1 - Anxiety Flashcards
1
Q
What are the 4 primary components of treatment for anxiety?
A
- dearousal techniques
- graded exposure
- cognitive therapy
- structured problem-solving
2
Q
Explain de-arousal techniques and potential issues
A
- address: hyperventilation, muscle tension, increased HR etc.
- hyperventilation control: slow breathing (reduces sx appraisal in panic)
- relaxation (esp. for GAD and PD)
ISSUES
- PMR: difficulties practicing at home
- clients often not comfortable relaxing: tension viewed adaptive + relaxation is weak/vulnerable
3
Q
Explain the key factors of graded exposure, how it differs from systematic desensitization and the issues with it
A
- most powerful technique in treating anxiety(?)
- derived from learning theory + habituation
- client must learn: fear is groundless
- treat: phobia, OCD, PTSD, PD
Differs from SD:
- exposure in real-world (not imagined) + no competing response (relaxation).
NOTE: some argue that relaxation allows clients to disengage from exposure and that treatment is more effective without. Other literature posits relaxation should be provided as a coping mechanism
ISSUES:
- not repeated or prolonged enough
- dealing with resistance from the client (psychoed important: you will be uncomfortable, but that is the whole point)
- some fears not groundless (eg. fear of dog after dog attack)
4
Q
What are the guidelines for exposure?
A
- baseline SUDS 40-70/100 (terminate when 50% reduction in SUDs)
- encourage risk + flexibility
- plan to counter obstacles + deal with resistance
- educate to tolerate discomfort and develop coping strategies
- avoid flooding; encourage habituation
- use rewards to encourage gains
- explore feelings that arise
- continually review and follow through graded hierarchy
5
Q
What are the 4 processes underpinning the efficacy of exposure?
A
- habituation: natural reduction in responding with repeated exposure
- extinction: over-writing previously learned fear associations
- emotional processing: developing new interpretations and meanings for feared stimuli and fearful responses
- self-efficacy: increased perception that one is capable of tolerating feared stimuli and responses
6
Q
Explain cognitive therapy for anxiety
A
- Beck’s principles
- modify irrational/faulty thinking and beliefs about feared objects/situations
- replace with more helpful thoughts
- not usually stand-alone, use alongside behavioural/exposure
- effective for: SAD, GAD, PD
7
Q
Explain the efficacy of problem-solving interventions
A
- useful in addressing GAD
- not evaluated as stand-alone treatment
8
Q
What does evidence suggest is the most effective way to treat anxiety?
A
- cognitive therapy + exposure therapy alone, or combined with relaxation training efficacious across anxiety disorders (no specific findings for unique disorders)
- CBT superior to no treatment
- CBT equally effective to relaxation-only treatments(?)
- relaxation is a really strong component
9
Q
What is the argument regarding cognitive therapy for anxiety?
A
- is it necessary?
- Beck etc. argue that therapy works by altering dysfunctional cognitions (directly or indirectly)
- some say: cog therapies have no added value to therapy
- does changing thoughts actually lead to changes in behaviours/feelings?
- CBT often associated with fast/early improvement, often before any distinct cognitive techniques are implemented
- maybe therapy should focus on strengthening helpful thought processes rather than challenge unhelpful ones?
- not really any support for changes in cognitive mediators preceding symptom change
- little evidence for cognitive change being responsible for tx gains
- behavioural evidence (testing beliefs) > insufficient research
- component analysis of anxiety treatment: few studies to date but emerging to suggest that exposure are just as effective
10
Q
What are the benefits (4), issues (3) and types of technology-assisted therapy (4) for anxiety?
What is it effective for?
A
BENEFITS:
- increased access to tx
- decrease logistic barriers
- improved self-monitoring, portability
- immediate feedback + structured instructions on techniques
ISSUES:
- lower compliance if no human-contact
- minimal therapist contact better than none at all
- methodological problems in research to date (small, varied protocols, poor controls, limited follow-ups etc.)
4 TYPES
- self-administered
- predominantly self-help
- minimal-contact therapy
- predominantly therapist-administered
EFFECTIVE FOR:
- mixed anxiety
- OCD + panic: best if combined with therapist guidance
- SAD: best if combined with therapist-directed exposure
- GAD/PTSD: too few studies
- phobia: diff for diff phobias
11
Q
Explain avoidance and safety behaviours + treatment
A
- central to anxiety maintenance
- adaptive defence mechanisms to ensure survival > in anxiety, things are perceived as more harmful than they really are
- can be cog or behavioural
- CBT interventions helpful
- very effective > but can lead to increased distress
- safety behaviours: medication, companions etc.
TREATMENT
- CBT typically emphasises elimination of SB during tx
- ongoing debate about whether SB can be implemented to foster therapy
12
Q
What are the 2 types of safety behaviours? Give cognitive and behavioural examples of each
A
PREVENTATIVE:
- to prevent future distress/increases in anxiety
- COG: preparation
- BEHAV: avoid situations, rely on company, compulsions (checking before leaving home), avoid eye contact, check for exits
RESTORATIVE
- to impede emotional experience in feared situation
- COG: distract/focus (self-monitoring), neutralising (praying/counting)
- BEHAV: escape, medication, relaxation/breathing, compulsive (washing after contamination), reassurance seeking
13
Q
How can safety behaviours maintain anxiety?
A
- directly amplify fear/anxiety
- reduce anxiety in situations but facilitate recurrence/persistence over time
- contribute to the development of clinical anxiety
14
Q
What are the criticisms of disorder-specific CBT for anxiety?
A
- comorbid presentations
- neglect common/shared features across dx
- fail to demonstrate sig. additive advantage of cog ingredients over purely behavioural interventions
- difficulty establishing cog mediation
15
Q
Explain transdiagnostic interventions for anxiety, why you would want to use them, the 2 key advantages they provide and and the 2 approaches
A
- apply same treatment principles across disorders without tailoring to specific disorders
- do not rely on knowledge of diagnosis > easier to learn for general clinicians to increase dissemination
- difference b/w transdiagnostic and disorder-specific is a matter of degree
- needs more trials
WHY USE IT FOR ANXIETY
- Craske: anxiety disorders only differ in content of perceived threat
- overlapping sx: over-estimate perceived threat, panic attacks, repeated checking, intrusive/unwanted throughs/images/urges, desire to avoid
- common maintaining processes: emotional reasoning, selective attn to threat, interpretive and expectancy biases
- same tx work for more anxieties: CBT and SSRIs
- Craske: hypervigilance + physiological responses, danger-laden judgments, avoidance
- Barlow: maladaptive cognitive appraisals, poor emotional regulation, emotional avoidance + behaviour congruent with disordered emotion
- Barlow’s transdiagnostic treatment for anxiety: alter antecedent cognitive appraisals, modify emotion-driven behaviours, prevent emotional avoidance
2 ADVATANGES:
- increased dissemination (easier to train clinicians)
- address the common challenge of comorbid anxiety dx or ADNOS
2 APPROACHES:
- pragmatic: based on clinical experiences that the same interventions are applicable to many disorders (eg. relaxation)
- theory-driven: protocols developed to target cogs/behaviours involved in a number of disorders (eg. perfectionism)
