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Brief Interventions for Anxiety Disorders with Children and Adults
Anxiety Disorders continuing education psychologist CEUs

Section 8
Structured Clinical Diagnostic Interview
Four Specific Interventions for Anxious Thoughts

CEU Question 8 | CE Test | Table | Anxiety
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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Guidelines for Asking Questions
As you know, you help your clients correct faulty ideas and logic mainly through questions. Ideally with the anxiety-disordered client, he or she learns to pose your questions to themselves. The following is a checklist for asking questions. Think of an anxiety-disordered child or adult you are treating and see if you need to fine tune your questions in the next session.

Six-Point Checklist for Asking Questions
Here is a six-point checklist:
1. Did your questions help the client to focus on the specifics?
For example, do you need to try the "close your eyes technique"?
---Therapist: What do you think would happen if you confronted your boss about changing your hours?
---Client: Oh, probably nothing would happen.
---Therapist: Can you be more specific? What exactly do you think would happen?
---Client: Well, he probably would just shrug it off and say, "Well, it's just the way it is."
---Therapist: Can you be even more specific? Maybe think about it for a moment? Can you close your eyes and imagine it?
---Client: Well, I imagine he might be taken back at first. But then he would probably ask me why I brought it up; then I really think that he wouldn't carry it any further.
---Therapist: Can you imagine it again?
---Client: I can see him act another way. He's very mad at me.
---Therapist: How you are reacting to him?
---Client: Well, I'm getting uptight and I can't talk. I want to leave.
---Therapist: That's what I was wondering about. To be even more specific, what would be the worst thing about the situation? Your feeling? The way you would act? Or the reaction of your boss?
Here I used questions to get the client to specify what exactly he was afraid of in the situation.

2. Were your questions specific, direct, and concrete enough?
Although an open-ended question such as "How have you been feeling?" is useful for obtaining general information, questions that get particular types of information are usually more helpful: for instance, "How anxious were you when you asked for the date?" Such questions enhance the client's observing self in the session and, thus, improve communication, provide structure, and facilitate relief of symptoms. When one client said his anxiety concerns the "meaning of life," I ask the client "What specifically concerns you about the meaning of life?" What at first appeared to be a client's existential or preoccupation with vague philosophical concepts was traced to a specific fear of cancer.

3. Did your questions grow out of your conceptualization of the client's problem?
Think over your last session with your anxious client. For example, if your strategy for a battered wife is for her to see the possible course of action, "I could call the police," was your question geared to having the client think along the lines of "What could you do?"

4. Were your questions timed to foster rapport and problem-solving?
As you know, poorly timed questions can increase your client's anxiety. As would, for example, asking a client to cognitively "rehearse" a fearful event before you have established trust with him. Were questions geared to enhance trust, like "Do you feel nothing will happen if you tried what we discussed?" asked early in treatment?

5. Did you ask questions too rapidly for the child's level of development?
The result I find, especially with a child, is they feel cross-examined and become defensive. To avoid this, I find I need to take added time with a child to think about the information I have before I phrase my next question. I need to constantly be vigilant to avoid the common error of formulating a new question instead of listening to the client's answer.

6. Were your questions in-depth enough or were you aiding your client in avoidance of the issues?
As you know, your client usually has more information than he is aware of. You may stop asking questions before the client gets to the real cause of the anxiety. To avoid this, I ask "Can you think of anything else?" I find often a client's most helpful reconceptualizations come after his immediate responses. I then repeat, "Take a couple of minutes and see if you can think of anything else." By simply repeating this question, it often brings up new material. In the following clinical example, I use questions to elicit information and to open up a client's closed logic.
---Client: I don't think I'll ever be able to get a job.
---Therapist: How often do you have this thought?
---Client: Quite often.
---Therapist: And what do you base this thought on?
---Client: I just feel it. There's no use.
---Therapist: Do you think feelings are always logical?
---Client: No. I guess not always.
---Therapist: Your feelings are often wrong and just reflecting what you're thinking. What are the advantages of this type of thinking?
---Client: Well, I don't have to go for the interview. I don't have to think about it.
---Therapist: Those are real benefits. What disadvantages are there?
---Client: Well, I'll never get what I want. I may be making a mountain out of a molehill.
---Therapist: On balance, is this thinking helpful to you?
---Client: I suppose not.
---Therapist: What do you think you could do about this type of thinking if it's getting in your way?
---Client: Well, maybe look at it more closely.

Peer-Reviewed Journal Article References:
Long, E. E., Haraden, D. A., Young, J. F., & Hankin, B. L. (2020). Longitudinal patterning of depression repeatedly assessed across time among youth: Different trajectories in self-report questionnaires and diagnostic interviews. Psychological Assessment, 32(9), 872–882.

Powell, D. M., Stanley, D. J., & Brown, K. N. (2018). Meta-analysis of the relation between interview anxiety and interview performance. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 50(4), 195–207. 

Recklitis, C. J., Blackmon, J. E., & Chang, G. (2017). Validity of the Brief Symptom Inventory-18 (BSI-18) for identifying depression and anxiety in young adult cancer survivors: Comparison with a Structured Clinical Diagnostic Interview. Psychological Assessment, 29(10), 1189–1200.

Schneider, L. H., Pawluk, E. J., Milosevic, I., Shnaider, P., Rowa, K., Antony, M. M., Musielak, N., & McCabe, R. E. (2021). The Diagnostic Assessment Research Tool in action: A preliminary evaluation of a semistructured diagnostic interview for DSM-5 disorders. Psychological Assessment.

Vrshek-Schallhorn, S., Wolitzky-Taylor, K., Doane, L. D., Epstein, A., Sumner, J. A., Mineka, S., Zinbarg, R. E., Craske, M. G., Isaia, A., Hammen, C., & Adam, E. K. (2014). Validating new summary indices for the Childhood Trauma Interview: Associations with first onsets of major depressive disorder and anxiety disorders. Psychological Assessment, 26(3), 730–740.

Online Continuing Education QUESTION 8. What are six key points for asking questions of an anxious child or adult? To select and enter your answer go to CE Test.

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