What Every Therapist Needs to Know About Anxiety Disorders
What Every Therapist Needs to Know About Anxiety Disorders is an integrated and practical approach to treating anxiety disorders for general psychotherapists. What is new and exciting is its focus on changing a patients relationship to anxiety in order to enable enduring recovery rather than merely offering a menu of techniques for controlling symptoms. Neither a CBT manual nor an academic text nor a self-help book, What Every Therapist Needs to Know About Anxiety Disorders offers page after page of key insights into ways to help patients suffering from phobias, panic attacks, unwanted intrusive thoughts, compulsions, and worries. The authors offer a rich array of therapist patient vignettes, case examples, stories, and metaphors that will complement the work of trainees and experienced clinicians of every orientation. Readers will come away from the book with a new framework for understanding some of the most frustrating clinical challenges in anxiety disorders, including reassurance junkies, endless obsessional loops, and the paradoxical effects of effort.
Martin N. Seif, PhD, ABPP, cofounded the Anxiety and Depression Association of America and was a member of its board of directors from 1977 through 1991. Dr. Seif is associate director of the Anxiety and Phobia Treatment Center at White Plains Hospital and a faculty member of New York Presbyterian Hospital/Cornell Medical School. He maintains a private practice in Manhattan and Greenwich, Connecticut, and leads Freedom to Fly, an airport-based program for fearful fliers.
Sally Winston, PsyD, cofounded the Anxiety and Stress Disorders Institute of Maryland, where she is codirector. She is the inaugural recipient of the Jerilyn Ross Award of the Anxiety and Depression Association of America and has decades of experience treating patients, training therapists, and advocating for public awareness of anxiety disorders and advances in their treatment. She has given training workshops in the US, Canada, Asia, and Africa.
What Every Therapist Needs to Know About Anxiety Disorders
Key Concepts, Insights, and Interventions
Martin N. Seif and Sally Winston
First published 2014
by Routledge
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and by Routledge
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Routledge is an imprint of the Taylor & Francis Group, an informa business
2014 Martin N. Seif and Sally Winston
The right of Martin N. Seif and Sally Winston to be identified as authors of this work has been asserted by them in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
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Library of Congress Cataloging-in-Publication Data
Seif, Martin N.
What every therapist needs to know about anxiety disorders : key concepts, insights,
and interventions / by Martin N. Seif and Sally Winston.
pages cm
Includes bibliographical references and index.
1. Anxiety disorders. 2. Anxiety disordersTreatment. 3. Anxiety
Physiological aspects. I. Winston, Sally. II. Title.
RC531.S37 2014
616.8522dc23 2013040802
ISBN: 978-0-415-82898-7 (hbk)
ISBN: 978-0-415-82899-4 (pbk)
ISBN: 978-0-203-51884-7 (ebk)
Typeset in Minion
by Apex CoVantage, LLC
To David Seif and Emily Seif
To Frank and Phyllis Margolick
Contents
Tables
We are Drs. Marty Seif and Sally Winston, psychologists who specialize in treating anxiety. Since the late 1970s, we have treated thousands of people with anxiety disorders. Dr. Seif is one of the seven founders of the Anxiety and Depression Association of America, which began in 1977. Dr. Winston co-founded the Anxiety and Stress Disorders Institute of Maryland, in 1978. This was before the term panic disorder was in the DSM and anxiety specialization was in its infancy. We were both trained as psychodynamic and interpersonally oriented clinicians before learning about cognitive or behavioral therapies. We learned from each other, from other early pioneers, and from our patients, and we helped to create what has become the gold standard treatment for anxiety disorders. We have integrated into our work much of the extensive research done in the last 30 years to improve therapy for people with anxiety disorders.
State of the art treatment of anxiety has changed rapidly and radically, and it is almost impossible for non-specialists to keep abreast of new findings. One author, while preparing a lecture on OCD for a Grand Rounds in 2010, realized that everything taught about OCD in the 1970s is now understood to be incorrect. Additionally, both authors have made their own clinical discoveries and developed ways to approach certain issues that could be helpful to others. Our goal is to share with psychotherapists of all backgrounds and theoretical orientations the key concepts that we, as specialists, have learned over the course of our professional lives dedicated to understanding and treating anxiety disorders.
Organization
We provide information about anxiety and anxiety disorders before going into specifics to treat symptoms. A guiding principle is that the more we can educate a patient about anxiety, the less bewildered and afraid he becomes. We therefore encourage specific guided reading, asking questions, and seeking understanding of what is happening in the brain and the body and the mind. It is our responsibility to answer questions, offer explanations, and correct misinformation. Most people with intense anxiety are concerned that there is something profoundly and irreversibly wrong with their psyche or their body. There is an enormous therapeutic benefit in talking to someone who is knowledgeable, understands their experiences, educates them about what is happening, and also provides them with a model of what is going on in their mind that is in clear and accessible language.
For these reasons, the first parts of this book talk about anxiety from a more theoretical point of view, giving some basic facts as well as the overarching principles upon which they are anchored. Learning about something intrinsically changes our experience of it. When talking about anxiety with patients, there are often new perspectives, new realizations, and resultant therapeutic benefits. For example, it is not uncommon for non-psychotic patients who experience repeated panic attacks to become terrified that they are losing their mind. Simply educating them that they are experiencing panic attacks, whichwhile profoundly uncomfortableare treatable and have nothing to do with psychosis, often results in a marked decrease in anxiety. So it is frequently unrealistic to make a distinction between learning about anxiety, and learning how to manage it. The early chapters provide the basic information that forms the core of the assessment and psycho-education phase of treatment.