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Section 13
Track #13 - 'Silly Nightmares' &
4 Key Steps to Overcoming Agoraphobia

Question 13 | Answer Booklet | Table of Contents | Child Abuse CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, MFT CEU

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On the last track, we discussed various causes of anger: ignored need to be loved; feeling controlled; and creating your own anger.

On this track, we will examine traits of anxiety related to sexual abuse and techniques to deal with the anxiety.

As you know, anxiety is one of the effects of sexual abuse. I have noticed in my work with sexually abused clients that there are specific symptoms to look for related to anxiety. These symptoms are: regressed behavior; physical restlessness; sudden, unusual, or multiple fears; unusual shyness; sleep disturbances or nightmares; generalized fears relating to the offender; withdrawal or isolation; and hyperalertness.

Share on Facebook #1 Panic Disorder
As you know, one of the most extreme forms of anxiety disorders is panic disorder. Here, anxiety attacks can occur spontaneously and without warning. Usually, there is no consistent avoidance. One of my sexual abuse clients named Kevin, age 12, would have unpredictable shortness of breath, chest pain, and he would say that he felt like someone was choking him. I asked him if there was anything that he could tell that brought on these attacks.

Kevin stated, "It happens everywhere. Sometimes in public and sometimes in bed. There's no one particular place that it happens. It just happens all of a sudden." Because Kevin's attacks were so sudden, the only way to handle them was to come up with strategies to cope with his shortness of breath and other symptoms. To do this, I told Kevin that, when he feels a panic attack coming on, to stop and take a deep breath and hold it.

I expressed to him the importance of not cheating and taking little breaths. In about 60 seconds, his body won't be able to keep itself from breathing and it will force him to take deep breath, thus helping him in his inability to breath. Do any of your clients have panic disorder? What are other ways you can treat their symptoms?

Share on Facebook #2 General Anxiety
General anxiety results when the client experiences such symptoms as muscle tension, hyperactivity, apprehension about an unrecognizable fear, and excessive vigilance. Roy, age 9, described himself as feeling always in danger. He said, "I feel like someone's there, waiting for me. Like when I'm walking down an empty hallway, I feel like someone's going to just jump out at me." He was terrified of being alone in empty places because he thought that he might be harmed and Kevin suffered from frequent nightmares of being attacked again. Roy, who was abused by a stranger in a public bathroom, was, as you can see, suffering from hypervigilance.

Share on Facebook Technique: Silly Nightmares
To help Kevin with his sleep disturbances, I found the "Silly Nightmares" exercise to be beneficial. I asked Kevin to draw picture of one of the scenes from his Nightmare that he felt comfortable drawing.

Step # 1. I told him to exaggerate one part of his picture so it becomes silly instead of scary. Kevin made the arms really, really small so, as he put it, "They couldn't reach me."
Step # 2. I told him to imagine that he had a powerful eraser to "wipe out" whatever part of the picture he wanted. Kevin erased the booming voice I had represented through large lines coming out of his mouth and he replaced them with small, squiggly lines so that, "he'd only sound like a mouse."
Step # 3. I asked him to pretend that the picture is on a television screen and to simply reach out and change the channel to a screen he wanted to see. Kevin changed it to one of his favorite cartoon characters.
Step # 4. I asked him to imagine a bomb blast that destroys the scary dream. Kevin said, "Like Wile E. Coyote."

Over the next few months, Kevin created his own ways of destroying his nightmare. Very soon, he began to have less and less nightmares and his anxiety started melting away.

Lamont, a sexual abuse client of a colleague of mine, had developed agoraphobia. At 15, he had been abused and as a result, ridiculed at family gatherings and by his peers. At 17, he refused to go to any public places. He had lived in a small town of about 3,000, so any place he went, he was sure to run into somebody he knew and who knew about his abuse.

Feeling extremely ashamed, he soon developed a fear of seeing anyone he knew or being anywhere that contained 10 or more people. He also started spending much time in his room and in the basement. By the age of 19, he had developed a full fledged agoraphobia.

Share on Facebook Technique: Four Steps to Overcoming Agoraphobia
To help Lamont, his therapist, Dr. Friber, used a "Four Step" strategy for helping him with his agoraphobia. As you know, one of the most basic ways to cure a phobia is through exposure to the object or place of which the client has a fear.

Step # 1 - First, Dr. Friber asked Lamont to write out anything that gave him anxiety or caused fear. Lamont wrote, "Public places. Lots of people. Talking to people I know."
Step # 2 - Second, Dr. Friber told Lamont to write down a specific problem and goal that he definitely wanted to work with now. Lamont wrote "going to public places" for his problem and "go to the movie theater" as his goal.
Step # 3 - Third, Lamont was asked to complete a checklist of his sensations.
The checklist included the following symptoms:
-- I want to scream or run away.
-- My heart pounds and beats fast.
-- I freeze in my tracks.
-- I feel dizzy, faint, lightheaded, about to fall.
-- I tremble and shake.
-- I can't breathe properly.
-- I feel nauseated.
-- I break into a cold sweat.
-- My stomach gets churned up or tight.
-- I feel that I'm going crazy.

After writing out anything that gave him anxiety, writing down specific problems, completing checklists…Dr. Friber then told Lamont to use the items he checked as signals to use the coping devices he will choose in step four.

Step # 4 - He asked Lamont to choose, from the following list of tactics, three the he might find useful to do or say in order to cope with his anxiety. The list included the following:
-- I must breathe "slow and shallow"-in and out-and gradually learn to deal with this situation.
-- I feel horribly tense. I must tense all my muscles as much as I possibly can, then relax them, then tense them again, then relax them.
-- What can I do? I have to stay here until I can tolerate this panic, even if it takes an hour.
-- I have to get away, but I know I must remain here.
-- I'm so embarrassed, but it's something I have to get used to.

Step # 5 - Then, over small periods of time, Lamont began going to more and more crowded places. He dealt with his anxiety through the tactics he had decided on. As you can see, with help from a regimented system, Lamont was able to deal with exposure to his phobia.

On this track, we discussed traits of anxiety related to sexual abuse and techniques to deal with the anxiety.

On the next track, we will examine the depression that many sexually abused boy clients experience and techniques to facilitate recovery.

QUESTION 13
What are the four parts in the "Silly Nightmare" drawing technique? To select and enter your answer go to Answer Booklet

 
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