Lecture 3, Treating Anxiety Flashcards
Overview of Cognitive Theory
Cognitive Theory focuses on an individual’s interpretation of events, thoughts, and beliefs in the development and maintenance of emotional problems.
It suggests that dysfunction occurs from an individual’s interpretation of events, which in turn influences behaviors that are important in maintaining emotional problems.
The model can be represented as: SITUATION -> NEGATIVE AUTOMATIC THOUGHTS -> REACTION (EMOTION/BEHAVIOR)
Negative Automatic Thoughts and Unhelpful Thinking Styles
Negative automatic thoughts and distortions in processing reflect the underlying beliefs and assumptions stored in memory, which are called schemas.
Negative automatic thoughts can be verbal, image-based, involuntary, rapid, and negative.
Unhelpful thinking styles that can lead to negative automatic thoughts include overgeneralization, magnification or minimization, mind-reading, and arbitrary inference.
Schemas and Core Beliefs
Schemas are underlying beliefs and assumptions about oneself and the world based on experiences and used to organize and interpret new information that are stored in our memory. They are also called core beliefs.
Schemas can be specific to a disorder, such as anxiety, where they involve assumptions and beliefs about danger and lack of ability to cope.
Schemas are interpreted as absolute truths and can bias information processing, influence how an individual behaves, thinks and feels, and can be formed through early learning experiences.
Principles of Cognitive Theory
Emotional disorders are maintained by a thinking disorder, which involves negative interpretation of events.
Negative interpretations involve distortions in thinking or thinking errors.
Biased processing manifests as automatic thoughts, which are content-specific.
Distortions and automatic thoughts reflect the operation of underlying beliefs or schemas.
Schemas remain dormant until activated.
Individuals behave in a way that is consistent with their schemas to prevent disconfirmation.
Behavior is important in maintaining/exacerbating emotional problems.
Panic Disorder – Clark’s (1986) panic model:
Panic results from catastrophic misinterpretation (CM) of internal sensations.
The therapist challenges belief in CM by:
-> Corrective information
-> Socratic method – What makes you think anxiety can cause a heart attack?
-> Behavioral experiments, e.g., hyperventilation provocation.
Efficacy of CBT:
Recommended treatment in NICE Guidelines for treating psychological disorder
Effectiveness varies: Approximately 50% recovery in GAD, and MDD
Higher recovery in panic and social phobia
50% of patients treated in IAPT recover – 66% improved.
Psychological Therapy in Practice:
Improving Access to Psychological Therapies (IAPT):
Step 1: ID, assessment, active monitoring
Step 2: low-intensity treatment, I.e., guided self-help
Step 3: high intensity treatment, I.e., CBT, EMDR, IPT, behavioural activation, psychodynamic therapy, counselling
Step 3+: multi disciplinary treatment, often complex/recurrent cases
Capobianco et al., 2022 – Aims:
What effects on anxiety and depression symptoms are associated with remote delivery of therapies?
How do the effects compare with those associated with face-to-face therapy delivered prior to COVID-19?
Analysed routinely collected data from IAPT services.
Remote therapy (n=5515); In person (n=9199)
CBT During COVID:
Both remote and face-to-face CBT significantly reduce symptoms of anxiety and depression over time.
Remote therapy required a shorter treatment length than face-to-face therapy.
Clinical improvement was slow, and relapse rates are a problem, especially in depression.
Some anxiety disorders, such as OCD and GAD, are harder to treat with CBT.
CBT is no more effective than exposure therapy for PTSD and OCD.
Metacognitive Therapy (MCT) (Wells, 2009):
MCT is a theory-driven approach to treating psychological distress.
Psychological distress is maintained by a style of thinking called the Cognitive attentional syndrome (CAS), which includes worry, rumination, threat monitoring, and unhelpful coping strategies.
The CAS is driven by a set of beliefs called Metacognitive beliefs, which are beliefs about thinking.
Metacognitive beliefs can be negative (uncontrollability/dangerousness of worry) or positive (benefits/usefulness of worrying).
The goal of MCT is to change maladaptive metacognitive beliefs and reduce the CAS, leading to a reduction in psychological distress.
Efficacy of CBT:
CBT is recommended as a treatment for various psychological disorders.
The effectiveness of CBT varies, with higher recovery rates in panic and social phobia.
The efficacy of CBT appears to be falling over time.
Johnson & Friborg (2016) found a negative association between BDI effect size and remission rates over time.
Improving Access to Psychological Therapies (IAPT):
IAPT is a stepwise approach to delivering psychological therapy in the UK.
Step 1 involves identification, assessment, and active monitoring.
Step 2 involves low-intensity treatment, such as guided self-help.
Step 3 involves high-intensity treatment, such as CBT, EMDR, IPT, behavioral activation, psychodynamic therapy, or counseling.
Step 3+ involves multidisciplinary treatment for complex or recurrent cases.
Panic Disorder – Clark’s (1986) panic model:
Panic results from catastrophic misinterpretation (CM) of internal sensations.
The therapist challenges the belief in CM through corrective information, the Socratic method, and behavioral experiments (e.g., hyperventilation provocation).
Sun et al., (2017) meta-analysis
Found that negative metacognitive beliefs regarding uncontrollability and danger are seen across various psychological disorders.
Capobianco et al., (2010) systematic review
Found that negative metacognitive beliefs are positively associated with increased anxiety and depression across physical illnesses, even after controlling for other factors.
