Anxiety Flashcards
Anxiety and Avoidance?
Avoidance of thought, feelings, emotions and experiences.
Avoidance can interfere with our every day functioning.
What is a Panic Attack; what is DSM 5 requirement for Panic disorder?
◦Sudden, overwhelming experience of terror or fright
◦Panic is more intense than anxiety; has a sudden onset.
◦DSM-5
◦A person must experience at least four of the 13 symptoms in order for the experience to qualify as a full-blown panic attack.
◦Note: Panic attack vs panic disorder
Two types of Panic Attacks
Cued
◦Expected or occurring only in the presence of a particular stimulus
Unexpected
◦Appear without warning or expectation, as if “out of the blue”
How does a Panic Happen?
AND PANIC CYCLE
Trigger Stimulus»> perceived threat»> apprehension»_space;> Body sensations»_space; interpretation as catastrophic (cognitive) »_space; perceived threat = PANIC
PANIC CYCLE
Trigger»_space;> Normal Physical Changes»_space; Catastrophic Automatic Thoughts
» Anxiety Increases»_space; increases Normal Physical Changes.
LATER
» exhaustion and anxiety decrease (anxious about becoming anxious)
» hyper vigilance
» oversensitivity to small physical changes»>
» feeds back into perception of normal physical changes
What are PHOBIAS (DSM)
DSM-5 provides a severity threshold
◦Avoidance or distress associated with the phobia must interfere significantly with the person’s normal activities, relationships with others; must be persistent.
Specific Phobia Subtypes
◦Animal Type; e.g. spiders, snakes, insects, dogs, etc.
◦Natural Environment Type; e.g. storms, thunder, heights, water, etc.
◦Blood-Injection Type; e.g. seeing blood, seeing injury, receiving an injection
◦Situational Type; e.g. public transport, tunnels, bridges, elevators
◦Other Type; e.g. choking, vomiting, etc.
What defines SOCIAL ANXIETY DISORDERS?
What is the reason for avoidance?
Marked fear of social / performance situations in which the patient is exposed to unfamiliar people, or to scrutiny of others
Exposure to the feared situation invariably provokes anxiety, which may escalate to panic.
Anxiety is recognised as excessive or unreasonable.
Feared situations are avoided or endured with anxiety.
◦Reason for avoidance typically fear of negative evaluation
◦Fear of humiliation of embarrassment / being shamed or exposed
Why does Psychoeducation help Anxiety Disorders ?
◦Psychoeducation is important with anxiety disorders
◦Giving panic patients an acceptable alternative explanation to their symptoms.
◦Greater sense of control from an understanding of their illness.
◦Much anxiety is about the unknown, with psychoeducation serving to fill in gaps in knowledge about their condition.
◦Psychoeducation can dispel some concerns that patients may have about their symptoms or their consequences.
◦Develop a shared understanding of the presenting problem.
Psychoeducation: What should be conveyed?
◦Anxiety disorders themselves are common.
The Yerkes-Dodson (1908) curve:
◦Anxiety is a normal reaction to fearful situations or objects
◦Everybody experiences anxiety to some degree
◦Anxiety is functional and desirable
◦Anxiety at low to moderate levels enhances performance
◦It is impossible (and undesirable) to eliminate anxiety.
Function of the Alarm Reaction- Explain physiological realms for the following symptoms.
Cognitive Restructuring (for anxiety).
How can it work and what are the three general cognitive errors to target?
Look at evidence and work disprove
Think in a way that might be more helpful
very good combo with exposure
Three General Errors - focus for restructuring
- Overestimatingthe probability that a negative outcome will occur.
- Overestimatingthe severity of the feared negative outcome.
- Underestimatingthe ability to cope or manage in the face of the negative outcome.
Cognitive ‘Targets’ in Anxiety Disorders - Panic Disorder
◦Catastrophic cognitions regarding the meaning of interoceptivecues.
◦Cognitions re dangerousness of panic attacks themselves.
◦Perceptions of poor ability to cope in face of panic attack.
◦Perceptions of lack of control over bodily sensations.
◦Memory biases for threat related information.
Cognitive ‘Targets’ in Anxiety Disorders - Specific Phobia
◦Overestimation of chance/severity of threat.
◦Memory bias for threat related information.
◦Self-efficacy beliefs.
Cognitive ‘Targets’ in Anxiety Disorders - Social Phobia
◦Fear/unacceptability of negative evaluation
◦Expectation that others are critical evaluators.
◦Interpretation of ambiguous audience cues as negative.
◦Overestimation of manifest anxiety
◦Realistic performance self-appraisal
◦Dichotomous thinking of operating rules regarding performance.
- The mental representation of the self as seen by the audience.
Exposure
Exposure is gradually asking the client to confront or experience the things that scare them
- Detailed behavioural interview examining antecedents, responses, phobic stimuli
- Sharing of rationale with patient
- Construction of an Exposure Hierarchy
- For each item on the hierarchy, conduct the exposure tasks (see later)
- Review the exposure session
- Set appropriate homework
- Depending on success consider moving along the hierarchy
Exposure Hierarchy Construction
1.Specify a target stimulus
◦Hierarchy should focus on a single set of stimuli (e.g. lifts, spiders, public speaking, etc. rather than all of the above in a single hierarchy).
- Define the dimensions; e.g. for Spiders; Hairy versus non-hairy, moving versus dead, proximity
- Use the defined dimensions to generate tasks
- Have the patient give a SUDs (subjective unit of distress) rating for each level and sort the tasks.
- Negotiate elimination of redundant tasks (e.g. the same SUDs level) and fill in any large gaps in the hierarchy.
- Develop the final exposure hierarchy, including homework tasks.
Types of Exposure
Invivo - reality
Imaginal
Interoceptive
Virtual Reality
