Week Four - Anxiety Disorders

Question 1

Components of anxiety?

Answer 1

Cognitive: what person is thinking
Physiological: whats happening to body (SNS)
Behavioural: what person is doing

Question 2

Cognitive model of anxiety?

Answer 2

thoughts, feelings, behaviours, physical reactions

Question 3

Common themes in anxiety disorders?

Answer 3

overestimate something bad
underestimate ability to cope
activation of fight/flight

Question 4

Specific phobia disorder?

Answer 4

Intense fear of specific objects/situations

- anything can be the object

Question 5

Subtypes of specific phobia?

Answer 5

Animal
Situation (eg flying)
Natural Environment
Blood Injection Injury

Question 6

Diagnostic criteria for Specific Phobia (A)

Answer 6

A. Marked fear or anxiety about a specific object or situation
(e.g., flying, heights, animals, receiving an injection, seeing blood).
NOTE: In children, the fear or anxiety may be
expressed by crying, tantrums, freezing, or clinging

B. The phobic object or situation almost always provokes
immediate fear or anxiety

C. The phobic object or situation is actively avoided or
endured with intense fear or anxiety

D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context

E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

G. The disturbance is not better explained by the symptoms of another mental disorder.

Question 7

Cognitive behavioural case formulation for specific phobia

Answer 7

Trigger, unhelpful thoughts, emotion, unhelpful behaviour(avoidance or safety)

Question 8

Social Anxiety Disorder?

Answer 8

Unrealistic (out of proportion) and intense fear of negative evaluation in social or performance situations. Belief that others will see them as stupid or foolish

Question 9

Criteria for SAD (A)

Answer 9

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others

B. The individual fears that they will act in a way or show
anxiety symptoms that will be negatively evaluated

C. The social situations almost always provoke fear or anxiety

D. The social situations are avoided or endured with intense fear or anxiety

E. The fear/anxiety is out of proportion to the actual threat
posed by the social situation/sociocultural context

F. The fear/anxiety/avoidance lasts for at least 6 months

G. Causes clinically significant distress or disturbance in functioning

H. Not due to the effect of a drug or other medical condition

I. Not due to another mental disorder

J. If another medical condition is present, the fear, anxiety, or avoidance is clearly unrelated or excessive

Question 10

Generalised Anxiety Disorder (GAD)

Answer 10

Uncontrollable worries that result in (eg irritability, concentration) about a number of real life events for at least 6 months

Question 11

Generalised Anxiety Disorder (GAD) diagnostic criteria (A)

Answer 11

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)

B. The individual finds it hard to control the worry

C. The anxiety and worry are associated with 3 (or more) of the following 6 symptoms (with at least some of the
symptoms having been present for more days than not for the past 6 months):
1. Restlessness or feeling keyed up or on edge
2. Being easily distracted
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling or staying asleep, or
restless, unsatisfying sleep)

D. The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning*

E. The disturbance is not attributable to the physiological effects of a substance or another medical condition*

F. The disturbance is not better explained by another mental disorder*

Question 12

People worry excessively because

Answer 12

– They have positive beliefs about worry (i.e., it’s helpful)
– They have negative beliefs about worry (i.e. “what if all
this worrying makes me have a mental breakdown”

Question 13

Dominant CB model of generalized anxiety disorder

Answer 13

• Behavioural factors that maintain the worry:
– Avoidance of situations that may trigger worry
– Reassurance seeking from others
– Distracting self when they do worry

• Cognitive factors that maintain worry:
– Attempts to supress thoughts that would trigger worry

• Emotional factors that maintain worry
– Worries trigger increase in anxiety symptoms that validate the worries

Question 14

Panic Disorder

Answer 14

Panic attacks that are unexpected and come out of the blue quite rapidly (within 10 minutes).

Fear of fear:
– Worry about the implications of panic attacks
– Worry about having more attacks in the future

• change in behaviour related to said panic attack (eg avoidance of unfamiliar area)

Not everyone who has panic attacks will have panic
disorder

Question 15

Diagnostic criteria for panic disorder (A)

Answer 15

A. Recurrent unexpected panic attacks.

B. At least one of the attacks has been followed by one
month (or more) of one or both of the following:
1. Persistent concern or worry about additional panic
attacks or their consequences (e.g., losing control,
having a heart attack, going “crazy”)
2. A significant maladaptive change in behaviour related
to the attacks (e.g., behaviours designed to avoid
having panic attacks, such as avoidance of exercise or
unfamiliar situations)

C. The disturbance is not attributable to the physiological
effects of a substance or another medical condition

D. The disturbance is not better explained by another mental disorder

Question 16

Diagnostic criteria for panic disorder (D)

Answer 16

D. The disturbance is not better explained by another mental disorder

Question 17

3 types of panic attacks in panic disorder?

Answer 17

A. Unexpected – occur spontaneously without any
(apparent) situational trigger

B. Situationally bound – these attacks occur immediately
after exposure to the feared stimulus, such as being in a
confined seat in a cinema or church, being in a lift, being
“trapped” in a crowded supermarket.

C. Situationally predisposed – occur on exposure to the
feared stimulus, but not always immediately after every
exposure, say, to a crowded situation or only after
prolonged exposure.

Question 18

Agoraphobia?

Answer 18

6 months of more of feeling anxious or fearful in places that is out of proportion and where it would be difficult to escape if a panic attack or other anxiety related event occurred:
– Crowded places
– Public transportation
– Traffic
– Bridges
– Remote locations
Number grows over time and avoided if without company

Question 19

Diagnostic criteria for Agoraphobia (A)

Answer 19

A. Marked fear or anxiety about two (or more) of the
following five situations:
1. Using public transportation (e.g., automobiles, buses,
trains, ships, planes)
2. Being in open spaces (e.g., parking lots, marketplaces,
bridges).
3. Being in enclosed spaces (e.g. shops, theatres,
cinemas)
4. Standing in a line or being in a crowd
5. Being outside of the home alone

B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly)

C. The agoraphobic situation almost always provoke fear or anxiety

D. The agoraphobic situations are actively avoided, require the presence of a companion or are endured with intense fear and anxiety

E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context

F. The fear, anxiety, or avoidance is persistent, typically lasting 6 months or more

G. The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational, or some other important area of functioning

H. If another medical condition (e.g., inflammatory bowel
disease, Parkinson’s disease) is present, the fear, anxiety
and avoidance is clearly excessive

I. The fear, anxiety or avoidance is not better explained by the symptoms of another mental disorder

Question 20

CBT parts for Anxiety?

Answer 20

• Relaxation training
• Exposure therapy
• Cognitive restructuring
• Behavioural experiments

Question 21

Relaxation Training?

Answer 21

Relaxation techniques can be used to help clients manage symptoms of anxiety and stress

The relaxation response is the opposite reaction to the “fight or flight” response.

Question 22

Exposure Therapy?

Answer 22

Exposure therapy can include:
• Graded exposure: The psychologist helps the client develop an exposure fear hierarchy. The client is exposed to each step of the hierarchy.
• Flooding: Using the exposure fear hierarchy to begin
exposure with the most difficult tasks.
• Systematic desensitisation: Exposure is combined with
relaxation exercises and coping skills

Question 23

Cognitive Restructuring?

Answer 23

The psychologist helps the client to identify their automatic thoughts
• The use of thought diaries assist this process

In these diaries clients can record:
– The situation that triggered and emotional response (record description, date, time)
– The behaviours they were engaging in
– The associated thoughts
– The feelings triggered by the thoughts
– Any other related responses

Question 24

Cognitive distortion examples?

Answer 24

• Catastrophising
• Black and White Thinking
• Mind Reading
• Filtering
• Shoulds
• Overgeneralisation
• Magnifying
• Personalising

Question 25

Behaviour Experiments?

Answer 25

Behavioural experiments are an information gathering exercise designed to test the accuracy of an individual’s beliefs (about themselves, others, and the world) or to test new, more adaptive beliefs.

Question 26

BE are broken down into?

Answer 26

‘hypothesis testing’ and ‘observational’ forms.

Question 27

Hypothesis testing in BE?

Answer 27

Testing hypothesis A: testing an existing unhelpful belief
Testing hypothesis B: testing a new belief
Testing hypothesis A vs. hypothesis B

Question 28

Observation in BE?

Answer 28

Discovery experiments
Surveys
Direct observation
Information gathering from other sources