treating anxiety

Question 1

what are the stages in Becks cognitive theory

Answer 1

situation - negative automatic thoughts - reaction

Question 2

what are the stages in Becks cognitive theory

Answer 2

situation - negative automatic thoughts - reaction
|
schema

Question 3

what happens in Becks cognitive theory

Answer 3

Emotional disorders are maintained by thinking disorders where anxiety and depression are accompanied by distortions in thinking.

This is manifest as a stream of negative, automatic thoughts.
Distortions in processing and negative automatic thoughts reflect the beliefs and assumptions stored in memory. These are stable representations of knowledge termed schemas. Schemas are cognitive structures, they are often specific to a disorder for example anxiety schemas contain assumptions and beliefs about danger and lack of ability to cope. When activated schemas influence information processing. They shape the interpretation of experience and affect behaviour. So while the behaviour thinking of an anxious individual may seem irrational, it’s logical based on the beliefs and assumptions held.
According to Becks theory, schemas are what create a bias in information processing and these biases are often distortions that impact how events are interpreted and threes biases lead events to be interpreted in a way that is consistent with the content of schemas therefore maintaining negative beliefs and appraisals.

Question 4

name 4 unhelpful thinking styles

Answer 4

overgeneralisation
magnification or minimization
mind reading
arbitrary interference

Question 5

what is overgeneralisation as an unhelpful thinking style

Answer 5

Applying a conclusion to a range of situations based on isolated evidence
e.g. nothing good ever happens, everything is always bad

Question 6

what is magnification or minimisation as an unhelpful thinking style

Answer 6

Enlarging/reducing importance of events.

Question 7

what is mind reading as an unhelpful thinking style

Answer 7

Assuming people are reacting negatively to you despite a lack of evidence for this

Question 8

what is arbitrary interference as an unhelpful thinking style

Answer 8

Drawing a conclusion without sufficient evidence

Question 9

what do schemas do in Becks cognitive theory

Answer 9

underlie disorders and are a maintenance factor

Question 10

model of becks congitive theory in depth

Answer 10

learning experience - danger schema formed - critical incident - schema activated - negative automatic thought – anxiety symptoms – behavioural responses – cognitive biases

Question 11

what are the general principles of cognitive theory

Answer 11

1. Emotional disorders maintained by a “thinking disorder”
2. Anxiety and depression accompanied by distortions in thinking (thinking error) e.g. Overgeneralization
3. Biased processing manifest as automatic thoughts which are content specific
4. Distortions and automatic thoughts reflect the operation of underlying beliefs (schemas)
5. Schemas remain dormant until activated
6. Individuals behave in a way that is consistent with their schemas- prevent
   disconfirmation
7. Behaviour is important in maintain/exacerbating emotional problems

Question 12

what does panic result from in Clarks panic model (1986)

Answer 12

Panic model based on cognitive theory. Based on the model, panic results from catastrophic misinterpretations of bodily sensations as indications of immediate impending physical or mental catastrophe.

Question 13

what happens in Clarkes panic model (1986)

Answer 13

trigger stimulus (internal or external)
percieved threat
apprehension
body sensations
interpretations of sensations as catastrophic

Question 14

how does the therapist challenfe belief in catastrophic misinterpretation

Answer 14

corrective information
socratic method
behavioural experiments

Question 15

what is the socratic method

Answer 15

Using a Socratic dialogue to question the patients evidence and ask questions like you’ve had lots of panic attacks so why haven’t you had a heart attack yet, what makes you think that anxiety can cause a heart attack.

Question 16

what is an example of a behavioural experiment

Answer 16

Hyperventilation provocation task where patients are asked to to hyperventilate to really push symptoms in order to find out that catastrophes dont actually occur

Question 17

what is the efficacy of CBT

Answer 17

• Recommended treatment in NICE Guidelines for treating psychological
  disorders
• Effectiveness varies: Approximately 50% recovery in GAD, and MDD (major depressive disorder)
  -Higher recovery in panic and social phobia

Question 18

issues with CBT

Answer 18

■ Relapse rates a problem, especially in depression
■ Some anxiety disorders are harder to treat (OCD, GAD; Springer et al (2018))
■ CBT is no more effective than exposure (PTSD, OCD; Fisher & Wells, 2005)
■ Addition of CBT to exposure does not improve outcomes
■ The efficacy of CBT appears to be falling (Johnsen & Friborg, 2016)

Question 19

efficacy of CBT in OCD

Answer 19

In OCD - reanalysed treatment out comes for cognitive therapy and exposure and response prevention ERP - found that ERP. Was associated with a reliable improvement in 75% of patients and a 60% recovery rate whilst cognitive therapy was associated with a 61% increase in improvement and only a 53% recovery rate
Suggested that EPR. Rather than cognitive therapy may be the most effective treatment of OCD

Question 20

remission rates of CBT in GAD

Answer 20

Remission rates in GAD post treatment were 53% and only 56% at follow up
Only about half of patients no longer meet diagnostic criteria for generalised anxiety disorder after CBT

Question 21

what is MCT

Answer 21

■ Metacognitive Therapy (MCT) (Wells, 2009)
– Theory driven (S-REF Model) systematic development and estimation
– Overcome theoretical limitations of CBT

■ Example of a CBT limitation: most people have negative thoughts but do
not develop anxiety disorder, why?

Based on the self-regulatory executive function model
Majority of psycho therapies are based on clinical observation rather than scientifically tested techniques or an a priori theory but MCT was developed more systematically and driven by advanced theory

Question 22

difference between MCT and CBT

Answer 22

CBT challenges content of negative thoughts but MCT is focused on the response to the thoughts

CBT says disorders arise from maladaptive schemas

MCT - maladaptive metacognitive beliefs - so the beliefs we have about our thinking

Question 23

principles of MCT

Answer 23

• “Thoughts don’t matter but your response to them does” (Wells, 2009,
  p. 1).
  -Psychological distress is maintained by a style of thinking (the
  Cognitive attentional syndrome (CAS))
• CAS includes worry, dwelling (rumination), threat monitoring, unhelpful
  coping strategies (thought suppression)
• CAS is driven by a set of beliefs à Metacognitive beliefs
• Metacognitive beliefs are beliefs about thinking

Question 24

what is cognitive attentional syndrome

Answer 24

CAS includes worry, dwelling (rumination), threat monitoring, unhelpful
coping strategies (thought suppression)
CAS is driven by a set of beliefs à Metacognitive beliefs
Metacognitive beliefs are beliefs about thinking

Question 25

what are the characteristics of GAD

Answer 25

uncontrollable worry

Question 26

what are metacognitive beliefs

Answer 26

Beliefs individuals hold about their thinking

maintenance mechanism of anxiety and depression

Question 27

examples of positive metacognitive beliefs

Answer 27

• worrying helps me cope
• if i worry ill be prepared
  concern the usefulness of worry

Question 28

examples of negative metacognitive beliefs

Answer 28

-i cannot control my worrying
-worrying will harm my mind/body
concrn the uncontrollability and dangerousness of worry

Question 29

what do behaviours do as coping strategies

Answer 29

Control processes that maintain psychological distress, prolong maladaptive thinking, and maintain maladaptive metacognition
– More thinking 
– Suppression of trigger thoughts 
– Reassurance seeking
 – Avoidance

Question 30

model of MCT

Answer 30

trigger
positive meta-beliefs activated - strategy selection
type 1 worry
negative meta-beliefs activated
type 2 worry - meta-worry
behaviour - thought control - emotion

Question 31

what is a trigger

Answer 31

trigger, thought - e.g. not passing an exam or an image e.g. an image a family member getting hurt

Question 32

what happens in the metacognitive model of GAD

Answer 32

Trigger, thought
Positive belief that worrying helps them to cope

Pick worrying as a strategy to deal with these thoughts or image bc they think that strategy is helpful

metacognitive model of GAD distinguishes between two types of worry
Type 1 worry - worrying about the social, the self and the world and this leads individuals to feeling anxious - result in additional physical symptoms e.g. start to feel tense or nauseous or they could have difficulty concentrating
Type 1 worry alone is not sufficient to cause GAD .

GAD in the context of the meta cognitive models develops when metacognitive beliefs are activated.

After a patient engages in type one worry their negative metacognitive beliefs become activated, the idea that worry is uncontrollable. Then they start to negatively appraise worry
Patients start to engage in type 2 worry or meta worry, examples or meta worry are I’m losing control or im going crazy

Meta worry can lead to increased anxiety and it can increase maladaptive behaviours such as avoidance or reassurance seeking and then lead the patient to also engage in maladaptive thought control strategies such as distraction or thought suppression.

Question 33

what is type 1 worry

Answer 33

Type 1 worry - worrying about the social, the self and the world and this leads individuals to feeling anxious - result in additional physical symptoms e.g. start to feel tense or nauseous or they could have difficulty concentrating
Type 1 worry alone is not sufficient to cause GAD .

Question 34

what is type 2 worry

Answer 34

After a patient engages in type one worry their negative metacognitive beliefs become activated, the idea that worry is uncontrollable. Then they start to negatively appraise worry

Patients start to engage in type 2 worry or meta worry, examples or meta worry are I’m losing control or im going crazy

Meta worry can lead to increased anxiety and it can increase maladaptive behaviours such as avoidance or reassurance seeking and then lead the patient to also engage in maladaptive thought control strategies such as distraction or thought suppression.

Question 35

MCT for GAD

Answer 35

■ Generate case formulation
■ Share case formulation 
■ Challenge uncontrollability metabeliefs
– Evidence, hypotheticals, worry postponement 
■ Challenge danger metabeliefs
– Try to lose control of worry 
■ Challenge positive metabeliefs
– Worry modulation experiment

Question 36

what does challenging beliefs look like in MCT

Answer 36

We can challenge these beliefs using an evidence analysis but unlike CBT. Which uses evidence analysis for the content of the thoughts in MCT the evidence analysis challenges the meta beliefs so asks fro evidence for and against the belief that worrying is uncontrollable for example. We can also use metaphors to challenge uncontrollability beliefs e.g. think of negative thoughts a little bit like a nuiscance caller, annoying but what happens when we dont answer the phone, it stops ringing. Most patients pick up the phone and get engaged with them by worrying

Experimental exercises with helping patients discover that they do in fact have control over their attention as a way to challenge uncontrollability

On the other hand CBT would ask to think about it more and ask for evidence of that thought or belief but in a MCT they dont do any of that - more about not engaging with the thought

After challenging uncontrollability beliefs then go on to challenge danger meta beliefs - use tasks like trying to get patients to lose control of worrying then challenge positive meta beliefs with a worry modulation experiment

Question 37

efficacy of metacognitive therapy

Answer 37

■ MCT has been evaluated systematically from case studies, to pilot
studies, uncontrolled trials, and randomized controlled evaluations
■ Normann & Nexhmedin (2018) conducted a systematic review and meta-analysis
■ 25 efficacy studies of MCT, 15 were controlled trials
■ MCT significantly more effective than waitlist (Hedges’ g = 2.06)
■ MCT significantly more effective than CBT (Hedges’ g = 0.69) and follow-up (0.37)

Conclusions: Results suggest that MCT is highly effective in treating disorders of anxiety and depression and may be superior to CBT

Question 38

conclusions

Answer 38

■ CBT is effective but outcomes vary
■ MCT improves outcomes
■ MCT and CBT have different mechanisms of change
– CBT focuses on challenges the content of thoughts
– MCT focuses on challenging metacognitive beliefs (beliefs individuals hold about their thinking)

Question 39

what are the different mechanisms of change in MCT and CBT

Answer 39

– CBT focuses on challenges the content of thoughts = reality test idea - how much do you believe you are a failure and is there any evidence to support that
Evidence based treatment approach - problems arise from overthinking

– MCT focuses on challenging metacognitive beliefs (beliefs individuals hold about their thinking) - how much time do you spend analysing your failures and think about being foolish - changing thinking processes and bringing overthinking under control - metacognitive beliefs - beliefs about thinking

Question 40

what does MCT stand for

Answer 40

metacognitive therapy