9 Abuses substances in an attempt to control anxiety symptoms (i.e. self-medicates).
LONG-TERM GOALS
1 Maintain a program of recovery, free from addiction and excessive anxiety.
2 End addiction as a means of escaping anxiety and practice constructive coping behaviors.
3 Reduce overall frequency, intensity, and duration of the anxiety so that daily functioning is not impaired.
4 Stabilize anxiety level while increasing ability to function on a daily basis.
5 Resolve the core conflict that is the source of anxiety.
6 Enhance ability to cope effectively with the full variety of life's worries and anxieties.
7 Learn and implement coping skills that result in a reduction of anxiety and worry and improvement in daily functioning.
SHORT-TERM OBJECTIVES
THERAPEUTIC INTERVENTIONS
Work cooperatively with the therapist toward agreed-upon therapeutic goals while being as open and honest as comfort and trust allow. (1, 2)
Establish rapport with the client toward building a strong therapeutic alliance; convey caring, support, warmth, and empathy; provide nonjudgmental support and develop a level of trust with the client toward him/her/their feeling safe to discuss his/her/their generalized anxiety and its impact on his/her/their life.
Strengthen powerful relationship factors within the therapy process and foster the therapy alliance through paying special attention to these empirically supported factors: work collaboratively with the client in the treatment process; reach agreement on the goals and expectations of therapy; demonstrate consistent empathy toward the client's feelings and struggles; verbalize positive regard toward and affirmation of the client; and collect and deliver client feedback as to the client's perception of his/her/their progress in therapy (see Psychotherapy Relationships That Work: Vol. 1 by Norcross & Lambert and Psychotherapy Relationships That Work: Vol. 2 by Norcross & Wampold).
Describe situations, thoughts, feelings, and actions associated with anxieties and worries, their impact on functioning, and attempts to resolve them. (3)
Ask the client to describe his/her/their past experiences of anxiety and their impact on functioning; assess the focus, excessiveness, and uncontrollability of the worry and the type, frequency, intensity, and duration of his/her/their anxiety symptoms (consider using a structured interview such as the Anxiety and Related Disorders Interview Schedule for the DSM-5).
Complete psychological tests designed to assess worry and anxiety symptoms. (4)
Administer psychological tests or objective measures to help assess the nature and degree of the client's worry and anxiety and their impact on functioning (e.g. The Penn State Worry Questionnaire; OQ-45.2; the Symptom Checklist-90-R).
Cooperate with and complete a medical evaluation. (5)
Arrange for a medical evaluation to rule out nonpsychiatric medical and substance-induced etiologies (e.g. hyperthyroidism, stimulant use).
Provide behavioral, emotional, and attitudinal information toward an assessment of specifiers relevant to a DSM diagnosis, the efficacy of treatment, and the nature of the therapy relationship. (6, 7, 8, 9)
Assess the client's level of insight (syntonic versus dystonic) toward the presenting problems (e.g. demonstrates good insight into the problematic nature of the described behavior, agrees with others' concern, and is motivated to work on change; demonstrates ambivalence regarding the problem described and is reluctant to address the issue as a concern; or demonstrates resistance regarding acknowledgment of the problem described, is not concerned, and has no motivation to change).
Assess the client for evidence of research-based correlated disorders (e.g. oppositional defiant behavior with ADHD, depression secondary to an anxiety disorder) including vulnerability to suicide, if appropriate (e.g. increased suicide risk when comorbid depression is evident).
Assess for any issues of age, gender, or culture that could help explain the client's currently defined “problem behavior” and factors that could offer a better understanding of the client's behavior.
Assess for the severity of the level of impairment to the client's functioning to determine appropriate level of care (e.g. the behavior noted creates mild, moderate, severe, or very severe impairment in social, relational, vocational, or occupational endeavors); continuously assess this severity of impairment as well as the efficacy of treatment (e.g. the client no longer demonstrates severe impairment but the presenting problem now is causing mild or moderate impairment).
Cooperate with a medication evaluation by a prescriber. (10, 11)
Refer the client to a prescriber for a medication evaluation.
Monitor the client's medication adherence, side effects, and effectiveness; consult with the prescriber, as needed.
Discuss ambivalence about changing current worry patterns toward deciding on whether to make changes. (12)
Use Motivational Interviewing techniques to assess the client's current stage of change and willingness to take action steps toward change (see Motivational Interviewing by Miller & Rollnick).
