07/01/2006

Mental Health and Vocational Disability: Part 2 - A Quick Guide to Anxiety Disorders

by Peter Manzi

As mentioned in Part 1 of Mental Health and Vocational Disability, it behooves career counselors to understand the DSM's classification of mental disorders, their symptomology and likely course, and treatment modalities. This quick guide is the result of the author's 25 years as a career counselor and 13 years as a vocational consultant for about 2500 disability hearings.

Nearly 25% of the population has experienced an Anxiety Disorder at sometime in life and 12-13% have experienced one in any given year. Stress related to anxiety is a significant factor in more than 30% of those who consult physicians with concerns about physical ailments. While career counselors are probably not trained in clinical mental health counseling techniques, they will likely interact with anxious clients, and need to know how these disorders affect the client's work life and what interventions could be helpful.

Symptoms

Generalized Anxiety Disorder

• Preoccupation with what others think, say or do
• Hypersensitivity- may exaggerate criticisms or comments made by others, including overreacting to problems and seeking praise
• Apprehensive, fearful- especially about losing control; overly concerned with own
  appearance.
• Disturbances in sleep, appetite, may be tired and have irregular lunch dinner breaks;
  May arrive at work early and stay late to ward off fears of failure.
• Diminished ability to concentrate and persist in tasks requiring extended monitoring
  and follow up;
• Easily confused
• Anxious mood (worried, fearful, angry, hostile, critical of others, distances self from
  others
• Irritability - easily upset or angered
• Muscle tension -neck and back ache common, as are GI (gastro-intestinal) symptoms

Panic Disorder
Panic attacks can be expected (such as those triggered by an event/situation), or somewhat expected (when situational factors predispose a person to have one) or unexpected (untriggered). They vary most in their frequency and duration (anywhere from 5-30 minutes), but the intensity is generally at a high level. Usually a recovery period of varying duration is needed. Most individuals with severe panic disorder are receiving at least one anti-anxiety and/or anti-depressant medication. Symptoms often include:

• experiencing intense physical symptoms like heart pounding, chest tightness, hard breathing, and the world caving in on them.
• intense stress and tendency to see self as powerless and the world, and people, as threatening and harmful.

Agoraphobia is an associated condition where people rigidly avoid physically closed situations in which they could not obtain help from others, e.g., in a public place. For this reason, they prefer to be accompanied by friends and family members every time they leave their residence. Since this is not feasible for employment, it creates problems with lateness and absenteeism.

Obsessive Compulsive Disorderis defined as having recurrent obsessions (thoughts) or compulsions (actions) that are severe enough to be time consuming (more than one hour a day) or cause significant distress to the person (or more typically others) as well as impaired functioning. Ability to maintain long conversations and interactions may be impaired by distractions from obsessions. Symptoms may include:

• Excessive preoccupation with germs, dirt, etc.
• Obsessive doubts leading to time consuming and sometimes ritualized and repetitive
  checking behaviors (lights off, computer off, desk locked, etc.)
• Powerful need for symmetry or precision- overdoing a task- perfectionism- wasting time; as a result, tasks are left unfinished- no such thing as "quick and dirty" performance.

Counseling Interventions
To aid career counselors working with people experiencing mood and anxiety disorders, the following interventions are suggested.

• Have clients focus on their thoughts, emotions and behaviors created by their disorder that cause distress and/or impairment to themselves, co-workers, customers/clients, and supervisors.
• Initiate a discussion of what types of mental health counseling treatments they are receiving and how helpful they are.
• Ask the client if anything could be done to make things better, such as lowering stress that precipitates a panic attack or high anxiety. If a bathroom break is available or a place to isolate oneself, the client can practice deep breathing and relaxation techniques. One client had a portable CD player for relaxation exercises during breaks.
• Ask clients to rely on friends or colleagues who are supportive, or use an e-mail/cell phone "support" hotline.
• Ask them to brainstorm solutions. A client with migraines used an unlit tutoring room in a nearby college library to wear an eye cover for 20 minutes during lunch. Another scheduled 15 minute brisk walks after lunch inside her building, including stair climbing, to help overcome the drowsy effects of sleeping medication.
• Keep logs to record how time is spent alone and with others, obsessions or compulsions, levels of anxiety or panicky feelings. This is a good way to help clients get control over symptoms.
• Ask clients to choose one or two examples where the disorder presents its greatest challenge. Picking out one or two instills a sense that not every situation at work is dire or stressful, and that they can master the fear, anxiety, low/high moods and physical symptoms associated with their disorder. I like using a "fill-in the sentence" technique:

  
  When I feel a panic attack coming on I feel___ I start thinking _____I begin to do ___...
  
  If I find myself thinking terrible or strange thoughts in the middle of a meeting or conversation, I start thinking ___ believing ___telling myself___...
  
  If I am feeling down , and someone tells me I am being unreasonable or critical, I think ___ feel____ say ___ to others, and do____...

Dean Pappas, a graduate student in the Mental Health Counseling Program at Walden University, with prior experience as an art therapist, offers the following for managing anxiety:

• Feelings often are more easily accessed as images. Consider having the client draw the anxiety, compulsion or obsession as a person, creature or symbol. Disposing of the drawing in a ritual fashion allows the client to feel power over the feeling. On a follow-up session allow the client to draw a positive person, creature or symbol that depicts a positive attitude having overcome the negative feeling. Continue to work with the positive person, creature or symbol, reinforcing the client's power over the feeling. The three key components to this process are disposing and reformulating in a positive light, enabling empowerment, and reinforcement.
• Create a journal to communicate with positive people or symbols that show up in the drawings. Keep active conversations with these supportive figures, exploring ways to overcome or remove self-judgment, self-criticism, and negativistic thinking.

Maintain a Positive Focus
The focus in career counseling should just not be on mitigating negative symptoms, but on using positive psychology approaches. Can clients see some stress as challenges, an opportunity for mastery, or as a way to build support among peers? What can they do to cope? How did they change diet and exercise to sleep better? Self generated, salubrious activities are always in vogue, as they promote positive emotions and thoughts, which over time can become habitual and even enthralling to people with mood and anxiety disorders.

Reference

Seligman, L. (1998). Selecting effective treatments: A comprehensive, systematic guide to treating mental disorders. San Francisco: Jossey Bass Publishers.

Peter Manzi, Ed. D, NCC, NCCC, MCC, CDFI is a part-time faculty member in counseling and education and a full-time vocational consultant and counselor, who resides in Rochester NY. His interests include technology in counseling and career development and education, working with diverse populations, people with disabilities, and the relationship between mental health and career development. He can be contacted at pmanzi@waldenu.edu