Anxiety Management

In 10 Groupwork Sessions

Robin Dynes

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9780863882227
• eBook ISBN: 9781351699372
• Edition: 1
• Topic: Education
• Subtopic: Education General

Designed for anyone wanting to develop an anxiety management programme for use with groups or individuals, this practical handbook will be invaluable to anyone who is called upon to respond to people who have anxiety problems. It is divided into two parts: information for anxiety management training; and, 10 chapters each looking at specific aspect of anxiety management. This is an invaluable working manual which will help everyone understand anxiety and to explore techniques for successfully controlling it.

Part I
Preparing for Anxiety Management Training

Preparing to Run a Group

To ensure a successful anxiety management group a number of issues will need to be considered before the group begins.

Selecting Group Members

It is important to match individuals to any treatment. One person may benefit from a particular approach while another may not. An urgent task, therefore, is to assess the suitability of each person being considered for the group. Anxiety management is an educational approach, using cognitive and behavioural methods. When considering individuals it is necessary to assess:

• If the person will be able to work constructively in a group. Inhibitors may include: difficulty fitting in because of demanding or disruptive behaviour; fear or embarrassment about sharing thoughts and feelings in a group; lack of ability to concentrate; an unwillingness to make a commitment to attend regularly; substantial cognitive impairment (dementia) or poor verbal skills.
• Whether the main problem is one of anxiety or is physically related. Physical problems may include: hormonal changes; the menopause; thyroid problems; infections; anaemia; allergies; pre-menstrual tension and glandular disorders. Unless physically-related conditions are treated, no psychological approach alone will be effective.
• If there are any diagnosed physical conditions which may endanger life, such as severe asthma, pregnancy, colitis or a heart condition. Putting the techniques in this book into practice involves people facing their fears – if anyone has a diagnosed condition their doctor will need to be consulted to ensure it is safe to do this in a gradual way.
• If anxiety is secondary to some other major psychiatric disorder, such as severe depression, and the person has active psychotic symptoms such as delusions, hallucinations, confusion of thought processes, loss of contact with reality or suicidal thoughts. These conditions will need to be treated before the person can begin an anxiety management programme.
• If the individual is taking high doses of sedatives or other medications which will affect their motivation and their ability to concentrate and absorb the content of the course. The person’s doctor will need to be consulted for advice about when and how, or even if it is desirable, to reduce medication.
• If the individual is regularly under the influence of alcohol. The person will need to consult their doctor to arrange a detoxification programme before starting an anxiety management group.
• If the problems originate with, for example, marital difficulties, from unresolved issues in the person’s life, or are behavioural. Anxiety management on its own will not address these problems.
• If the individual has problems which may be better approached by working with the person on a one-to-one basis, by cognitive therapy, psychotherapy or a combination of two approaches. These might include:
  • specific phobias where a desensitisation programme may be more appropriate.
  • fears related to thoughts such as being a total failure or being rejected. In this case cognitive therapy might be more successful.
  • anxiety based around lack of confidence, assertiveness or social skills. A social skills or assertiveness group might address the issues more directly.
• If the individual is willing to take responsibility for helping themselves and accept the possibility that thought patterns could have some relevance to their anxiety.
• Whether or not the person is able to engage in self-help strategies. The more severe the anxiety the more difficult it is to carry out assignments and challenge faulty thinking. Initially, one-to-one sessions may be more effective in enabling the person to achieve some success and build confidence.
• If the client wishes to explore childhood events or traumas experienced in depth. If they do, then this more action-based approach is unlikely to appeal or produce results.
• If the individual feels too threatened by the approach or being in a group. Starting a person on a one-to-one basis and then, when some confidence has been gained, having them in a group where benefits can be gained from sharing and working with other group members can help overcome these problems.
• If the individual is able to read and write sufficiently well to be able to understand the material in the way it is to be presented and to complete the assignments. Additional one-to-one help/sessions may be needed or they may have a partner or friend who can assist them. Discreet support may be needed in the group. The programme can be adapted to focus more on behavioural aspects, concepts can be simplified and visual aids provided for presentations to help them understand the material. More time can be allowed for discussion, practice and exercises as required.
• If the individual has learning difficulties. It will be necessary to adapt the programme to focus on behavioural aspects, simplify concepts and present the material in a more concrete and visual manner to aid understanding. More time can be allowed for discussion, practice and exercises.

The answers to many of the above issues may be known, depending on the referral system or the setting in which group leaders work. For example, if they work in a day centre they will probably know the group members well and have most of the above information in each person’s records.

The Initial Interview

It is usually necessary to have some sort of interview to establish the problem and in order to gather and give information. Also, it provides an opportunity to enable individuals to explore any fears they may have about the process. It will help group leaders to decide whether the person being considered is suitable and give the person an opportunity to decide whether they want to commit themselves. What form the interview takes and how detailed it is will depend largely on the setting and how much information is known about the person. However, even if a substantial amount of information is available it is always safest to confirm it with the person before proceeding.

When identifying problems it is helpful to understand them in the different aspects suggested by P J Lang (1968). These are:

• What physical symptoms are being experienced?
• What does the person think might happen?
• What do the above two reactions cause the person to do? For example: avoid the situation by not going to social occasions.

It is also useful to take into account each person’s individual lifestyle. What stress does this cause and what effect does it have on general health and well-being? During the interview explanations will need to be included about what is involved in the programme, what participants will be expected to do and what the benefits will be. Discussion should include:

1. Group members needing to take responsibility for their own learning.
2. The investment of time and energy to complete assignments.
3. What the skills to be learned are. The fact that, once learned, they will need to be practised in anxiety-provoking situations, that this will be uncomfortable at times but, once accomplished, the skills are theirs for life.
4. Commitment to attending each session.
5. Acknowledgement that their thought patterns could have some relevance to the problem.
6. What the person will gain from the programme.

Appendix 1 provides an informal format for obtaining the necessary basic information. This may need to be adapted and changed to suit particular settings. The format should give sufficient information to decide if the programme is suitable. Permission may be needed from the person to gain information about anything group leaders are unsure of, such as a physical condition.

Using a Co-worker

Advantages of using co-workers are:

• Two people working together can be more aware of what is happening in the group and pick up on the issues.
• They can give each other feedback about their perception of what was happening in the group and use this as a check and to help plan for the next session.
• They can give each other feedback about their performance.
• They can share the load.
• A broader view of what is happening in the group can be obtained.
• Two people working together can ensure preparation is more thorough and each participant’s needs are taken into consideration.
• Two workers make it easier to divide the participants into subgroups to complete exercises.
• Sharing ideas and solving problems together can be more creative than working alone.

Disadvantages of co-working can be:

• Power struggles can develop between workers.
• Co-workers may collude with each other and not want to give each other honest feedback.
• Co-workers may think in ways that are incompatible, or harbour unresolved conflicts.

If two people are going to co-work it is necessary to ensure that they are compatible, feel equal and can work in a complementary way to support each other. Both will need to be involved in planning discussions to provide a basis for predicting compatibility. Views will need to be shared about preferred styles of participation, who will be responsible for leading which parts of the session and what each expects from the other.

Where compatibility exists, with a mutually supportive attitude, experience suggests that it is advantageous and more effective to work with a co-worker – particularly so when working with a large group.

Considering the Setting

Careful thought should be given to the venue where the group is to be held. Consider the following:

• Is the room large enough to seat the group number in comfort?
• Is there enough space for everyone to move around freely and to use a flipchart or chalkboard?
• Is there enough space to do exercises such as relaxation? (Chairs will, preferably, have arm and head rests. Mats or blankets and cushions may be provided so that relaxation can be practised lying down.)
• Is the room suitable for people with any disabilities or special needs? Is there a loop system for people with hearing impairment?
• Will anyone with disabilities be able to access toilets without embarrassment and without disturbing other members of the group?
• Is the room reasonably quiet?
• Does the room enable privacy to be respected?
• Is it possible to ensure that there will be no interruptions from other people using the building?
• Is there adequate heating and ventilation?
• Are there power points for the use of audio-visual aids if you are using them?
• Can equipment be used safely in the room without putting anyone in danger?
• Can drinks be made in the room, if required, during the break?

Attention to the above practical details will help ensure the group members settle down quickly and feel comfortable. It will also eliminate most unwanted interruptions.

Thinking about the Group Size

Having fewer than six people in the group does not allow enough diversity of interaction and reduces the environment needed to achieve change. A small group of this size will also be vulnerable when members are absent or drop out.

A group that is too large makes it difficult to keep track of what is going on and gives each person less time to contribute. Between eight and ten people is about the right number in each session. However, to make allowance for absenteeism and those who stop attending, it is expedient to recruit up to 15 members.

Deciding the Number and Length of Sessions

Option 1 The course has been designed as a cohesive whole, scheduled to take place over a period of ten weeks, using two-hour sessions with a ten-minute break. This may not suit all client groups or situations.

Option 2 If participants are likely to take longer to master the concepts involved, the number of sessions can be doubled. Thus a shorter session each week, of say, one-and-a-half hours could be run, using half of the material but allowing more time for discussion, practice and consolidation. The course would then run for 20 weeks.

Option 3 One session could be used to teach and the following session to consolidate and reinforce material taught at the previous session. This would allow more time for discussion, feedback and practice of the techniques. It also gives more time for the participants to adapt techniques and concepts to their daily lives, practice assignments and effect change. This course would also run for 20 weeks.

Option 4 Have sessions twice a week for the first two weeks, then weekly for four weeks, then fortnightly for the last two sessions. This is more difficult to operate but has the advantage of focusing on the important initial learning and then encouraging more independence as the meetings progress.

Option 5 A more advanced group may obtain more momentum from proceeding at a faster pace. In this case, two sessions each week is suggested, completing the course in five weeks. However, this does mean less time for practising techniques and assignments and to consolidate learning. It may have the advantage of a reduced drop-out rate.

Option 6 It would be exceptional to have a whole group of very severely anxious people. If this is the case, however, then a group of six to eight people is more practical, run over a longer period of time. It will also be necessary to allow extra time at the end of sessions – say about 30 to 45 minutes – for group members who are severely agoraphobic to practise going out from the group, assisted, where necessary, by group facilitators. This enables group members to gain confidence and then build on this success, making it more likely that they will complete assignments. Usually, only one or two members of any group will need this type of support. Also, when a group member has difficulty applying the techniques, a few outings in this manner with a group facilitator supporting and observing can enable solutions to their difficulties to be applied quickly.

Option 7 As the first four sessions present the basic information and techniques required by anyone before facing their fears, it is paramount that these techniques are thoroughly ...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of handouts
• Acknowledgements
• INTRODUCTION
• Part I: PREPARING FOR ANXIETY MANAGEMENT TRAINING
• Part II: UNDERSTANDING ANXIETY MANAGEMENT TECHNIQUES
• Appendixes
• Bibliography