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Sunday, February 23, 2014

Overcoming Health Anxiety: Salkovskis




Overcoming Health Anxiety
Table of Contents
Chapter 3 Setting goals. 1
Chapter 4 Dealing with distressing thoughts and images. 1
Label your thinking style. 1
Decatastrophising. 2
1 Physical effects of anxiety. 2
2 Do a Survey of your friends. 2
3 Trying to be certain is part of the problem.. 2
4. Thinking bias. 2
Responsibility pie chart. 2
Watching your thoughts pass by. 2
Chapter 5 Understand the process of worry. 2
ABC for Worry. 2
CBA for Worry. 2
Worry Beliefs. 2
Chapter 6 learning to retrain your attention. 2
What is the motivation for being overly self-focused?. 3
Chapter 7 Reducing anxiety by facing your fears. 3
Dropping safety behaviours. 3
Exposure. 4


Chapter 3 Setting goals

1.       Define short, medium and long term goals
2.       Establish your values such that you can spend more time focussing on these and less focussing on your health anxiety

Chapter 4 Dealing with distressing thoughts and images

Label your thinking style

1.       Catastrophising
2.       Mind reading
3.       Mental filtering
4.       Disqualifying the positives

Monitor your thoughts and memories, do it for a day to identify the main ones, then do it for a week and collect the number of thoughts you have.

Decatastrophising

1 Physical effects of anxiety

Understanding the effect that anxiety has in terms of physical symptoms

2 Do a Survey of your friends

Ask if they have similar symptoms as you do, or if they ever have

3 Trying to be certain is part of the problem

To be certain that something isn’t the sign of an illness is part of the problem, if you have continually treated abnormalities in a certain way, what about treating it in a different way as if you have a worry about your health problem

4. Thinking bias

If you have a thinking bias to assume the worst and you are continually wrong, then why don’t you deliberately assume you are ok?

Responsibility pie chart

Think of an illness that you get, that you could prevent by checking, work out who or what is responsible for you having the illness.

Watching your thoughts pass by

So imagine where you are, and you have a distressing thought, how could you manage this, use a metaphor, look at where you are and what you are doing?

Chapter 5 Understand the process of worry

Look at worry as something you do rather than suffer from.

ABC for Worry

Then do an ABC for worry, activating event, behaviour how did you worry, then put down the intended and unintended consequences. There’s a form on p103.

CBA for Worry

Worry Beliefs

Write down positive and negative beliefs about worry. Then establish how true each of these beliefs are and how useful.

Chapter 6 learning to retrain your attention

In health anxiety, your attention is focussed on yourself, on your body, on your mind, on you. The effect of this is that you become more sensitive to small changes, you can make worse symptoms,  If you focus on negative thoughts, they can be magnified and increase their frequency and intensity.

What is the motivation for being overly self-focused?

What situations are you self-focussed
What are the benefits you think you get from being self-focused?
Maybe prevent illness
What is the motivation for being self-focused?
Challenges to use
1.       Would you recommend other people take this approach
2.       Does this help you get things that are important to you in your life?
3.       What is the cost of being self-focussed
Treatment
1.       Monitor where your attention is and what the effect of this is on your anxiety and physical symptoms. Do this a couple of times and compare when you have high internal focus and low internal focus, and see what the difference is.
2.       Refocussing, any time you notice your attention being on yourself refocus it on the environment or the task at hand
3.       Attentional training
a.       Get n sounds\locations
b.      Spend 5 minutes moving slowly between each
c.       Spend 5 minutes moving quickly between each
d.      Hold all together for 2 minutes

Chapter 7 Reducing anxiety by facing your fears

The fear in health anxiety is the triggers to it, these can be thoughts, situations or sensations.

Theory A I have a medical condition
Theory B I have a problem with being excessively worried about my health. Worrying about your health means you have become intolerant of uncertainty about your health

Dropping safety behaviours

Safety behaviours are those behaviours that are used to keep you safe, but prevent you from finding out that your fears are unfounded and also have the unintended consequence of increasing your preoccupation with your health and the intensity of the distress. Safety behaviours, increase physical sensation, increase preoccupation, increase levels of distress and don’t get you to find out that you would have been ok without doing them

Exposure

Expose to your triggers to health concern and stay with the feeling until the fear drops by half without doing anything to reduce it, don’t check, don’t reassure yourself just wait until the fear comes down.  Write down a feared hierarchy and move slowly up the list.
Use the exposure form on page 146 which is rather nice

Summary

Stages:
1.       Assess
a.       Early experiences
                                                               i.      Experience around illness
                                                             ii.      Experiences around people protecting themselves from illness
b.      What are the triggers to worrying about health anxiety
c.       What behaviours do you have to keep yourself safe
d.      What do you avoid because of health problems
e.      What is your fear of having a serious health problem, what do you think would happen, what makes you think you couldn’t cope with it.
f.        What are your health based IBS, that underlie each behaviour
                                                               i.      Checking can prevent me from having a health problem
                                                             ii.      I’m likely to have a health problem
g.       What is your current preoccupation with health, i.e. how much time do you put on it, how sensitive to news articles, to sensations in your body etc., how has the preoccupation changed over the years
2.       Establish Theory A and Theory B
a.       Theory A I have a medical problem
b.      Theory B I am anxious about having a medical problem
3.       Conceptualise
a.       Do a functional analysis (have at the top both the preoccupation with health anxiety and I have a problem with my health, i.e. Theory a and b)
                                                               i.      Find a bump
                                                             ii.      Have a thought
                                                            iii.      Get anxious
                                                           iv.      Get physiological response which can provide more evidence
                                                             v.      Do something to feel absolutely certain there is no problem
                                                           vi.      Reduce anxiety
b.      List all the triggers, in a box on the diagram of the functional analysis above.
c.       List all the behaviours, in a box on the diagram of the functional analysis above
d.      Establish what the short and long term impact of the behaviours is
                                                               i.      This results in what the point of these behaviours is and gives us a treatment option already, draw this on the conceptualisation
4.       Treatment
a.       Theory A/B
                                                               i.      Establish what you would need to do if theory A  or B is true
                                                             ii.      Rate theory A and Theory B
                                                            iii.      What is the back ground to supporting theory A\B
                                                           iv.      How much do you believe theory a/b.
                                                             v.      What gives us evidence to support theory A or theory B
b.      Testing effects of various behaviours to prove short\term long term effect
c.       Managing the triggers
                                                               i.      Exposure to triggers without response prevention
                                                             ii.      Finding body abnormality
1.       Do the thumb test
2.       Establish beliefs about abnormality and health
a.       Challenge, do nice recommend this, should everyone operate this standard
3.       Try reducing checking to a tenth of what you do at the moment and see the impact of how many abnormalities you find
                                                            iii.      Thoughts
1.       Challenge
2.       Mindfulness
3.       Best\worst\most likely case
d.      Managing behaviours
                                                               i.      Increase the behaviour see if it decreases anxiety or provokes it
                                                             ii.      Deal with Worry (CBA, worry time, decatastrophise)
                                                            iii.      Socratically question criteria for certainty and its affect (You can never prove, with absolute certainty that something isn’t the case)
e.      General
                                                               i.      Self-focussed attention
1.       Do the self attention focus monitoring to see the effect then do the treatment

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