Psychopathology (Final) Anxiety Disorders

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1

Phobic behavior

  • Vary widely in object, severity, generality
  • Great variation in the number, kinds, and patterning of individuals’ phobias
  • Can be accompanied by sad mood, panic attacks, somatic concerns, and many others
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Compulsive behavior

  • Carried out one or more action far beyond reason and with a feeling of being compelled to do so
  • Include cleaning, hand washing, repeating, checking, counting, arranging, hoarding
  • Can involve elaborate time-consuming rituals that have a symbolic function (Rather than practical effect)
  • Accompanied by obsessions, feelings of fear/ discomfort that declines with the behavior, idea that compulsions prevent harm, recognitions that behavior is unreasonable
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What are troubling thoughts and how do they fit in with these disorders

  • Aversive, intrusive thoughts that are difficult to control
  • Excessive worries, obsessive preoccupations
  • Slow elements of both worries and obsessions
  • Some people engage in compulsions in response to troubling thoughts
  • And some people are phobic of situations that may cause these troubling thoughts and thus might require compulsions
  • The compulsion or neutralizing rituals might actually increase the thought’s frequency
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Causes of phobia avoidance

  1. two factor theory
  2. panic theory
  3. perceived danger
  4. anticipated panic
  5. perceived self-efficacy
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Two factor theory of anxiety

  • theory of cause of phobia avoidance
  • 1) person learns by classical conditioning to be afraid of pf a previously neutral stimuli (after having it paired with an aversive stimulus)
  • 2) anxiety provoked by the now conditioned stimulus motivates person to avoid that stimulus. The avoidance is rewarded (operant conditioning) by the decline in anxiety
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Panic theory of avoidance

  • theory of cause of phobia avoidance
  • Agoraphobia specific
  • Agoraphobic avoidance is caused by panic attacks and panic-like attacks
  • Same idea as the two factor theory but coming from a place that panic does not correlate much with phobic behavior
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Perceived danger

  • theory of cause of phobia avoidance
  • Perceived liklihood of a harmful or dangerous outcome
  • Perceptions of danger are largely linked to avoidance, fear, other problem associated with panic, phobia, and obsession/ compulsion
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Anticipated panic

  • theory of cause of phobia avoidance
  • Likelihood of a task would result in a panic attack. This anticipated distress has been proposed to underlie dysfunctional avoidance
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Perceived self efficacy

  • People are afraid because they don’t think they will be able to act effectively and remain in control of the circumstances
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Treatment of phobia

  1. Exposure
  2. guided mastery
  3. cognitive therapies
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Exposure

  • tx for phobia
  • Performance-based methods are more effective than methods based on only imagining/ viewing activities
  • Treatments likened to Pavlovian extinction
  • can be paced in three ways: graded, flooding, systematic desensitization
  • can be done in four ways: in vivo, imagined, interoceptive, VR
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Guided mastery

  • tx for phobia
  • seeks to build strong sense of self efficacy by fostering performance accomplishments
  • the best way of acquiring a cognitions around success is to experience success firsthand
  • thus, they assist people at succeeding at tasks that would otherwise be too difficult. Help guide them to do it proficiently, free of defensive maneuvers and self restrictions, and promote success and the benefits they gain from success
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cognitive therapies

  • tx for phobia
  • designed to help people change their overestimations of danger and adopt alternative, less self-undermining ways of perceiving events
  • used a lot with exposure methods to treat phobic avoidance and rituals
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Treatment of subjective anxiety

  • Anxiety about a specific thing
  • Mastering the avoidance behavior alone often eliminates subjective anxiety
  • Tx by guiding people to imagine themselves encountering stressors, coping effectively
  • Tx by using relaxation methods and cognitive reappraisal treatment methods (under broad label of CBT)
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treatment of panic attacks

  • usually display some avoidance
  • performance-based therapies for avoidance are really effective in tx
  • cognitive therapies designed to increase rational appraisal and decrease catastrophic thoughts, somatic interventions to induce autonomic arousal , and breathing/ relaxation techniques designed to normalize and calm physiological arousal
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treatment of troubling thoughts

  • most widely used technique is imagined performance of avoided activities (with response prevention)
  • cognitive treatments use verbal elements (dialogue to convey obsession are normal), challenging beliefs, increasing tolerance of uncertainty, and methods to alter problematic imagery (but not necessarily trying to decrease the number of intrusive thoughts directly
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medication treatment for anxiety

  • SSRIs
  • Benzodiazepines
  • Can reduce symptoms to that psychotherapy can begin
  • Usually side effects
  • Symptom relapse after medication is discontinued
  • Not all patients respond to medications
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Cognitive-Behavioral treatments for anxiety

  • exposure therapy
    • systematic desensitization
    • flooding
  • exposure and ritual prevention
  • modeling
  • social skills training
  • coping skills training
  • cognitive restructuring
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Exposure therapy

  • individual is gradually introduced to increasingly difficult encounters with feared object/ situation until the fear dissipates. May begins with indirect contact (e.g. visualization)
  • can be graded, systematic desensitization, or flooding
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Systematic desensitization

  • relaxation response is repeatedly paired with anxiety- provoking stimulus, in increasingly difficult degrees of exposure
  • ****different from graded exposure as there is a relaxation response
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Flooding

continued actual or imagined exposure to the anxiety-provoking situation

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Exposure and ritual response prevention

individual exposed to the anxiety- provoking stimulus and prevented from engaging in compulsive behaviors

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Separation anxiety disorders treatment

  • SAD
  • No current approach that currently qualified as an empirically supported treatment for separation anxiety disorder
  • Pharmacological tx (tricyclic antidepressants)= mixed results
  • Behavioral and psychodynamic approaches to therapy
    • Case studies show some success with modeling, in vivo exposure, and relaxation training
  • More research is needed
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Social Phobia treatment

  • Currently no empirically supported treatments for social phobia
  • BUT some evidence that supports the following:
    • CBT methods (modify maladaptive self statements that may contribute to anxiety and avoidance)
    • Desensitization (decrease anxiety response to specific situations)
    • Modeling and operant approaches (teach social skills)
    • Psychopharmacological approaches
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GAD treatment

  • CBT
  • Modeling
  • In vivo exposure
  • Relaxation training
  • Reinforced practice
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CBT specific techniques for phobias

  1. imagined desensitization
  2. in vivo desensitization
  3. historical resynthesis
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Imagined desensitization

  • cbt technique for phobia
  • Safest, least anxiety provoking
  • Doesn’t engage in stimuli directly
  • Combines relaxation with imagined anxiety-provoking situation
  • Associate feelings of relaxation with feared stimuli
  • Relaxation and anxiety are incompatible: goal is to remain relaxed while thinking of the feared stimuli
  • 15 minutes a day and during session
  • Make a hierarchy (and anxiety stimuli) and gradually work the way up it in each session (sit, relax, think of first level of hierarchy for a minute while staying relaxed, then move to the next level. Focus on relaxation if anxiety increases. If anxiety gets too high, go down a level in the hierarchy). Process with client at the end.
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In vivo desensitization

  • cbt technique for phobia
  • Client confronts fears irl
  • More effective than imagined
  • Can cause great discomfort
  • Client must be motivated
  • Create a hierarchy of anxious situations. At the first level, encouraging the client to stay calm until the situation is unmanageable. Then leave situation. Once the anxiety lowers, client to come back to the situation. One practice session a day
29

Historical resynthesis

  • cbt technique for phobia
  • Things we’ve learned about ourselves and others and the world affect who we are
  • Past beliefs can turn into today’s problems
  • Finding historical roots to client’s irrational beliefs and challenge them
  • Client to relax. Review client’s critical events list. Let client talk about these events in detail. Determine if any beliefs from the critical events list contribute to the problem. Then exposure past/ present feelings and behaviors. Work with client to reinterpret these events.
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OCD Treatment

  • Ritual/response prevention
  • Cognitive therapy
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Ritual/response prevention for OCD

  • for OCD
  • Client to interact with stimulus that might spark obsessive thoughts (compulsive hand washer to touch a door knob). They are to avoid engaging in compulsive behavior until the anxiety has diminished
  • Treatment is step by step—guided by patient’s tolerance to anxiety and control compulsive acts
  • Client experiences less anxiety from obsession and are able to resist compulsions
  • repeated exposure (in vivo or imagined) to thoughts/ situation results in desensitization and cognitive change
  • support and brainstorm with client for alternative behavior and avoidance techniques (Rather than compulsive behavior). encouragement
  • can take form of gradual vs abrupt exposure, imagined vs in vivo exposure, and length of exposure (though longer and more frequent has more effective results)
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Cognitive therapy for OCD

  • ACT
  • Mindfulness- based therapies
  • Suppressing thoughts isn’t helpful
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Thought suppression

  • Suppression of thoughts is a maladaptive way of dealing with obsessions
  • Almost impossible to suppress thoughts
  • Attempting to suppress the thoughts actually increases the thoughts… which makes anxiety worse
  • Psychoeducation might help (validation/ normalization)
  • Encouragement
  • Acceptance and commitment therapy (ACT)