Week 7: Treatment of Anxiety Overview Flashcards
What approaches exist for Anxiety?
3 treatments and one combo of 2
Biological treatments
-Selective serotonin reuptake inhibitors (SSRI)
Psychosocial/behavioral treatments
-Cognitive therapy
-Behavioral therapy
(Often together as CBT)
Combination treatment
-CBT + SSRI
SSRIs
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, but some evidence of effectiveness
Features of Anxiety Disorders and 3 Targets
Focus on threat or danger
- future oriented
- “anxious apprehension”
Strong negative emotion or tension, displayed as:
3 Targets
1) cognitive shifts
2) physical sensations
3) behavioral patterns
Core Components of Effective Interventions
3 Classical treatments
(1) Reduce cognitive biases
Self talk Anxious feelings Thoughts that go with anxious feelings -“This is so scary" -“I can’t do it"
Child learns to identify different thoughts and the behavior that goes with those thoughts
Coping self talk
“I’m a brave girl. I can take care of myself in the dark.”
“ Nobody’s perfect. We all make mistakes.”
2) Reduce bodily tension -Diaphragmatic breathing -Progressive muscle relaxation -Guided imagery (internal safe space)
(3) Exposure and habituation
-Facing feared stimuli
-Controlled exercise
Only to be done with help because if they give up and run, they reinforce the fear and make it worse
-Usually graded (baby steps)
-Key technique in CBT for anxiety
Novel Cognitive Interventions
Retraining threat bias
- 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
Attention Re-Training (Study with kids)
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
Participants randomly assigned to:
G1 Attention bias modification (ABM
-Angry/neutral stimulus pairs, and target was always paired with neutral
Neutral neutral
Only see neutral neutral pairs
(eliminates the idea that this could just be done by doing a dot probe i.e. it must be the effect of the intervention)
Placebo
Angry neutral stimulus pairs, and target was paired with neutral 50% of the time
(So as to check this does not cause any effect
Trial is double blind
Families and clinic staff are unaware of assignment
All participants received four training sessions over four weeks (one session a week)
480 dot probe trials per session
Attention Re-Training (Study with kids)
Results
After treatment, had all participants complete a dot probe task
Only participants in the ABM group showed decrease in threat bias at post test
Clinicians (who were blind to treatment group) rated the ABM group as significantly less anxious afterwards by anxiety symptom count and severity
Cognitive Interventions for Anxiety
2 things
Targeting maladaptive thoughts
Attentional re training
Why is Exposure Important?
2 steps of creating and maintaining anxiety and how to break it
-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 15 th time
If you do it, you habituate and learn there is nothing to fear
Exposure
Extinction paradigm
US: Danger
UR: Fear
CS: Dog
CR: Fear
CS –: CS presented in the absence of the US
Repeated exposure to CS will extinguish the relationship between CS
and CR
= No more anxiety (or a manageable level)
Types of exposure
In vivo versus imaginal
It might be needed to start very small, just with imaginary stuff.
It can also be very hard to create real exposure to things like assault
Flooding versus graded exposure
Usually graded exposure
Flooding is extreme
Developing a Graded Exposure Hierarchy
List anxiety triggers
Rate each trigger
“Subjective Units of Distress” from 0 10
May use a Mood Thermometer (faces) with young children
Rank order triggers
Organize from easiest to hardest tasks
Build a good ladder
Conducting Exposure
Plan
-Where to start?
Towards the bottom of the hierarchy
-Keep track
Rate anxiety during exposure
Keep track of anxiety across exposures
Practice
- Practice each exposure until habituation
- Move up the hierarchy
Effects of Exposure on Anxiety
With time, anxiety drips
Especially over multiple exposures
HAVE TO STAY IN THE SITUATION
