CLINICAL- Anxiety disorders

Question 1

The 3 anxiety disorders are

Answer 1

• Generalized anxiety disorder
• Agoraphobia
• Specific phobia (blood injection phobia)

Question 2

Describe Generalized anxiety disorder

Answer 2

• This is a long term- condition wherein feelings of anxiety may be on everyday events such as health, finances or family
  symptoms are:
• fear of losing control
• Nausea
• feeling dizzy or light headed
• sweating

Question 3

Describe agoraphobia

Answer 3

• This is characterized by excessive fear in response to situations where escape may be difficult or help is unavailable such as:
• public transport
• crowded areas
• being outside home alone.
• Being in enclosed spaces
• The person is scared of having panic attacks or other embarrassing symptoms in a public place

Question 4

Describe specific phobia

Answer 4

• This is characterized by excessive fear/ anxiety when exposed to or in anticipation of a specific stimulus
• The fear is usually disproportionate to the actual threat from the stimulus
• The symptoms can persist for several months and can impair important parts of functioning.

Question 5

What are the 2 measures used for anxiety disorders

Answer 5

• The Generalized Anxiety Disorder 7 (GAD-7)
• The Blood Injection Phobia Inventory (BIPI)

Question 6

Describe the GAD-7

Answer 6

• This is a questionnaire
• It has 7-items that measure the severity of anxiety. examples of items:
  > feeling nervous
  > being so restless its hard sit still
  > feeling afraid as if something might happen .
• Respondents are asked to provide a score between 0-3 for each item whereby it checks the frequency of their symptoms:
  0= not at all
  1=several days
  2=more than half the days
  3=nearly everyday

Question 7

Describe the BIPI

Answer 7

• This is a self-report measure containing 18 possible situations involving blood and injections
• for each situation they are asked to evaluate different reactions they might experience for that situation.
• These include psychological, cognitive and behavioural
  EXAMPLE SITUATION: When i see someone injured/bleeding on the road
  EXAMPLE REACTIONS:
  a) I wont bear the situation
  b) I think I am going to faint
  c) I think something bad is going to happen to me
• The must rate on a scale 0-3 with 0- never and 3-always

Question 8

What did Mas et al 2010 find about the BIPI

Answer 8

• he found the BIPI has excellent reliability and concurrent validity and was able to clearly discriminate between diagnosed with the phobia and those that werent.

Question 9

Evaluate the GAD-7 and BIPI

Answer 9

• High concurrent validity
• Response bias due to self-report
• Reductionists as they rely on a single quantitative measurement of a complex patient experience.
• Cultural bias does not support non-western cultures due to medical procedures being rare

Question 10

What does the Biological explanation suggest for this disorder

Answer 10

GENETICS:
- It suggests that we are born prepared to fear certain objects.
- There are stimuli in the environment that pose a threat to survival that we are genetically set up to avoid.

Question 11

in Ost et al. Describe what the blood-phobic patients went through

Answer 11

• they watched a 30 mins silent colour video of surgery being performed
• They were told not to close their eyes but try to watch as long as they could
• the experimenter would track their gaze direction
• if the participant looked away or stopped the video, the test would end

Question 12

in Ost et al. Describe what the injection- phobic patients went through

Answer 12

• This involved 20 steps from the individuals fingertip being cleaned to having a fingertip being pricked
• The steps were described to the patients and they were to say whether or not it was ok to perform

Question 13

Describe the measures used in Ost et al.

Answer 13

• The measures recorded their maximal performance and rated their fainting behaviour (0-4)
• the patients would do a self-rating of anxiety (0-10)
• The patients were given another questionnaire on their thoughts and feelings during the tests
• Their blood pressure and heart rate were monitored

Question 14

state one result found in Ost et al.

Answer 14

There was a higher proportion of the participants with blood phobia (70%) and injection phobia (56%) that had a history of fainting when exposed to their respective phobic stimuli compared to those with other specific phobias.

Question 15

what did Ost et al. conclude

Answer 15

There seems to be a strong genetic link for these behaviours which are more likely for these phobias than other phobias to produce a strong physiological response (fainting)

Question 16

Evaluate the biological explanation

Answer 16

• Supports nature
• Reductionist
• Deterministic
• Objective uses standardized behavioural tests and interviews with large groups

Question 17

what does the Behavioural (psychological) explanation suggest about this disorder: Classical condition

Answer 17

• Classical conditioning: An individual may develop a phobia of a harmless stimulus if it is paired with a frightening stimulus. Future association with the neutral stimulus will produce a fearful conditioned response
• Watson and Rayner used the principles of classical conditioning to create a phobia in a young healthy 9-month-old infant ‘‘Little Albert’’
• little Albert was shown a variety of neutral stimuli such as a white rat, a rabbit, or a dog
• He was then exposed to the unconditioned stimulus which was the loud noise of a metal bar leading to an unconditioned response of fearful crying
• The experimenters combined Neutral stimulus + unconditioned stimulus and after conditioning it became a conditioned stimulus (white rat or anything similar) to bring out a conditioned response (fearful crying and avoidance)

Question 18

what does the Behavioural (psychological) explanation suggest about this disorder: operant condition

Answer 18

• Operant conditioning is based on the principle of learning through consequences
• Negative reinforcement is the increased likelihood of repeating a behaviour due to the removal of something negative or unpleasant
• Negative reinforcement can explain how phobia persists
  
  • The removal of the phobic stimulus reduces the fear and so acts as a reward and the avoidant will continue this behaviour
• This leads to a continuation of the phobia because, avoiding the stimulus completely, gives the avoidant no opportunity to see that there is little fear

Question 19

what does the Psychodynamic (psychological) explanation suggest about this disorder

Answer 19

• A fear is repressed into the unconscious to protect the ego
• Freud suggested that phobias are a result of the id being denied/repressed during the psychosexual stages of development
• . Conflict is repressed into the unconscious
  and the phobic object/situation symbolises this conflict.
• Example study Little Hans

Question 20

What had the father of Hans reported to Freud

Answer 20

• He believed that his fear of horses was due to their large penis
• He said that one dream he had was when he had several children with his mother and the father was the grandfather
• He also dreamed that a plumber came to cut his penis off and replace it with a larger one
• The Oedipus complex was further supported by the 2 fantasies which represented the dynamic of the 3-way relationship between Little Hans and his parents

Question 21

Evaluate the Psychological explanation

Answer 21

• Supports nurture side
• Deterministic: If you are subject to conditioning where an association is made between a feared stimulus
• Ethical concerns were found in Little Albert as he was exposed to psychological harm however there was parental consent
• Both Little Hans and Albert were case studies, so they are not generalizable. However one could argue that Watson carried out a number of trials
• In-depth and qualitative research was carried out in Freud’s study which can help get a better understanding

Question 22

What refers to systematic Desensitisation

Answer 22

• This is a way of reducing undesirable responses to a particular situation. It assumes that nearly all behavior is a conditional response to stimuli
• Wolpe et al. introduced the idea of reciprocal inhibition, which is the impossibility of 2 strong opposing emotions at the same time
• the aim is to put the fearful feelings associated with the phobic stimulus in conflict with feelings of calmness/relaxation.

Question 23

What are the steps that systematic desensitization goes through:

Answer 23

1- The patient is first taught relaxation techniques such as progressive relaxation exercises or anti-anxiety drugs
2- The patient and therapist will then work together to create an anxiety hierarchy which is a list of anxiety-provoking situations that increase in severity. They will depend on whether they are working with in vitro or in vivo exposure to each stage.
3- At each stage of the hierarchy, they will be required to remain calm using the different techniques learned. The patient cannot move to the next level in the hierarchy unless they report no feeling of anxiety in their current stage

Question 24

How does CBT treat anxiety disorders

Answer 24

• They work by challenging their irrational thoughts
• Next, replace them with more rational ones
• The rational thinking leads to changes in behavioral and emotional response until the phobia is treated.

Question 25

What were the main theories and explanations in Chapman and Delapp

Answer 25

- CBT is an effective treatment for a range of phobias as it enables the individual to challenge their irrational thoughts and replace them with more rational ones - this form of CBT involves applying tension. Because fainting is a result of lowered blood pressure, the therapy aims to reduce instances of fainting and other unpleasant responses by applying tension to the muscles

Question 26

Evaluate the psychodynamic explanation

Answer 26

- There is no empirical evidence to support the explanation - Case study has low generalizability - Han's father provided the correspondence so could have been biased in information to fit the theory - Use of longitudinal study allowed detailed collection - Deterministic, unresolved conflict leads to fear and anxiety and individuals have no control over this development

Question 27

Evaluate systematic desensitzation

Answer 27

- Supports nurture as some phobias come from traumatic events - Time-consuming to learn relaxation and move down the hierarchy - Applicable as once they have learned it, they can apply it away from therapy - Individualistic as individual differences may happen - Reductionist only focuses on negative associations - Free will as it is up to the patient to decide to go through therapy

Question 28

Describe how applied tension for blood/injection phobia works

Answer 28

- This works by applying tension to the muscles to increase blood pressure throughout certain areas in the brain as blood phobia is associated with a drop in blood pressure and fainting

Question 29

What is the aim in Chapman

Answer 29

- They want to investigate whether BII phobia can be successfully treated by CBT and applied tension

Question 30

Describe the sample in Chapman and DeLapp

Answer 30

- One participant - Male - 42 year old - diagnosed with BII phobia - referred to as "T'' throughout the study

Question 31

List the 5 measures used in the study by Chapman

Answer 31

- Beck Anxiety Inventory (BAI - Beck Depression Inventory (BDI) - The Quality of Life Satisfaction Questionnaire (Q-LES-Q) - The Blood Injection Symptom Scale (BISS) - Subjective Unit of Discomfort Scale (SUDS)

Question 32

What were the results of the interview about T's history with anxiety

Answer 32

- He witnessed several deaths of family members - he lived with a highly anxious grandmother who used a scanner to listen to emergency dispatch calls throughout - he witnessed other family members faint during medical procedures

Question 33

What was the Procedure in Chapman

Answer 33

- T underwent 9 CBT sessions and applied muscle tension - During CBT, T was educated about common phobias and created a fear hierarchy - He then took the SUDS and gave his ratings of anxiety (0-100) at different stages of the hierarchy exposure

Question 34

What were the results BEFORE the treatment

Answer 34

- T's self assessments showed he and severe anxiety - minimal depressive symptoms - Overall good health - showed intense fear/anxiety surrounding blood and injections

Question 35

What were the results at the 4, 10 and 12 month post-treatment

Answer 35

- It showed that his anxiety levels had significantly dropped and he no longer showed fear to medical-related stimuli

Question 36

What did Chapman conclude

Answer 36

- CBT and applied muscle tension are effective treatments to BII phobia

Question 37

Evaluate Chapman

Answer 37

- Case studies gives detailed understanding of their background and the cause of the phobia - Quantitative data was provided - detailed interviews for qualitative analysis - Applicable to everyday life - Lack of generalizability - A case study cannot be replicated - Self reports lack validity due to social desirability and subjective interpretation