Anxiety Management

Description of the Strategy

Anxiety management training (AMT) is a form of coping skills training that teaches applied relaxation as a means of anxiety control. AMT was first designed for the treatment of generalized anxiety disorder in adults and has been conceptualized as a treatment for any problem in which anxiety plays a central role. Although AMT was initially developed for adults, researchers have also suggested a modified set of AMT procedures for children. AMT alone does not appear to be the current treatment of choice for childhood anxiety disorders; however, components of AMT seem to be incorporated into a number of well-accepted treatment protocols for childhood anxiety.

In AMT, clients are taught to identify and respond to both physiological and cognitive signals of anxiety with a specific coping behavior. More specifically, clients learn to respond to their anxiety symptoms through the implementation of a relaxation response. As sessions progress, clients are instructed in how to recognize physiological and cognitive cues that signal the onset of anxiety. This enables the client to prevent even higher levels of anxiety from developing by responding to early anxiety cues with the execution of relaxation behaviors.

There are several subtle distinctions that differentiate AMT from other behavioral treatments for anxiety, such as systematic desensitization or flooding techniques. In AMT, the clients take an active role in their anxiety reduction by selectively applying a coping skill (i.e., relaxation training) to reduce anxiety symptoms evoked during imaginal exposure exercises. During systematic desensitization, relaxation training and exposure are also employed, although the usage of such skills differs from AMT procedures, as a relaxed state is optimally maintained from the start of a systematic desensitization session and imaginal exposure episodes are typically brief and terminated by the therapist before high levels of fear or anxiety fully disrupt the client's relaxed state. In addition, AMT uses only two levels of anxiety (moderate and high) for exposure tasks, whereas systematic desensitization utilizes a gradual, stepwise hierarchy of stimuli intensity that induces a range of anticipated responding spanning from very low levels of anxiety to much higher levels of anxiety. Flooding procedures, unlike AMT, do not include active coping skills training, such as the learning of relaxation exercises. In flooding, adaptation to feared stimuli is more of a passive process that focuses on habituation to such stimuli, whereby clients are usually exposed to highly feared stimuli without any previous, incremental presentation of less fear-evoking stimuli.

AMT treatment protocols usually consist of five structured sessions. However, more than five sessions are often implemented, as particular sessions may be repeated. The sessions typically take place once a week for approximately 1 hour at a time. The therapist begins the first session with an overview of the treatment [Page 663]structure and rationale. The reason for this overview is that client understanding of the therapeutic process is considered an important component of AMT. Therapy is described to clients as a type of skill acquisition, learned primarily through extensive practice. Furthermore, AMT is discussed as a method to train clients in the early identification of anxiety and the elimination of anxiety through relaxation. The therapist also emphasizes the importance of active involvement on the part of the clients during the course of their AMT treatment. The therapist may also describe how relaxation will be taught, and clients are informed that imagery will be used as a way for the clients to induce anxiety in session.

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