Adaptable Interventions for Counseling Concerns

A Step-by-Step Clinical Workbook

Freeman Woolnough, Autumn Marie Chilcote

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781317222309
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Adaptable Interventions for Counseling Concerns is filled with more than 40 interventions appropriate for new and experienced professionals alike. The interventions are organized in a unique yet practical manner, including options for individual reader creativity and personal adaptations within the text itself. The book's uniqueness lies in the broad coverage of common concerns, formatting, and ease in navigation. Each chapter is devoted to a specific client concern, with seven suggested intervention strategies clearly labeled by modality to make it easy for readers to find new interventions best suited to their practice. Chapters also introduce relevant and recent research on client concerns, contextualizing the circumstances for which a counseling professional could apply the chosen interventions. Intervention sections also include space for individualized notes and reader personalization.

1
Stress and Anxiety

▶ What are Stress and Anxiety Concerns?

Feelings of stress, as well as the varied accompanying effects, contribute to some of the most common issues for which clients seek help (Guindon, 2011). It is important to note that this prevalence comes as no surprise; the stress reaction itself is a natural part of the human experience, and is one of the most common reactions in nature. At low to moderate levels, stress can actually be quite beneficial (McGonigal, 2015), and in many ways has contributed to our survival as a species. Unfortunately for many, stress has a contradictory nature. When experienced at high levels or for prolonged periods of time, stress and anxiety can significantly and negatively impact day-to-day tasks. These effects are typically what will bring clients into our offices for support. Below are some examples of what clients may say when looking for support around stress or anxiety.

“I’ve been unable to concentrate recently; my focus is wandering all over the place.”

The stress reaction at the physiological level is often referred to as the fight-or-flight reaction (McE-wan, 2005). At its most basic level, stress is triggered by a threat to the person; the trigger itself can be physical or psychological. In preparation for dealing with this threat, the person’s attention is drawn to the trigger. From a survival standpoint this makes sense, given that we need to be aware of what is happening around us in order to keep ourselves safe. For clients who are experiencing stress or anxiety concerns, however, this focus on the threat can often lead to an inability to concentrate on other areas of their lives. Note that a lack of concentration can also be indicative of other mental health concerns (American Psychiatric Association, 2013), though it is commonly mentioned by clients who are experiencing difficulties with stress or anxiety.

“I haven’t been able to get to sleep recently—my thoughts are keeping me awake.”

The terms stress and anxiety are used almost interchangeably in today’s society. Though they are, in fact, two aspects of the same physiological reaction, the terms refer to different psychological notions. For the purposes of this chapter, stress refers to an occurring fight-or-flight reaction that matches the triggering threat. For example, when faced with an exam in the first semester of university, most students feel a certain level of heightened awareness and difficulty in calming oneself until after the exam has finished. This reaction is expected, and proves to be useful at moderate levels, as the racing thoughts can contribute to planning for success (McGonigal, 2015). One common side effect of stress is sleeplessness; in particular, clients may find getting to sleep can be difficult because of their body’s natural inclination toward focusing and concentrating on threats.

“Everybody tells me that I’m overreacting and stressing out over small things.”

On the other hand, anxiety refers to a fight-or-flight reaction that is mismatched, or above and beyond the reaction that is typically expected from a certain triggering threat. In the above example of a student facing their first university exam, if the student is experiencing sleeplessness and thoughts about exam failure three months before the exam is scheduled to take place, we would typically consider this reaction to be anxiety. In these cases, it is important that helping professionals recognize that the underlying physiological reaction is the same for both stress and anxiety; the differences lie within the intensity. For this reason, the intent in helping clients with stress or anxiety concerns is to manage or regulate the reaction. Because it is an essential biological process, it would be difficult (and possibly harmful) to eliminate it entirely.

“I’ve been having a lot of anxiety…”

As noted earlier, it has become commonplace for the general population to interchange the terms stress and anxiety. In part due to the prevalence of stress-related issues, there is also a growing knowledge of mental health diagnoses and supports, although this knowledge can be limited in the general public (Furnham & Lousley, 2013). While this phenomenon can positively impact a client’s decision to seek out help, we recently have seen an increase in the number of clients coming to our offices having already self-diagnosed with ‘anxiety.’ Though many of these clients may indeed already have a diagnosis, or may fit the criteria, it is essential that helping professionals are aware of the diagnostic criteria for Generalized Anxiety Disorder (GAD), found in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). While it is not in all helping professionals’ frameworks or professional capabilities to actually diagnose a client, some may find it useful mentioning the distinction between GAD and other stress-related issues, and should consider consulting with a clinical or medical health professional.

“It felt like I couldn’t breathe—was I having a heart attack?”

Some clients may present with stress that exists seemingly with no apparent threat or trigger. When the fight-or-flight reaction occurs in this scenario, or if a person is having a reaction to the possibility of a reaction—anxiety about anxiety—in this text, this is referred to as panic. Another part of the stress reaction is the escape response, which triggers increased breathing and pulse rates, as well as increased muscle tension. These symptoms, in particular, are exacerbated during panic, and clients can feel overwhelmed, sometimes with a sense of dread. Though stress, anxiety, and panic all have the potential to arise for intense, specific periods of time (attacks), panic in particular seems most likely to present in attack form (Bourne, 2010). Assuring clients that the reaction itself is not deadly can be an integral part of therapy.

“I just don’t know what to do.”

Sometimes a client may present with underlying indicators of stress, but with an additional symptom: an inability to make a decision or choice. This phenomenon is sometimes referred to as choice paralysis. A relatively newer concept, choice paralysis is indeed linked to the fight-orflight response—scientists have shown that the response can actually contain a third component, a freeze response (Bracha, Ralston, Matsukawa, Williams, & Bracha, 2004). With this in mind, choice paralysis is simply another way that our bodies react to stress, and any of the interventions found in this chapter may therefore be useful in helping clients to address this concern.

▶ Relevance

As noted above, the stress (fight-or-flight) response is one of the most natural reactions in the human body. When triggered at the appropriate level, stress can help our brains and bodies deal with threats, manage problems, and focus just enough to meet our goals. Countless studies have shown that an appropriate level of stress can be beneficial for performance on a number of tasks, including test-taking and project completion (McGonigal, 2015). In fact, people who are experiencing little to no stress will typically perform sub-par on a variety of tasks, showing that stress is a necessary part of the human experience.

On the other hand, the ideal level of stress is not limitless; people with higher levels of ongoing stress, anxiety, or panic will also perform sub-par. Because stress is a very natural reaction, it should come as no surprise that stress and anxiety issues make up more than 40% of client concerns in some therapeutic settings (American Psychological Association, 2013). Despite stress being a beneficial reaction, it is important to recognize that the stress response excels when dealing with physical threats—and in today’s world, the vast majority of threats and triggers are psychological in nature (worry about the future, concern about relationships, etc.). The human population in general, and clients specifically, tend to fall on the distress/over-stress end of the spectrum, and providing them with stress-management and anxiety-reduction techniques and strategies generally proves to be quite useful, regardless of the trigger.

▶ What Works Well

Outside of the psychological or therapeutic setting, clients will often seek out medical support, and therefore it is integral that helping professionals are aware that medication is an option to help manage stress and anxiety. Although medication has had limited success when used as the sole treatment option (Kimmel, Roy-Byrne, & Cowley, 2015), many clients still see benefit if other treatments are not amenable. Typical anxiety management medication falls into two categories. Longer-term treatment medications, such as selective serotonin re-uptake inhibitors (SSRIs), are more commonly prescribed, and are thought to help with cases where anxiety is underlying or pervasive across all areas of a person’s life. Shorter-term medications, such as benzodiazepines, can also be prescribed for anxiety or panic attacks, and can be effective for in-the-moment stress management (Kimmel et al., 2015). Of course, as with all medications, there are side effects, and the risk of dependence is very real; close consultation with a clinical or medical health professional is critical should concerns arise from medication usage.

As with medication, we would be amiss to omit the importance of healthy lifestyles when working with stress and anxiety issues. Both caffeine and nicotine have been shown to exacerbate the symptoms of the stress response; therefore, it is generally recommended that clients reduce coffee and cigarette use (Crocq, 2003). Increasing the association between positive health and physical distress, such as a racing heart and perspiration, can also be beneficial. Ensuring that clients are getting regular physical activity in their schedules is also a recommended first step to stress reduction.

Cognitive Behavioral Therapy (CBT) is a popular therapeutic framework used by many helping professionals for mental health concerns across the board. Though initially developed for working with low mood and depression (see the Low Mood and Depression chapter on page 33), CBT has also been shown to be effective for stress and anxiety concerns. This is not surprising, as ...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Acknowledgments
• Introduction
• 1 Stress and Anxiety
• 2 Low Mood and Depression
• 3 Emotional Regulation
• 4 Trauma and Safety
• 5 Relationships and Communication
• 6 Identity
• 7 Endings
• Afterword: Hope-Work
• Afterword: Words We Like
• Index