40 THE SEVERE AND PERSI STENT MENTAL ILLNESS PRO GRESS NOTES PLANNER D. As the client's persecutory delusions or other bizarre beliefs have decreased, he/she has also identified a decrease in his/her fear. 5. Hypervigilance (5) A. The client related that he/she is constantly feeling on edge, sleep is interrupted, and concentration is difficult. B. The client reported being irritable in interactions with others as his/her patience is thin and he/she worries about everything. C. The client's family members report th at he/she is difficult to get along with, as his/her irritability is high. D. As new anxiety/coping skills have been implemented, the client's level of tension has decreased, sleep has improved, and irritability has diminished. 6. Concentration Difficult ies (6) A. The client reported an inability to concentrate or maintain his/her train of thought due to anxious preoccupation. B. The client's lack of ability to concentrate has resulted in poor functioning in his/her social, vocational, and educational n eeds. C. The client's ability to concentrate seems to be increasing as he/she reports decreased anxious preoccupation. INTERVENTIONS IMPLEM ENTED 1. Develop Trust (1) * A. Today's clinical contact focused on building the level of trust with the client thr ough consistent eye contact, active listening, unconditional positive regard, and warm acceptance. B. Empathy and support were provided for the client's expression of thoughts and feelings during today's clinical contact. C. The client was provided with support and feedback as he/she described his/her maladaptive pattern of anxiety. D. As the client has remained mistrustful and reluctant to share his/her underlying thoughts and feelings, he/she was provided with additional reassurance. E. The client ver bally recognized that he/she has difficulty establishing trust because he/she has often felt let down by others in the past and was accepted for this insight. 2. Assess Nature of Anxiety Symptoms (2) A. The client was asked about the frequency, intensity, duration, and history of his/her anxiety symptoms, fear, and avoidance. B. The Anxiety Disorder's Interview Schedule for DSM-IV (Di Nardo, Brown, and Barlow) was used to assess the client's anxiety symptoms. C. The assessment of the client's anxiety sym ptoms indicated that his/her symptoms are extreme and severely interfere with his/her life. * The numbers in parentheses correlate to the number of the Therapeutic Int ervention statement in the companion chapter with the same title in The Severe and Persistent Mental Illness Treatment Planner, 2nd ed. (Berghuis and Jongsma) by John Wiley & Sons, 2008. 