Anxiety: exposure Flashcards
1
Q
Why can exposure be used to treat anxiety disorders?
A
- The most important maintaining factor for anxiety disorders is avoidance
- GAD: Worrying
- SAD: Safety behaviours
- PD: Interoceptive avoidance
- Anxiety has been shown to spontaneously resolve (Wells et al, 2016)
- Exposure actively prevents avoidant behaviours so that this resolution is experienced
- Creating discrepancies between anxious perceptions and reality, with enable extinction learning
- New association of stimulus causing no adverse outcome is created and overrides the original fear/anxious conditioning
2
Q
What difficulties prevent the successful implementation of exposure therapy?
A
- Despite evidence base supporting the central role of avoidance and exposure
- Common misconception amongst therapists that exposure exacerbates anxiety and damages the therapeutic alliance (Whiteside et al, 2016)
3
Q
Outline the recommended treatment of GAD and PD
A
- CBT and Applied relaxation are recommended high intensity psychotherapies for GAD and PD (NICE, 2011)
- CBT has greatest evidence base
- Focuses on worry in cases of GAD
- Homework is a crucial component, which involes reaching alternative perspectives, behavioural tasks, and exposure to worry
- Applied relaxation
- Key difference to other relaxation is its exposure to anxiety-provoking situations
- It is the only relaxation technique with equivocal large effect as CBT (NICE, 2011)
4
Q
Discuss the empirical evidence for psychotherapy in GAD
A
- CBT produces significant improvements to WLC (Beck, 2005; NICE, 2011)
- Clinican-rated anxiety (large effect)
- Self-rated anxiety (moderate effect)
- Self-rated worry (moderate effect)
- Largely improves worry symptoms
- Overall quality moderate-high
- Applied relaxation has equivocal large effect as CBT (NICE, 2011)
- Clinician-rated anxiety (large effect)
- Self-rated anxiety (moderate effect)
- Self-rated worry (moderate effect)
- Overall quality moderate
5
Q
Discuss newer interventions for GAD
A
Other interventions such as Emotional regulation therapy and Acceptance and commitment therapy have arisen from some new explanatory models for GAD, show promosing preliminary evidence (Salters et al, 2004)
6
Q
Discuss the recommended treatment for SAD
A
- Increasing evidence for specific-CBT approaches (Spence & Rapee, 2016)
- NICE (2013) recommends individual CBT based on Clark and Wells model for SAD
- Clark and Wells (1995) noted that exposure alone was insufficient to treat SAD
- Individual’s excessive desire to behave favourably
- Overestimation of risk for misbehaving
- This specific model maximises disconformity evidence over repetition
- Use of exercises and feedback to raise awareness of adverse effects of safety behaviours and avoidance
7
Q
Discuss the empirical evidence for treatment of SAD
A
- Exposure-based treatment is the preferential evidence-based treatment for SAD and childhood anxiety disorders (Chorpita et al, 2011)
8
Q
Discuss the empirical evidence of treament for PD
A
- Ito et al (2001) adds support for exposure to treat PD
- RCT demonstrated benefits of exposure to interoceptive cues
- Either separate or combine with exposure to external cues
- Findings retained at 1-year follow-up with significant higher rates than controls
- Meta-analysis of VR exposure therapy showed medium-large effect size for SAD and PD (Powers, 2008)
- Unique part of PD: once panic attacks start, little to stop them. Attempts result in worsening (Salters et al, 2004)
- Provides a need for Acceptance and commitment therapy
- Helps relieve panic attack symptoms and minimise duration
9
Q
Discuss the empirical evidence for exposure-based therapy
A
- Expert consensus agrees exposure is the active component (Whiteside et al, 2016)
- Review of 11-years of childhood and adolscent treatment literature (Chorpita et al, 2011)
- Majority support for CBT and exposure-base approaches
- Greatest generalisability across patient demographics and healthcare settings
- Considered highly trainable
