Therapist's Guide to Clinical Intervention - Sigmund Freud

It is evident that unless cognitive-behavioral changes are made, the cycle of anxiety if selfperpetuating.
1. Functional impairment
A. Sometimes a patient is more focused on the panic attacks themselves than on such
issues as avoidance, which significantly impacts his/her daily life (these issues
become of secondary importance)
B. It is important to determine how the individual defines a desired/satisfactory
outcome, which influences motivation/compliance
C. If the defined quality of life is not at an adequate functioning level, the individual
should be encouraged to be more realistic
2. Monitoring progress
A. While there is often an initial positive response in the control of panic attacks,
subthreshold panic attacks may continue necessitating further treatment
B. The feat that attacks may occur in the future often continue when panic attacks
cease
C. It is not uncommon to experience a panic attack after a period of no panic attacks
1. Predict this possibility for patients
2. Use as a monitoring tool to rule out the resumption of a poor self-care routine
(i.e., increased stress/expanded demands, no exercise, lack of sleep, lack of
progressive muscle relaxation)
D. Be aware of comorbid issues of depression and substance abuse
E. Be alert to emergent depression
3. Improving treatment compliance
A. The anxiety associated/produced by treatment may result in noncompliance
1. Fear side effects of medication (therefore, fear of taking medication)
2. Sensitive to somatic sensations
B. Treatment must be sensitive, supportive, honest, reassuring, and, whenever possible,
predictive of what to expect (to reinforce choice/control and to validate)
* Anxiety disorders demonstrate a higher than average rate of suicide attempts (Weissman
et al, 1989).
TRAUMA RESPONSE
The sequential responses to trauma include the following stage: stressful event, outcry,
denial, intrusion, working through, and resolution. Sometimes an individual will bypass
the outcry stage and proceed from the traumatic event to denial. Corresponding to the stages
of sequential responding are normal reactions or intensification/pathological reactions.
Intensifications result when the normal reaction is unusually intense or prolonged.
1. Traumatic/Stressful Event
A. Normal emotional response: anxiety, fear, sadness, distress
*If normal response is unusually intense or prolonged, the result is a pathological
response.
B. Pathological response: overwhelmed, confused, dazed
70 l. Treatment Planning-. Goals, Objectives, and Interventions