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Insession 6, diaphragmatic breathing is taught to illustrate that normal breathing relieves anxiety, and hyperventilation is used to show that abnormal breathing can induce symptoms but that those symptoms are not dangerous. The patient is educated about breathing and educated about distress associations to and catastrophic cognitions about symptoms caused by hyperventilation and chest breathing, such as chest tightness, dizziness, cold extremities. The patient is made to hyperventilate to educate about breathing-induced symptoms, to create positive reassociations to dizziness and other sensations, to address distress associations to the symptoms, to reduce fear of the hyperventilation-induced symptoms, and to act as interoceptive exposure that creates new non-threating associations to the symptoms that decreases fear and other negative associations.
In session 10, cultural syndromes are used as a means to explore catastrophic cognitions and distress associations. The session ends by encouraging the patient to do a transitional ritual. The patient is told of the next follow-up session, if that is planned.
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