Week 6-Anxiety

Question 1

What are 3 Behavioural Models of Anxiety?

Answer 1

1. Classical Conditioning (Pavlov)
2. Operant (instrumental) Conditioning (Watson, Skinner)
3. 2 stage theory of the acquisition & maintenance of fear and avoidance behaviour (Mowrer, 1939; 1960)

Question 2

What was Pavlov’s dogs experiment

Answer 2

-Showed Innate unconditioned reflexes vs conditioned reflexes

1. Before conditioning: Food (UCS) resulted in salivation from the dog (UCR)
2. Before conditioning: Tuning fork (NS) showed no salivation from dog (No CR)
3. During conditioning: Tuning fork + food caused the dog to salivate (UCR)
4. After conditioning: Tuning fork (CS) caused the dog to salivate (CR)

Question 3

What is operant (instrumental) conditioning?

Answer 3

-Method of learning that occurs through rewards and punishments for behaviour

-Through operant conditioning, an individual makes an association between a particular behaviour and a consequence (Skinner, 1938)

-Learned consequences modify the type and frequency of behaviour

Question 4

What did John Watson (1878-1958) contribute to behaviourism?

Answer 4

-Published “Psychology from the Standpoint of a Behaviourist” in 1919

-Classical (Pavlovian) and instrumental conditioning can explain much, if not all behaviour

-Inferring internal states is redundant and unnecessary

-Cognitive explanations are not scientific

Question 5

What did Skinner say about the rise of behaviourism?

Answer 5

“All we need to know in order to describe and explain behaviour is this: actions followed by good outcomes are likely to recur, and actions followed by bad outcomes are less likely to recur.” (Skinner, 1953)

Question 6

What’s the main difference between classical conditioning and operant conditioning?

Answer 6

CC-Associate an involuntary response and a stimulus

OC-Associate a voluntary behaviour and a consequence

Question 7

What is positive reinforcement and negative reinforcement in operant conditioning?

Answer 7

PR-Increasing a behaviour through reward e.g., an extra 30 minutes TV for helping with clearing up

NR-Increasing a behaviour by removing an aversive stimulus e.g., leaving for work early to avoid being stuck in traffic

Question 8

What are 2 main aspects of obsessive compulsive disorder (OCD)?

Answer 8

1. Obsessions: Recurrent & persistent thoughts, images or urges that are experienced as intrusive and unwanted and cause marked anxiety or distress
2. Compulsions: Repetitive behaviours (e.g., hand washing, checking) or mental acts (e.g., praying, counting) that the person feels driven to perform in response to an obsession to reduce distress or preventing some dreaded event or situation

Question 9

What is the behavioural theory of OCD?

Answer 9

-2 stage theory of the acquisition & maintenance of fear and avoidance behaviour (Mowrer, 1939; 1960)

Stage 1 Acquisition - Thoughts, images, objects can acquire distressing properties through association e.g., an obsession is linked to distress e.g., thought of hurting an animal

Stage 2 Maintenance - Avoidant, escape responses i.e., RITUALS develop because they decrease anxiety/distress and are maintained through negative reinforcement

Question 10

Behaviour therapy for OCD: What’s Exposure and Response Prevention (ERP)?

Answer 10

-Exposes people to obsessional stimuli

-Prevents compulsions used to lessen distress associated with the obsessional stimuli

-Repeated exposure to the obsessions while using strict response prevention leads to habituation (removal of habits)

Question 11

How is an Exposure Therapy constructed?

Answer 11

1. Generate a list of feared situations (external/internal)
2. Teach “subjective units of distress” (SUDS) and get a rating for each situation
3. Hierarchies typically need 10-20 steps
4. Refinement to hierarchy often required during treatment

Question 12

What is an example of an Exposure Hierarchy - Obsession about Contamination

Answer 12

1. Use toilet at work (100)
2. Touch toilet seat at home (85)
3. Open a new bleach container at home (70)
4. Put bleach with other cleaning materials (60)
5. Buy bleach and bring home (55)
6. Pick up unopened bleach container e.g., supermarket (40)
7. Open cupboard door at home e.g., bleach (35)
8. Walk down the supermarket aisle (25)

Question 13

What is an example of a Response Prevention Plan - Contamination Obsessions & Washing Rituals

Answer 13

-Shower only once per day (15 minutes). Use only water and soap. Don’t repeatedly scrub hands. Time length of shower.

-Wash hands only before eating, after using toilet for no more than 30 seconds.

-Avoid washing unless agreed with therapist

-Can wash briefly when exposed to items on the hierarchy not yet worked on

Question 14

What are the 4 main pros of the Behavioural Model of OCD?

Answer 14

1. Foundation for experimental investigation of OCD
2. Provided some support for Mowrer’s Model (at least for the maintenance phase)
3. Delineated between forms of compulsive behaviour
4. Development of an effective therapy (ERP)

Question 15

What are the 5 main limitations of the Behavioural Model of OCD?

Answer 15

1. Little evidence supporting acquisition stage
2. Does not adequately explain the cognitive aspects of OCD
3. Not all obsessions provoke anxiety/distress
4. Compulsions can elevate anxiety
5. Doesn’t differentiate between anxiety disorders

Question 16

Could a different psychological treatment be needed for OCD?

Answer 16

-ERP or CBT - recommended psychological approaches for OCD (NICE, 2006; Katzman et al., 2014)

A meta-analysis (Ost, Haven, Hansen, and Kvale, 2015) concluded:
a) effect sizes between ERP and waiting list (1.31) and placebo (1.33) were “very large”
b) 62-68% of patients were treatment responders

Question 17

What is the Cognitive Theory of Emotional Disorders? (Beck, 1967; 1976)

Answer 17

-Emotional disorders maintained by ‘distorted thinking’

-Distorted thinking characterised by frequent negative automatic thoughts (NATs)

-NATs are a product of beliefs and assumptions stored in memory i.e., schemas

-Beliefs & assumptions represent knowledge structures, which are relatively stable constructs termed schemas (Bartlett, 1932)

-Schemas guide behaviours and shape interpretation of events

-Behaviour and thinking follows logically from the beliefs and assumptions

Question 18

How is focus therapy based on the content of schemas?

Answer 18

1. Beliefs: Unconditional in nature perceived as reflecting the truth about the self and world
   Declarative statements: ‘I’m worthless, i’m a failure, I can’t cope’
2. Assumptions: Conditional in nature -guides behaviour
   ‘If I don’t achieve success in everything I am a failure’

Question 19

What are Negative Automatic Thoughts?

Answer 19

-Specific schemas/NATs are associated with specific disorders. ‘Content specificity hypothesis’

-Schemas can arise from early experience, or develop subsequently to the development of the disorder

NATs:
-Reflects the activation of schemas
-Appraisals/interpretation of events
-Automatic, rapid, involuntary, plausible, thoughts/images, systematic errors

Question 20

What are examples of reasoning biases/thinking errors?

Answer 20

-Selective abstraction: Draws conclusions based on limited evidence without considering wider evidence

-Catastrophising: Overestimating the significance of events

-Dichotomous thinking: Black & white thinking/all bad or all good

-Overgeneralisation: Applying a belief based on one situation to all situations

Question 21

What is the Cognitive Model of Anxiety? (Beck, Greenberg & Emery, 1985)

Answer 21

1. Early experience
2. Dysfunctional Schemas
3. Critical Incident
4. Schema Activation
5. Negative Automatic Thoughts
6. Symptoms
7. Behavioural, Motivational, Affective, Cognitive, Somatic

Question 22

Give an example scenario of the Cognitive Model of Anxiety

Answer 22

1. (Core Belief) The world is dangerous
2. (Assumptions) I won’t be able to cope
3. (Coping Strategies) Limited effort / avoidance of new tasks etc
4. (Situation) Forthcoming interview
5. (NATs) I’ll mess it up, it will be a disaster
6. (Reaction) avoidance, anxious, worries, physiological symptoms, scared

Question 23

What are the 4 pros of the Cognitive Theory?

Answer 23

1. Provided the impetus for disorder specific models
2. Useful heuristic to explain anxiety/psychological difficulties
3. Notion that information stored in long term memory influences processing
4. Clinically relevant & effective treatments

Question 24

What are the 4 limitations of the Cognitive Theory?

Answer 24

1. Question mark over the validity of the theory
2. Clinical, rather than a scientific theory - developed from practical experience
3. Negative thoughts might be a consequence not an antecedent of anxiety
4. Focus is only on one level of cognition

BUT This was the first incarnation of the cognitive model of emotional disorders and set the scene for anxiety disorder specific models

Question 25

What can the cognitive model of anxiety provide?

Answer 25

-One criticism of cognitive approaches to anxiety disorders is that they simply re-label symptoms

-BUT, cognitive models can provide a complex theory of the cognitive processes and structures underpinning anxiety disorders

Examples include:
-Clark (1986) Model of Panic Disorder
-Clark & Wells (1995) Model of Social Phobia

Question 26

What is a Panic Disorder including its diagnostic criteria from DSM V? (In terms of Panic Attacks)

Answer 26

Panic attacks:
An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time 4+ of the following symptoms occur:
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or faint
9. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
10. Fear of losing control or “going crazy”
11. Fear of dying
12. Paresthesias (numbness or tingling sensation)
13. Chills or heat sensations

Question 27

What is a Panic Disorder including its diagnostic criteria from DSM V?

Answer 27

2) Recurrent & Unexpected Panic Attacks
≥1 attack has been followed by 1 month or more than 1 or more of the following:
-Persistent concern about additional attacks
-Worry about the implications of the attack or its consequences
-A significant change in behaviour related to the attack

3) Symptoms not due to medical condition/direct physiological effects of a substance

4) Not attributable to another psychiatric disorder

Question 28

What is the influence of cognitive psychology on cognitive therapy?

Answer 28

-Led to theories and therapies for clinical disorders

-Provides more empirical evidence than can be obtained within therapy

-Casts light on the causal role of cognitive processes in the development of psychological disorders

-Research in cognitive psychology of direct relevance for treatment strategies