ANXIETY chapman and delapp (2013) Flashcards
(19 cards)
diphasic response
treatment of BII phobia differs from other
includes strategies to avoid risk of fainting/sudden loss of consciousness
people w BII the presence or thought of blood or med related stimulus can trigger diphasic > two part bio response
increase in bp and heart rate seeing or imaginging
but then sudden decrease in bp and heart rate
^ vosavagal synvope
cause fainting due to reduced blood flow to brain
not serious > but fainting can cause injury like knocking head when faint
role of disgust
people w BII stronger than avg disgust response
associated w fainting as disgust triggers activity in parasympathetic nervous system such as reducing bp
only one specific type of disgust predicts fainting in BII phobia
left untreated can cause mental physical health impacts
avoidance of routine checkups and failure to seek med attention
animal reminder disgust
repulsion experienced when reminded of own animalness
sight of blood or veins
found to predict fainting in BII phobic patients
core disgust - anxiety relating to contamination did not olatunji et al. 2006
techniques to target symptoms of BII phobia
cognitive > challenge and restructure irrational beliefs/thoughts
behavioural > encourage approach behaviour reduce avoidnt
include invivo graduated exposure like SD and also maybe modelling - observing and imitating trusted peer or therapisy
applied tension > reduce risk of fainting
aim
provide insight into active mechanisms of change chapman and delapp 2013
throughout a 9 week course of applied tension and manualised CBT for an adult male w BOO phobia
sample + case history
T was a hispanic male
aged 42
self referred
after 20 years of intense fear/panic in med sitchs
suffered from vasovagal syncope in blood tests/procedures
procedures = dangerous
distress and physical symptoms
racing heart hot flashes cold chills dizziness and unsteadiness additional to fainting
T’s child has ASD, guilt and shame when cant go for med appts
T’s mother jokes he might have heart prob
grandma had anxiety relating to med emergencies
> each day listened to ambulance dispatch scanner and T was also exposed to this
also witnessed the deaths of grandpa uncle aunt from illness like cancer
T exercise routine included running cycling weight training and swimming
giving the impression of being in control of health
> in reality not gone to doc in years except psychiatrist who prescribed anti anxiety meds
assessment
self report ques used to collect quantitative data about T’s symptoms
diagnostic interview confirmed his BII phobia diagnosis
also experienced major depressive episode in college
self report questionnaires
beck anxiety inventory BAI:
21 items 0-3 rating
T: baseline 41 severe anxiety
12 month followup 7 low anxiety
fear survey schedule II FSS-II:
assess fear to 51 objs or sitchs rated on 7pt scale
T: baseline 6 terror blood 5 very much fear death illness death of love one untimely or early death and hypodermic needles
12 month follwoup none items terror or very much fear
blood injection symptom scale BISS:
17 items assessing sensations experienced during blood or injections
T: baseline yes for all 17
12 month follow up 4/17 sensations experienced when exposed to med related stimuli
anxious heart pounding feeling nauseous sweating
treatment
9 CBT sessions
applied tension as detailed in mastering your fears and phobias (MYFP) manual craske et al 2006
T + therapist worked tgt to set weekly goals
completed hw between sessions
reading assignments
applied tension 5 times a day
completing graduated exposure tasks > watching vids of blood tests, finger prick blood test, testing bp and attending med appts
completed the phobic encounter record PER between sessions
rated anxiety from 0-100
listed thoughts feelings and behaviours when exposed to blood and or med stimuli
applied tension procedure
1) find comfortable chair
2) tense muscles of arms torso legs
3) hold tension for 10-15 seconds
4) release for 20-30 seconds
5) repeat 5 times
following 9th session T took own BP at pharmacy
had BP taken by nurse and examined by doctor
did not need to use AT and described his SUDS as rather low
said he had never felt better on my life
did not need more treatment
follow up
4 months later
thanked therapist
had several doctor appts booked
10 month later still doing well
12 month completed followup ques to allow comparisons to be made btwn baseline and followup scores
conclusions
psychoeducation
objective recording
cognitive restructuring
graduated exposure
highly effective when combined w applied tension
in treatment of a man w severe BII phobia
partially related to increases in self efficacy achieved through highly individualised treatment plan of a sufficient duration to meet his needs
strength quali and quanti data
SUDS scored before and after and during T exposed to items on fear hierarchy so changes monitored
quali data provided sense of T subjtv experience of recovery
triangulation of data gathering important
increases credibility of the findings
strength generalisability
despite being case study can use findings to generalise
detailed case history so can draw own conclusions about trasnferability of the findings to setting of own clients
weakness self report validity lacking
SUDS self report
may not be valid
oral answers
socially desirable bias
T also had social anxiety
more motivated to give pos answers
data may not reflect T’s genuine anxiety levels
weakness no control grp
RCT usually have sham treatment grp to test extent of expectancy effects influence ps recovery
ps might believe learning skills to reduce risk of fainting but not
important bc difficult to see how much of Ts recovery bc of the specific theraoy or bc of increased motivation and desire to change behaviour for sake of family
ethics
strength
maintained anonymity
used initial
therapist worked w him so progress thru hierarchy at his pace
not moving on until proetection from harm
imporved quali of life and save life bc he can go med appts
minimised harm to client the way the study was conducted
max benefits for T and therapists
may find detailed info provided in studt useful for own clients
application to everyday life
demos that people w BII can be treated in outpatient community settings w great success
may be linked w patient satisfaction
> increases compliance > attendance imoroved at treatnent sessions
practical POV BII harder to treat than other specific phobias as ps also need to learn to use AT
increase num of sessions and financial cost
another practical issue > lack of access to specialist clinics like the one attended by T
^ bro had to travel 2.5 hours for appts
increased financial costs and time required to access therapy
idiographic vs nomothetic
IDIOGRAPHIC
deatiled record of way manualised CBT w AT personalsied to T
but focus on one person means cant be sure if successful for others
larger people in study can calc avg SUDS scores before and after CBT AT treatment
^^ compare spread of data in each set to better understand how individual diff affect treatment efficacy
nomothetic approach could be helpful > focus on single patient and therapist may be misleading as this treatment programme may not be as effective for everyone
especially people being treated by less experienced or skilful therapists
