Week 2 Anxiety and Mood Disorders Flashcards
Kinds of reliability
Inter-rater: between two clinicians
Test-retest: test is administered twice to the same person
Internal: different parts of the test give similar results
Alternate form: two versions of the same test give similar results
Kinds of validity
Face validity: does is ask the kinds of questions that we expect
Content validity: covers breadth of symptoms, refers to that when we are assessing for say depression, we are using questions that dive into the criteria for diagnosing depressive disorders
Predictive validity: prediction, disturbance in the future
Concurrent validity: converges with other tests that measure the same behaviours, thoughts, emotions, ask similar questions
Construct validity: see that the correlation between different diagnosis are very low (depression and anxiety present differently)
Issues with relying solely on our clients
Honesty and comfort to tell the truth
Disordered perceptions or internal bias - may not be a good reporter on themselves, may be incapacitated
May not have metacognition necessary to reflect on emotional state
Reactivity
People behaving differently when they know that are being observed/assessed
What diagnostic system does DSM-5 use
Prototype:
polythetic criterion
Fear vs Anxiety
Fear is present oriented, fight or flight, alarm and escape, abrupt activation of SNS
anxiety is future oriented, somatic tension, behaviour inhibition system, apprehension
Characteristics of anxiety disorders
Maladaptive anxiety
Avoidance behaviour
distress/impairment
pervasive and persistent fear
Panic attack
4 or more symptoms that peak within ten minutes
Criteria of Panic Disorder
A) Unexpected panic attack (or attacks)
B) One month or more of the following:
- Concern about additional attacks or worry about
consequences
- Change in behaviour related to attacks
C) Panic not due to medical condition or drugs
D) Distinction from other anxiety/mental disorders
- Have to think really carefully about the context in which people are experiencing these attacks
E) Clinically significant distress/impairment
Cognitive theories
involve catastrophic misinterpretations of their bodily sensations
Anxiety sensitivity - belief that the somatic symptoms related to anxiety will have negative consequences that extend beyond the panic episode itself
genetics
neurotransmitter disregulation - norepinephrine
treat with CBT
Difference between panic disorder and agoraphobia
The focus of the fear
Panic disorder: symptoms/misinterpretation of the symptoms (I might be having a heart attack) -fear of the physical symptoms
Agoraphobia: location, their ability to escape, attain help, or the negative consequences about panicking in this space - lasts for 6 months or more
Specific phobia and etiology
A marked and persistent fear of an object or situation that produces an excessive and unreasonable anxiety reaction
evolution
conditioning/association
can be treated by behaviour therapy (exposure), cognitive restructuring
Social Anxiety Disorder diagnosis and etiology
Self-report, structured or semi structured interview
genetics, behavioural inhibition (conditioning, avoidance learning, observation), early psychosocial experiences, negative cognitive schemas about the self
Treatment for panic disorder
CBT
- exposure
control therapy
cognitive restructuring of schemas
breathing and relaxation training
GAD criteria
Presence of excessive worry more days than not for a period of at least 6 moths
Individual must find it difficult to control their worry
Symptoms: keyed up, tiring easily, difficulty concentrating, irritability, muscle tension and sleep problems
Only one of these symptoms necessary
Must cause significant distress/impairment in important areas of functioning
A persons worry must not be better explained by another disorder, medicine, or substance abuse
Etiology of GAD
Neurotransmitter GABA
Primarily cognitive in nature
- worry is a helpful coping strategy even though it is an avoidance behaviour
lower threshold for anxiety
OCD symptoms
obsessions and compulsions for neutralizing behaviour
GAD treatment
CBT
- worry exposure
-stimulus control
-address biases in thinking
Medication
-antidepressants
Social anxiety disorder
focus of fear is being evaluated by others (failing, being humiliated/embarrassed)
significant distress regarding social situations
treat with CBGT
SAD treatment
CBT in groups, role play - social skills training
relaxation skills
exposure
cognitive therapy - challenging schemas
tricyclic antidepressants
OCD Criteria
Presence of obsessions or compulsions
consumes more than an hour a day or causes significant clinical distress and impairment
not due to substance or other mental condition
Thought suppression and rebound effect
efforts at thought suppression maintains them and makes them more available
OCD etiology
Cognitive
-maladaptive metacognitive beliefs (control, thoughts are bad)
-thought action fusion
-thought suppression/rebound
Behavioural
-compulsions negatively reinforce
Neurobiological
- cingulo-opercular network (high activities in regions that detect errors and correct, low activities in regions for enacting inhibitory control
OCD treatments
Behaviour therapy
- exposure and response prevention = cbt
cognitive therapy
-address core OCD beliefs
Increase serotonin (SSRIs) help with the anxiety
Psychosurgery (cingulotomy)
PTSD Diagnosis and Assessment
Exposure to traumatic event, intrusion symptoms, avoidance, negative alteration in cognition/mood, increased arousal/reactivity
Combination of a semi-structured clinical interview and the results of psychometric scales
Clinician Administered PTSD Scale -5 (CAPS-5)
PTSD Etiology
Behavioural
-avoidance
UCR and CR
-learning and responses
Cognitive
-negative beliefs after trauma
Biological
-vulnerability to anxiety
-predisposition to high risk environments
-trauma alters brain structure and function - HPA axis damages hippocampus
PTSD treatment
Behaviour therapy
-focuses on exposure (habituation)
Cognitive therapy
-reinterpret events, beliefs and sense of responsibility
EMDR- eye movement tracking
cognitive processing therapy
narrative exposure therapy
SSRIs REDUCE ANXIETY AND PANIC
Exposure techniques
Systematic desensitization
-fear hierarchy (subjective units of distress)
In vivo exposure
Worry imagery exposure (GAD)
Interoceptive exposure (body sensations) - panic disorder
OCD- ritual prevention and exposure
