Week 7 Psyc 412 Anx3 Flashcards

0
Q

Psychosocial Approaches
 Psychosocial / behavioral treatments
Behavioral therapy
Cognitive behavioral therapy (CBT) CBT + family therapy
 50 to 75% effective

A

First line of defense,

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1
Q

SSRIs
For Anx (not depression)

A

 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

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2
Q

Review: Core Features of Anxiety Disorders

A

 Focus on threat or danger
 future oriented
 “anxious apprehension”
 Strong negative emotion or tension, displayed as:
 cognitive shifts
 physical sensations
 behavioral patterns

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3
Q

Core Components of Effective Interventions
For anx

A

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

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4
Q

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?

A

 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

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5
Q

Novel cognitive treatment for attention all bias in. Children with anx. Results and limitations.

A

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

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6
Q

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.

A

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

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7
Q

Reduce bodily tension in ppl anx, through Cbt by?

A

 Diaphragmatic breathing
 Progressive muscle relaxation

 Guided imagery: think of place that is relaxing. Eg. Butterscotch world!

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8
Q

Exposure and Habituation
What is exposure?

A

 Facing feared “stimuli”
 Controlled exercise
 Usually graded (baby steps)
 Key technique in CBT for anxiety

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9
Q

Why is Exposure Important?

A

 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

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10
Q

Exposure
Extinction paradigm, this table is confusing but it is reLly simple, just expose using baby steps. In vivo vs imagined exposure,

A

 CS- : CS presented in the absence of the US
 Repeated exposure to CS- twill extinguish the relationship between CS and CR

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11
Q

In vivo versus imaginal

A

Flooding versus graded exposure

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12
Q

Developing a Graded Exposure Hierarchy

A

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.

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13
Q

Conducting Exposure

A

■ 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

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14
Q

Generalizability of Exposure

A

 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

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15
Q

Cbt for ocd mind map.

Where can we break into this system? Not thoughts!

A

Stopping the ritual
 What happens when we stop the ritual?

 Habituate to the thought

16
Q

Treatment Goals for Cbt ocd

A

 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

17
Q

Efficacy of CBT for OCD

A

 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.

18
Q

Role of Parents in Treatment
How can parents make anxiety worse?

A

 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!

19
Q

How can parents make anxiety better?

A

 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