Self-help interventions for worrying Flashcards
What is worry
- Chain of thoughts and images, negatively affect laden and relatively uncontrollable.
- Attempt to solve a problem with an uncertain outcome but contains the possibility of one or more negative outcomes.
- Related to the fear process
Example: “What will people think when I mess up tomorrow’s presentation” 3
Generalised Anxiety Disorder
‘Excessive anxiety’ and ‘pathological worries’
- In two or more domains,
- on more days than not
- for 6 months or more
Theoretical models of pathological worrying
All emphasize different cognitive determinants of pathological worrying in GAD, they are not mutually exclusive
- Cognitive avoidance model
- Intolerance of uncertainty
- Metacognitive model of worry
Cognitive avoidance model (Borkovic & Costello, 1993)
Worrying is a cognitive attempt to avoid emotional processing of future potential threats
- Positive beliefs about worry
- Emotionally laden images are suppressed
- Reduced arousal is a reinforcer for the worry process
Intolerance of uncertainty (worrying)
The possibility of a negative event occurring is experienced as unacceptable and threatening
Tendency to have negative beliefs about uncertainty and its outcomes
Not knowing triggers the worry-thoughts: What if…..
This is not related to the likelihood of the event happening!
Metacognitive model of worry (Wells, 1995)
Pathological worry is explained by positive and negative meta-cognitions (meta-worry=worry about the worry)
- Positive meta-cognition: e.g. ‘worrying is an effective means of dealing with threatening situations’.
- Negative meta-cognition: e.g. ‘worrying is uncontrollable and harmful’
Worrying starts with with positive meta-cognitive beliefs and is exacerbated by negative meta-cognitive beliefs, the latter is key in the development of pathological worrying in GAD.
Treatments (3 approaches)
• Cognitive avoidance model
Mindfulness-based CT, emotion regulation, Cognitive therapy
• Intolerance of uncertainty
Problem solving, cognitive therapy, behavioral exposure to uncertain situations
• Metacognitive model of worry
Modifying meta-cognitions, reduce worry
• Psycho-education
Rumination
Response styles theory:
Response styles theory:
response to distress that involves repetitively and passively focusing on problems and feelings about problems, its possible causes and consequences (as opposed to focusing on its solution).
Example: “Why did I respond this way to my partner?”
Worrying versus rumination (Nolen Hoeksema, 2008)
worry:
- more future oriented
- focused on anticipating stress
- conscious motive is to anticipate and prepare for threat
- nonconscious motive is to avoid core negative affect and painful images
rumination:
- more past-/present-oriented
- focused on issues of self-worth, meanings, themes of loss
- conscious motive is to understand the deep meanings of events, gain insight, and solve problems
- nonnconscious motive is to avoid aversive situations and the responsibility to take action
Repetitive negative thinking (Nolen Hoeksema, 2008)
Includes both rumination and worry:
- Repetitive
- Difficult to control
- Self-focused
- Overgeneral thinking style
- Cognitive inflexibility
- Difficulty switching attention from negative stimuli
- Performance deficits
- Difficulties concentration and attention
- Poor problem solving
- Inadequate solution implementation/ instrumental behaviour
Treatments for Rumination
Behavioral Activation or Problem Solving: distraction and action orientation
Mindfulness: Non-judgmental approach to feelings and thoughts, and distancing from thoughts
Cognitive Therapy: Challenging ruminative thoughts
Interpersonal Therapy: work on interpersonal processing
Treatments for Rumination (Dodo bird verdict)
Dodo bird verdict
All therapies give an explanation for for why they are depressed and what they can do to overcome depression
Psychopathology of worrying and rumination
Worrying has stronger relationship with GAD
Rumination has stronger relationship with depression
Repetitive negative thinking also present in substance use, eating disorders, suicide
The stepped care model (GAD) :
Low intensity psychological interventions for GAD for those that don’t have improved symptoms after step 1:
For people with GAD whose symptoms have not improved after education and active monitoring in step 1. offer one or more of the following as a first-line intervention guided by the person’s preference:
- individual non-facilitated self-help
- individual guided self-help
- psychoeducational groups.
Low intensity psychological interventions for GAD
Individual non-facilitated self-help for people with GAD should:
Individual non-facilitated self-help for people with GAD should:
- include written or electronic materials of a suitable reading age for alternative medial
- be based on the treatment principles of cognitive behavioural therapy ICBT)
- include instructions for the person to work systematically through the materials over a period of at least 6 weeks
- usually involve minimal therapist contact. for example an occasional short telephone call of no more than Sminutes.
Low intensity psychological interventions for GAD
Individual guided self-help for people with GAD should:
Individual guided self-help for people with GAD should:
- be based on the treatment principles of CBT
- include written or electronic materials of a uitable reading age lor alternative media)
- be supported by a trained practitioner, who facilitates the self-heip programme and reviews progress and outcome
- usually consist of five to seven weekly or fortnightly face-to-face or telephone sessions each lasting 20-30 minutes Inew 2011.
Low intensity psychological interventions for GAD
Psychoeducational groups for people with GAD should:
Psychoeducational groups for people with GAD should:
- be based on CBT principles, have interactive design and encourage observational learning
- include presentations and self-help manuals
- be constructed by trained practicioners
- have a ratio of one therapist to about 12 participants
- usually consist of six weekly sessions, each lassting 2 hours
Practiotioners providing guided self-help and/or psychoeducational groups should:
Practiotioners providing guided self-help and/or psychoeducational groups should:
- receive regular high-quality supervision
- use routine outcome measures and ensure that the persson with GAD is involved in reviewing the efficacy of the treatment
How to do ‘worry time’
- Introduce the approach
- Schedule in worry time
- Make a list of hypothetical worries and focus away from worries
- Use the worry time
- Review the learning
Introduce the approach
Discuss real versus hypothetical worries
Recognize increased anxiety and physiological symptoms ———————–
What symptoms?
Headache, muscle tension, irritability, poor sleep, problems to focus
Worry time can help limit symptoms and control problems!
Schedule in worry time
Plan when you will schedule the worry time
30 minutes a day, play with this!
Free from distractions, not being disturbed
Make a list of hypothetical worries and focus away from worries
New fresh list of hypothetical worries every day
Note these down throughout the day
‘Park’ them, which should take the attention away, focus on current activities by focusing in the here and now (midnfullness techniques)
Use the worry time
Read the list with hypothetical worries
Cross them off when passed
When worry time is up, shift attention back to present
Difficulties in therapy (with worry time)
- Practice and time is needed
- Re-focus exercise might help
- Introduce this as an experiment
Exam questions
Name three ways in which low intensity treatments can contribute to accessible care?
exam question II
Please explain how the theoretical underpinning of problem-solving treatment fits with the stressvulnerability model.
exam queston III
In which phase of motivational interviewing would you place the following exercise. Explain why. (On a scale from 0 to 10, how IMPROTANT is it for you right now to change? On a scale of 0 to10 how CONFIDENT are you that you could make that change?)
exam question IV
Explain the rationale of motivational interviewing
Tips for students
- Try to cocentrate worrying twice a quarter of an hour a day. Postpone worrying until these moments. If you are still worrying in between, you can write down your thoughts so that you can continue during worrying moment. 2. Realise that you do not have to complete an entire process. Accept that certain bad ideas come to mind and look at them from a distance. For example, imagine that the thought is a cloud that makes you swirl around. 3. Think of three future scenarios about what you worry about. In the first everything goes wrong. You fail your exam and you have to stop your studies and then spend the rest of your life as a cashier at AH. In the second scenario everything goes great. Not only do you get a ten for the exam , you are asked to take PhD and you will become the youngest professor ever. Then come up with an intermediate formm that probable resembles reality the most.
