Controlling ANGER ANXIETY DEPRESSION Management PowerPoint Presentation on CD

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Contains the following key public domain (not copyrighted) U.S. Government publication(s) on one CD-ROM in both Microsoft PowerPoint and Adobe Acrobat PDF file formats: TITLE Anger, Anxiety and Depression Management, 61 pages (slides) SLIDE TOPICS, SUBTOPICS and CONTENTS: Anger Management Presented by 1st Infantry Division Mental Health Section Advantages of Anger Feelings of Power Self-Righteous Get people’s attention Make them do what you want Disadvantages of Anger Physical Symptoms: Tension Fatigue Psychological Symptoms: Remorse Guilt May cause fear rather than respect Understanding Your Anger Who controls your anger? Who can make you angry? Answer: ? The Answer? YOU! Facts about Anger Anger in not: a reflex automatic caused by others Anger is: a result of our thinking a choice controlled by your own thinking A-B-C Theory of Emotional Arousal A B Event Consequent Emotion Somebody pushes Annoyance in line ahead of you Anger A-B-C Theory of Emotional Arousal A B C Event Beliefs Emotion Somebody pushes Inconsiderate Annoyance in line ahead He’s a jerk Angry of you He shouldn’t do that Keys to Controlling Your Anger Recognize that your thoughts control your anger; Accepting that you alone can control your anger; Choosing how much and how long you want to be angry; Controlling your anger by controlling your thinking. Hot Thoughts Labeling “That jerk” “That Idiot” Mind-reading “She did it on purpose” “He’s trying to drive me crazy” Fortune Telling “She will never change” “There is no use in trying” Hot Thoughts Labeling Mind-reading Fortune Telling Hot Thoughts Catastrophizing “It’s driving me crazy” “I can’t stand it” Should Statements “He shouldn’t act like that” “She can’t get away with that” Vengeance “I’d like to wring her neck “I want to kill him” Hot self talk is the ‘B’ to the ABC’s of Anger Hot Thoughts Catastrophizing Should Statements Vengeance Hot self talk is the ‘B’ to the ABC’s of Anger A-B-C Theory of Emotional Arousal A B Event Pause Choose Control Thinking C Emotion Control your anger by controlling your thinking Listen to your Self-Talk; Identify the hot, self angering thoughts; and substitute cooler, more rational self statements. Cool Thoughts Labeling Not: “That jerk” But: “I don’t like what Jack just did” Mind-reading Not: “She did it on purpose” But: “I can’t read her mind, so I don’t know why she did it” Fortune Telling Not: “She will never change” But: “I can work on my part and hope for the best” Cool Thoughts Labeling Mind-reading Fortune Telling Cool Thoughts Catastrophizing Not: “It’s driving me crazy” But: “It’s inconvenient, but it’s not the end of the world” Should Statements Not: “He shouldn’t act like that” But: “It would be nice if he didn’t act like that” Vengeance Not: “I’d like to wring her neck But: Remember that vengeance usually invites retaliation and invites conflict Cool Thoughts Catastrophizing Should Statements Vengeance A Practical Overview of Anxiety and Its Management By Willis T. Leavitt, MD 1st ID MHS Objectives To characterize anxiety and fear To identify common pathological anxiety disorders To highlight practical supportive interventions for anxiety symptoms Anxiety and Fear Anxiety and fear are both alerting signals, notifying the body and mind of danger. Emotionally and physically, the two may seem indistinguishable. Fear is generated by an outside threat which is known and definite. Anxiety, on the other hand, is a threat from within and is often vague and unknown. Anxiety and Fear Anxiety, like fear, can result in physical changes: Racing pulse Labored breathing Sweating Faintness Distractibility and Confusion Anxiety and Fear Anxiety, like fear, although uncom-fortable, can have lifesaving benefits: Warns of potential pain and punishment Alerts to potential damage to one’s success or status Alerts to threats to one’s identity Anxiety and Fear Anxiety helps a person best adapt to an environment, developmental changes, or changing circumstances. Anxiety becomes pathological when the intensity or duration is beyond that expected. Anxiety and Fear Many theories shed light on our understanding of anxiety: Psychoanalytic Behavioral Existential Biological Psychoanalytic Theory Punishment from a harsh Superego Guilt Failure to achieve ideal goals Retaliation by a powerful authority Castration anxiety Abandonment or separation from others Separation anxiety Emerging un-acceptable impulses Sexual or aggressive impulses Behavioral Theories Conditioning Associating anxiety with neutral stimulus Learning Adopting parental anxieties Cognitive Anxiety results from faulty, distorted or counterproductive thinking patterns Anxiety follows from overestimation of danger Existential Theories Life is meaningless and results in death. Anxiety results from an inner sense of nothingness in the greater scheme of things. Biological Theories Anxiety, being a natural emotion, is mediated by biology. It is unclear whether pathological anxiety is an overstimulation of natural pathways, or something completely unique. Neurotransmitters GABA Norepinephrine Serotonin Areas within the Brain Limbic System Temporal Cerebral Cortex Common Anxiety Disorders Simple Phobia Social Phobia Adjustment Disorder with Anxious Mood Generalized Anxiety Disorder Panic Disorder with Agoraphobia Obsessive-Compulsive Disorder Posttraumatic Stress Disorder General Non-Medication Therapy Interventions Show interest in alleviating symptoms. Make empathic statements. Psychoeducation calms unrealistic expectations. Communicate realistic optimism. Explore possible medication/specific techniques to alleviate symptoms. Contain your own anxiety. Simple & Social Phobias Systematic Desensitization Make a list of least to worst feared object or situation. Gradually expose patient to least object or situation through fantasy/imagery or real-life contact. Train the patient to focus on relaxation while exposed to the feared stimulus. In time, the patient will feel less fear and can move to the next feared stimulus. Example of Systematic Desensitization Fear of Crowded Places Least Feared PX Mid-Range Fear Barber Shop at high noon Most Feared Seagras Restaurant Plan Trained Pt in relaxation imagery. Pt stood at door to PX using relaxation. Stood in entrance way then behind cashiers. Moved to rear of store in time. Panic Disorder Hyperventilation Syndrome can cause panic attacks. During the initial phase of anxiety, respiration rate can increase causing the patient to exhale excessive CO2. Build up of lactate in the blood serum triggers panic symptoms in susceptible persons. Panic Disorder A paper bag is the perfect solution. Provide education about underlying physiology Have a bag on hand to demonstrate use Encourage use daily for practice and when panic arises. Deliberate hyperventilation must be done with caution!! Conclusion Anxiety helps to safeguard against internal dangers. Pathological anxiety is greater in intensity or duration than everyday anxiety. Supportive interventions alone can reduce anxiety symptoms, and can establish a therapeutic relationship on which other interventions can occur. Management of the Depressed Patient Willis T. Leavitt, MD 1st Infantry Division Mental Health Section Topics Identifying Depression Management Strategies Guide to Referral Open Discussion Objectives To identify depression To distinguish critical components To develop a four step management strategy To review effective treatment intervention Identifying Depression Recognized as a distinct illness by ancient scholars. Today, studies reveal a 10-15% lifetime incidence. Large spectrum of depressive symptoms. Depression’s Varied Faces Mental Health Depression, Anxiety, and Suicidal Impulses. CCC Substance Use to alter mood; and consequence of prolonged substance use. Medical Clinic Unremitting somatic complaints. Depression’s Varied Faces Cont. Chaplains Grief and Marital Discord Family Advocacy Abusive Relationships (sexual, physical, emotional, & neglect) Command Declining work performance Depression Diagnoses Groups Situational/Environmental Complex (Biological & Situational) Situational/Environmental Group Adjustment Disorders with Depressed Mood with Mixed Disturbance of Conduct & Emotions “V Codes” Bereavement Phase of Life Occupational Problems Relational Problems Complex Group Major Depression Bipolar Disorder Dysthymic Disorder Alcohol / Substance Abuse & Dependence Personality Disorders Eating Disorders Schizoaffective Disorder General Symptom Differences Key DSM-IV Signs & Symptoms Depressed Mood Insomnia (or Hypersomnia) Anorexia Poor Concentration Anhedonia (isolation and loss of interest in life) Fatigue Feelings of Guilt, Hopelessness, Worthlessness Pre-occupation with death or thoughts of suicide Slowing in movement and thinking processes Other Associated Symptoms Tearfulness Irritability/Anger Decreased Sex Drive Poor Work/School Performance Boredom Anxiety Hallucinations & Delusions (severe) Increased Alcohol/ Substance Use Agitation Risky Behaviors Physical Complaints Self Harm Components of Depression Situational Social and/or Psychological Complex Biological and/or Social and/or Psychological Social Component Loss of a loved one to death, geographic separation, and divorce. Significant change in life (i.e. work, school, home, finances, social status, and other responsibilities). Decrease in Support Network. Abuse (physical, sexual, emotional, and neglect). Psychological Component Past Emotional Traumas Ambivalence Decreased self esteem/self worth Guilt Failure to meet self expectations (realistic and/or unrealistic) Negativistic thinking patterns Biological Component Family History A family history of depression suggests a serotonin and/or norepinephrine regulation problem. Past Mental Health History Underlying Physical Illness Hypothyroidism, Diabetes, Cancer, etc.. Alcohol/Substance Abuse Post-Partum Poor Sleep Hygiene Management Strategies 1. Identify Depression Symptoms (number, severity, and time course) Components (social, psychological, biological) Safety Issues* (suicide or impaired self care) If Situational, initiate a trial of interventions. If Complex, consider referral to or consultation with Mental Health. * to be addressed in future discussion Management Strategies 2. Develop Intervention Plan Target identified Components Keep the plan simple Patient agreement and input is essential!! Monitor progress of symptoms Requires 3-4 weeks (or sessions) to assess success of interventions Management Strategies 3. Intervention Options Supportive Essential intervention in all strategies; key to compliance Listen to emotional tone and to content Reflect emotional tone and posture Attempt to clarify emotions Non-judgemental or critical statements Maintain time boundaries Management Strategies 3. Intervention Options Continued Behavioral Changed behavior results in changed mood. Target a depressive symptom Schedule a daily activity to counter the symptom Examples: ride a bike for an hour to address fatigue attend church to address isolation/anhedonia Monitor progress (via patient charting) Requires 3-4 weeks Management Strategies 3. Intervention Options Continued Problem Solving (Cognitive) Inability to solve a problem results in learned helplessness. Identify problem (usually a social component) and several solutions Construct a list of “pros and cons” for each solution Identify the best solution, and put into action. Helps to develop greater cognitive flexibility and sense of power. Management Strategies 3. Intervention Options Continued Counseling Referral Classes (eg. stress management, parental guidance) Individual, Marital, Family, and/or Group Helps focus on interpersonal issues and intrapsychic exploration Available through a variety of agencies Management Strategies 4. Assessing the Intervention Trial Review symptom development at each visit Ask about Suicidal/Homicidal Ideations Modify unsuccessful interventions Add interventions as needed Requires 3-4 weeks (or sessions) to assess success of interventions If depression worsens, consult Mental Health. Summary Common Depressive Symptoms Distinguishing Situational from Complex Depressions Four Step Management Strategy Review of Effective Treatment Interventions

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