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YEAR 2 Mental Health > Treating Anxiety and Beyond > Flashcards

Treating Anxiety and Beyond Flashcards

1
Q

What is anxiety?

List 3 points

A
  1. A basic emotion
  2. A personality dimension
  3. A psychological disorder
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2
Q

Anxiety is known as a basic emotion

What does this mean? List 2 points

A
  1. Normal response to danger or thoughts
  2. Has multiple subsystems
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3
Q

Anxiety is known as a basic emotion that has multiple subsystems

What are the 3 subsystems?

A
  1. Cognitive
  2. behavioural
  3. Physiological
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4
Q

One subsystem of anxiety is cognitive

Describe this subsystem

A

Worry, racing thoughts, hypervigilance, tunnel vision

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5
Q

One subsystem of anxiety is behavioural

Describe this subsystem

A

Avoidance, fleeing, freezing

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6
Q

One subsystem of anxiety is physiological

Describe this subsystem

A

Increased blood pressure, heart rate, sweating

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7
Q

Which subsystem of anxiety does this apply to?

Increased blood pressure, heart rate, sweating

a. Behavioural
b. Physiological
c. Cognitive

A

b. Physiological

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8
Q

Which subsystem of anxiety does this apply to?

Avoidance, fleeing, freezing

a. Behavioural
b. Physiological
c. Cognitive

A

a. Behavioural

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9
Q

Which subsystem of anxiety does this apply to?

Worry, racing thoughts, hypervigilance, tunnel vision

a. Behavioural
b. Physiological
c. Cognitive

A

c. Cognitive

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10
Q

Normal response to danger or thoughts

This is known as…?

A

Anxiety

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11
Q

When does anxiety go from being a normal emotional reaction to a disorder?

List 3 points

A
  1. When anxiety interferes with functioning
  2. When anxiety is prolonged/excessive
  3. When anxiety impairs quality of life
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12
Q

What are the 3 chapters of anxiety disorders in the DSM-5?

A
  1. Anxiety disorders
  2. OCD and related disorders
  3. Trauma and Stress related
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13
Q

What are the 10 types of anxiety disorders?

A
  1. Separation anxiety
  2. Selective mutism
  3. Specific phobia
  4. Social anxiety disorder
  5. Panic attack
  6. Agoraphobia
  7. Generalized anxiety disorder
  8. Substance induced
  9. Anxiety due to medical condition
  10. Unspecified anxiety disorder
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14
Q

What are the 9 types of OCD and related disorders?

A
  1. Obsessive Compulsive Disorder
  2. Body Dysmorphic
  3. Disorder Hoarding
  4. Trichotillomania (hair pulling)
  5. Excoriation (skin picking)
  6. Substance induced OCD
  7. OCD related medical condition
  8. Other specified OCD
  9. Unspecified OCD
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15
Q

Hair pulling OCD is known as…?

A

Trichotillomania

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16
Q

What is Trichotillomania?

A

Hair pulling OCD

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17
Q

Skin picking OCD is known as…?

A

Excoriation

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18
Q

What is Excoriation?

A

Skin picking OCD

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19
Q

What are the 7 types of trauma and stress disorders?

A
  1. Reactive attachment disorder
  2. Disinhibited social engagement disorder
  3. Post traumatic stress disorder (PTSD)
  4. Acute stress disorder (ASD)
  5. Adjustment disorder
  6. Other specified trauma and stressor disorder
  7. Unspecified trauma and stressor disorder
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20
Q

General form of anxiety, people worry about anything and everything

This is known as…?

A

Generalized anxiety disorder

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21
Q

What is generalized anxiety disorder?

A

General form of anxiety, people worry about anything and everything

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22
Q

How do we treat anxiety disorders?

List 2 ways

A
  1. Cognitive theory (CBT)
  2. Metacognitive Beliefs (MCT)
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23
Q

According to the Cognitive Theory (Beck, 1976), how does dysfunction occur?

A

Dysfunction occurs from an individual’s interpretation of events which in turn influences behaviours important in maintaining emotional problems

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24
Q

This approach to treating anxiety believes:

Dysfunction occurs from an individual’s interpretation of events which in turn influences behaviours important in maintaining emotional problems

This is known as…?

A

Cognitive Theory (Beck, 1976)

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25
Q

According to the Cognitive Theory (Beck, 1976), how are emotional disorder maintained?

A

Emotional disorders are maintained by how individuals interpret events which influences behaviours that maintain emotional problems (i.e., anxiety/ depression)

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26
Q

This approach to treating anxiety believes:

Emotional disorders are maintained by how individuals interpret events which influences behaviours that maintain emotional problems (i.e., anxiety/ depression)

This is known as…?

A

Cognitive Theory (Beck, 1976)

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27
Q

Situation -> Negative Automatic Thoughts -> Reaction (emotion/behaviour)

Which approach does this apply to?

a. Cognitive theory (CBT)
b. Metacognitive Beliefs (MCT)
c. All of the above
d. None of the above

A

a. Cognitive theory (CBT)

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28
Q

What are Negative Automatic Thoughts?

A

Things that trigger reactions

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29
Q

Things that trigger reactions

This is known as…?

A

Negative Automatic Thoughts

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30
Q

What are the 3 forms of Negative Automatic Thoughts?

A
  1. Verbal
  2. Image
  3. Involuntary, rapid and negative
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31
Q

Feeling worried, characterised by “what ifs”

This is known as…?

A

Anxiety disorders

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32
Q

Feeling worried, characterised by “why” questions

This is known as…?

A

Rumination

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33
Q

Future oriented

a. Anxiety
b. Rumination

A

a. Anxiety

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34
Q

Past oriented

a. Anxiety
b. Rumination

A

b. Rumination

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35
Q

According to the Cognitive Theory (Beck, 1976), what 2 things reflect the underlying beliefs and assumptions stored in memory?

A
  1. Negative automatic thoughts
  2. Distortions
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36
Q

According to the Cognitive Theory (Beck, 1976), negative automatic thoughts and distortions in processing reflect …?

A

The underlying beliefs and assumptions stored in memory

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37
Q

Negative automatic thoughts and distortions in processing reflect the underlying beliefs and assumptions stored in memory

These are also known as…?

A

Schemas

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38
Q

What are the 4 types of Unhelpful Thinking Styles (Cognitive Distortion)?

A
  1. Overgeneralisation
  2. Magnification or minimisation
  3. Mind Reading
  4. Arbitrary Inference
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39
Q

What are cognitive distortions?

A

Unhelpful Thinking Styles

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40
Q

Define overgeneralisation

A

Applying a conclusion to a range of situations based on isolated evidence

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41
Q

Define Magnification or Minimisation

A

Enlarging/reducing importance of events

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42
Q

Define mind-reading

A

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

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43
Q

Define Arbitrary Inference

A

Drawing a conclusion without sufficient evidence

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44
Q

Enlarging/reducing importance of events

This is known as…?
a. Overgeneralisation
b. Magnification or minimisation
c. Mind Reading
d. Arbitrary Inference

A

b. Magnification or minimisation

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45
Q

Drawing a conclusion without sufficient evidence

This is known as…?
a. Overgeneralisation
b. Magnification or minimisation
c. Mind Reading
d. Arbitrary Inference

A

d. Arbitrary Inference

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46
Q

Applying a conclusion to a range of situations based on isolated evidence

This is known as…?
a. Overgeneralisation
b. Magnification or minimisation
c. Mind Reading
d. Arbitrary Inference

A

a. Overgeneralisation

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47
Q

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

This is known as…?
a. Overgeneralisation
b. Magnification or minimisation
c. Mind Reading
d. Arbitrary Inference

A

c. Mind Reading

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48
Q

I’m so boring that I’m sending the audience to sleep

This is known as…?
a. Overgeneralisation
b. Magnification or minimisation
c. Mind Reading
d. Arbitrary Inference

A

c. Mind Reading

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49
Q

She thinks I’m a horrible person

This is known as…?
a. Overgeneralisation
b. Magnification or minimisation
c. Mind Reading
d. Arbitrary Inference

A

d. Arbitrary Inference

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50
Q

I’m never good at anything

This is known as…?
a. Overgeneralisation
b. Magnification or minimisation
c. Mind Reading
d. Arbitrary Inference

A

b. Magnification or minimisation

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51
Q

Nothing good ever happens; everything is always bad

This is known as…?
a. Overgeneralisation
b. Magnification or minimisation
c. Mind Reading
d. Arbitrary Inference

A

a. Overgeneralisation

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52
Q

According to the Cognitive Theory (Beck, 1976), what 2 things contribute to Negative Automatic Thoughts?

A
  1. Situation
  2. Schemas
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53
Q

Define schemas

A

Underlying beliefs and assumptions about self and world based on experience and used to organise and interpret new information that are stored in our memory

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54
Q

Underlying beliefs and assumptions about self and world based on experience and used to organise and interpret new information that are stored in our memory

This is known as…?

A

Schemas

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55
Q

Schemas are also known as…?

A

Core beliefs

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56
Q

Schemas are often specific to a disorder

What are the schemas for anxiety disorders?

A

Assumptions and beliefs about danger and lack of ability to cope

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57
Q

Assumptions and beliefs about danger and lack of ability to cope

This is a schemas for which disorder?

A

Anxiety disorder

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58
Q

Interpreted as absolute truths

This is known as…?

A

Schemas

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59
Q

Schemas bias information processing

What does this mean?

A

Schemas influence how an individual behaves, thinks and feels

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60
Q

When can schemas be formed?

A

Through early learning experiences

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61
Q

True or False?

Schemas tend to lie dormant and then become activated later in life when faced with events (e.g. PTSD would be activated after facing some kind of trauma)

62
Q

Who proposed the panic model?

A

Clark (1986)

63
Q

What did Clark’s (1986) panic model conclude?

A

Panic results from catastrophic misinterpretation (CM) of internal sensations

64
Q

According to Clark (1986), panic results from…?

A

Catastrophic misinterpretation (CM) of internal sensations

65
Q
  1. Patient has an internal event (e.g. increase in heart rate)
  2. This could be interpreted as something bad is about to happen

This is known as…?

A

Panic disorder (based on the panic model)

66
Q

Describe Clark’s (1986) panic model

List 5 points

A
  1. Trigger stimulus (internal or external)
  2. Perceived Threat
  3. Apprehension (feeling anxious)
  4. Body sensations
  5. Interpretation of sensations as catastrophic
67
Q
  1. Trigger stimulus (internal or external)
  2. Perceived Threat
  3. Apprehension (feeling anxious)
  4. Body sensations
  5. Interpretation of sensations as catastrophic

This is known as…?

A

Clark’s (1986) panic model

68
Q

Describe Clark’s (1986) panic model when a person feels unreal

A
  1. Felt Unreal
  2. What if I panic?
  3. Scared/anxious
  4. Shaking, heart rate increases, breathless
  5. I’m going to have a heart attack
69
Q

How can we correct/challenge belief in catastrophic misinterpretation (CM) of internal sensations?

List 3 ways

A
  1. Providing corrective information
  2. Socratic method
  3. Behavioural experiments
70
Q

Describe the socratic method

A

A form of argumentative dialogue between individuals, based on asking and answering questions

What makes you think anxiety can cause a heart attack?

71
Q

A form of argumentative dialogue between individuals, based on asking and answering questions

What makes you think anxiety can cause a heart attack?

This is known as…?

A

Socratic method

72
Q

What behavioural experiments can help challenge belief catastrophic misinterpretation (CM) of internal sensations?

A

Hyperventiliation provocation

73
Q

Recommended treatment in NICE Guidelines for treating psychological disorders

This is known as…?

A

Cognitive Behavioural Therapy (CBT)

74
Q

With Cognitive Behavioural Therapy (CBT), how many people recover from generalised anxiety disorder and depression?

75
Q

With Cognitive Behavioural Therapy (CBT), 50% of people recover from ___ and ___

A
  1. Generalised anxiety disorder (GAD)
  2. Depression (MDD)
76
Q

With Cognitive Behavioural Therapy (CBT), there is higher recovery in ____ and _____ phobia

A
  1. Panic
  2. Social
77
Q

What are the issues with Cognitive Behavioural Therapy (CBT)?

List 5 points

A
  1. Relapse rates, especially in depression
  2. Some anxiety disorders are harder to treat (OCD, GAD)
  3. CBT is no more effective than exposure
  4. Addition of CBT to exposure does not improve outcomes
  5. The efficacy of CBT appears to be falling
78
Q

Cognitive Behavioural Therapy (CBT) has high relapse rates of…?

A

Depression

79
Q

According to Springer et al.’s (2018) meta-analysis of GAD outcomes, how many post-treatment patients actually recovered with CBT?

A

Only 47.9%

80
Q

According to Springer et al.’s (2018) meta-analysis of GAD outcomes, how many completer patients actually recovered with CBT?

81
Q

True or False?

CBT is more effective than exposure

A

False

CBT is no more effective than exposure

82
Q

True or False?

Addition of CBT to exposure improves outcomes

A

False

Addition of CBT to exposure does not improve outcomes

83
Q

True or False?

BDI effect size and remission rates negative association overtime

84
Q

Who proposed the metacognitive therapy (MCT)?

A

Wells (2009)

85
Q

What treatment for anxiety overcomes the theoretical limitations of CBT?

A

Metacognitive Therapy (MCT) (Wells, 2009)

86
Q

Which anxiety treatment was developed systematically?

A

Metacognitive Therapy (MCT)

87
Q

Which anxiety intervention was developed based on clinical trials and seeing how patients do within therapy sessions?

A

Cognitive Behavioural Therapy (CBT)

88
Q

Which anxiety intervention was developed first in experiments before it was translated into larger scale studies and developed into a full therapy package?

A

Metacognitive Therapy (MCT)

89
Q

Theory driven (S-REF Model) systematic development and estimation

This is known as…?

A

Metacognitive Therapy (MCT)

90
Q

Development of ____ is scientifically tested techniques and driven by a- priori theory

A

Metacognitive Therapy (MCT)

91
Q

What are the 5 principles of Metacognitive Therapy (MCT)?

A
  1. “Thoughts don’t matter but your response to them does”
  2. Psychological distress is maintained by a style of thinking (the Cognitive attentional syndrome (CAS))
  3. CAS includes worry, dwelling (rumination), threat monitoring, unhelpful coping strategies (thought suppression)
  4. CAS is driven by a set of beliefs -> Metacognitive beliefs
  5. Metacognitive beliefs are beliefs about thinking
92
Q
  1. “Thoughts don’t matter but your response to them does”
  2. Psychological distress is maintained by a style of thinking (the Cognitive attentional syndrome (CAS))
  3. CAS includes worry, dwelling (rumination), threat monitoring, unhelpful coping strategies (thought suppression)
  4. CAS is driven by a set of beliefs -> Metacognitive beliefs
  5. Metacognitive beliefs are beliefs about thinking

These are principles of…?

A

Metacognitive Therapy (MCT)

93
Q

What are the 2 types of metacognitive beliefs?

A
  1. Negative metacognitive beliefs
  2. Positive metacognitive beliefs
94
Q

What are negative metacognitive beliefs?

A

Uncontrollability/dangerousness of worry

95
Q

What are positive metacognitive beliefs?

A

Benefits/usefulness of worrying

96
Q

Benefits/usefulness of worrying

These are known as…?

A

Positive metacognitive beliefs

97
Q

Uncontrollability/dangerousness of worry

These are known as…?

A

Negative metacognitive beliefs

98
Q

I cannot control my worrying

a. Negative metacognitive beliefs

b. Positive metacognitive beliefs

A

a. Negative metacognitive beliefs

99
Q

Worrying helps me cope

a. Negative metacognitive beliefs

b. Positive metacognitive beliefs

A

b. Positive metacognitive beliefs

100
Q

If I worry I’ll be prepared

a. Negative metacognitive beliefs

b. Positive metacognitive beliefs

A

b. Positive metacognitive beliefs

101
Q

Worrying will harm my mind/body

a. Negative metacognitive beliefs

b. Positive metacognitive beliefs

A

a. Negative metacognitive beliefs

102
Q

Describe the findings of Sun et al (2017) meta-analysis of metacognitive beliefs in various psychological disorder

A

Negative Metacognitive beliefs regarding uncontrollability and danger were seen across psychological disorders

103
Q

Negative Metacognitive Beliefs regarding ____ and ____ were seen across psychological disorders

A
  1. Uncontrollability
  2. Danger
104
Q

_____ Metacognitive Beliefs regarding uncontrollability and danger seen across psychological disorders

a. Negative
b. Positive

A

a. Negative

105
Q

Describe the findings of Capobianco et al (2020) systematic review of metacognitive beliefs in patients with physical illnesses

A

Negative Metacognitive Beliefs were positively associated with increased anxiety and depression across physical illnesses

Even after controlling for age, gender, disease factors and cognition

106
Q

Negative Metacognitive Beliefs were positively associated with ____ and _____ across physical illnesses

Even after controlling for age, gender, disease factors and cognition

A
  1. Increased anxiety
  2. Increased depression
107
Q

_____ Metacognitive Beliefs were positively associated with increased anxiety and depression across physical illnesses

Even after controlling for age, gender, disease factors and cognition

a. Negative
b. Positive

A

a. Negative

108
Q

_____ are a stronger predictor of anxiety and depression

a. Negative automatic thoughts

b. Schemas

c. Metacognitive beliefs

d. None of the above

A

c. Metacognitive beliefs

109
Q

True or False?

Metacognitive beliefs are more important than cognition

110
Q

Describe the Metacognitive Model of Generalised Anxiety Disorder (GAD)

List 5 points

A
  1. Trigger
  2. Positive meta-beliefs activated (strategy selection)
  • The idea that worrying is helpful
  1. Type 1 worry
  2. Negative meta-beliefs activated
  3. Type 2 worry (meta-worry)

6.
- Behaviour (e.g. Avoiding things, doing less activities associated with the worry)

  • Thought control
  • Emotion
111
Q

What are the characteristics of GAD?

A

Uncontrollable worry

112
Q

What is Type 1 worry?

A

Worry about social, self and world

113
Q

What is Type 2 worry?

A

Worrying about the fact that you are worrying

114
Q

Worrying about the fact that you are worrying

This is known as…?

A

Type 2 worry

115
Q

Worry about social, self and world

This is known as….?

A

Type 1 worry

116
Q

According to the Metacognitive Model of GAD, when does GAD develop?

A

When negative metacognitive beliefs are activated

(beliefs that worrying is uncontrollable)

117
Q

If you view worrying as helpful, you will use worrying as a strategy to dealing with negative thoughts

What type of worrying is this?

118
Q

Belief that worrying is helpful

What type of worrying is this?

119
Q

Belief that worrying is uncontrollable

What type of worrying is this?

120
Q

What if I lose my place at uni? What if I can’t get a job? What if my parents get upset?

What type of worrying is this?

121
Q

I could go crazy; I could lose my mind

What type of worrying is this?

122
Q

Define behaviours

A

Control processes that maintain psychological distress, prolong maladaptive thinking, and maintain maladaptive metacognition

123
Q

Control processes that maintain psychological distress, prolong maladaptive thinking, and maintain maladaptive metacognition

This is known as…?

A

Behaviours

124
Q

Behaviours are control processes that maintain …?

List 3 points

A
  1. Psychological distress
  2. Prolong maladaptive thinking
  3. Maladaptive metacognition
125
Q

What are the 4 types of behaviours related to (Type 2) worrying?

A
  1. More thinking
  2. Suppression of trigger thoughts
  3. Reassurance seeking
  4. Avoidance
126
Q

What are the 5 stages of Meta-Cognitive Therapy for GAD?

A
  1. Generate case formulation
  2. Share case formulation
  3. Challenge uncontrollability metabeliefs
  4. Challenge danger metabeliefs (try to lose control of worry)
  5. Challenge positive metabeliefs (worry modulation experiment)
127
Q

Challenges schemas

a. MCT
b. CBT

128
Q

Challenges metacognitive beliefs (the level above cognition)

a. MCT
b. CBT

129
Q

List 5 ways MCT can challenge uncontrollability metabeliefs for GAD

A
  1. Evidence
  2. Hypotheticals
  3. Worry postponement
  4. Metaphors
  5. Experiential exercises (free association)
130
Q

Describe worry postponement

A

Teaching patients that they can develop control over the worrying by postponing it

131
Q

Teaching patients that they can develop control over the worrying by postponing it

This is known as…?

A

Worry postponement

132
Q

Describe free association

A

Show patients that they have flexibility over their attention that by the time they get to the end, the first word they were asked to imagine would not be remembered

133
Q

Show patients that they have flexibility over their attention that by the time they get to the end, the first word they were asked to imagine would not be remembered

This is known as…?

A

Free association

134
Q

Show patients that they have flexibility Iover their attention that by the time they get to the end, the first word they were asked to imagine would not be remembered

What does this suggest?

A

Suggests that if you leave your thoughts alone, they tend to take care of themselves and you can move your attention around

135
Q

What metaphors are used in the MCT for GAD to challenge uncontrollability metabeliefs?

A

e.g. Telephone; worries and negative thoughts are like a nuisance caller ringing, annoying, just want to distract you

But do you have to answer the phone when they call?

136
Q

e.g. Telephone; worries and negative thoughts are like a nuisance caller ringing, annoying, just want to distract you

But do you have to answer the phone when they call?

This is known as…?

137
Q

Which stage of MCT for GAD does this apply to?

Worry modulation experiment

A

Challenge positive metabeliefs

138
Q

Which stage of MCT for GAD does this apply to?

Try to lose control of worry

A

Challenge danger metabeliefs

139
Q

Which stage of MCT for GAD does this apply to?

Evidence, hypotheticals, worry postponement

A

Challenge uncontrollability metabeliefs

140
Q

What is worry modulation?

A

Going back and forth between worrying

141
Q

True or False?

Dialogue within MCT is always about the content of their thoughts

A

False

Dialogue within MCT is never about the content of their thoughts

142
Q

Dialogue within MCT is never about the content of their thoughts

Instead, it is about …?

A

How patients are dealing with those thoughts and focus on the process and meta-level

143
Q

How patients are dealing with those thoughts and focus on the process and meta-level

a. CBT
b. MCT

144
Q

MCT has been evaluated systematically in 4 different types of studies

What are they?

A
  1. Case studies
  2. Pilot studies
  3. Uncontrolled trials
  4. Randomised controlled evaluations
145
Q

_____ has been evaluated systematically from case studies, to pilot studies, uncontrolled trials, and randomized controlled evaluations

a. MCT
b. CBT

146
Q

Describe the results of Normann & Nexhmedin’s (2018) systematic review and meta-analysis of the efficacy of metacognitive therapy

List 3 points

A
  1. 25 efficacy studies of MCT, 15 were controlled trials
  2. MCT significantly more effective than waitlist (Hedges’ g = 2.06)
  3. MCT significantly more effective than CBT (Hedges’ g = 0.69) and these results were maintained at follow-up(0.37)
147
Q

True or False?

MCT significantly more effective than waitlist

148
Q

True or False?

CBT is significantly more effective than MCT and these results were maintained at follow-up

A

False

MCT is significantly more effective than CBT and these results were maintained at follow-up

149
Q

MCT is highly effective in treating disorders of …?

List 2

A
  1. Anxiety
  2. Depression
150
Q

True or False?

CBT is highly effective in treating disorders of anxiety and depression and may be superior to MCT

A

False

MCT is highly effective in treating disorders of anxiety and depression and may be superior to CBT

YEAR 2 Mental Health (11 decks)

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