Anxiety Disorders: Fears Flashcards
What is a more frequent referral in little kids? Low mood or Anxiety?
Anxiety
- definitely prominent in school-aged children
What is a common phobia associated to Terry Fox? Explain Julians client
phobia of amputations a strong bodily response when exposed to amputations
- Julian’s client was upset because she knew that it isn’t nice to judge anyone for being different, and she wasn’t judging anyway, she was just having an aversive response to amputations
- He treated her with gradual exposure to stimuli related to amputations and her tolerance increased with each exposure
Describe Plato’s analogy of the human mind:
He believed our mind was made up of different elements:
1. Chariot driver: rational part of you
- Ex: part of the little girl who knew it didn’t make sense to be afraid of people with amputations
2. Horses: desires or feelings that pull us toward things, pull us and direct us
- the feelings of fear and we don’t have total rational control over them
Is fear good?
It’s good that we have fear, it could save our life
ex: If we didn’t have fear we may approach the bear and get attacked
What is an analogy that can fear be used for describing fear?
An alarm system:
1. a true alarm
2. a false alarm
In an anxiety disorder, you have an alarm system go off again and again and it feels just the same as a true alarm but it is false
ex: when a fire alarm goes on when you’re cooking cookies but there’s no fire
What can we show kids so they know that fear is normal, and so they can think about the effects of fear on the body?
Can show a child a video of cats being afraid of cucumbers to show them animals feel fear as well
They can think about what is going on in the cat’s body during these false alarms:
- Heart beating fast
- Tense muscles
- Running
What is an intervention we can do with kids to have them process their fears?
Have the kids draw a picture of themselves and ask what sensations they experience when their alarm goes off:
○ Lump in throat
○ Butterflies in the stomach
○ Nauseous
○ Shaky
○ Cold and hot
We do this to say it’s completely normal to have these feelings when your alarm system goes off and it’s not dangerous to have these feelings
When we ask children what they think they can do to overcome their fears what do they respond?
They say they need to face their fears, be brave and go into situations that would set off their alarm
Jade gets a referral to a psychologist who says she’s experiencing anxiety at school. She takes the WIAT and the results show that she is scoring in the bottom 5, 2, and 1 percent for measures of reading and writing. What does this likely mean?
- Jade likely has a learning disability related to reading and writing
- she’s feeling anxious at school because she has a problem (a true alarm) - she needs support around reading and writing
- Referrals that seem like anxiety referrals are actually adaptive anxiety
Anxiety Cycle: Fear of dogs
Step 1: See a normal dog
Step 2: A thought (cognition) about the dog
- ex: “This dog is dangerous”
Step 3: Strong feelings (fear)
Step 4: Safety Behaviours: anything you’re doing to try to prevent the feared outcome or to reduce the intensity of a feeling you don’t like
Safety Behaviours:
- They are put in place to reduce the outcome or the feeling
- They contribute to a positive feedback loop that confirms that dogs are dangerous or they prevent you from gathering data that you need to gather in order to update the belief that dogs are dangerous
- Ex: if you never interact with a dog but hold the belief dogs are dangerous, you never get to have a reparative experience where it goes fine with being around a dog (avoidance)
- A lot of the time we think a safety behaviour is keeping us safe but it isn’t (ex: carrying a stick (dogs like them) OR looking away (social anxiety disorder))
What kind of intervention targets safety behaviours?
Exposure and response prevention (ERP)
What are the two steps of the Coping Cat protocol by Phil Kendall? What did a dismantling study find regarding this protocol?
- Skills that make it easier for someone to stay in an anxiety-provoking situation (ex: relaxed breathing)
- Exposures
The study found that the first part isn’t necessary, you can go straight to practicing and exposures
What treatment effect size are protocols generally meeting for the treatment of fears?
0.8 - large effect size
What are 2 main categories of animal related fears?
- Animals related to harm ( ex: I’m going to get sting and its going to be painful)
- Disgust animals: spiders, snakes, mice, bats (not so much afraid of being attacked but mote that their afraid of their own disgust reaction)
what is a common safety behaviours for animal related fears? it is effective?
Reassurance seeking: asking someone before going out for a walk “are you sure I wont be attacked by a dog?”
- repeated behaviour
- no one can actually guarantee that you wont be attacked
- can make people feel good in the moment,but if they ever come into contact with the feared thing this would not end well.
reassurance seeking vs. information seeking:
- asking someone about something they cannot guarantee and asking repeatedly
- asking someone about something they do know but you don’t, and generally only needs to be asked once
Intervention for animal-related fears + typical length of treatment
exposure therapy:
- viewing pictures of the animal, holding it (ex: bugs) in a jar, going to a zoo, let the animal touch them
- ease into it - sometimes just saying the name of the animal is enough to get a reaction
- 4-6 sessions, may be conducted in a 3 hour session
Why do we want the client to eliminate safety behaviours during the exposure and what could that teach them?
- we want them to attribute success to actual strength and confidence
- for example: if you always cross the street when you see a dog, you’ll never learn to know what would happen if you stayed on the same side
- you miss an opportunity to learn that the feared thing isn’t dangerous
SUDS score:
Subjective units of distress scale: how distressed you are from 0-100
- Asked during an exposure exercise:
- Ask before and then again during the interaction to see if there is improvement
Environmental fears:
- Fears of places or situations
- This can include the weather (ex: natural disasters) or places like heights or elevators
Examples of exposure exercises for environmental fears + typical length of treatment
- watch videos of storms
- watch planes land and take off
- drive slowly on empty side streets
- remain in a small elevator
- stand on a high balcony
- 1-12 sessions
- incorporate exposure by session 2 or 3
Body cues and health fears
- This can include panic disorder or health/illness anxiety
Rule of thumb:
- If people are afraid that the crisis is imminent and currently happening to them (currently having a stroke/heart attack) then it’s a panic disorder
- If it’s over a longer term, then it’s like a health/illness anxiety (ex: I see a blemish on my skin and I’m terrified it means I have a horrible medical thing happening inside me)
Exposure exercises for body cues + health fears, + typical length of treatment
- anything that brings on a body sensation, people are afraid of
- close eyes and imagine a medical event happening to show that they can tolerate having thoughts about a scenario happening
- 12 individual therapy sessions
- interoceptive exposure by session 2 or 4
situational exposure by session 6 or 7 - combine imaginary and situational exposure
- implement response prevention with exposure
Trauma related fears:
- thoughts and reminders of a trauma, and having an intense body reaction to it, thinking they are still in danger
- people engage in avoidance as a safety behaviour: avoidance of reminders, avoidance of thinking of the experience, safety checking
Exposure for trauma-related fears + typical length of treatment
- going out alone
- use public transportation
- drive
- visit scene where trauma took place
- watch show about the same thing
- 12 individual therapy sessions
- begin situational exposure by session 3 or 4
- begin imaginal exposure by session 4 or 5
Blood, Injection, Injury Fears
- The only category that can induce fainting, people faint in this category sometimes
- a reaction people have when exposed to blood will be to faint
these people:
- avoid dental and medical procedures and situations
- rely on a safe person
- use distractions during injection
applied tension:
taught to patients to help with fainting in blood, injection, injury fears
- tense muscles as hard as you can, and then relax the,m which tends to stabilize the fainting response
Exposure exercises for blood, injection, injury fears + typical length of treatment
- view images, watch videos, hold a jar containing blood, prick finger, donate blood
- 1-6 individual therapy sessions, may be in a single 3-4 hour session
- begin situational exposure by session 2
Social Fears:
- Main feared outcome of social fears is fear of negative evaluation - that other people with judge you harshly
- “Going to think I’m weird, look weird, judge my signs of anxious arousal”
safety behaviours for social fears
Safety behaviour is like the camera is pointing at you (self-focused attention)
Common Social Safety Behaviours:
- Sitting in the back row of class
- Remaining silent in social situations
- Escaping at the first available opportunity
- Avoiding eye contact
- Saying as few words as possible when spoken to
Post event processing:
- playing out the social interaction that just happened and picking out all the things that went wrong
- Not actually paying attention to the right thing because the camera is on you, you didn’t really see the other persons reactions
exposured for for social fears + typical treatment length
- shop at a crowded store (being in public)
- answer a question in class (center of attention)
- speak to strangers (interactions)
- etc…
- 12 individual therapy sessions
- situational exposures by session 3 or 4
