Anxiety Disorders & Fear-Related Disorders Flashcards
assesment for BIP
The Blood Injection Phobia Inventory (BIPI)
A self-report measure
lists 18 possible situations involving blood and injections
for each situation the individual is asked to evaluate different reactions they might experience for that situation.
These include cognitive, physiological and behavioural responses.
They are then asked to rate on a scale of 0-3 the frequency of each symptom
0= never, 1 = sometimes, 2 = almost always, 3 = alway
assesment for anxiety
The Generalised Anxiety Disorder Assessment (GAD-7)
A 7-item questionnaire
can also be used as a structured interview schedule.
how often you have experienced anxiety-related symptoms in the last two weeks items rated on a four-point scale, from 0-3
BIO explanation
GENETIC INHERIHANCE
we are born prepared to fear certain objects.
particular stimuli in the environment that may pose a threat to survival and that we are more genetically set up to avoid.
This is transmitted in our DNA through the generations to help our survival.
DE NOVO
Vulnerability may arise due to new (de novo) genetic mutations
that can affect the child’s mental health
are not present in all/ any of the biological parents’ cells.
NTRK3 gene
Overexpression of the NTRK3 gene in this brainstructure (where arousal vigilance and attention is linked) may be linked to high levels of norandrenaline - a neurotransmitter linked with stress and anxiet
behavioural explanation
Classical conditioning
Harmless stimulus paired with a frightening experience
Maintenance of Fear Reactions
fears are maintained through operant conditioning
Classical conditioned behaviours usually become extinct as the person learns that the CS is not always followed by the UCS.
Albert’s fear of rats should become less intense as he learns that the rat is not always followed by a loud noise
Operant conditioning
Avoidance helps people to escape the unpleasant feelings of fear, so is negatively reinforced
the person rarely comes into close contact with their feared object/situation => there is no opportunity to unlearn the association between the CS and UCS
Fear reactions may also be positively reinforced (rewarded) as others often provide comfort and reassurance.
Psychodynamic
Psychological explanation
unresolved conflicts from early infancy and childhood.
personality has three parts that develop between birth and age five: ID (the unconscious), ego (rational plans to get what they need) and superego (conscience, morality)
Conflicts between the id and the superego are generally resolved by the ego using defence mechanisms.
Short-term coping strategies that protect us from becoming aware of anything that could overwhelm the conscious mind with negative emotions (e.g. shame, anger or fear).
Defence mechanisms often allow the id’s socially unacceptable impulses to be expressed but in a socially acceptable way.
displacement - in Hans’ case involved redirecting his fear of his father onto something else- horses.
dreamwork and wish fulfilment:
Freud believed that the ego uses a process called dreamwork
to turn unconscious desires into symbols linked together into a dream.
The psychosexual stages of development:
If the conflict was not fully resolved it could lead to the development of certain personality traits through a fixation process.
oral - weaning
anal - potty training
phallic - the Oedipus complex
Behavioural Therapy - Counter conditioning
psychological treatment
Mary Cover Jones and the case of Little Peter - Counter-Conditioning
Little Peter, a child with a phobia of small animals
Initially, Jones encouraged 3-year-old Peter to play with other children in the presence of a rabbit.
He tolerated the animal well but, following some time in hospital, his fears returned.
Jones decided to try counter-conditioning.
She sat Peter in a highchair and allowed him to eat some candy, his favourite treat.
Next, she placed a caged rabbit near his highchair while he ate.
Over the course of several visits to her laboratory, she moved the rabbit closer as he ate
Eventually he ate the candy with the uncaged rabbit sitting next to him.
Systematic Desensitisation
psychological treatment
.
Reciprocal inhibition: The way in which relaxation and fear responses cancel each other out.
Little Peter, for example, could not feel scared of the rabbit while also feeling relaxed and happy because of the candy.
deep muscle relaxation, anti-anxiety drugs may also be used to achieve a state of relaxation.
the therapist helps the patient to enter a deeply relaxed state before exposing them to each stage of the fear hierarchy
supported by the cat experiment (fear of cage with electircal shocks + eating)
Psychological therapy - CBT
CBT practitioners do not spend time looking into the past for reasons for the person’s behaviour
They help to find solutions to problems the person is facing in their present (current) daily life.
Cognitive Fear Structures
describe networks of stored information about threatening stimuli.
a person with a phobia of dogs will have a cognitive fear structure for dogs that contains concepts such as big teeth fierce, aggressive, and dangerous
It may also include a memory of bodily sensations associated with dogs
e.g. rapid heart rate which may then trigger further associations with heart attacks, hospital and even death.
cognitive fear structures may be activated even by small, calm dogs leading them to avoid dogs completely.
Avoidance
The CBT practitioner will attempt to disconfirm the person’s inaccurate beliefs about their feared stimuli
How? → Through exposure to replace the fear structure with new positive memories.
Psychoeducation
Teach people with fear and anxiety disorders about the links between thoughts, emotions and behaviour
Homework
Applied Tension - psychological therapy
Developed specifically for the treatment of blood-injury-injection phobias (BII).
BII is characterised by a slightly different pattern of symptoms to other specific phobias
this is why applied tension is required as an additional technique that can be combined with other CBT strategies
- Find a comfortable chair.
- Tense the muscles of your arms, torso and legs.
- Hold the tension for 10 to 15 seconds.
- Release for 20 to 30 seconds
- Repeat five times.
key study - Chapman and delapp
context
The diphasic response:
the person experiences an increase in blood pressure and heart rate → followed by a sudden decrease in blood pressure and heart rate (vasovagal syncope) → fainting due to reduced blood flow to the brain.
The role of disgust:
disgust triggers activity in the parasympathetic nervous system, such as reducing blood pressure.
Animal reminder disgust refers to repulsion experienced when reminded of our own, human, ‘animalness’, such as the sight of blood or veins.
chapman and delapp AIM
to provide insight into ‘active mechanisms of change’ throughout a 9-week course of applied tension and manualised cognitive-behavioural therapy for an adult male patient with BII phobia.
chapmann and delapp methodology
The case study method was used to collect quantitative data from self-reported questionnaires (he rated his anxiety from 0 to 100 and listed his thoughts, feelings and behaviours when exposed to blood and/or medical-related stimuli between sessions) and qualitative data from a diagnostic interview which confirmed his BIl phobia diagnosis.
SUDS
chapman and delapp case history/sample
T was a Hispanic male, aged 42.
physical symptoms, which included racing heart, hot flashes, cold chills, dizziness and unsteadiness additional to the fainting.
T’s child had autism spectrum disorder and he felt a sense of guilt and shame due to being unable to attend regular medical appointments with his child.
His grandmother suffered anxiety relating to medical emergencies; each day, she listened to an ambulance dispatch scanner and T was also exposed to this.
T’s exercise routine included running, cycling, weight training and swimming, giving the impression of being in control of his health.
In reality, he had not visited a doctor in years
chapman and delap treatment and followup
- t and the therapist worked collaboratively and set weekly goals
- homework (practicing applied tension x5 a day, completing graduated exposure tasks such as watchig online videos of blood tests…)
- Four months later, T thanked the therapist and had several doctor’s appointments booked.
- Ten months later, he was still doing well
- 12 months post-treatment he completed follow-up questionnaires, to allow comparisons to be made between his baseline and follow-up scores
chapman and delapp conclusions
Psychoeducation, objective recording, cognitive restructuring and graduated exposure were highly effective when combined with applied tension in the treatment of a man with a severe BII phobia.
This was, in part, related to increases in self-efficacy (an individual’s belief in his or her capacity) achieved through a highly individualised treatment plan of sufficient duration to meet his needs.
