Lecture 11: Competing Models of Anxiety Disorders

Question 1

What are the four attachment styles?

Answer 1

Secure - can display affection but comfortable with independence

Anxious - needy - infant will require a lot of reassurance when mother returns

Avoidant - uncomfortable with intimacy and infant won’t be bothered when mother leaves

Anxious-avoidant

Question 2

What are the crticisms of attachment theory?

Answer 2

Peers influence attachment style in addition to parents

Some characteristics may be due to nature not just nuture

Is there crucial period of attachment??

Lack of emphasis on other caregivers other than mother

Question 3

What are the goals of family systems therapy?

Answer 3

1) Make family members aware of how the emotional system works
2) Helping family members differentiate themselves from others - make changes to themselves

Question 4

Name some criticisms of the family systems theory approach?

Answer 4

Theoretical - not evidence based

Gender roles - Mother’s “over-concerned” & men “under-involved”

Lack of emphasis on importance of emotional experiences

Is the family correlational or causational? (Anxiety not necessary cause of problems: could be in other direction also problems ► anxiety or correlational)

Question 5

Outline some aspects of the technique of exposure therapy

Answer 5

• Prepare the patient
• Formulate a graded list (can be flexible grading)
• Minimise uncertainty and avoid surprises, be explicit
• Practise and generalising
• Use positive reinforcement and encouragement
• Be patient
• Foster curiosity - no is acceptable but agree for persuasion

Question 6

What are some criticisms of behavioural treatments for anxiety?

Answer 6

Not disorder specific

Less take up and more drop-outs

Some patients don’t habituate

Lack of generalising

Needs practice

Question 7

Explain how are the cognitive biases for anxiety formed

Answer 7

• Anxiety: catastrophic dysfunctional interpretations
• Interpretations: set of rules/assumptions which help make sense of world and experience and shape how you feel and act. Influenced by multiple factors, such as life events and family background.
• Dysfunctional interpretations or cognitive biases: negative, rigid and demanding view of the world/experiences

Question 8

Give an overflow of the simplified model of persistence and anxiety?

Answer 8

• Events and situations
• Negative interpretations
• Reactions
• Automatic reactions
• Strategic reactions

–> These then interact with the event & the interpretation

Question 9

Give an equation for the proportionality of anxiety to the perception of danger or threat:

Answer 9

All these factors are based in the perception of patient:

(likelihood it will happen * awfulness if it did) ÷

(coping ability when it does + rescue factors)

Question 10

Name some maintaining process in axiety disorders

Answer 10

Avoidance

Safety seeking behaviour - prevents disconfirmation, increase preoccupation and rumination, can increase stimuli which are misinterpreted. Linked to specific focus of threat by internal logic of person employing them

Attention - paying too much attention to this event

• Towards what’s important - selective attention
• Towards threat i.e physical symptoms
• Towards safety i.e. exit
• -> Help the client focus on more stimuli

Imagery - visualise the situation in a negative manner

strong emotions (emotional reasoning) - because you feel something it must be a reality

memory processes - negative memories of previous events
–> Memories specific, over-general and recurrent memories

worry / rumination
- Worry themes are developmentally relevant and often about everyday events > less important events

Question 11

Name some pioneers in Behavioural theory in anxiety and outline their proposals

Answer 11

• Bowlby: questioned role of attachment insecurity / anxiety in the development and maintenance of paranoia in psychosis
• Edmond Jacobson: Progressive muscle relaxation (PMR)
• Mary Cover Jones: Systematic desensitization

Question 12

What is the rationale of exposure therapy?

Answer 12

• Anxiety provoked by trigger makes patient run away from it, which in turn exacerbates anxiety
• Thus, it is important that patient stays in anxiogenic situation until his adrenaline is reduced by 50% -only after that patient might leave situation
• Exposure must be repeated continuously until patient reaches habituation

Question 13

Name some models for anxiety under the Cognitive Therapy framework

Answer 13

• Cognitive model of emotional response
• Cognitive model of the persistence of anxiety
• 5 areas model
• Vicious flower model - maintaining processes

Question 14

How does cognitive therapy address anxiety?

Answer 14

• Therapists helps consider alternative, less threatening explanations for their problems
• Identify threat appraisals