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CBT Sanderson > Anxiety Disorders, General > Flashcards

Anxiety Disorders, General Flashcards

1
Q

Anxiety Disorders Commonalities

A

Overestimation of danger
cognitive bias –focus on danger related cues

Lack of acceptance/intolerance of anxiety

Anxiety sensitivity

Intolerance of uncertainty

Increased Vulnerability / Unwillingness to accept existential realities

Avoidance of thoughts, stimuli and affect

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2
Q

Systematic Biases

A

Confirmatory bias

  • -seek out information that confirms thinking
  • -mood-congruent processing
    • drives processing to be consistent with mood o

Evolutionary function – attention biased toward perceived threat

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3
Q

Prevalence of Anxiety Disorders

A

24% (1 in 4) Lifetime Prevalence of Anxiety Disorders

Associated with significant functional impairment

The prevalence of anxiety disorders seems to be increasing (stress, media influences)

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4
Q

DSM-5 Anxiety Disorders

A

Panic Disorder
Agoraphobia (now sty not needed?)
GAD
Specific Phobias
Social Phobia
Selective Mutism (IV-childhood disorder)
Separation Anxiety Disorder (IV-childhood disorder)

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5
Q

DSM-5 Other Categories Anxiety Disorders

A 
OCRD: 
OCD 
BDD (IV- somatoform) 
Hoarding Disorder (new) 
Trichotillomania (IV- impulse control) 
Excoriation Disorder (new)

Trauma and Stress Related Disorders:
PTSD Acute Stress Disorder
Adjustment Disorders (IV-adjustment disorders)
Reactive Attachment Disorder (child)

Somatic Symptom Disorders:
Illness Anxiety Disorder (hypochondriasis)

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6
Q

Cognitive mechanisms in anxiety disorders:

A
  1. Overestimation of danger (cognitive bias)
  2. Focus of attention on danger-related cues (hypervigilance)
  3. Lack of acceptance/tolerance of anxiety (anxiety sensitivity)
  4. Unwillingness to accept existential realities (tolerance of uncertainty, risk)
  5. Avoidance of anxiety provoking thoughts/affect (cognitive avoidance, thought suppression)
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7
Q

Treatment Strategies:

Cognitive Content

A

ANXIETY
REDUCTION
*Corrective Information
(psychoeducation)

*Cognitive
Reappraisal

*Modify Schema

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8
Q

Psychoeducation

A

“Correcting” content

Understanding the nature of emotions (anxiety) and their meaning

Corrective information about perceived dangers (somewhat disorder specific)

Discussion of risk perception: Possibility vs probability

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9
Q

Cognitive Reappraisal

A

Cognitive therapy – e.g., Clark and Beck

Modify content of immediate appraisals

Focus on logical analysis

Utilize corrective information

Note theme(s) of cognitions (schema) – to be addressed later if relevant

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10
Q

Existential Aspect: Anxiety and the Human Condition (e.g., Yalom, May)

A

Existential Therapy:

Anxiety = inability to confront and accept existential realities:

inevitability of death

physical dangers

social rejection

failure

Goal:
Acceptance of risk, uncertainty, danger as a necessary part of living

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11
Q

Schema-Focused Therapy (Young)

A

Focus is on identifying and modifying deeply entrenched beliefs that tend to be central to one’s sense of self or view of the world.

Goal: Insight into, and awareness of, “biased” information processing will allow for correction

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12
Q

Emotion Driven Responses

(Maladaptive Action Tendencies)

A

Maladaptive responses that allow the individual to avoid, escape, or reduce the emotion (action tendency) – thereby reinforcing these maladaptive responses.

Avoidance: prevents activation of emotion

Escape: terminates activation of emotion

Reduce: lessens the intensity of the emotion (e.g., safety behaviors)

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13
Q

Cognitive: Modification of the thought process

A

Meta-Cognitive Strategies:

Cognitive Defusion–acceptance of thought as thought, nothing else

Cognitive Processing–exposure to thoughts instead of avoidance or suppression

Attention Refocusing/Modification

  • direct attention away from threat
  • alternative environmental cues
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14
Q

Cognitive Processing

A

Focus on decreasing cognitive avoidance and facilitating
processing/integration

Exposure to anxiety provoking thoughts
e.g.
worry

post-trauma reactions

catastrophic thoughts,

social rejection

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15
Q

Attention Refocus/Modification

A

Focus attention away from threat cues to disrupt biased information processing

Increase presence in situation – focus on external details (awareness)

Focused on nonthreatening stimuli in situation (e.g., friendly face)

Focus on neutral stimulus (breathing)

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16
Q

Proposed Sequence of Cognitive Interventions

A

PSYCHOEDUCATION
(Corrective Information)

COGNITIVE REAPPRAISAL

CORE BELIEFS (Insight)
Schema Modification
Existential Acceptance

META-COGNITIVE - ACCEPTANCE BASED
Cognitive Defusion
Cognitive Processing
Attention Refocus

17
Q

AFFECTIVE Emotion Driven Responses

A

Maladaptive responses that allow the individual to avoid, escape, or reduce affect.

e.g.
Avoiding watching a tense movie because it will cause anxious affect

Not fully paying attention to a news story because it evokes a negative emotion

Avoiding a roller coaster because it produces anxious affect

Taking a tranquilizer to reduce anxiety during a presentation

Drinking alcohol to reduce anxious affect at a party

18
Q

PHYSIOLOGICAL Emotion Driven Responses

A

Maladaptive responses that allow the individual to avoid, escape, or reduce physiological responses.

examples:

avoidance of caffeinated beverages

avoidance of exercise

avoidance of the heat, humidity, and various weather conditions

sitting down at a party to avoid feeling unsteady

19
Q

BEHAVIORAL Emotion Driven Responses

A

Maladaptive responses that allow the individual to avoid, escape, or reduce anxiety in phobic situations.

Avoidance of phobic situations

Escape from phobic situations

Reduction strategies are more subtle:

Asking for reassurance about one’s health status

Wearing gloves on the train to avoid touching the

Sitting down when at a party to avoid feeling unsteady

Always being with someone in case one had a heart attack

20
Q

EXPOSURE: Treatment of Emotion Driven Responses

A

Exposure: Undoing the process of negative reinforcement

Identification of Emotion Driven Responses:
Fear and Avoidance Hierarchy

Imaginal and In-vivo
a. inoculation prior to an in vivo exposure

b. cognitive processing (exposure) to confront cognitive avoidance, thought suppression, distraction

c. implosive therapy (feared fantasy, disastrous consequences) to facilitate
habituation, facilitate corrective processing

In-vivo

a. Systematic (gradual) vs flooding
b. self-directed, other-assisted, therapist-assisted

21
Q

Additional behavioral strategies

A

Behavioral Activation (depression)

Skills building when indicated:
	assertiveness training
	social skills enhancement
	sleep hygiene
	relaxation strategies
	organizational skills and goal setting
	stress management
	problem-solving
22
Q

General Vulnerability Model

A

A negative schema can always be present but these mechanisms only activate from stressful life events

If a parent has a specific anxiety, their child is more vulnerable to acquire any anxiety disorder

*Not just specifically the same type the parent has

23
Q

Imaginal Exposure

A

Inoculation prior to an in vivo exposure

Cognitive processing (exposure) 
-confront cognitive avoidance, thought suppression, distraction

Implosive therapy

  • feared fantasy
  • disastrous consequences
  • -facilitate habituation
  • -facilitate corrective processing
24
Q

In-vivo Exposure

A

Systematic (gradual) vs flooding

Self-directed, other-assisted, therapist-assisted

25
Q

Role of Cognitive Appraisals

A

Schemas are responsible for processing information

Inaccurate appraisals stem from faulty schemas (outside conscious awareness)

In treatment we attempt to redirect these faulty attentional biases

  • task is to to hold old and new schemas in the current mind
  • requires cognitive flexibility
  • slowly separate from old schemas towards the new ones
26
Q

Common thoughts related to specific emotions

A

Anger = cognitions of being mistreated, unfairness

Anxiety = cognitions of risk/danger

Sad = cognitions of loss

Guilt = cognitions of doing wrong

Shame = thoughts of moral imperative

27
Q

Behavioral Experiments

A

Design experiments to test validity of anxious predictions

Focus on facilitating disconfirmation of negative thoughts

Extinction really is inhibitory learning of new associations

Continued exposure strengthens this newly learned associations = inhibitory learning

28
Q

Behavioral Experiments: Increase chance of success

A

Set up exposure aimed at disconfirming expectations

Label emotions during exposure

Use items that can be used as a later retrieval cue to recall exposures

29
Q

Why anxiety disorders don’t self-correct

A

High road being hijacked by the low road amygdala

Lack of problem solving

Biases

Mood-congruent processing

  • autopilot versus manual pilot
  • mindfulness, get out of autopilot being caught up in the jet stream

*mindfulness as a distraction
or, more accurately, distraction from the distractions

30
Q

Treatment Strategies:

Cognitive Process

A

Cognitive Defusion
(acceptance)

Existential Acceptance

Redirect Attention
Mindfulness

Cognitive Processing

31
Q

Thought Records

Utility

A

Identify emotions and triggers

Identify cognitive distortions

Identify rationale responses

CBT Sanderson (10 decks)

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