Program stream: This module applies to the anxiety program.
This module explores the connection between behaviour and anxiety and helps the client learn how to do small things that make them anxious to work up to bigger things.
The first section talks about how our natural human reaction to anxiety is to avoid or distract ourselves from whatever is making us feel anxious to help us escape the situation for safety. However avoiding our anxiety can make it worse over time.
The section explains to the client that avoiding things that make us anxious reinforces the following:
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That there is something to be afraid of
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We were right to think we couldn't handle the situation.
Each time we avoid what makes us anxious, we strengthen these thoughts, which makes us believe our worries are real. This in turn makes us even more likely to avoid the situation in the future and strengthens our beliefs, creating a cycle of worry.
To break the cycle we have to start exposing ourselves to the things that make us anxious so that we can unlearn the messages we have told ourselves.
Section 2 explains how anxiety levels spike and that by completing exposure activities we can eventually get to a point where our anxiety will not spike so high and will come down faster.
A short quiz follows to test content retention.
This section talks about how to make exposure exercises work:
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The client has to stay in the anxious situation long enough for the anxiety to go down so that they learn that there is nothing to be afraid of and the exposure wasn't as bad as you thought it would be.
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It has to be repeated so that the situation is no longer difficult for them and they no longer try to avoid it.
Clients are encouraged to take exposures slowly, in order to work up to bigger steps. The concept of a Fear Ladder is introduced as a list of situations that make the client anxious, which are then put in order from least stressful to most stressful. The client can then work on them from first to last.
The Fear Ladders section takes the client through the steps to create their own fear ladder:
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Identify an anxiety theme you want to work on and a specific goal - This helps the client discover the type of anxiety they struggle with and then make a specific goal that they want to achieve.
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Brainstorm steps to get to your goal - The steps should help the client work up to their goal that causes the most worry. All steps should relate thematically to the goal.
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Rate each step with the anxiety scale - Rate the steps on a scale of 1 (least anxiety) to 10 (most anxiety) and then put the steps in order based on their rating.
An example is provided of "being able to go to parties" to help the client understand the content more deeply.
A short quiz follows that tests client retention of the content.
In this section, the client is asked to create their own fear ladder by identifying an anxiety theme and creating a specific goal they want to work on. Then, they are prompted to identify and add possible steps to their fear ladder by brainstorming specific situations related to the goal and ranking them on a scale of 1-10 from no fear to severe fear.
This section helps the client understand how to plan an exposure and presents a set of questions for the client to answer before and after the exposure:
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Before the exposure: "What are you exposing yourself to?", What are you afraid will happen during the exposure?", "When do you plan to complete the exposure?", "How likely is the feared outcome to actually happen?", and "How likely is it to be as bad as you feared?"
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After the exposure: "How anxious were you at the beginning or before starting your exposure?", "How anxious were you at the peak of the exposure?", "How anxious were you by the end of the exposure?", "What did you notice during the exposure?", and "After the exposure, how likely is it that your fear will actually come true? and how likely is it that it is going to be as bad as you think?"
This section presents tips to help clients to complete exposures:
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Practice - Exposure won't work if the client only does it once. They are encouraged to keep doing the current step until it is easier to do and then move to the next step.
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Reward yourself - Exposure is hard work, so the client should give themselves small rewards when they complete each step and large rewards when they complete a whole fear ladder.
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Everyone has bad days - It is important to remember that the client won't always feel like completing the next, more difficult step and that's okay. Encourage them to repeat the last step again, instead of hitting pauses on steps to keep them practicing without losing momentum.
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Sometimes a step is harder than you think - If a step is too difficult to complete, try again the next day. Or if it continues to be too difficult, try breaking it down and adding an easier step in between.
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Watch for signs your ladder is too easy or too difficult - If it is too hard, the client might be struck on a step, constantly having bad days that prevent momentum, or have continuously higher anxiety ratings than expected. If it is too easy, the client might be going through each step very quickly, or not needing to repeat steps to become comfortable, or have continuously lower anxiety ratings than expected.
A short quiz follows this section to test content retention.
The exercise for this module encourages the client to create and complete at least one step from their fear ladder. The client is prompted to consider how completing a fear ladder can help them and give an importance rating for this task. They are then asked to think of any potential barriers to completing the exercise and ways to get back on track if that happens.
The client is then prompted to give a confidence rating and reflect on available supports to help them. Lastly, they are encouraged to reflect on whether their fear ladder relates to their SMART goal and how to get closer to completing that goal.