Lecture 6 - Anxiety-Based Disorders Flashcards
What is anxiety?
What is anxiety? – basic emotion, personality dimension, psychological disorder
Normal response to danger/thoughts, has multiple subsystems (cognitive/behavioural/physiological)
When is anxiety a disorder?
Interferes w/ functioning, prolonged/excessive, impairs quality of life
DSM 5: anxiety disorders, OCD/related disorders, trauma/stress-related
What is cognitive theory? (Beck)
Dysfunctions occur from individual’s interpretation of events which influences behaviours important in maintaining emotional problems
Emotional disorders maintained by how individuals interpret events which influences behaviours that maintain emotional problems
Situation – Negative Automatic Thoughts (NATS) – Reaction (emotion/behaviour)
NATs – verbal/image/involuntary
Negative automatic thoughts/distortions in processing reflect underlying beliefs/assumptions stored in memory (eg. Schemas)
What are 4 Unhelpful Thinking Styles?
Overgeneralisation – applying conclusion to range of situations based on isolated evidence
Magnification/Minimisation – enlarging/reducing importance of events
Mind Reading – assuming people reacting negatively to you despite lack of evidence
Arbitrary inference – drawing conclusion without sufficient evidence
What are schemas?
Underlying beliefs/assumptions about self/world based on experience + used to organise/interpret new info (core beliefs)
Often specific to disorder (eg. Assumptions/beliefs about danger/inability to cope in anxiety)
Interpreted as absolute truths, influence how one behaves/thinks/feels
Can be formed through early learning experiences
What is panic disorder?
Clark’s (1986) model – panic results from catastrophic misinterpretation (CM) of internal sensations
*model in ppt
Therapist challenges belief in CM by – corrective info, socratic method (what makes you think anxiety can cause a heart attack?), behavioural experience (hyperventilation provocation)
What is the efficacy of CBT in anxiety?
Recommended treatment in NICE guidelines for treating psychological disorders
Effectiveness varies, approx 50% recovery in GAD and MDD
Higher recovery in panic + social phobia
What are the issues with CBT in anxiety?
Relapse rates a problem (esp depression)
Some anxiety disorders harder to treat (OCD, GAD) – remission rates in GAD
CBT no more effective than exposure (PTSD, OCD)
Addition of CBT to exposure doesn’t improve outcomes, efficacy appears to be falling
What do we move to after CBT?
Metacognitive therapy (MCT) – Wells, 2009
Theory driven (S-REF Model) systematic development + estimation
Overcome theoretical limitations of CBT, development scientifically tested techniques + driven by a-priori theory
Most people have negative thoughts but don’t develop anxiety disorder, why?
What are the principles of MCT?
Thoughts don’t matter but response to them does
Psychological distress maintained by style of thinking (cognitive attentional syndrome – CAS)
CAS includes worry, dwelling (rumination), threat monitoring, unhelpful coping strategies (thought suppression)
CAS driven by set of beliefs – metacognitive beliefs (beliefs bout thinking)
Negative metacognitive beliefs: uncontrollability/dangerousness of worry, I can’t control my worrying
Positive metacognitive beliefs: Benefits/usefulness of worrying, helps me cope, if I worry I’ll be prepared
What is the metacognitive model of GAD?
Characteristics of GAD = uncontrollable worry
Type 1 worry – worry about social/self/world, this alone not enough to cause GAD
GAD develops when negative metacognitive beliefs activated —> becomes Type 2 worry
Type 2 worry (meta-worry: worry about worrying)
How does metacognitive theory for GAD work?
Control processes that maintain psychological distress, prolong maladaptive thinking, and maintain maladaptive metacognition
More thinking, suppression of trigger thoughts, reassurance seeking, avoidance
Generate (case formulation) – Share (formulation) – Challenge (uncontrollability metabeliefs, danger metabeliefs, positive metabeliefs)
What is the efficacy of metacognitive therapy?
Evaluated systematically from case studies (pilots, uncontrolled trials, randomised controlled evaluations)
Significantly more effective than waitlist/CBT + follow-up
Suggest MCT highly effective in treating anxiety/depression disorders, may be superior to CBT
