Social and Childhood Anxiety and GAD Flashcards
state the two components to the automatic nervous system.
- sympathetic nervous system (creates)
- parasympathetic nervos system (inhibits)
outline sections in clark and well’s cognitive model of SAD.
- social situation
- activates assumptions
- perceived social danger
- processing self as social object
- safety behaviours
- cognitive and somatic symptoms
state the two ways how people can process themselves as social objects.
- observer perspective
- field perspective
give examples of safety behaviours.
- avoiding eye contact
- gripping tightly onto glass
- wearing dark clothing to hide sweat
give examples of cognitive biases.
- attentional biases (focus on the bad things that reinforce phobia)
- misinterpretations
outline CBT for SAD.
- identify and challenge irrational beliefs
- behaviour experiments (catastrophes unlikely to come true)
- feedback
- homework
what was the effect size for CBT for SAD.
large effect size , d = 1.04, effective.
what is the prevalence for SAD?
- 12% in adults
- 0.32% in children
- onset in adolescence
describe the DSM-5 diagnosis for SAD.
- persistent fear of 1+ social performance situations
- evokes immediate reaction
- irrational
- avoidance
- minimum 6 months duration
- not better explained by another diagnosis
what is the heritability of SAD.
.65
define pre and post-mortem.
pre- mortem is where the person reviews likely runs of events and recollection of past failures before the interaction, post-mortem is where the person negatively processes the event after the interaction.
children can all the anxiety disorders adults have plus one more…
separation anxiety.
which childhood disorder has the highest prevalence?
separation anxiety - 1.09%-20.2%
what is the min and max found of children with anxiety disorders?
min - 3.19%
max - 41.9%
state consequences of anxiety disorders.
- depression, substance misuse, psychosis, underachievement at school, poor relationships
- anxiety in children often does not get spotted until its very serious.
describe heritability causes for childhood anxiety.
- first degree relative with pain disorder, 5 times more likely to develop panic disorder
- anxious parents, twice as likely to develop anxiety
- shared environment
state findings from twin and adoption studies on childhood anxiety.
- panic 30-40% heritable
- GAD 31.6%
- phobias 20-40%
variations of heritability is due to…
- severity being measured
- type of anxiety being measured
- whose reporting anxiety
- age
describe how parents can contribute to childhood anxiety.
vicarious learning
overprotective parents:
- reduced opportunity to develop coping skills
- reduced opportunities to take risks and succeed or fail
- reduced opportunities to learn to cope with feeling scared
- think the world is dangerous and so scary things should be avoided
which comes first: anxiety or overprotective parenting?
we don’t know!!
give evidence that parents are not the cause of childhood anxiety.
- parenting only accounted for 4% of variance in child anxiety, studies may overestimate the relationship between variables.
how is CBT improved for children?
- treating septic disorders rather than general
- one-to-one better than group
what is the best kind of treatment for anxiety?
CBT and sertaline (80.7% improvement)
- although no treatment groups ended up significantly better than others.
outline CBT in treating children.
- explain fight-flight response
- explain role of avoidance
- gradual exposure (steps model)
describe the DSM-5 diagnosis of GAD.
- excessive, uncontrollable worry
- distress/functional impairment
- 3+ : restlessness, fatigued, difficultly concentrating, sleep disturbance
- minimum 6 months
state exclusion criteria of diagnosis of GAD.
- focus of the anxiety and worry is confined to another axis 1 disorder e.g specific phobias
- if disturbance is a result of medical condition, or effects of a substance
- worry occurs during a mood disorder, developmental disorder, psychotic disorder
what is the epidemiology of GAD?
- prevalence 3.7%
- highest in highest income countries 5%
- comorbidity 81%
why is studying GAD important?
- one of the most prevalent and problematic disorders in primary care
- highly comorbid with other MH conditions
- high burden on health care services
- long-term impact on cardiovascular health
- CBT effective for approx 50%
define aspects of the model of pathological worry GAD.
- cognitive biases: attention bias, interpretation bias
- attentional control: limited capacity resource allows us to exert goal-directed control over allocation of attention.
which cognitive model involves top-down and bottom-up processes in leading to perception of threat (GAD).
model of pathological worry.
give evidence for the model of pathology.
- habit to attend to threat promotes worry
- making negative interpretations of ambiguous information promotes worry
- engaging in imagery when worrying (vs verbal worry) reduces worry.
define aspects of the intolerance of uncertainty model.
- greater need for certainty
- uncertainty perceived as more unpleasant (less well able to tolerant ‘not knowing’.
state positive beliefs of worry according to IU model.
- worry is seen as useful
- worry is necessary to prevent surprise at negative future outcomes.
describe negative problem orientation according to the IU model.
- dysfunctional attitudes relating to problem-solving process
- perceptions of problems as threats
- lack of confidence in problem-solving abilities
what is meant by cognitive avoidance in the IU model.
- using worry to avoid emotional arousal
- worry serves to suppress negative intrusive thoughts
give evidence for the IU model.
- experimentally increasing IU also increases worry
- individuals with GAD had positive beliefs about worry to a greater extent than the general population
- individuals with GAD have greater negative problem orientation than people with other anxiety disorders.
describe the avoidance model of GAD.
- worry focuses on possible, but non-existent future bad things that may happen
- as perceived danger does not exist, there is no effective flight/fight response
- humans are left with only mental attempts to solve the problem
how does worry serve as an avoidant response in the avoidance of GAD model?
- to avoid distressing negative imagery associated with more distress in short-term
- to avoid physiological arousal
- to avoid thinking about more distressing topics.
give evidence for the avoidance model of GAD.
- people who experience GAD display increased muscle tension at rest
- worry is primarily a verbal-linguistic process than imagery-based
- worry is reinforced by positive beliefs about worry.
name and describe the steps of the NICE ‘focus of intervention’ stepped-care.
- preventions of GAD
- diagnosed GAD that has not improved after step 1
- inadequate response to step 2 or marked functional impairment
- complex treatment-refractory, very marked functional impairment
name and describe the ‘nature of the intervention’ steps in the NICE stepped-care model.
- identification and assessment, education, treatment options, monitoring
- low-intensity psychological interventions, self-help materials
- high-intensity intervention (CBT) or drug
- specialist treatment, including inpatient care.
state core treatment components of CBT in targeting intolerance of uncertainty.
- 12-16 sessions
- psychoeducation about CBT
- worry awareness training
- coping with uncertainty
- re-evaulating beliefs about usefulness of worry
- improving problem orientation and solving ability
- processing core fears through imaginal exposure
- relapse prevention
what happens during psychoeducation?
- collaboration between therapist and patient
- focuses on ‘here and now’
- homework between sessions
- blueprint at end - reinforce therapy gains as a relapse-prevention technique.
how is worry awareness trained?
worksheet, state:
- date and time
- describe situation
- ‘your worry’
- how anxious (0-10 scale)
- classify (practical or hypothetical worry)
describe how to help cope with uncertainty as a treatment method.
- explain to patient what IU is and how feeds into the worry process
- present dilemma to patient, give options t reduce uncertainty or/and increase intolerance
give examples of behavioural experiments to seek out uncertainty.
- sending email without checking for errors
- not seeking reassurance about a decision from others
- completing ‘challenging your beliefs’ worksheet.
how does treatment approach improve problem orientation?
- work on idea problems are a normal part of everyday life
- target appraisal of problems as threatening e.g could be an opportunity?
- maintaining progress and ‘incase of a setback’ worksheets e.g ‘what have I learnt? what could I do differently?’.
state the steps of applied relaxation for GAD.
- worry awareness and self-monitoring
- relaxation training
- cognitive therapy
- imagery rehearsal of coping strategies
focus on progressive muscle relaxation is based on the premise that…
… chronic worry is associated with deficiency in parasympathetic tone and excessive muscle tension.
training in progressive muscle relaxation involves…
… systematically tensing and relaxing muscle groups in order to learn the difference between the two.
eventually individuals create relaxing by recalling how muscles felt when relaxed.
