Integrative CBT for Anxiety Disorders E-Book

Assen Alladin

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 650

Veröffentlichungsjahr: 2015

Beschreibung

Integrative CBT for Anxiety Disorders applies a systematic integrative approach, Cognitive Hypnotherapy (CH), to the psychological treatment of anxiety disorders; it demonstrates how simple techniques can be used to create a therapeutic context within which CBT is more effective.

• An evidence-based approach to enhancing CBT with hypnosis and mindfulness when treating anxiety disorders shows how simple techniques can be used to create a therapeutic context within which CBT can become more effective

• Offers detailed and comprehensive coverage for practitioners, with specific protocols for each anxiety disorders covered and a hort case study per treatment chapter in order to demonstrate the approach in action

• Anxiety disorders is an area where the interaction between conscious and unconscious processes is especially important, and where the use of hypnotherapeutic and mindfulness techniques can therefore be especially effective

• Builds on the author’s research and experience and develops his significant earlier work in this area – notably Cognitive Hypnotherapy: An Integrated Approach to the Treatment of Emotional Disorders (Wiley, 2008)

Leseprobe

Table of Contents

Cover

Title Page

About the Author

Foreword

Preface

Acknowledgements

1 An Integrative Approach for Understanding and Treating Anxiety Disorders

Overview

Introduction

Self-Wounds Model of Anxiety Disorders

Summary

2 Integrated Therapy for Anxiety Disorders

Overview

Integrated Therapy

Cognitive Hypnotherapy for Anxiety Disorders

Summary

3 Social Anxiety Disorder (Social Phobia)

Case of Betty

Diagnostic Criteria for Social Anxiety Disorder (Social Phobia)

Prevalence of Social Anxiety Disorder

Causes of Social Anxiety Disorder

Treatment of Social Anxiety Disorder

Cognitive Hypnotherapy for Social Anxiety Disorder

Summary

4 Specific Phobia

Case of Mandy

Diagnostic Criteria for Specific Phobia

Prevalence of Specific Phobia

Causes of Specific Phobia

Treatment of Specific Phobia

Cognitive Hypnotherapy for Specific Phobia

Summary

5 Panic Disorder

Case of Harry

Diagnostic Criteria for Panic Disorder

Prevalence of Panic Disorder

Causes of Panic Disorder

Treatments for Panic Disorder

Cognitive Hypnotherapy for Panic Disorder

Summary

6 Generalized Anxiety Disorder

Case of Fred

Diagnostic Criteria for Generalized Anxiety Disorder

Prevalence of Generalized Anxiety Disorder

Causes of Generalized Anxiety Disorder

Treatment of Generalized Anxiety Disorder

Cognitive Hypnotherapy for Generalized Anxiety Disorder

Summary

7 Agoraphobia

Case of Margaret

Diagnostic Criteria for Agoraphobia

Prevalence of Agoraphobia

Causes of Agoraphobia

Treatment of Agoraphobia

Cognitive Hypnotherapy for Agoraphobia

Summary

8 Separation Anxiety Disorder

Case of Andrew

Diagnostic Criteria for Separation Anxiety Disorder

Prevalence of Separation Anxiety Disorder

Causes of Separation Anxiety Disorder

Treatment of Separation Anxiety Disorder

Cognitive Hypnotherapy for Separation Anxiety Disorder

Case of Fran

Summary

9 Selective Mutism

Case of Jessica

Diagnostic Criteria for Selective Mutism

Prevalence of Selective Mutism

Causes of Selective Mutism

Treatment of Selective Mutism

Cognitive Hypnotherapy for Selective Mutism

Summary

10 Conclusions and Future Directions

Appendix A: Appendix 1A: Cognitive-Hypnotherapy Case Formulation and Treatment Plan

Appendix B: Cognitive-Hypnotherapy Case Formulation and Treatment Plan

References

Index

End User License Agreement

List of Tables

Chapter 02

Table 2.1 Eight-step cognitive hypnotherapy case formulation

Table 2.2 Systematic desensitization hierarchy of fear of using public washroom

Chapter 04

Table 4.1 Systematic desensitization hierarchy of fear of using public washroom

Chapter 05

Table 5.1 Example of CAB form for monitoring the trigger, cognitive distortions and emotional consequences

Table 5.2 Completed cognitive restructuring form for PD

Chapter 06

Table 6.1 Example of CAB form for monitoring worry trigger, irrational beliefs and emotional consequences

Table 6.2 Completed cognitive restructuring form

Chapter 07

Table 7.1 Systematic desensitization hierarchy of fear of visiting the mall downtown

Table 7.2 Completed cognitive restructuring form

Chapter 08

Table 8.1 Factors that are known to precipitate SAD

Table 8.2 Systematic desensitization hierarchy of fear of separation

Chapter 09

Table 9.1 Systematic desensitization hierarchy of anxiety related to speaking at school

List of Illustrations

Chapter 01

Figure 1.1 Schematic model of an anxiety disorder.

Guide

Cover

Table of Contents

Begin Reading

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Integrative CBT for Anxiety Disorders

An Evidence-Based Approach to Enhancing Cognitive Behavioural Therapy with Mindfulness and Hypnotherapy

Assen Alladin

This edition first published 2016© 2016 John Wiley & Sons, Ltd.

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Library of Congress Cataloging-in-Publication Data

Alladin, Assen, author. Integrative CBT for anxiety disorders : an evidence-based approach to enhancing cognitive behavioral therapy with mindfulness and hypnotherapy / Assen Alladin.  1 online resource. Includes bibliographical references and index. Description based on print version record and CIP data provided by publisher; resource not viewed.

 ISBN 978-1-118-50988-3 (Adobe PDF) – ISBN 978-1-118-50991-3 (ePub) – ISBN 978-1-118-50992-0 (cloth) 1.  Anxiety disorders–Treatment. 2. Cognitive therapy. I. Title. RC531 616.85′2206–dc23

      2015023162

A catalogue record for this book is available from the British Library.

Cover image: alenkadr/ iStock 177263382

About the Author

Dr Assen Alladin is a clinical psychologist and adjunct associate professor in the Department of Psychiatry at the University of Calgary Medical School. He is a fellow of the Royal Society of Medicine, president-elect of the American Society of Clinical Hypnosis and Conference Coordinator and past president (two terms) of the Canadian Federation of Clinical Hypnosis – Alberta Society. He has been practicing and teaching hypnosis, cognitive behavioural therapy (CBT), psychotherapy and clinical psychology for over 30 years, and he is the 2005 recipient of the Best Research Paper from Division 30 of the American Psychological Association.

Dr Alladin has published over 35 chapters and papers on clinical hypnosis and has authored three books – Handbook of Cognitive-Hypnotherapy for Depression: An Evidence-Based Approach (2007), Hypnotherapy Explained (2008) and Cognitive Hypnotherapy: An Integrated Approach to the Treatment of Emotional Disorders (2008). He served as guest editor for special issues in hypnotherapy for the Journal of Preventive Neurology and Psychiatry (1992), the Journal of Cognitive Psychotherapy: An International Quarterly (1994), the International Journal of Clinical and Experimental Hypnosis (April 2007 and July 2007) and the American Journal of Clinical Hypnosis (2012). He is also on the Board of Editorial Consultants of the American Journal of Clinical and Experimental Hypnosis.

Dr Alladin is internationally recognized as an expert in the field of integrating CBT with hypnosis in the management of emotional disorders. He has presented over 200 papers and workshops nationally and internationally, and he is known to be an excellent and dynamic presenter. He comes from the island of Mauritius, and he completed all his studies in England. He was initially trained as a registered nurse and social worker before pursuing psychology and clinical psychology. Dr Alladin has two adult children, and he lives in Calgary, Alberta, Canada.

Foreword

Millions of people suffer from anxiety, and anxiety disorders are among the most prevalent problems for which individuals seek psychotherapy. Also, anxiety disorders are associated with other psychological disorders such as depression and stress-related symptoms. In Integrative CBT for Anxiety Disorders: An Evidence-Based Approach to Enhancing Cognitive-Behavioural Therapy with Mindfulness and Hypnotherapy, Dr Assen Alladin provides an integrative model and understanding of how to identify and provide the most effective therapies for treatment of anxiety disorders.

Every student and clinician who treats patients with anxiety problems will want to have this invaluable text. This book represents a tremendous resource for effectively conceptualizing anxiety disorders and learning effective treatment strategies that are well supported by research. Anxiety disorders can be highly complex with both conscious and unconscious dynamics. Dr Alladin provides an understanding of how cognitive behavioural therapy (CBT) can be enhanced by the skilful use of mindfulness and hypnotherapy techniques. In this regard, this book stands out as highly innovative and clinically useful.

This is a book for clinical practitioners who are on the front lines of treating clients with anxiety disorders. The book includes many clinical case examples and transcripts of actual therapy sessions. A multitude of clinical techniques for relief of anxiety symptoms and for exploration of underlying dynamics are presented. The concept of ‘wounded self’ is introduced as the theoretical foundation for the understanding of the etiology of anxiety disorders and for an integrative approach to treatment. The concept of self-wounds refers to the interaction between damaging life experiences and the self-defeating cognitive and emotional strategies that clients develop to cope with the associated anxiety. By highlighting Self-Wounds Model of Anxiety Disorders, the author explains that anxiety disorders often represent both an implicit (unconscious) fear as well as conscious anticipations. Throughout the book, he illustrates this model through clear case examples and psychotherapy research.

Drawing upon this integrative model, a step-by-step treatment protocol is provided as it relates to specific anxiety disorders. The treatment protocol covers the entire process from case conceptualization to treatment. The initial phase of this integrative approach is on competent clinical assessment, case conceptualization and establishment of a therapeutic relationship. The author illustrates how to use DSM-V diagnostic criteria to identify various anxiety disorders and in treatment planning. The second phase of the protocol is on management of symptoms. Here, the author provides clear guidance on use of relaxation and other cognitive-behavioural methods to reduce symptoms and gain a sense of control. In the third phase, the option of uncovering and healing self-wounds is introduced. In the fourth phase of the treatment protocol, methods are introduced for promoting psychophysiological coherence (PC), acceptance, gratitude and mindfulness.

Psychotherapists will find practical guidance for treatment as well as establishing a therapeutic alliance as the basis for a range of cognitive, behavioural and hypnotherapeutic strategies. The treatment model is both flexible and comprehensive. It emphasizes the integration of theory and empirically based interventions to achieve maximum flexibility and efficacy. The author is the developer of cognitive hypnotherapy (CH), and Chapter 2 describes the latest developments in CH for anxiety disorders at each phase of treatment.

This book is a tremendous resource for treatment of the most commonly encountered anxiety disorders. Treatment of specific phobias, social anxiety disorder (SAD), panic disorder (PD) and agoraphobia have been covered in the clinical chapters. A wealth of precise methods are provided in regard to effective treatment. The author succinctly reviews the relevant empirical research in support of each method. In addition, case examples are used to illustrate interventions. The reader will find a rich resource of transcripts for explaining and delivering interventions. For example, transcripts have been provided for hypnotic suggestions, addressing cognitive distortions, healing the wounded self and mindfulness practice, just to name a few.

Generalized anxiety disorder (GAD) is very well covered in this book. Chapter 7 is highly relevant as GAD is the most prevalent anxiety disorder seen in primary care. It is a disorder that can be chronic. It is not unusual for patients to have experienced anxiety symptoms for more than 10 years before seeking treatment. Medications can reduce symptoms, however, psychotherapy is usually required to identify unconscious issues and to develop coping skills. In this chapter, a wide variety of behavioural, cognitive, hypnotic, unconscious, and acceptance and mindfulness-based strategies have been presented. Methods such as self-monitoring, problem solving and expanding awareness have been covered. Transcripts are provided on techniques such as ego strengthening, learning self-hypnosis, mindfulness and exploring unconscious issues.

Separation anxiety and selective mutism (SM) are covered in the remaining clinical chapters. These are disorders that occur mostly in children but, if untreated, can persist in adolescence or even adulthood. The integrative treatment model provides a comprehensive approach including therapeutic confrontation of unconscious conflicts and emotions that may contribute to maintaining the symptoms. Case examples and transcripts for specific interventions are provided.

This book provides a groundbreaking theoretical model for understanding and treating anxiety disorders. The concept of the wounded self is illustrated throughout the book, and its relationship to the development of anxiety disorders is explained in a way that is clear and useful. Furthermore, it is an essential resource for the most effective psychotherapy methods in treatment of anxiety disorders.

Dr Assen Alladin is a clinician of exceptional talent and knowledge. In this book, he demonstrates the expertise that he has in integrating the best and most effective methods from a variety of theoretical orientations. In addition, he shares his profound knowledge of contemporary psychotherapy research and how it can be applied to effective clinical practice. Although he is the most prolific researcher in the area of CH, he is primarily a clinician, and this book will resonate with most clinicians. With the publication of this book, Dr Assen Alladin, has advanced our understanding of anxiety disorders and provided a model for truly integrative treatment that will serve as an extremely important and useful resource for clinicians for many years to come.

Gary Elkins, PhD, ABPP, ABPH

Professor, Department of Psychology and Neuroscience, Baylor University

Director, Mind-Body Medicine Research Laboratory, Baylor University, Waco, Texas

President, Society of Psychological Hypnosis

President-Elect, Society of Clinical and Experimental Hypnosis

Past-President, American Society of Clinical Hypnosis

Associate Editor, International Journal of Clinical and Experimental Hypnosis

Preface

This project is the product of over 30 years of clinical practice in both in- and outpatient settings. Over these years, there have been some major developments in the classification, understanding and treatment of anxiety disorders. The book incorporates some of these major developments into an integrated perspective on anxiety disorders, known as the Self-Wounds Model of Anxiety Disorders (SMAD). This model of anxiety disorders accesses the best theoretical constructs and the most effective treatment strategies derived from various extant etiological theories and treatment approaches. The focal point of this theoretical integration is Wolfe’s (2005, 2006) concept of self-wounds or early unresolved emotional injuries. According to this conceptualization, anxiety represents an unconscious fear of unbearable insult to the wounded self, which is protected by maladaptive conscious strategies such as avoidance, cognitive distortions or emotional constriction. This perspective, which is described in Chapter 1, provides a theoretical basis for blending elements of behavioural, cognitive, psychodynamic, experiential and mindfulness perspectives in the understanding and psychological management of anxiety disorders.

Based on this integrative model, and in recognition of the fact that anxiety disorders do not form a homogeneous group, the book adopts a multi-component approach to treatment. A step-by-step treatment protocol for each anxiety disorder from DSM-V is described in detail in order to provide a practical guide to clinical practice. This book fills an important gap in the literature. It provides a common thread for binding the best extant theoretical constructs and the most effective treatment strategies for anxiety disorders into a comprehensive integrated model. To accomplish this purpose, a number of specific topics are sequentially presented in each chapter. Each chapter begins with a case description, the listing of the DSM-V criteria for each target anxiety disorder, an overview of the prevalence rate, a brief review of the causes and current treatments, followed by detailed description of the treatment protocol.

The treatment protocol itself is subdivided into four separate but overlapping phases, including (i) assessment, case conceptualization and establishment of therapeutic alliance, (ii) management of symptoms, (iii) uncovering and healing of self-wounds and (iv) promotion of acceptance, mindfulness, gratitude and PC. The treatment generally consists of 16 weekly sessions, which can be expanded or modified according to patients’ clinical needs, areas of concern and severity of symptoms. An additional 10 sessions may be needed for patients who wish to explore and remedy tacit causes of their symptoms. As a rule, uncovering work, which is more dynamic and involves deep hypnotherapy, is introduced later in the therapy.

The first phase of the therapy consisting of assessment, case formulation and therapeutic alliance is not described in detail in each chapter as Chapter 2 covers it in great detail. The second phase of the therapy primarily focuses on symptomatic relief, and it comprises a variety of extant behavioural, cognitive and hypnotherapeutic strategies. However, based on research from third-wave cognitive-behavioural therapies, the goal is not on controlling the symptoms but learning to cope with them. Once a patient has overcome his or her symptoms, the therapist has to make a decision about the next stage of intervention. For those patients who have improved and believe that they have met their goals, the therapy is considered complete and is duly terminated. For those patients who wish to explore the roots of their anxiety, they continue with the third phase of therapy, which involves uncovering and healing of tacit self-wounds. The symptom-management phase of the therapy, therefore, for some patients, serves as a preparatory phase for more complex therapy of exploring the roots of the anxiety disorder later in the therapy. Hypnosis and gestalt therapy provides an array of methods for uncovering and healing underlying cause of the anxiety disorder.

In the final phase of therapy, acceptance and mindfulness-based strategies are applied to anxiety disorders, with the main goal of helping patients learn to observe their symptoms without overly identifying with them or without reacting to them in ways that aggravate their distress. This phase also serves as an evidence-based approach for relapse prevention. Moreover, this phase introduces an innovative and practical approach, breathing with your heart, for integrating mind-body-heart in therapy, which facilitates cultivation of PC. Abundant research evidence suggests that heart-focused positive emotional state synchronizes the entire body system to promote healing, emotional stability and optimal performance.

In summary, each clinical chapter contains a variety of strategies derived from behavioural, cognitive, hypnotic, psychoanalytic and mindfulness strategies from which a clinician can choose the best set of techniques that suits his or her patient. The techniques are described in sufficient details to allow replication and adaptation. For these reasons, the techniques may be repetitive in each chapter. However, each technique is modified according to each target anxiety disorder. For example, the systematic desensitization procedure for agoraphobia and specific phobia may be similar, but the hierarchies and mode of presentation vary. This approach was selected to render each clinical chapter self-sufficient.

The term ‘patient’ and ‘client’ are used interchangeably in the book as the author has worked mostly with severe cases and in health settings, where the care-receiver is referred as ‘patient’. The usage of the term ‘patient’ is not to undermine or label the individuals with anxiety disorders.

Assen Alladin

January 2015

Acknowledgements

I would like to thank my wife, Naseem Alladin, for her ongoing support and encouragement— without her help this project would not have been completed.

I would also like to thank all the individuals with anxiety disorders I have worked with. I have learned so much from them, and this book would not have been possible without their presence.

1An Integrative Approach for Understanding and Treating Anxiety Disorders

Overview

This chapter reviews the concept of wounded self, which provides a common thread for binding the best extant theoretical constructs and the most effective treatment strategies for anxiety disorders into a comprehensive integrated model. The focus of this theoretical integration is the concept of self-wounds or early unresolved emotional injuries. This model offers an integrative perspective on the nature, development, aggravation and maintenance of anxiety disorders. According to this view, anxiety represents an unconscious fear of unbearable insult to the wounded self. This chapter describes SMAD and outlines the theoretical and empirical rationale for integrating CBT, mindfulness and hypnotherapy in the psychological management of anxiety disorders.

Introduction

Although anxiety disorders constitute the most common psychological disorders treated by mental health professionals and family physicians, a coherent etiological theory and a comprehensive integrated treatment for anxiety disorders are lacking. From his review of the literature, Wolfe (2005) found mainstream views of anxiety disorders to be flawed in respect to their conceptualization, etiological theories, treatment approaches, research hypotheses and research methodologies. He noticed that none of the current perspectives on anxiety disorders, including psychoanalytic, behavioural, cognitive-behavioural, experiential, and biomedical, provide a complete theory or a comprehensive treatment for anxiety disorders, albeit each viewpoint has made some important contribution to our understanding and treatment of the disorders. He also noted that none of the etiological theories upon which the current treatments are based on accentuated the role of interpersonal, family, cultural and ontological factors in the formation, onset and course of anxious symptoms. To rectify these shortcomings, Wolfe has developed an integrated perspective of anxiety disorders that accesses the best theoretical constructs, the most effective treatment strategies and specific evidence-based techniques from various existing etiological theories and treatment approaches. Before discussing the clinical implications of this integrated perspective of anxiety disorders, the main components of Wolfe’s model are described and, where relevant, expanded on.