1st half Flashcards
Core Features
A. Marked fear or anxiety about a specific object or situation • Flying • Heights • Animals • Receiving an injection • Seeing Blood
Specific Phobia DSM 5 Criteria
- The phobic object or situation almost always provokes immediate fear or anxiety.
- The phobic object or situation is actively avoided or endured with intense fear or anxiety.
- The fear or anxiety is out of proportion to the actual danger posed by the specific onset or situation and to socio-cultural context.
- The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
- The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Disturbance not caused by other impairment.
specifiers
○ Animal
○ Natural environment (heights, storms, water)
○ Blood-injection injury
○ Situational (elevators, enclosed places, etc)
○ Other
Associated Features
○ Increase in physiological arousal in anticipation of or during phobic exposure
○ Natural environment – sympathetic nervous system arousal
○ Blood-injection injury – vasovagal / fainting response
Development and Course
○ Sometimes develop following a traumatic event, observing others experience a traumatic event, an unexpected panic attack in the to be feared situation
○ Many unable to recall the specific reason
○ Usually develops early in childhood- before age 10
○ Median age of onset 7-11 years of age
○ Situational phobias later age in onset then natural
○ Wax and wane in adolescence
○ Those that persist to adulthood often unlikely to remit
Risk and Prognostic Factors
○ Temperamental: neuroticism, behavioral inhibition
○ Environmental: parental over-protectiveness, loss, separation, physical and sexual abuse, trauma
○ Genetic/physiological: genetic susceptibility
Culture
In the US, Asians and Latinos report significantly lower rates than non-Latino whites, African Americans, and Native Americans
Assessment
● There is much debate about the validity of the DSM when it comes to Anxiety Disorders because of the symptom overlap
● Requiring a “threshold” of symptoms may lead to the subclinical population NOT being treated
● Assessment should look at the developmental, medical, family history and social history as well as the onset, development, and context of anxiety symptoms
● Identification / screening: treatment vs. no treatment
● Is the fear developmentally appropriate?
● What is the significant impact?
● Triage-treatment planning
● Nature of the fear or anxiety
● Outcome assessment
● Is the treatment effective?
- Self-rating Scales
○ Child Depression Inventory 2nd Edition; CDI-2
○ Revised Children’s Manifest Anxiety Scale; RCMAS
○ Fear Survey for Children-Revised; FSSC-R
○ State Trait Anxiety Inventory for Children; STAIC
○ Coping Questionnaire for Children; CQ-C
○ Social Phobia & Anxiety Inventory; SPAI
○ Multidimensional Anxiety Scale for Children; MASC
- Parent Rating Scales
○ Child Behavior Checklist; CBCL
○ BASC-2; PRS
- Interviews
○ Anxiety Disorder Interview Scale for Children
Physiological Measures
● Heart rate ● Blood pressure ● Galvanic skin response ● Respiration rate ● Pulse blood volume
Treatment
Probably Efficacious: ○ Individual CBT ○ Group CBT ○ Group CBT with parents CBT components included: ○ Gradual exposures (in vivo or imaginal) ○ Developing coping plans ○ Use of cognitive self-control ○ Relaxation ○ Learning self-evaluation & self-reward
Possibly Efficacious
○ Individual CBT with parents
○ Group CBT with Parental Anxiety Management
○ Graded In Vivo Behavioral Exposures
○ School-Based Group CBT
- CBT research
Research
○ Effective to reduce anxiety in both children and adolescents
○ 50-80% show reduction in anxiety symptoms
○ Effects remain stable with up to 7 years post treatment
○ High client treatment acceptability
Preschool Children
○ Less research in pediatric populations
○ Most studies mixed anxiety samples
○ Young children may benefit less
CBT: Cognitive Restructuring
Purpose:
○ Control negative self-statements, correct faulty self-statements, building self-efficacy
○ Teach children to identify maladaptive anxious thoughts
○ Understand the connection between their thoughts, feelings, and behavior
○ Challenge and dispute the anxiety provoking thoughts and replace them with healthier adaptive ways of thinking
● Challenging Maladaptive Anxious thoughts
○ Evidence testing
○ Functional and logical disputation
- Exposure
● Purpose:
○ Address avoidance
● Most essential component in intervention package
● Graded Exposure
○ Teaches children that the anxiety provoking stimuli is not as threatening as they perceive it to be
● Systematic desensitization
○ The goal of is to overcome this avoidance pattern by gradually exposing patients to the phobic object until it can be tolerated.
○ 3 steps: teach client to relax, construct anxiety hierarchy, present anxiety-stimuli when child is relaxed
○ Difficulties in school setting: sometimes stimuli not present or feasible to implement in school
- Developing a Fear Hierarchy
● Fear hierarchy provides a framework for systematically reducing anxiety
● Work with the student to create lists about the various steps they may encounter in going through the feared situation
○ Record physical and mental sensations (ie., feeling nervous, dry mouth, heartbeat racing, Hands or legs trembling)
○ Sort into ascending order of intensity. Put them side by side and select the most fearful to least fearful
○ Use a SUDS (Subjective Units of Discomfort) scale/ fear thermometer to assign a value to situation
● Proceed on to systematic desensitization
- Relaxation Training
Purpose: help a person to relax by achieving a state of increased calmness; or otherwise reduce levels of anxiety, stress or anger Types ○ Diaphragmatic breathing ○ Progressive Muscle Relaxation ○ Autogenics and Biofeedback
- Progressive muscle relaxation
● PMR allows you to lower your overall tension and stress levels by helping you relax when you are feeling anxious or experiencing physical problems such as stomachaches and headaches.
● People with anxiety difficulties are often so tense throughout the day that they don’t even recognize what being relaxed feels like.
● Learn to distinguish between the feelings of a tensed muscle and a completely relaxed muscle & then to “cue” this relaxed state at the first sign of the muscle tension that accompanies feelings of anxiety.
● PMR teaches you how to relax your muscles through a two-step
● First, you systematically tense a particular muscle groups in your body (e.g., arms, legs, face, etc.)
● Second, you release the tension and notice how your muscles feel when you relax th
- Parent component
Treatment implementation
○ Teach parents to remove their reinforcement of anxious behaviors
○ Reinforcement of bravery for engaging in exposure tasks
Parenting Style/environment
○ Reduce family conflict
○ Train parents to manage their own anxiety
○ Help parents realize they may model anxious behaviors
- School based services
Advantages:
○ Schools can monitor children at risk
○ Anxiety provoking stimuli may involve school settings
○ Stigma
○ Cost and referral barriers
Disadvantages
○ School’s responsibility
