Week 7 Psyc 412 Anx3 Flashcards
Psychosocial Approaches
Psychosocial / behavioral treatments
Behavioral therapy
Cognitive behavioral therapy (CBT) CBT + family therapy
50 to 75% effective
First line of defense,
SSRIs
For Anx (not depression)
Selective Serotonin Reuptake Inhibitors
Paxil, Prozac, Zoloft, Celexa
Work by stopping the reuptake of serotonin into the presynaptic neuron
Increases the amount of serotonin in the synapse
OCD, GAD, SAD, social phobia
Not many studies looking at use of these drugs in youth
Cognitive-behavioral approaches usually recommended first
Medication does not cure anxiety! Suppress systems only.
60% of patients free of panic disorder while on an effective drug, but between 20% and 90% will relapse
Review: Core Features of Anxiety Disorders
Focus on threat or danger
future oriented
“anxious apprehension”
Strong negative emotion or tension, displayed as:
cognitive shifts
physical sensations
behavioral patterns
Core Components of Effective Interventions
For anx
1) Reduce cognitive biases
Self-talk
Anxious feelings
Thoughts that go with anxious feelings
Child learns to identify different thoughts and the behavior that goes with those thoughts
Coping self-talk
Positive self talk,
(I know statements! Or got those yesterday lol. )
Novel cognitive interventions
Retraining threat bias
Recall that anxiety is associated with attentional bias for threat
Can we retrain that?
2) Reduce bodily tension
Diaphragmatic breathing
Progressive muscle relaxation
Guided imagery
Exposure to feared stimuli
Novel Cognitive Interventions, for anx.
Attention bias reduction
Novel cognitive interventions
Retraining threat bias
Recall that anxiety is associated with attentional bias for threat
Can we retrain that?
Do a dot-probe task
Majority of trials the probe follows a neutral face Trained to look away from threat
Evidence from randomized trials with adults that this re-training reduces attention bias and internalizing symptoms
Study with kids:
Severity comparable to RCTs for anxiety
Completed 3 10 to 15 minute dot probe sessions a week for 4 weeks
One session in the lab and two at home
Met criteria for a primary diagnosis of separation
anxiety, social phobia, generalized anxiety disorder
Post-treatment
Reduction in attentional bias to threat
Significant reductions on parent and child report of anxiety
12 of 16 youth no longer met diagnostic criteria for an anxiety disorder
Novel cognitive treatment for attention all bias in. Children with anx. Results and limitations.
Reduction in attentional bias to threat
Significant reductions on parent and child report of anxiety
12 of 16 youth no longer met diagnostic criteria for an anxiety disorder
No control, expectation could be a
40 children seeking treatment for anxiety at a hospital based clinic
Primary diagnosis of separation anxiety, generalized anxiety, specific phobia, or social phobia
75% met criteria for two anxiety disorders
Joe robust study changing attention all bias, using novel treatment.
Participants randomly assigned to:
Attention-bias modification (ABM)
Angry-neutral stimulus pairs, and target was always paired with neutral
Placebo
Angry-neutral stimulus pairs, and target was paired with
neutral 50% of the time
Neutral-neutral
Only see neutral-neutral pairs,
wondered if child’s wee getting desensitized to angry faces.
So it has a control group.
Had similar findings.
Only participants in the ABM showed decrease in threat bias at post-test
Reduce bodily tension in ppl anx, through Cbt by?
Diaphragmatic breathing
Progressive muscle relaxation
Guided imagery: think of place that is relaxing. Eg. Butterscotch world!
Exposure and Habituation
What is exposure?
Facing feared “stimuli”
Controlled exercise
Usually graded (baby steps)
Key technique in CBT for anxiety
Why is Exposure Important?
Stage 1: Fear develops through classical
conditioning
Unconditioned stimulus (US)
A stimulus that leads naturally to the response
Unconditioned response (UR)
Response to the unconditioned stimulus
Conditioned stimulus (CS) Neutral stimulus
Conditioned Response (CR)
Response to the CS that results from reliably pairing the CS and the US
Stage 2: Maintenance of avoidant behavior
What happens if you do not avoid?
Habituation
Think about:
Walking into a dark room
Jumping into a cold pool
Watching “The Exorcist” for the 15th time
Exposure
Extinction paradigm, this table is confusing but it is reLly simple, just expose using baby steps. In vivo vs imagined exposure,
CS- : CS presented in the absence of the US
Repeated exposure to CS- twill extinguish the relationship between CS and CR
In vivo versus imaginal
Flooding versus graded exposure
Developing a Graded Exposure Hierarchy
List anxiety triggers
■ Rate each trigger
“Subjective Units of Distress” from 0-10 SUDS
May use a Mood Thermometer (faces) with young children
■ Rankordertriggers
Organize from easiest to hardest tasks Build a good ladder, no gaps !
Need a lot of detail to fill in gaps.
Conducting Exposure
■ Plan
Where to start? (bottom or middle) What will happen EXACTLY?
■ Keep track
Rate anxiety during exposure
Keep track of anxiety across exposures: DATA! Across and during exposure show it goes down.
■ Practice
Practice each exposure until habituation
Move up the hierarchy
Generalizability of Exposure
Extinction learning is very context specific
May not generalize to new contexts
Eg. Phobia of dog? - Where? What type of dog?
Conduct exposures in multiple contexts
Context includes internal states
Medication
Exposure may not generalize when person stops taking meds
Continuing treatment after point when meds are discontinued
Cbt for ocd mind map.
Where can we break into this system? Not thoughts!
Stopping the ritual
What happens when we stop the ritual?
Habituate to the thought
Treatment Goals for Cbt ocd
Normalize OCD and Intrusive Thoughts
Not your fault
Everyone has intrusive thoughts
Most people just forget about them
Exposure and response prevention
Limit neutralization of the thought
Hierarchically expose patient to feared stimulus and allow for habituation to occur naturally
Ex. For exposure to ocd
Efficacy of CBT for OCD
Pediatric OCD Treatment Study (POTS)
112 youth with OCD
Randomly assigned to one of four groups CBT
CBT + SSRI SSRI
Pill placebo
POTS Trial
Measured OCD symptoms
Rated by an observer blind to treatment condition
Efficacy of CBT for OCD
Combined treatment work best
CBT = Meds
Placebo worst
BUT!,…
Placebo at one location, penn. Than the other! (Duke)
Meds better from other. So combined may be an illusory better treatment. Depends on rela with therapist?
Site effect calls into q the findings.
Role of Parents in Treatment
How can parents make anxiety worse?
Avoidance can be reinforcing for parents
Parents may share / model youths’ fears
Good intentions can go wrong
Aiding in escape (e.g., picking up child early)
Arranging avoidance (e.g., restricting activities)
Net. Reinforcers!
How can parents make anxiety better?
Reduce support for anxious behavior
-Positive reinforcement
Attention, care, time
Increases behavior!
-Negative reinforcement
Less responsibilities
Increases behavior!
Increase support for age-appropriate independence
Praise for attempts at exploration / management of fear
Practical support for exposure
Allow natural reinforcers to have effects
Allow “punishment” of anxiety to occur
Support positive (social) reinforcement of new behaviors
