Week 3 Lecture 3 - Treating anxiety Flashcards
What is Beck’s cognitive theory?
- Dysfunction occurs from an individual’s interpretation of events which in turn
influences behaviors important in maintaining emotional problems - different cognitions give rise to different emotions
What do automatic negative thoughts (NATs) and distortions in processing reflect in Beck’s CT?
- the underlying beliefs and assumptions stored in memory
- e.g., schemas
What are some characteristics of NATs?
- verbal
- image
- involuntary, rapid, negative
- spontaneous
What are 4 types of unhelpful thinking styles?
- overgeneralisation
- magnification or minimisation
- mind reading
- arbitrary inference
What is overgeneralisation?
applying conclusions to a range of situations based on isolated evidencde
What is magnification/minimisation?
enlarging or reducing the importance of events
What is mind reading?
assuming people are thinking negative things about you despite a lack of evidence
What is arbitrary inference?
jumping to conclusions despite no sufficient evidence
What are schemas?
- 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
- intepreted as absolute truths
Are schemas often specific to a disorder?
yes
e.g., anxiety –> assumptions and beliefs about danger and lack of ability to cope
What do schemas bias?
- information processing
- they influence how an individuals behaves, thinks and feels
How can schemas be formed?
through early learning experiences
What is the order in Beck’s CT?
situation –> NATs (influenced by schemas) –> reaction
What are the principles of Beck’s CT?
- emotional disorder are maintained by a thinking disorder
- negative interpretations involve distortions in thinking
- biased processing manifests as automatic thoughts which are content specific
- distortions and automatic thoughts reflect the operation of underlying beliefs
- schemas remain dormant until activated
- individuals behave in a way that is consistent with their schemas
- behaviour is important in maintaining emotional problems
What is Clark’s panic model?
- panic results from catastrophic misinterpretation (CM) of internal sensations
How do therapists challenge beliefs in CM?
- corrective info
- Socratic method
- behavioural experiments
What is the efficacy of CBT?
- recommended treatment (NICE) for treating psychological disorders
- effectiveness varies –> approx 50% recovery in GAD and MDD, higher recovery in panic and social phobia
- 50% of patients treat in IAPT recover –> 66% improved
What did a study by Capobianco et al (2022) investigating the effects on anxiety and depression symptoms with remote delivery of therapy during COVID find?
- overall remote and in person treatments significantly reduced symptoms over time
- however clinical improvement was slow
What are some issues with CBT?
- relapse rates especially in depression
- some anxiety disorders are harder to treat e.g., GAD
- CBT is no more effective than exposure
- Addition of CBT to exposure does not improve outcomes
- The efficacy of CBT appears to be falling
What are the principles of metacognitive therapy (MCT)?
- “Thoughts don’t matter but your response to them does”
- 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 –> Metacognitive beliefs
- Metacognitive beliefs are beliefs about thinking
What are the 2 types of MC beliefs?
Negative
Positive
What did Sun et al’s (2017) meta-analysis of metacognitive beliefs in various psychological disorder find?
Negative metacognitions regarding uncontrollability and danger seen across psychological disorders
What did Capobianco et al’s (2020) systematic review of metacognitive beliefs in patients with physical illnesses find?
- negative metacognitions positively associated with increased anxiety and depression across physical illnesses
– Even after controlling for age, gender, disease factors and cognition
What is the metacognitive Model of GAD?
- Characteristics of GAD = Uncontrollable worry
-Type 1 worry = worry about social, self and world - Type 2 worry (meta-worry)
What are behaviours in MCT?
Control processes that maintain psychological distress, prolong
maladaptive thinking, and maintain maladaptive metacognition
– More thinking
– Suppression of trigger thoughts
– Reassurance seeking
– Avoidance
How might MCT be used to treat GAD?
- Generate case formulation
- Share case formulation
- Challenge uncontrollability metabeliefs
- Challenge danger metabeliefs
- Challenge positive metabeliefs
What is the efficacy of MCT?
- MCT has been evaluated systematically from case studies, to pilot studies, uncontrolled trials, and randomized controlled evaluations
- MCT significantly more effective than waitlist
- MCT significantly more effective than CBT and follow-up
Conclusions: Results suggest that MCT is highly effective in treating disorders of anxiety and depression and may be superior to CBT
