Clinical Manual of Supportive Psychotherapy by Novalis Peter N.;Singer Virginia;Peele Roger;

Author:Novalis, Peter N.;Singer, Virginia;Peele, Roger;
Language: eng
Format: epub
Publisher: American Psychiatric Publishing
Published: 2019-08-15T00:00:00+00:00

The techniques described above work together as part of an integrated CBT approach, and thus we encourage you to implement them in this manner. However, many of the CBT techniques, especially exposure exercises, could be perceived as quite grueling to the patients and thus cause them to want to drop out of treatment. Thus, we emphasize that a strong therapeutic alliance, based on supportive therapy, is a necessary precursor to CBT interventions.

Patients with anxiety, particularly those with GAD, stand to benefit from therapy that specifically targets improving sleep hygiene. Research suggests that poor sleep not only is a common symptom of GAD (Comer et al. 2012) but also may exacerbate it, along with other disorders such as depression (Goldstein et al. 2013; Morin and Ware 1996). Patients should be encouraged and taught to practice good sleep habits. This includes setting aside sufficient time for sleep, establishing a daily routine prior to sleep, having consistent sleep and wake times, using the bed only for sleep or sexual activity (e.g., refraining from using the bed for television, internet, texting, reading), and refraining from consuming caffeine late in the day.

Finally, we strongly encourage that you consider prescribing a regimen of regular physical exercise to your patients with GAD. The many benefits of exercise in terms of both physical and mental health are well documented; this includes an increasing body of literature demonstrating anxiolytic effects (Knapen and Vancampfort 2013; Strickland and Smith 2014; Wipfli et al. 2008). The mechanisms through which physical exercise can reduce anxiety are not clear, but it is hypothesized that they involve both physical fitness (and related physiological and biochemical factors) and psychological improvements, such as increased self-esteem, distraction from rumination and worry, and decreased negative appraisals (Knapen and Vancampfort 2013).

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