L1: ANXIETY & DEPRESSION Flashcards
je moeder (35 cards)
Is anxiety normative (in adolescence)?
Anxiety is a normal evolutionary response with adaptive functions:
* Indicating when caution is warranted & to engage in fight vs flight
* Aiding goal achievement: Yerkes Dodson Law = performance improves with a moderate level of anxiety
Define anxiety disorders
- Anxiety: excessive and persistent worry, fear, or anxiety that significantly impairs daily functioning
- Anxiety disorders are distinguished by the main feared stimulus and the anxiety response produced
4
List causal mechanisms of anxiety
- Maladaptive coping (avoidance)
- Classical / operant conditioning (reinforcement and maintenance of avoidance behaviours and feared stimulus)
- Negative core beliefs (“I can’t handle the anxiety”)
- **Negative cognitions&&
Is depressed mood normative (in adolescence)?
Mood problems are normative in adolescence, but become clinical when there is a high intensity, long duration, and/or causes significant impairment
9
List DSM-V Criteria for MDD
- 5+ symptoms present in the same 2-week period, representing a change from previous functioning
1) Depressed mood most of the day nearly everyday (children: irritable mood)
2) Anhedonia (loss of interest/pleasure)
3) Significant weight/appetite loss or gain (children: failure to make expected weight gain)
4) Insomnia/hypersomnia
5) Psychomotor agitation/retardation
6) Fatigue/loss of energy
7) Diminished concentration
8) Feelings of worthlessness/guilt
9) Recurrent thoughts of death / suicidal ideation
5
List DSM-V Criteria for PDD
- Depressed mood most of the day, most days for at least 2 years, evident by 2+ symptoms
1) Poor appetite/overeating
2) Insomnia/hypersomnia
3) Low energy/fatigue
4) Poor concentration
5) Feelings of hopelessness
- No period without symptoms for longer than two months
- No (hypo)manic episode
- Children: minimum 1 year, mood can be irritable
Describe the ABC-model
- ABC-model: functional analysis tool for case conceptualization and identifying treatment targets
- Antecedent: the event/situation that happens before the response which triggers/influences the response
- Behaviour: emotions, thoughts, and behaviours occurring as a result of the antecedent
- Consequences: outcome of the response
List and provide examples of the three most important CBT technique categories
The three most important CBT technique categories are techniques that target:
1) Cognitions
* Cognitive restructuring
2) Emotions
* Emotive education
* Relaxation training
3) Behaviour
* Exposure
* Roleplay
List phases and steps of the Coping Cat Program
Phase 1: Skill Building (FEAR)
1) Feeling Frightened?
2) Expecting Bad Things to Happen?
3) Attitudes and Actions that Might Help
4) Results and Rewards
Phase 2: Exposure & Practice
Name a treatment for anxiety in children and adolescents
- Coping Cat: ages 7 - 13
- C.A.T Program: adolescents
What is the goal of Coping Cat?
- Goal of treatment is to teach people to recognize signs of anxious arousal and implement strategies to cope with the distress caused by the arousal.
- The goal is not to eliminate all anxiety, as anxiety often serves an adaptive function.
FEAR
Explain step 1 of the Coping Cat Program
Step 1: “Feeling Frightened?”
Emotive Education:
* Goal is to increase affective awareness: being aware of the underlying experience of feeling, emotion, or mood
* Helps children be able to identify their own anxiety-related emotions and understand the link between emotions, thoughts, and behaviour (and somatic sensations)
* In turn, this helps children be able to anticipate future anxiety-provoking events, as well as helping them understand their own experience and the rationale behind treatment
Relaxation Techniques:
* Relaxation techniques show patients that they are capable of controlling their anxiety-related somatic sensations
* Taught through therapist modeling and roleplay → the therapist describes anxiety-provoking scenarios, models emotive awareness through recognition of somatic sensations, and models coping through demonstrating relaxation techniques
Explain step 2 of the Coping Cat Program
**Step 2: Expecting Bad Things to Happen?”
- Cognitive restructuring is used to help children recognize and change maladaptive thoughts (about anxiety) to more adaptive/realistic thoughts
Steps:
1) Identify maladaptive thought
* Including its strength and impact
2) Challenge maladaptive thought
* Examine evidence for and against the thought through methods like socratic dialogue or the pie chart method
3) Identify adaptive thought
* The focus of treatment is more on creating adaptive thoughts than changing maladaptive thoughts. Adaptive thoughts will eventually become so strong that it counteracts the maladaptive thought
4) Check reliability of the new thought vs the old thought
Explain step 3 of the Coping Cat Program
Step 3: Attitudes and Actions that Might Help
- Developing confidence in the ability to handle daily challenges
- Problems (which become increasingly anxiety-provoking) are identified and potential solutions are brainstormed. Solutions are evaluated on their potential outcomes, and one is chosen and implemented in the patients real life
Explain step 4 of the Coping Cat Program
- Positive rewards are used in contingent reinforcement
- Goal is to increase approach behaviours and decrease avoidance behaviours
- Effort is also rewarded in order to counter maladaptive expectations of perfectionism (which is common in anxiety)
Explain Phase 2 of the Coping Cat Program
Phase 2: Exposure and Practice
* Previously learned FEAR skills are used in gradual exposure
Explain the steps of cognitive restructuring
1) Identify maladaptive thought
* Including its strength and impact
2) Challenge maladaptive thought
* Examine evidence for and against the thought through methods like socratic dialogue or the pie chart method
3) Identify adaptive thought
* The focus of treatment is more on creating adaptive thoughts than changing maladaptive thoughts. Adaptive thoughts will eventually become so strong that it counteracts the maladaptive thought
4) Check reliability of the new thought vs the old thought
Name a treatment for MDD in adolescents
Adolescent Coping with Depression Course (CWD-A)
Explain the theoretical framework of CBT for MDD
Cognitive Vulnerability Model:
* People at-risk for MDD selectively attend to and have stronger recall for negative stimuli
* Goal of CBT is to help patients recognize and replace these maladaptive cognitions with more adaptive cognitions
Behavioural Theories:
* MDD symptoms develop and are maintained because of a decrease in environmental rewards, a decrease in the occurrence of positively reinforced behaviours, and increased reinforcement of depressive behaviours
* Goal of CBT is to increase engagement in activities that are personally reinforcing
Define social skills
Different classes of social behaviour within the individuals’ repertoire to deal appropriately with the demands of interpersonal situations
Define behavioural inhibition
Lack of display of social skills during high states of anxiety
Explain the debate regarding social skill impairments in SAD
There exists a debate regarding whether impairments in social performance and interactions are due to social skills deficits (in acquisition, performance, or fluency) or behavioural inhibition
* Social skills: different classes of social behaviour within the individuals’ repertoire to deal appropriately with the demands of interpersonal situations
* Behavioural inhibition: lack of display of social skills during high states of anxiety
Describe the findings from the literature review on social skills in SAD
Literature review found that elevated social anxiety adversely affects social functioning (performance, academic achievement, communication skills, overall competence)
How is Coping Cat flexible?
- Coping Cat is flexible because it is driven by the model and not exact outlined techniques
- Treatment goals are adapted to the needs of the child
- FEAR acronym can be modified by the patient
- Can be modified to increase parental involvement, emotion focus, treatment duration, online-setting, group-based
