7 - Anxiety disorders Flashcards
True or false: There are more fear based problems than mood based in ages 3 - 5.
True
Explain Plato’s chariot driver analogy.
- Your mind is like a chariot driver with horses; the driver is like the rational part of you, very logical
→ but your mind is also composed of these horses which are like feelings and desires
→ the idea is, your mind is not just that rational chariot driver
→ this helps with anxiety disorders; the little girl knew she shouldn’t be afraid of amputations (logical), yet, she still had these strong feelings
→ fear is a feeling, they are associated with urges to act in some way
→ fear is related to running away, fighting off a threat (survival)
→ anger is more so confronting a threat
Fear is the body’s __ __.
Alarm system
Why is it good to have fear?
For motivational purposes, it keeps us safe
→ p.ex: if you come across a bear in the woods and have no sense of bear, it would end poorly; if you were at the edge of a cliff and didn’t feel any fear, you might let your curiosity keep leading you and again, it would be unsafe
What can a psychologist have a child do when they experience a fear?
- we’ll often have the child draw a picture of themself and ask what their body feels or looks like when they have a fear
→ this helps normalize all these experiences, and show them that it isn’t dangerous, it may just be uncomfortable (the setting off of the alarm system)
→ we frame it as practicing being brave; you don’t have to not feel afraid, it means continuing forward even when afraid, which does change how you feel over time
If a referral is given stating the child is experiencing anxiety at school, what would a psychologist look at?
- First do a WIAT test to look at achievement
- If the child is low in these academic areas, it might not be just generalized anxiety, it’s likely a learning disability which would explain the anxiety felt at school
→ we wanna ask ourselves; is the problem anxiety, or is smt else happening that is causing the anxiety?
→ this is a true alarm because there really is a problem
→ we have to address the learning disability, not just the anxiety here
→ it’s normal to feel anxious under this situation, because we’re in a situation that we can’t really tackle (on our own)
What are some DSM-5-TR diagnoses that are directly implicating fear?
→ Specific Phobia
→ Social Anxiety Disorder (Social Phobia)
→ Panic Disorder
→ Agoraphobia
→ Generalized Anxiety Disorder (GAD)
→ Separation Anxiety Disorder
→ Selective Mutism
→ Obsessive-Compulsive Disorder (OCD)
→ Hoarding Disorder
→ Posttraumatic Stress Disorder (PTSD) / Acute Stress Disorder
→ Adjustment Disorder with Anxiety
→ Illness Anxiety Disorder (formerly Hypochondriasis)
→ Substance/Medication-Induced Anxiety Disorder
What are some DSM-5-TR diagnoses that aren’t certain to be related to fear?
→ Body dysmorphic disorder
→ Anorexia/Bulimia
→ Psychotic Disorders
→ Substance Use Disorders
→ Conduct/Opposition Defiant Disorder
→ Somatic Symptom Disorder
→ Insomnia, Nightmare Disorder
→ Autism Spectrum
What is Phillip Kendals coping cat method?
!! Find in textbook!!
Explain the steps of the anxiety cycle in a fear of a cat.
1) Seeing a normal cat
2) Give an interpretation of the cat
- “this means smt” or “this is dangerous”
3) Strong feeling; in this case, fear
4) Safety behaviours
- anything you’re doing to prevent a fear outcome from occurring
- can be all kinds of things; in your head, physical behaviour
→ p.ex: staring at the cat, leaving the room, not moving, scream
- either reinforce the belief, or prevent you from learning that there’s no threat
- if the safety behaviour is running away, you never have the change to change the interpretation
- some safety behaviours very paradoxically reinforce the fear (p.ex: leaving anytime you see a cat, you’re never in a situation that helps you get rid of the fear; if you walk around with a stick to fight off a dog, dogs actually like sticks so it might invite the dog to approach them)
- we want to face the fear, and cut the safety behaviours; through this experience, we can change the interpretations/beliefs
In OCD, the ___ are the safety behaviours.
Compulsions
What are the 2 categories of animal related fears?
1) Where you’re afraid they’ll harm you
2) Disgust animals
→ so disgusted, that they’re overwhelmed by the feeling
True or false: You can only have one category of an animal related fear.
False: You can fall into both
What are some common fear-based beliefs in animal-related fears?
- Overestimates of the likelihood of harm or attack
- Overestimates of the severity of harm or attack
- Beliefs that intense anxiety provoked by exposure to the animal will spiral out of control or cause physical or emotional harm
- Fears of felling overwhelmed from disgust
- Fears of contamination by the animal
What are some common safety behaviours in animal-related fears?
- Avoidance of animals or situations in which they might be encountered
- Presence of parents or companions
- Reassurance seeking
What is the DSM-5 diagnostic category for an animal-related fear?
Specific phobia
What is the treatment overview of an animal related fear?
- Typical length: 4 - 6 sessions; may be conducted in a single 3-hour session
- Begin with assessment and psychoeducation
- Begin exposure by second treatment session
What are some common examples of fear animals and disgust animals?
Fear animals:
- Dogs
- Sharks
- Bears
- Horses
- Birds
Disgust animals:
- Spiders
- Insects and other bugs
- Snakes
- Dead animals
- Rats and mice
- Bats
What are 3 examples of exposure exercises for different types of creature-related fears?
- For bugs: Look at pictures of bugs; touch plastic bugs; look at dead bugs in a plastic bag; touch dead bugs; let bugs that don’t fly walk around on hand and work up to face
- For sharks: View pictures of sharks swimming, pictures showing teeth; watch video of shark jumping out of water; observe sharks at aquarium
- For spiders: Look at pictures; look at household spider in a jar; put hand on jar and let spider walk on hand
What are the first 4 step guidelines for a good exposure?
1) Prepare to feel anxious during exposure: Feeling anxious is a sign that you’re doing the exposure correctly
- Expect the alarm to go off and feel 12/10 afraid, you can’t wait to feel good to do it
2) Don’t fight the anxiety or fear, lean into it: Think of anxious feelings as the raw materials of change
- Push yourself to say bring it on
3) Do not use safety behaviours or anxiety reduction strategies before, during or after exposure: An important goal of the exposure is to learn that you don’t need safety behaviours or anxiety reduction strategies
- If you participate in safety behaviours, then you can attribute your success to that behaviour, rather than the exposure itself
4) Use exposure to learn smt new: Before the exposure, identify what you’re afraid will happen when you confront this situation without using safety behaviours
- The exposure is an opportunity to test your predictions
What are the last 4 step guidelines for a good exposure?
5) Surprise yourself: The more you are taken aback by what happens during an exposure, the more experience stands out and gets encoded in your memory
6) Vary the intensity of exposures: Although you might start with easier exposure items, changing up the degree of anxiety you experience with each exposure helps you learn that you can manage even more
7) Practice in different settings: Confronting your fears in new settings helps to solidify your improvement
8) Practice every day: The more often you practice exposure, the quicker you will learn that your feared situations are safer than you think and you can manage the feelings of anxiety
What is SUDS?
Subjective Units of Distress Scale
- This measures how anxious you feel before AND during the exposure
- The clinician will ask the client these questions
→ often when we’re doing exposures, people are shocked that they’re able to do it, so we can stop and ask them if they want to keep going
After the exposure, what are some questions a clinician will ask the client according to SUDS?
- What happened during the exposure? Did your fears come true? Were you able to tolerate the distress?
- How was this outcome different from what you expected? What surprised you about the outcome?
- What did you learn from this experience?
- What could you do to vary this exposure?
What are some fear-evoking stimuli of environmental fears? What are some prototypical examples of environmental fears?
Fear-evoking stimuli:
- Places
- Natural phenomena (p.ex: thunder)
- Situations
Prototypical examples:
- Storms
- Airplanes
- Driving
- Large crowds
- Movie theatres
- Enclosed spaces
- Heights
