Acknowledge the powerlessness and unmanageability caused by excessive anxiety and addiction. (13, 14)
Help the client understand how anxiety and powerlessness over addiction have made his/her/their life unmanageable.
Teach the client about the relationship between anxiety and addiction (e.g. how the substance was used to treat the anxious symptoms, why more substance use became necessary; or supplement with “Coping with Stress” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma).
Verbalize an understanding of the cognitive, physiological, and behavioral components of anxiety and its treatment. (15, 16, 17)
Discuss how anxiety typically involves excessive worry about unrealistically appraised threats, various bodily expressions of overarousal, hypervigilance, and avoidance of what is threatening that interact to maintain the problem (see Mastery of Your Anxiety and Worry: Therapist Guide by Zinbarg, Craske, & Barlow; Treating Generalized Anxiety Disorder by Rygh & Sanderson).
Discuss how treatment targets worry, anxiety symptoms, and avoidance to help the client manage worry effectively, reduce overarousal, eliminate unnecessary avoidance, and reengage in rewarding activities.
Assign the client to read psychoeducational materials as a bibliotherapy adjunct to in-session work (e.g. Mastery of Your Anxiety and Worry: Workbook by Craske & Barlow; The Anxiety and Worry Workbook by Clark & Beck).
Learn and implement calming skills to reduce overall anxiety and manage anxiety. (18, 19)
Teach the client calming/relaxation/mindfulness skills such as applied relaxation, progressive muscle relaxation, cue controlled relaxation, mindful breathing, and biofeedback as well as how to discriminate better between relaxation and tension (or supplement with “Progressive Muscle Relaxation” in the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, McInnis, & Bruce); teach the client how to apply these skills to his/her/their daily life (see New Directions in Progressive Muscle Relaxation by Bernstein, Borkovec, & Hazlett-Stevens; or supplement with The Relaxation and Stress Reduction Workbook by Davis, et al.).
Assign the client homework in which he/she/they practice calming/ relaxation/mindfulness skills daily, gradually applying them progressively from non-anxiety-provoking to anxiety-provoking situations; review and reinforce success; problem-solve obstacles toward sustained implementation (or supplement with “Deep Breathing Exercise” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Learn and implement a strategy to limit the association between various environmental settings and worry, delaying the worry until a designated “worry time.” (20, 21)
Explain the rationale and teach a worry time intervention in which the client postpones interacting with worries until a designated time and place (or supplement with “Worry Time” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce); use worry time for exposure (repeating worry toward extinction) and/or the application of problem-solving skills to address worries; agree upon and implement a worry time with the client.
Teach the client how to recognize, stop, and postpone worry to the agreed upon worry time using skills such as thought stopping, relaxation, and redirecting attention (or supplement with “Making Use of the Thought-Stopping Technique” to assist in skill development); encourage use in daily life; review and reinforce success; problem-solve obstacles toward sustained implementation.
Verbalize an understanding of the role that thinking plays in worry, anxiety, and avoidance. (22, 23, 24)
Discuss examples that demonstrate how unproductive worry typically overestimates the probability of threats and underestimates or overlooks the client's ability to manage realistic demands (or supplement with “Past Successful Anxiety Coping” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Assist the client in analyzing his/her/their worries by examining potential biases such as the probability of the negative expectation occurring, the real consequences of it occurring, his/her/their ability to control the outcome, the worst possible outcome, and his/her/their ability to accept it (or supplement with “Analyze the Probability of a Feared Event” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce; Cognitive Therapy of Anxiety Disorders by Clark & Beck).
Convey how worry creates acute and/or chronic anxious apprehension, leading to avoidance that precludes finding solutions to problems, thus maintaining them and the worry-avoidance cycle.
Identify, challenge, and replace biased, fearful self-talk with positive, realistic, and empowering self-talk. (25, 26)
Using techniques from cognitive behavioral therapies including Intolerance of Uncertainty and Metacognitive therapies, explore the client's self-talk, underlying assumptions, schema, or metacognition that mediate his/her/their anxiety; assist him/her/them in challenging and changing biases; conduct behavioral experiments to test biased versus unbiased predictions toward dispelling unproductive worry and increasing self-confidence
