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Appendix A - Therapy Techniques Described on CD

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Sit Don’t Run
Replay CD track 1 for more information about this technique.
Client completes the following exercise when he or she uses needless activity to avoid anxiety.

  1. Slow down and stop.  Don’t run away.  Sit down, if possible.  Take several slow, deep abdominal breaths.  Inhale slowly; hold; exhale slowly.
  2. Feel you body’s heaviness.  Allow gravity to pull at you, tug at you, in a downward direction.  Become completely passive.
  3. Think health.  Remind yourself that you’re healthy, and stop scaring yourself.
  4. Then, allow time for that panicky feeling to pass.  When a high level of stress chemicals are already coursing through your bloodstream, it takes a few moments for them to dissipate.

Stop and Relax
Replay CD track 2 for more information on this technique.
Client completes following relaxation exercise to control panic symptoms.

  1. Stop or slow down.  Sit if you like.
  2. Relax your facial muscles. 
  3. Smile inwardly.  Imagine the smile spreading across your face and up towards your eyes.  Make sure your teeth and jaw are unclenched.
  4. Say to yourself, "My eyes are twinkling and sparkling."
  5. Take a deep abdominal breath.
  6. Imagine you are inhaling through holes in the bottoms of your feet, up through your legs, and into your stomach.
  7. Feel the upward flow of warmth and heaviness.
  8. As you exhale slowly, imagine the air flowing back down through holes in your feet, taking all the tension along with it.
  9. At the same time, let your jaw, tongue, and shoulders go limp.

Criteria
Replay CD track 5 for more information on this technique.
Consider using the following list of criteria when a client might be suffering from both anxiety and depression.

  1. General appearance, manner, and attitude.  Clients with panic disorder may appear calm during interview.
  2. Consciousness, including orientation as to time, place, and person.
  3. Apperception-perception as modified by one’s own emotions, memories, and biases.
  4. Affectivity and mood.  Fear and apprehension suggest anxiety.
  5. Conation and motor aspects of behavior.
  6. Associations and stream of thought.
  7. Thought life and mental trend including delusions (false beliefs).  I might suggest asking about phobias, obsessions, compulsions, and excessive fears or bodily preoccupation.)
  8. Perception, including auditory and visual hallucinations.
  9. Memory, both recent and remote.  Retention and recall—digit span is impaired in extremely anxious clients.
  10. Fund of information.  Intellectual function is intact in clients with anxiety disorders.
  11. Judgment.  The ability to compare facts or ideas, to understand their relations and to draw correct conclusions from them.
  12. Insight, the extent to which a client is aware that he or she is ill.  Anxiety clients are often unwilling to accept an emotional explanation for their physical condition.

Exposure Therapy
Replay CD track 6 for more information on this technique.
Use the following guidelines when considering using exposure therapy for a phobic client.

  1. Arrange the expected phobic situations into groups according to the amount of distress that the client anticipates in his or her particular case. 
  2. Choose an easy situation, enter it, and encourage client to force him or herself to remain their until his or her anxiety dampens down.  It most important that the client does not run away too soon.
  3. Repeat exposure to the easy situation—the phobic reaction should now be less unpleasant.
  4. Select a more difficult situation and repeat the procedure outlined in steps 1 and 2.
  5. Carry on this process with progressively more difficult situations. 

Eleven Tips for an Anxiety-Free Trip
Replay CD track 12 for more information on this technique.
Client follows following guidelines to minimize anxiety over a long trip.

  1. Have a definite, pleasant destination.  Don’t just go for the sake of going or to test yourself. 
  2. If at all possible, have a friend meet you at your destination or at a halfway point, to complete the trip together.  If that’s not possible, call up a friend before you leave the house and when you get to your destination. 
  3. Plan your overall trip before you start, but also make allowances for the unexpected.  Look forward to small delights:  colors, sounds, experiences.  It’ll make your trip far more interesting than if you try to plan each little detail in advance.
  4. The chances of something bad happening on this very trip are very, very slim.  So don’t spoil your trip with unnecessary worry.
  5. Bring along some food.  Don’t rely on what’s out there. 
  6. Greet people with cheerfulness and enthusiasm.  Get into a positive social mood.
  7. If you seem to have a lot of nervous energy ready to pounce out of you, think of it as excitement rather than nervousness.
  8. Have something enjoyable to do during the trip.
  9. As you travel, let go of all muscles not in use.  Make those muscles as slack as possible.  Even when they seem quite relaxed, make them even more floppy.
  10. Try not to jump too far ahead of yourself  Try not to see every aspect of the journey all at once.  Break it up into one baby step at a time. 
  11. Try not to control every aspect of your surroundings.  Whatever happens will happen.

Diet Tips
Replay CD track 13 for more information on this technique.
Client follows the following guidelines for a healthy diet.

  1. Increase your intake of fruits and vegetables.  Packed with nutrients and fiber, they also have disease-fighting properties.  Ideally, you might want to eat more vegetables than fruits, because they tend to be more nutrient-packed.
  2. Eat whole grains.  These are rich in B-Complex nutrients, of which the milling process can remove over 75 percent.
  3. Eat more foods from the bean family.  Tofu, green beans, lentils, and split peas, as well as regular beans are good sources of protein when combined with a grain product such as whole wheat bread.
  4. Cut down on sugar.  Reading food labels is essential as corn syrup, sucrose, and dextrose are just fancy names for sugar and can sneak into almost any food.  Products marked as "no fat" generally contain more sugar than they ordinarily would.
  5. Spread out your eating so you have four or five mini-meals a day instead of three large ones.  This will reduce the risk of low blood sugar, which can cause fatigue.  Try not to go more than four hours without eating.
  6. Avoid caffeine.  Gradually wean yourself off coffee with decaf or tea. According to Dr. Thomes Udhe, a former researcher at the National Institute of Mental Health, "Caffeine can cause panic attacks in panic disorder patients and, in sufficient quantities, can also trigger panic attacks in normal controls."
  7. Drink six to eight glasses of water a day. 
  8. Go easy on fats.  This means reducing the intake of meat and poultry.  Use olive or canola oil for cooking.  Switch to fat free milk.  Avoid products that contain partially hydrogenated oils, which causes trans-fatty acids that are harmful to the arteries.
  9. Reduce sodium intake.  Fast food, canned goods, processed meat, hard cheese are very high in salt.  Try using more natural herbs and spices for flavoring.
  10. Eat a varied diet.  Try new vegetables or fruits so you don’t get tired of one thing.

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