Anxiety treatment plan

Question 1

What problems would you expect to see in an anxiety disorder?

Answer 1

1. Safety-seeking behaviours (e.g. rehearsing conversations, avoiding eye contact) and worry cucles.
2. Narrow focus of attention (on self or threat cues).
3. Cognitive distortions like Emotional reasoning or memory bias (recalling past failures more than successes).
4. Misinterpretations of internal reaction to perceived threat (e.g., my heart is racing - I’m having a heart attack).

Question 2

What short-term goals might you have?

Answer 2

1. Identifying and tracking triggers, safety behaviours and patterns of thinking.
2. Increase awareness of attention shifts and their role in maintaining anxiety.
3. Begin challenging worry loops and catastrophic thinking.

Question 3

What long-term goals might you have?

Answer 3

1. Reduce frequency and intensity of anxious predictions.
2. Increase flexible attention and tolerance of uncertainty.
3. Reduce reliance on safety behaviour.
4. Build more adaptive interpretations and balanced memories.

Question 4

What target treatment would you use?

Answer 4

1. Functional analysis of safety behaviours and worry cycles = understanding the function of safety-seeking behaviours and worry cycles.
2. Behavioural Experiments = to challenge safety-seeking behaviours and gather disconfirming evidence.
3. Attention Training Exercises (e.g., external focus practice) = shift focus of attention from internal to external.
4. ABC thought records with a focus on cognitive distortion, like emotional reasoning, memory bias and catastrophising.
5. Psychoeducation around threat response and reinterpretation of physical symptoms = Normalising the threat response and reframing physical symptoms.

Question 5

What therapy stages should be expected?

Answer 5

1. Session 1-3: Psychoeducation and assessment of safety-seeking behaviours, worry loops and focus of attention.
2. Session 4-6: Begin thought record, attention training and behaviour experiments.
3. Session 7-10: Memory work and testing alternative interpretations
   - Homework throughout, tapering support towards the end of therapy.

Question 6

What clinical challenges might you come across?

Answer 6

1. Clients may cling to safety-seeking behaviours and struggle to drop them.
2. High anxiety can impair concentration during cognitive tasks.
3. The risk of avoidance increases if exercises feel too challenging.
4. Need for careful pacing and normalisation of internal sensations.