Anxiety (Shapiro Ch. 13)

Question 1

What does emotion encompass in anxiety?

Answer 1

Anxiety disorders involve fear, tension, nervousness and panic.

Question 2

What are the physiological characteristics of anxiety?

Answer 2

Anxiety has a physical state that may include stomach discomfort, muscle tension, rapid heartbeat and breathing, perspiration, and other manifestations of autonomic nervous system arousal

Question 3

What are the cognitive characteristics of anxiety?

Answer 3

Anxious thoughts are inherently future-oriented, with overestimation of both the likelihood and magnitude of possible negative events. Children are plagued by fearful self-talk, and they underestimate coping resources.

Question 4

What are the behavioral characteristics of anxiety?

Answer 4

The behavioral hallmark of anxiety is avoidance. When the feared situation cannot be avoided, there may be agitation, clinging to parents, crying, disorganization, and aggression.

Question 5

What is the neurobiological etiology of anxiety?

Answer 5

-larger amygdala
-behavioral inhibition: exhibit greater HPA axis and autonomic nervous system reactivity, elevated cortisol levels, heightened startle responses, and heightened amygdala activation in response to pictures of angry faces, compared to children without this behavior pattern
-people with anxiety disorders experience a mismatch between their neurophysiological states and the challenging situations they face.

Question 6

What is the behavioral etiology of anxiety?

Answer 6

-avoidance learning
-skill deficits include: relaxation, social skills

Question 7

What is the cognitive etiology of anxiety?

Answer 7

-Fear-dominated attentional biases and misperceptions of threat.
-Cognitive distortions: Pessimistic outlook, overestimating danger, forecasting, etc.
-Misinterpreting physiological cues

Question 8

What is the psychodynamic etiology of anxiety?

Answer 8

*Magical thinking: Fears are divorced from logic and external reality
*Unacceptable impulses (anger, sexual desires, selfishness) Punishment from the environment.Fear what they might do or that a wish may come true
*Object relations–Negative relationship expectations →closeness is frightening, dependency and love = pain, so sabotage relationships to avoid the anxiety of closeness *Irrational fears of fantasy figures

Question 9

What is the systemic etiology of anxiety?

Answer 9

*Parental messages/modeling
*Overcontrolling, overprotective parenting
*Behavioral inhibition–1/3 of babies with this temperament grow up to be adults with anxiety disorders
*What about the other 2/3?
>The response of mothers to infant distress in novel, challenging, but safe situations is important:
–Remove them →anxiety disorders
–Supportive soothing and encouragement to persevere in stress →most do not develop anxiety disorders
*Indirect, disguised, self-contradictory communication
*Double binds in particular cancause people to feel anxious without knowing why because problems are never acknowledged

Question 10

What are some psychodynamic interventions that are used with anxiety?

Answer 10

*Look for themes in talk, play, drawings, fantasies, behavior patterns
*What’s really going on? What is the child really afraid of? –Interpret projections, gain control over anger
*Corrective emotional experience to refute anxiety & misunderstandings

Question 11

What are some CBT interventions that are used with anxiety?

Answer 11

CBT for anxiety generally divides into two treatment phases: facilitative strategies and exposure. Facilitative strategies come first and exposure comes second.

Question 12

What do CBT facilitative strategies include?

Answer 12

-Relaxation training
-Social skills training
-Overt and covert modeling: include both overt activities, such as watching others demonstrate skills, and covert procedures, such as storytelling.
-Self-instruction: Therapists can use this technique to teach anxious youngsters how to talk themselves through the situations that scare them (Mental imagery is a version of self-instruction in which the client envisions the behaviors he wants to perform in anxiety-producing situations).

Question 13

What is decatastrophizing in CBT?

Answer 13

bringing the client’s perceptions or anticipations of a situation into line with what is realistic.
§ scaling the problem, clients use a scale from zero to ten to rate the severity of difficulties they encounter or anticipate

Question 14

What is scaling the problem in CBT?

Answer 14

clients use a scale from zero to ten to rate the severity of difficulties they encounter or anticipate

Question 15

What is categorical thinking?

Answer 15

Because children’s quantitative thinking ability is limited, they tend to recognize three categories of probability: (1) things that definitely will happen, (2) things that might happen, and (3) things that definitely will not happen.

Question 16

What does parent-child work include for children with anxiety?

Answer 16

parents and therapists need to ascertain the degree to which the child’s problematic behavior is due to inadequate self-regulatory capabilities versus the degree to which the behavior is potentially under the child’s control and so could respond to environmental cues and reinforcement. The objective is to push for a degree of self-management that is greater than the child’s current level but within her capabilities, so the child stretches and tries but is not overwhelmed with anxiety.

Question 17

What is the Hansel and Gretel technique used for?

Answer 17

Used for separation anxiety disorder.

The procedure consists of building a type of symbolic umbilical cord between the parent and child. The technique is peppered with humorous drama and exaggeration so that it becomes silly and fun. It can usually be completed in three sessions.