Week 5: Chapter 2: Cognitive Behavioural Therapy for Anxiety Disorders - White & Cheung

Question 1

What are the four revisions in the DSM-5 that impacted the classification and treatment of anxiety disorders?

Answer 1

1. Vergeleken met oudere edities weerspiegelt het DSM-5 over angst een ontwikkelingsbenadering met stoornissen die nu zijn gerangschikt volgens de typische leeftijd bij het begin
2. Separation anxiety disorder and selective mutism zijn nieuw geclassificeerd als angststoornissen, terwijl ze in eerdere edities tot stoornissen behoorden die voor het eerst in de kindertijd voorkomen
3. OCD en PTSS staan ​​in nieuwe DSM-5-hoofdstukken (en niet langer geclassificeerd als angststoornissen)
4. Omdat paniekaanvallen vaak voorkomen bij angststoornissen en andere psychologische en medische stoornissen, worden ze nu, waar van toepassing, gespecificeerd in de DSM-5
   a. De duur van 6 maanden geldt voor de meeste angststoornissen

Question 2

Generalised Anxiety Disorder (GAD)

Answer 2

impairs quality of life and role functioning and leads to high healthcare costs → anxiety and worry are the chief cognitive symptoms, and three of six associated symptoms (e.g. restlessness, irritability, sleep disturbance), it is a chronic disorder
→ individuals with GAD may experience symptoms partly due to an overlap in genetic and biological vulnerability related to disturbances in GABA, serotonergic, and noradrenergic systems → those prone to GAD may have an inherited underlying propensity toward neuroticism

Question 3

What is the most well-studied and empirically supported psychotherapy for treating GAD?

Answer 3

Cognitive Behavioural Therapy (CBT)

Question 4

What is CBT?

Answer 4

patients are taught to identify anxiety-related thoughts, images, and beliefs and then search for evidence to create alternative, less anxiety-arousing assumptions or interpretations → patients test alternative viewpoints and taught coping methods

Question 5

What is the primary goal in CBT for GAD?

Answer 5

to interrupt the negative, self-perpetuating cycles of worry and related behaviours: excessive, uncontrollable worry about future events and outcomes
→ relaxation training works who experience reduced autonomic functioning and muscle tension
→ breathing exercises are often paired with the progressive relaxation treatment

Question 6

Socratic Questioning Method

Answer 6

used to identify and modify thoughts and appraisal in GAD → excessive worry about future events, a key feature of GAD, may serve as an avoidance function by reducing arousal to feared outcomes (i.e. negative reinforcement). So, early in treatment, patients learn to identify anxious thoughts and worry (from environment).

Question 7

What is the purpose of the Socratic Questioning Method? Name two things.

Answer 7

1. To disrupt the negative, self-perpetuating cycle of worry and worry behaviours
2. To seek evidence to create rational, less anxiety-arousing alternatives to each worry,
   assumption, or interpretation via cognitive restructuring

Question 8

With what other disorder does GAD commonly occur?

Answer 8

Major depression.

Question 9

Why is is treatment response less than optimal for patients who experience GAD in the context of major depression?

Answer 9

as these disorders share worry and rumination → this is also known as negative self-referential processing

Question 10

negative self-referential processing

Answer 10

Zelfreferentiële verwerking verwijst naar de verwerking van informatie die relevant is voor jezelf en speelt een belangrijke rol bij cognitie. Bij depressie en angst stoornissen is dit zorgen maken/angst en rumineren

Question 11

Panic attacks

Answer 11

sudden and acute surges of fear or discomfort that reach peak levels of intensity within several minutes of onset → unexpected panic attacks occur in the absence of obvious cues, whereas expected panic attacks are elicited by situational determinants

Question 12

What happens during episoes of Panic?

Answer 12

accompanied by physical symptoms (e.g. palpitations, chest pain, nausea, dizziness, chills/heat sensations, and paresthesia) that may resemble myocardial infarction, as well as cognitive symptoms such as depersonalization, derealisation, and fears of going crazy or dying

Question 13

Panic Disorder (PD

Answer 13

individual experiences recurrent panic attacks, persistent concern about the occurrence or consequences of future attacks (e.g. fears of a heart attack) and significant behavioural change for a minimum of 1 month

Question 14

What do people with panic disorder learn during CBT?

Answer 14

patients learn panic attacks are harmless and time-limited symptoms, and breathing is an autonomic nervous system process that does not need (re)training

Question 15

Anxiety Sensitivity

Answer 15

the belief that interoceptive (own bodily sensations) sensations reflect signs of impending (dreigend) harm

Question 16

Interoceptive Avoidance

Answer 16

aversion to somatic sensations associated with anxiety and panic

Question 17

Agoraphobia

Answer 17

fear of being in situations where escape is di cult/help not there if it goes wrong

Question 18

Anhedonia

Answer 18

Nothing gives you pleasure anymore. unability to feel pleasure

Question 19

Person-Centred Therapy

Answer 19

a humanistic approach to therapy in which the clients themselves consciously take the lead, rather than the therapist interpreting and reflecting their unconscious thoughts and ideas based on a pre-established, standard treatment plan

Question 20

Social Anxiety Disorder (SAD)

Answer 20

long-term overwhelming fear of social situations → problem that often starts during teenage years: it can be very distressing and have a big impact on your life

Question 21

What happens when you leave SAD untreated?

Answer 21

left untreated, a large proportion of individuals with SAD (70% to 80%) meet diagnostic criteria for a comorbid diagnosis that onsets subsequent to the SAD diagnosis

Question 22

SAD has a high comorbidity with what three disorders?

Answer 22

Agoraphobia, major depressive disorder and substance abuse

Question 23

What are two aims of CBT for SAD?

Answer 23

→ one aim of CBT for SAD is to identify and modify maladaptive cognitions accompanying social situations.
- Another aim is to target and reduce behavioural factors that maintain avoidance during SAD, many theoretical models support evidence-based CBT approaches

Question 24

Specific Phobias (SPs)

Answer 24

the most common of anxiety disorders → a persistent fear of specific objects or situations. Phobias precipitate active avoidance of feared stimuli or are endured with extreme anxiety when faced.

Question 25

What are the five categorical subjects of Specific Phobias?

Answer 25

1. Animals (spiders, insects, dogs, birds → these are the most common)
2. Natural Environments (heights, storms, water)
3. Blood-Injection-Injury (needles and other invasive medical procedures)
4. Situational (aeroplanes, elevators, enclosed spaces)
5. Others (choking, vomiting, loud sounds, costumed characters, etc.)

Question 26

How does Specific Phobia occur?

Answer 26

door middel van angstconditionering wordt een goedaardige geconditioneerde aandoening gekoppeld aan een stimulus met een angstopwekkende ongeconditioneerde stimulus om een ​​geconditioneerde angstreactie op te wekken

Question 27

→ Virtual Reality (VR)

Answer 27

most beneficial when in vivo conditions are costly, unpredictable, or di cult to plan. Therapists immerse patients in a contextually relevant environment that is computer simulated, allowing for gradual exposure in a controlled setting

Question 28

What can help with Specific Phobias in addition to exposure treatments?

Answer 28

→ in addition to exposure treatments, cognitive interventions of SP target attributions regarding the safety of stimulus and one’s perception of control over external events

Question 29

What are the two core cognitive features of anxiety?

Answer 29

catastrophizing and overestimating the likelihood of negative outcomes

Question 30

Separation Anxiety Disorder

Answer 30

diagnosed when symptoms are excessive for the developmental age and cause significant distress in daily functioning
→ adults with separation anxiety disorder are typically (over)concerned about their children and partners and experience marked discomfort when separated from them

Question 31

Parent-Child Interaction Therapy (PCIT) and its two treatment phases:

Answer 31

an evidence-based treatment for young children with behavioural problem
1. Establishing warmth in your relationship with your child through learning and applying skills proven to help children feel calm, secure in their relationships, good about themselves
2. Equip you to manage the most challenging of your child’s behaviours while remaining confident, calm, and consistent in your approach to discipline

Question 32

Selective Mutism

Answer 32

inability to speak in specific situations (school), despite competence in verbal communication in other contextual settings (home), often in younger children and adolescents
→ children with SM are often willing to engage through nonverbal communication

Question 33

Why do younger children with SM may benefit more from in-vivo exposure (real life exposure)?

Answer 33

because they have di culty with exercises involving imagery and relaxation because of their developing cognitive skills and interoceptive sensitivity → SM remains an understudied area