CT for Panic Disorder, GAD, and SAD

Question 1

General cognitive theory of anxiety and fear - CBT cycle

Answer 1

behavioral: mobilization to escape from perceived danger, inhibition of risk-taking behaviors, deactivation of motor responses (avoidance)
cognitive: feelings of unreality, hypervigilance, and self-consciousness, difficulties with concentration, thought control, and reasoning, cognitive distortions, fear-based beliefs
affective: feeling frightened, feeling apprehensive

Question 2

General cognitive theory of anxiety and fear: results of anxious schemas of vulnerability and fear

Answer 2

leads to increased attention to potentially threatening cues, more likely to interpret ambiguous cues as threatening, more likely to remember cues relevant to fear

Question 3

General cognitive theory of anxiety and fear: stages

Answer 3

1) orienting mode: information processing system responsible for the initial recognition of stimuli, rapid, automatic, bottom-up
2) immediate preparation: activation of primal mode - survival, safety, security - and primary threat appraisal (narrowing of cognitive processing, cognitive distortions, biases, overestimation of threat, low intolerance for uncertainty, maximize safety, minimize danger

3) Secondary elaboration: effortful semantic processing that is schema-driven (top-down) and can either lead to an escalation or a reduction in anxiety - secondary appraisal process (coping resources)

Question 4

Cognitive Therapy for anxiety

Answer 4

deactivation of primal threat mode
strengthening of more reflective modes of thinking
modification of threat appraisals
exposure is needed for elaborative processing and to not enable avoidance

Question 5

Cognitive Model of Panic - panic-inducing agents

Answer 5

panic-inducing agents do not lead to panic, it’s the cognition that comes after the agent

Question 6

Cognitive model of panic attack - triggers

Answer 6

internal or external

Question 7

Cognitive model of panic disorder - anxiety sensitivity, hypervigilance, and catastrophic misinterpretation

Answer 7

anxiety sensitivity: fear of anxiety-related sensations

hypervigilance: the more you focus on the sensations, the stronger the sensations become, and can be activated in situations with previous attacks

catstrophic misinterpretation: the possibility of a much graver alternative explanation for symptoms of panic

Question 8

CT for panic disorder course

Answer 8

Psychoeducation about anxiety, fear response, and panic disorder
interoceptive exposures: induced feared bodily sensations * key intervention *
identifying/challenging catstrophic interpretations of bodily sensations
in-vivo exposures to avoided situations
HW

Question 9

GAD: Avoidance model of worry

Answer 9

worry is a verbal, thought based process
inhibits more emotionally provoking imagery
inhibition prevents full emotional processing of fear, habituation and extinction of anxiety cannot occur
worry is maintained by positive beliefs about worry

Question 10

GAD: Intolerance of Uncertainty Model

Answer 10

individuals with GAD worry in response to uncertain situations
positive beliefs about wworry
worry – anxiety – negative problem orientation and cognitive avoidance
negative problem orientation: lack of confidence in problem-solving ability, problem = threats, easily frustrated, pessimistic about outcome of problem solving

Question 11

GAD: metacognitive model

Answer 11

type 1 worry : worry about external situation
type 2 worry: worry about worry (fear that it’s out of control or dangerous)
type 1 – type 2 – increased anxiety

Question 12

GAD: Contrast avoidance model

Answer 12

worry serves to avoid a sharp upward shift in negative emotion
ex) if I expect the worst, I won’t be disappointmed
based on affective contrast theory that states the impact of an emotion depends on its contrast with the preceding emotion

Question 13

CT for GAD course

Answer 13

psychoeducation
exposures (especially to uncertainty) 
relaxation
cognitive restructuring (meta-beliefs
problem solving

Question 14

SAD overview

Answer 14

fear is due to belief that one will be negatively evaluated by other people
presumed perceived audience is critical
underlying belief it’s important to be judge positively
consequences of negative evaluation

Question 15

SAD cognitive model: post-event processing

Answer 15

a potential explanation for why social fears are not extinguished despite repeated exposure to social situations?

reinforces negative beliefs about social performance

Question 16

CT for SAD course

Answer 16

psychoeducation
exposure
relaxation
social skills training (mixed evidence)
cognitive restructuring

Question 17

Efficacy of CBT for PD, SAD, and GAD

Answer 17

meta-analysis of placebo-controlled trials shows significant effect size for CBT posttreatment and at follow up - largest for OCD and GAD; moderate for PD, SAD