Anxiety disorders and psychological therapies

Question 1

What is anxiety?

Answer 1

normal survival mechanism for dealing with real dangers

Question 2

When danger is perceived, what does the protective anxious response include?

Answer 2

• focusing of attention on the danger;
• increase in arousal - fight or flight response;
• a strong urge to avoid anxiety-inducing situations in the future

Question 3

When is an anxiety disorder diagnosed?

Answer 3

When anxiety is out of proportion to the danger, is persistent, is disabling

Question 4

What are some examples of anxiety disorder?

Answer 4

• panic disorder
• phobias
• OCD
• PTSD
• GAD

Question 5

What prevalence do anxiety disorders have in a 12 month period according to Layward and Clark, 2014? How many would warrant treatment? What is the cost to society of untreated anxiety disordered and depression?

Answer 5

10-18%
2/3
around 7% of GNP (gross national product)

Question 6

What are treatments of anxiety disorder?

Answer 6

Benzos (only short-term use due to dependency)
Antidepressants (SSRIs and SNRIs)
CBT and cognitive therapy

Question 7

What are the core mechanisms in CBT for anxiety?

Answer 7

Cognitive therapy is a brief (8-16 sessions) therapy based on cognitive models of emotional disorders, which aims to challenge problematic beliefs and related behaviours [rather than original causes]. It has a strong foundation in academic psychology. The patient is very active.

Question 8

Describe GAD

Answer 8

“excessive worry about several different things”

Question 9

What is panic disorder characterised by?

Answer 9

repeated spontaneous attacks of anxiety accompanied by marked bodily sensations

Question 10

What is Clark’s theory of panic disorder?

Answer 10

1986
states that panic attacks result from catastrophic misinterpretation of benign bodily sensations. The sensations misinterpreted are mainly those involved in normal anxiety responses (rapid heartbeat, hyperventilation, sweating, shaking etc.), and the misinterpretation is the belief that these represent an immediate physical or mental danger, where in actual fact these are completely benign.

Question 11

What is the vicious circle of anxiety? (according to Clark)

Answer 11

perceived threat -> apprehension -> bodily sensations -> interpretation of sensations as catastrophic -> further perceived threat.

Question 12

What factors contribute to the maintenance of panic disorder?

Answer 12

selective attention to bodily cues and safety behaviours, where patients believe that something horrible would have happened had they not engaged in a safety behaviour (e.g. lying down to prevent a heart attack).

Question 13

What does CT for panic disorder consist of?

Answer 13

consists of identification of the catastrophic interpretation of bodily sensations; generation of alternative, non-catastrophic interpretations; testing of validity of catastrophic and non-catastrophic interpretations through discussion and/or behavioural experiments.
The possible behavioural experiments include induction of feared sensations to show their true cause (e.g. by reading pairs of words [breathing-suffocate] or by focusing attention on particular body parts) and dropping safety behaviours in presence of feared sensations to illustrate that nothing changes in the absence of a safety behaviour.

Question 14

What did 1994 RCT by Clark et al show?

Answer 14

cognitive therapy leads to a significant improvement in patients with panic disorder and was superior to wait and impiramine (a TCA)

Question 15

What is social anxiety characterised by?

Answer 15

Marked fear & avoidance of social or performance situations (meeting strangers, talking to a group, eating or drinking while being observed, using public toilets, public speaking, etc)
Characteristic thoughts include
– They’ll think I’m boring, stupid, weird.
– I’ll look anxious
– I’ll blush, sweat, tremble
This is the most common anxiety disorder

Question 16

When does social anxiety typically onset?

Answer 16

Childhood

Question 17

Bruce et al 2005 → natural recovery rate of social anxiety?

Answer 17

37% natural recovery rate over 12 years

Question 18

What does social anxiety lead to?

Answer 18

increased risk of depression, other anxiety disorders, alcohol and drug abuse; as well as marked under-achievement.

Question 19

Describe Clark and Well’s theory of social anxiety disorder (1995)

Answer 19

states that it persists due to shift to internal focus of attention; use of internal information to infer how one appears to others; safety behaviours.

Question 20

What does cognitive therpay for social anxiety include?

Answer 20

• Personal version of model
• Experiential exercise to demonstrate adverse effects of self-focused attention and safety behaviours;
• Video/photo feedback to correct negative self-image (blushing example);
• Attention training to promote external focus;
• Behavioural experiments dropping safety behaviours and/or enacting feared outcomes to disprove fearful predictions in social situations;
• Surveys to discover other people’s views of feared outcomes;
• Memory work to reduce impact of early social trauma.

Question 21

Discuss relative effectiveness for different types of therapy for social anxiety

Answer 21

According to a number of RCTs CT is superior to exposure therapy, group CBT, psychodynamic psychotherapy (=other forms of therapy); SSRIs, medication based TAU (=drugs); placebo medication; no treatment.