Week 3 Lecture 3 - Treating anxiety

Question 1

What is Beck’s cognitive theory?

Answer 1

• 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

Question 2

What do automatic negative thoughts (NATs) and distortions in processing reflect in Beck’s CT?

Answer 2

• the underlying beliefs and assumptions stored in memory
• e.g., schemas

Question 3

What are some characteristics of NATs?

Answer 3

• verbal
• image
• involuntary, rapid, negative
• spontaneous

Question 4

What are 4 types of unhelpful thinking styles?

Answer 4

• overgeneralisation
• magnification or minimisation
• mind reading
• arbitrary inference

Question 5

What is overgeneralisation?

Answer 5

applying conclusions to a range of situations based on isolated evidencde

Question 6

What is magnification/minimisation?

Answer 6

enlarging or reducing the importance of events

Question 7

What is mind reading?

Answer 7

assuming people are thinking negative things about you despite a lack of evidence

Question 8

What is arbitrary inference?

Answer 8

jumping to conclusions despite no sufficient evidence

Question 9

What are schemas?

Answer 9

• 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

Question 10

Are schemas often specific to a disorder?

Answer 10

yes

e.g., anxiety –> assumptions and beliefs about danger and lack of ability to cope

Question 11

What do schemas bias?

Answer 11

• information processing
• they influence how an individuals behaves, thinks and feels

Question 12

How can schemas be formed?

Answer 12

through early learning experiences

Question 13

What is the order in Beck’s CT?

Answer 13

situation –> NATs (influenced by schemas) –> reaction

Question 14

What are the principles of Beck’s CT?

Answer 14

• 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

Question 15

What is Clark’s panic model?

Answer 15

• panic results from catastrophic misinterpretation (CM) of internal sensations

Question 16

How do therapists challenge beliefs in CM?

Answer 16

• corrective info
• Socratic method
• behavioural experiments

Question 17

What is the efficacy of CBT?

Answer 17

• 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

Question 18

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?

Answer 18

• overall remote and in person treatments significantly reduced symptoms over time
• however clinical improvement was slow

Question 19

What are some issues with CBT?

Answer 19

• 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

Question 20

What are the principles of metacognitive therapy (MCT)?

Answer 20

• “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

Question 21

What are the 2 types of MC beliefs?

Answer 21

Negative
Positive

Question 22

What did Sun et al’s (2017) meta-analysis of metacognitive beliefs in various psychological disorder find?

Answer 22

Negative metacognitions regarding uncontrollability and danger seen across psychological disorders

Question 23

What did Capobianco et al’s (2020) systematic review of metacognitive beliefs in patients with physical illnesses find?

Answer 23

• negative metacognitions positively associated with increased anxiety and depression across physical illnesses
  – Even after controlling for age, gender, disease factors and cognition

Question 24

What is the metacognitive Model of GAD?

Answer 24

• Characteristics of GAD = Uncontrollable worry
  -Type 1 worry = worry about social, self and world
• Type 2 worry (meta-worry)

Question 25

What are behaviours in MCT?

Answer 25

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

– More thinking
– Suppression of trigger thoughts
– Reassurance seeking
– Avoidance

Question 26

How might MCT be used to treat GAD?

Answer 26

• Generate case formulation
• Share case formulation
• Challenge uncontrollability metabeliefs
• Challenge danger metabeliefs
• Challenge positive metabeliefs

Question 27

What is the efficacy of MCT?

Answer 27

• 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