or later
• Terry Trepper’s approach and variations
• Refer to the literature • “Lesson”
• Picture
• Acknowledge this is different • Input from conference
• If one way mirror… • Experiment
• Adjunct /resource
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INCORPORATING:
• Questions informed by knowledge of problem and techniques
• Basic SF questions and variations tailored to specifics of anxiety and tools for it
– E.g.: “multiple choice” intensity of symptoms
• Sometimes what’s already working IS technique — build on it
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Incorporating
(what else?) (what else?) (what else?) Panic attacks Cognitive tools Wow! OCD Education Compliments Phobias Mindfulness Scaling Generalized anxiety Courage ladder Miracle question Anxiety problems Specific tools for anxiety Solution focused approachExercise: Creating solution focused
questions (and other thoughts)
These were created in our discussion of “incorporating”!
1. 1. Scaling questions using client’s language-e.g., 0=paralyzed; 10=absolutely no fear. Especially invite describing the positive state (calm, relaxed, etc.) -- in client’s own words. 2. How were you able to stop obsessing?
3. How did you manage to increase your calm? 4. What will it look like when you’re comfortable?
5. Tell me about a time when you were calm. Wow! How did you do that? 6. Tell me about a time when anxiety wasn’t a problem.
7. Tell me about a time when you had some anxiety and got through it. 8. Tell me about a time when the anxiety was a little less.
9. Tell me about a time when you were starting to move into panic but didn’t. 10. How did you keep panic from happening?
11. When you are comfortable, what will your body be telling you that’s different?
12. When you are relaxed, what will you be saying to other people? What will they notice about you?
13. What will you be doing instead?
14. How will the realization that anxiety is a common reaction help you?
15. Tell me about a time when being energized helped you to be at your best. How did it help you do exactly what you needed to do? Wow!
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Envision a miracle…
• SF perspective has become an integral component of evidence based practice with anxiety disorder.
• What will be different? • What will you continue? • What will you add?
• What will clients and colleagues notice? • How did you make this happen?
• Pieces already happening?
• A multi-center study?
• SF therapists and/or clients document scaling question changes of clients using SFBT for anxiety concerns.
• Similar to Doing What Works Group study (quantitative, qualitative)
29 Your degree of concern or caution is appropriate, not excessive. Anxiety isn’t so much a problem any more. When you first called
for help with your anxiety
0 1 2 3 4 5 6 7 8 9 10
How did you make your changes happen?
What do you want to continue, because you know it works for you?
This might go along with information from the therapist on these things:
• Client age • Client gender
• Presenting complaint • Session #
• Modality (individual, couple, family, group, etc.)
• Type of practice (private practice, inpatient, community mental health, outpatient clinic, student health, etc.) • Treatment (SFBT, SFBT plus specific techniques – which?, any other details therapist wants to provide)
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• Anyone who collects scaling question numbers and/or written comments (or other data) from clients who participate in solution focused anxiety management is invited to forward any data (with all
identifying personal information removed) to [email protected] for possible use in a multicenter study!
Detailed notes for running a solution focused anxiety management class
Some more detailed materials may become available over the next few months. If you would like a copy when/if these are ready, you may email me at
For detailed materials on conducting a solution focused group (useful for anxiety, depression, and other concerns), including handouts and full transcripts of 5 “miracle question visualizations,” see Chapter 10, Doing What Works in Brief Therapy: A Strategic Solution
Focused Approach, Second Edition, E. Quick, Academic
