Anxiety disorders Flashcards
treatment for anxiety disorders consists of following broad categories
symptom/arousal management skills
exposure based procedures
cognitive skills
most prevalent ADs
GAD, social phobia, PTSD (CBT especially effective) , panic disorder
psychoeducation content
typical symptoms of anxiety
normalisation of anxiety
alarm response
functional nature of anxiety
educating the client about their specific disorder
educating the client about their specific formulation
education about the range of available treatments
anxiety v panic
anxiety:
generally focused on future events
behavioural component of avoidance, caution, agitation, fidgeting
physiological component of muscle tension
panic:
generally focused on immediate danger
behavioural component is escape
physiological component is palpitations and autonomic arousal
there is no qualitative difference between normal and pathological anxiety
matter of degree, intensity, frequency, trigger
actual experience of anxiety is same, no different types
breathing control training
usually used with panic disorder clients to reduce the impact of hyperventilation
hyperventilation happens when
CO2 is expired leading to low conc
low conc is interpreted as high O2 conc
blood vessels constrict, reducing O2 flow
breathing control training description
At the very first sign of anxiety or panic, without inhaling, immediately hold your breath and count to 10.
Once you count to 10, slowly exhale, saying the word “Relax” to yourself as you breathe out.
Inhale and exhale through your nose, in a regular six-second cycle
In…2…3…Relax…2…3…
At the end of each minute, again hold your breath for ten seconds, and then repeat Step 3
Continue until the symptoms are under control.
Applied relaxation training- PMR
alternate tensing and relaxing of different muscle groups
ART rationale
if clients can be trained to recognise the difference between muscle tension and relaxation, they can use increasing tension as a cue to commence arousal management skills
ART
occurs in a series of phases over several sessions
long procedure
most steps can be completed in less than one hour, allowing incorporation of other techniques during those sessions
overall process is rationale, begin with slow relaxation of each muscle group, gradually move to increasingly rapid attainment of the relaxation response
ART process over sessions
- rational and awareness
rationale provided
client instructed to record time, situation and intensity of anxiety symptoms in diary for HW - awareness
review HW, particular focus given to early anxiety symptoms.
for HW client records time, situation, type of specific symptom and intensity of anxiety symptoms in diary - awareness
review diary
for hw client records time, situation, type and intensity, and reaction to anxiety symptoms in diary - progressive relaxation (15-20min)
tension-relaxation process
Hands, arms, face, neck, shoulders
hw is to practice relaxation skills twice per day (morning and evening) - tension-relaxation process
Hands, arms, face, neck, shoulders
Back, chest, stomach, breathing, hips, legs, feet
hw is to practice twice a day
6-7. same as above but to release only (without tension first).
8-9. cue controlled relaxation (2-3mins), release only relaxation, therapist records time taken
client asked to estimate relaxation time and reinforced for rapid relaxation
hw is to practice twice a day - differential relaxation (60-90sec), use some muscle groups while maintaining relaxation in others.
in chair, writing at a desk, talking on phone
hw is to practice twice a day - differential relaxation
standing, walking
hw is to practice twice a day
12-13. rapid relaxation (20-30 sec)
aim to further reduce time required and enhance ability to apply relaxation in natural non stressful situations
agree on relaxation cue, each time cue occurs, client takes 3 slow breaths, using cue word ‘relax’, scans for tension and focuses on relaxing tense areas
practice 15-20 times a day in natural situations
14-16. application training
brief periods of exposure to stressful situations, with use of relaxation skills in situ
repeated practice of rapid relaxation in different anxiety provoking situations
ART maintenance program
client should scan body at least once per fay and use rapid relaxation to reduce any tension that is present
client should practice differential relaxation, or rapid relaxation at least twice per week
relaxation practice should be built into client routine
ART information for client
not hypnosis- you will be aware the whole time
certain physical sensations are normal (tingling, warmth, numbness)
you will not fall forward out of your chair
if you begin to fall asleep or feel uncomfortable, the process can be stopped
ATT
blood, injury, injection phobias
trains clients to differentially apply tension to large key muscle groups with aim of preventing blood pressure from dropping and fainting
aims to keep BP up beyond vasovagal response drop
ART procedure
Tense the muscles in the arms, chest and legs simultaneously
Continue to apply tension in these muscles until there is a feeling of warmth in the face (usually about 10 – 20 seconds)
Release the tension and relax to starting level. Do not relax too much though.
Wait 20 seconds
Repeat Step 1 to Step 3 a minimum of five times, until the feelings of lightheadedness or faintness have reached a manageable level.
Forms of exposure therapy
in vivo exposure
imaginal exposure
worry exposure
exposure with response prevention
interoceptive exposure
ABC renewal
different context elicits previous stimulus fear response association
important to build up as many alternative responses as possible and in different contexts
Exposure rationale
early rationale based on reciprocal inhibition: pairing of exposure to phobic stimulus with incompatible behaviour
early models of phobia based on simple conditioning processes
increased recognition of inadequacy of simple conditioning models of phobia acquisition
incorporation of cognitive concepts
Rachman’s three pathways to phobia
experience it yourself
experience it by association
hear about it (media, verbal transmission)
flooding
rapid
direct contact with stimulus
exposure mechanisms: classic behavioural therapy
extinction of CS-CR association through repeated exposure to the CS in absence of CR
removal of negative reinforcement for avoidance behaviour
exposure mechanisms: foa and kozak
many associations are related to fearful stimulus
when one node is activated, spread in activation across network
some networks are stronger than others, these are repeatedly triggered
you can only change the strength of these activations when the network is activated itself
exposure has maximum effect when: fear networks are activated, within and between session habituation occurs
implied that exposure but be anxiety provoking; repeated; and prolonged
exposure mechanisms: bouton’s model
exposure does not operate through unlearning
a new CS-NoCR association is learned
both associations compete for retrieval on presentation of the CS
significant implications for relapse in successfully treated anxiety disorders
exposure mechanisms
rachaman et al: exposure works due to increases in patient perception of self efficacy
baker et al: no association between foa and kozak key variables and treatment outcome
in vivo v imaginal
in vivo more effective
generalisation from imaginal to real life may be uncertain
some situations may not permit use of in vivo
habituation v controlled escape
classical behaviour therapy: habituation necessary for exposure to be effective
specific phobia: controlled escape does not impact on exposure efficacy, sense of control gained through controlled escape may be important
agoraphobia: exposure to habituation point more effective
