Another great video Patricia. I'm wondering if you can do a follow-up video or small series on this for the topic of panic disorder If others would also have interest in this? Perhaps how you might work with somebody On the left of the spectrum through perhaps the standard approach versus somebody on the right with the graded approach. You started to talk about some of this at least from my view. For example like when you were talking about taking your foot off the gas and doing anxiety regulation. And so many ways you also at least for my view started talking about identifying Even little anxiety as it's manifested in the therapeutic hour. It sounds like you're helping them build their ego adaptive capacity further through this. The other request is that maybe, like you have other videos and your books, talk about case examples either to illustrate the differences between the standard and the graded or just some of the general examples of cases that may have exhibited features or that of panic disorder proper. Thank you again for the consideration and again for this wonderful video
This is an extension and request off of the comment I recently posted. There was a third component that I was going to inquire about if you did some follow-up videos. That was the role of the interventions later in the working through phase as well as the role of the PSE or punitive super ego in panic disorder. Part of what stimulated this was obviously watching this video but also you had directed me to a journal article by Carvth. It didn't have a date on it but I think the reference was for '06 in the journal of psychoanalysis. Title being self-punishment as guilt evasion. You seem to appreciate that article discussing it in a separate video. I too appreciated a number of aspects about it. If you have ideas about its relevace from an ISTDP framework and if you happen to do further videos on panic disorder that would be great too.
This is very helpful Patricia. When I was doing my practicum I had a client who had extreme recurrent panic attacks. We ruled out any medical issues (he had several medical tests done), so I assumed and proceeded as if they were psychogenic somehow. But this really makes sense, how the "lack of awareness" or not having any interoceptive cues of emotional experience could cause the smaller anxieties (if left unchecked) to build up into a full-blown panic attack. As such, the phrase we sometimes hear in therapy, that we generally want to " _avoid_ _avoiding_ " seems to ring especially true here. I had a little request of my own, for a future video, if that's ok. If you have the chance, I was wondering if you might be so kind and gracious to share with us your understanding of the difference between the following, and how to treat them generally: 1. Neurosis (neruoses plural - I think Karen Horney originated this term somehow?) 2. Neurotic (Kernberg's level of personality organization) 3. Neuroticism (Big 5 personality trait) All these words sound so alike, yet as I understand them they all refer to different things...its all very confusing. Any help with this question would be greatly appreciated, thanks!
Thank you Patricia for accepting my request, you are very kind! 👏 I agree with you that there are many patients who have panic attacks that systematically ignore their anxiety and have a very demanding personality that leads them to overload themselves with activities, not set limits for themselves (or others) and take very little care of themselves until they simply "explode" and have very intense panic symptoms. With these patients I have had good results... However, those who have panic in exposure situations (such as public speaking or oral evaluations) seem especially complex to me, since they identify the trigger but it is very difficult for them to identify feelings beyond the physical sensations of anxiety in those circumstances. They also recognize that the fear is irrational but the symptoms still persist. With other patients I have seen that there is a lot of anxiety linked to its projection of their own self-criticism in others and fear of "external judges" but even so the symptoms persist despite recognizing that only they evaluate themselves so harshly... Any suggestions with these types of patients?
In situations like public speaking or oral exams, I find that patients are projecting into the future experiences they have already had. They might say, I am afraid I will freeze or be humiliated, etc. I ask, when did that happen? They always come up with a memory and we can go from there, examining feelings from the past. Hope that helps.
Hello Patricia, thank you for your quick response! Of course it helps! Indeed, I have seen many patients who have that "fear of fear"... fear of experiencing those anxiety symptoms again, which activates avoidant behaviors and then greater anxiety when they can no longer avoid and have to expose themselves and relive those anxiety symptoms (and catastrophic anticipation is reinforced), establishing a "vicious circle" or self-fulfilling prophecy. My question is how to get them to stop projecting those aversive experiences when they have had multiple learnings along those lines in the past? And a second question... You mentioned patients ignoring their anxiety, but can the opposite happen as well? I have seen patients who are so hyperalert to any signal from the body that they interpret as anxiety and activate fear and catastrophic thoughts (for example patients who stop climbing stairs so their heart doesn't race). With these types of patients, I have doubts about whether it is advisable to connect them more with the body or not? Many thanks! 🙏
Of course, as you say, folks can become anxious about being anxious and get into a real cycle. The only way out of that is to face and bear it. Especially the younger generation who were raised by helicopter parents, they are like hot house flowers who can't live in the real world - which is tough. I talk about anxiety not being the problem but their inability to tolerate anxiety for growth. That is the switch. Also, activating the desire system helps. Given your questions, I realize another video is in order to discuss these things. Thanks for the prompts.
Another great video Patricia. I'm wondering if you can do a follow-up video or small series on this for the topic of panic disorder If others would also have interest in this? Perhaps how you might work with somebody On the left of the spectrum through perhaps the standard approach versus somebody on the right with the graded approach. You started to talk about some of this at least from my view. For example like when you were talking about taking your foot off the gas and doing anxiety regulation. And so many ways you also at least for my view started talking about identifying Even little anxiety as it's manifested in the therapeutic hour. It sounds like you're helping them build their ego adaptive capacity further through this. The other request is that maybe, like you have other videos and your books, talk about case examples either to illustrate the differences between the standard and the graded or just some of the general examples of cases that may have exhibited features or that of panic disorder proper. Thank you again for the consideration and again for this wonderful video
This is an extension and request off of the comment I recently posted. There was a third component that I was going to inquire about if you did some follow-up videos. That was the role of the interventions later in the working through phase as well as the role of the PSE or punitive super ego in panic disorder. Part of what stimulated this was obviously watching this video but also you had directed me to a journal article by Carvth. It didn't have a date on it but I think the reference was for '06 in the journal of psychoanalysis. Title being self-punishment as guilt evasion. You seem to appreciate that article discussing it in a separate video. I too appreciated a number of aspects about it. If you have ideas about its relevace from an ISTDP framework and if you happen to do further videos on panic disorder that would be great too.
This is very helpful Patricia. When I was doing my practicum I had a client who had extreme recurrent panic attacks. We ruled out any medical issues (he had several medical tests done), so I assumed and proceeded as if they were psychogenic somehow. But this really makes sense, how the "lack of awareness" or not having any interoceptive cues of emotional experience could cause the smaller anxieties (if left unchecked) to build up into a full-blown panic attack.
As such, the phrase we sometimes hear in therapy, that we generally want to " _avoid_ _avoiding_ " seems to ring especially true here.
I had a little request of my own, for a future video, if that's ok. If you have the chance, I was wondering if you might be so kind and gracious to share with us your understanding of the difference between the following, and how to treat them generally:
1. Neurosis (neruoses plural - I think Karen Horney originated this term somehow?)
2. Neurotic (Kernberg's level of personality organization)
3. Neuroticism (Big 5 personality trait)
All these words sound so alike, yet as I understand them they all refer to different things...its all very confusing. Any help with this question would be greatly appreciated, thanks!
I will add it to the list.
What about waking up with a panic attack? Seemingly without a causal factor. Have seen it explained by a physiological process.
Hi. Can you say a bit more about the physiological process?
Great question.
Thank you Patricia for accepting my request, you are very kind! 👏
I agree with you that there are many patients who have panic attacks that systematically ignore their anxiety and have a very demanding personality that leads them to overload themselves with activities, not set limits for themselves (or others) and take very little care of themselves until they simply "explode" and have very intense panic symptoms. With these patients I have had good results... However, those who have panic in exposure situations (such as public speaking or oral evaluations) seem especially complex to me, since they identify the trigger but it is very difficult for them to identify feelings beyond the physical sensations of anxiety in those circumstances. They also recognize that the fear is irrational but the symptoms still persist.
With other patients I have seen that there is a lot of anxiety linked to its projection of their own self-criticism in others and fear of "external judges" but even so the symptoms persist despite recognizing that only they evaluate themselves so harshly... Any suggestions with these types of patients?
In situations like public speaking or oral exams, I find that patients are projecting into the future experiences they have already had. They might say, I am afraid I will freeze or be humiliated, etc. I ask, when did that happen? They always come up with a memory and we can go from there, examining feelings from the past. Hope that helps.
Hello Patricia, thank you for your quick response! Of course it helps!
Indeed, I have seen many patients who have that "fear of fear"... fear of experiencing those anxiety symptoms again, which activates avoidant behaviors and then greater anxiety when they can no longer avoid and have to expose themselves and relive those anxiety symptoms (and catastrophic anticipation is reinforced), establishing a "vicious circle" or self-fulfilling prophecy. My question is how to get them to stop projecting those aversive experiences when they have had multiple learnings along those lines in the past?
And a second question... You mentioned patients ignoring their anxiety, but can the opposite happen as well? I have seen patients who are so hyperalert to any signal from the body that they interpret as anxiety and activate fear and catastrophic thoughts (for example patients who stop climbing stairs so their heart doesn't race). With these types of patients, I have doubts about whether it is advisable to connect them more with the body or not?
Many thanks! 🙏
Of course, as you say, folks can become anxious about being anxious and get into a real cycle. The only way out of that is to face and bear it. Especially the younger generation who were raised by helicopter parents, they are like hot house flowers who can't live in the real world - which is tough. I talk about anxiety not being the problem but their inability to tolerate anxiety for growth. That is the switch. Also, activating the desire system helps. Given your questions, I realize another video is in order to discuss these things. Thanks for the prompts.
Perfect, thank you very much!
you are a beautiful woman
Hello, I was wondering if you could do a video discussing what to consider when working with a client who never breaks the frame?
Not sure what you mean. Patients almost never break the therapeutic frame. Doing so is typically a manifestation of a borderline organization.