✅ L6 - Anxiety-based disorders

Question 1

What characterised as anxiety?

Answer 1

1. A basic emotion
2. Normal response to danger or thoughts
3. Affect bodily responses & processings:
   - Cognitive: Worry, racing thoughts, hypervigilance
   - Behavioural: Avoidance, fleeing, freezing
   - Physiological: Increased blood pressure, heart rate, sweating
4. Anxiety becomes a disorder when it impairs life functioning, prolonged/excessive (~6 month)
5. DSM-5 classifies anxiety into Generalised Anxiety Disorder (GAD), OCD, or stress-related disorders

Question 2

What is cognition theory in the context of anxiety disorders + its components?

Answer 2

1. Basic premise:
   - Dysfunction occurs from cognitive appraisal events -> influences behaviors
   - Emotional disorders are maintained by cognitive appraisal -> influences behaviours
   - These behaviours maintain emotional problems (e.g. anxiety and depression)
   => A feedback cycle
2. Components:
   - Stages: Situation -> Negative automatic thoughts (NATs) + Schemas -> Reaction (Emotion/Behaviour)
   - NATs are involuntary negative thoughts (cognitive distortion)
   - NATs reflect underlying beliefs and assumptions stored in memory (schemas)

Question 3

What are the 4 unhelpful thinking styles (cognitive distortion)?

Answer 3

1. Overgeneralization: Applying a conclusion to a range of situations based on isolated evidence
2. Magnification or minimization: enlarging/ reducing importance of events.
3. Mind Reading: Assuming people are reacting negatively to you despite a lack of evidence for this
4. Arbitrary Inference: Drawing a conclusion without sufficient evidence

Question 4

What are schemas?

Answer 4

1. Schemas are underlying personal beliefs based on experience and are stored in memory to interpret new information
2. Often specific to a disorder (e.g. anxiety - beliefs about danger and lack of abilities to cope)
3. Interpreted as absolute truths.
4. Bias information processing: influence behaviours, cognition, and emotions.
5. Can be formed through early learning experiences

Question 4

What is the Panic model (Clarks, 1986) and how to prevent/treat panic disorder?

Answer 4

1. Theory: Panic results from catastrophic misinterpretation (CM) of internal sensations.
2. Key features: Trigger stimulus -> Perceived threat -> Apprehension -> Body sensations -> Interpretation of sensations as catastrophic -> (Perceived threat )
   => A FEEDBACK LOOP
3. Therapist challenges belief in CM by:
   - Corrective information
   - Socratic method
   - Behavioural experiments: hyperventilation provocation

Question 5

What is the efficacy of CBT treatment for anxiety & issues?

Answer 5

• Recommended treatment in NICE Guidelines for treating psychological disorders
• Effectiveness varies: Approximately 50% recovery in ‘Generalized anxiety disorder’
  (GAD), and ‘Major depressive disorder’ (MDD)
• Higher recovery in panic and social phobia

2. Issues with CBT:
   - Relapse rate is a problem, especially in depression
   - Some anxiety disorders are harder to treat (OCD, GAD) => meta-analysis of GAD outcomes show that remission rate is (53%) and remain the same with follow-up
   - CBT is no more effective than exposure, AND its addition to exposure therapy does not improve outcomes

Question 6

What is a paradigm shift to replace CBT as treatment for anxiety disorders? What are its principles?

Answer 6

Metacognitive Therapy (MCT) (Wells, 2009)

Principles of MCT: “Thoughts don’t matter but your response to them does”
- Psychological distress is maintained by Cognitive Attentional Syndrome (CAS)
- CAS includes worry, rumination, threat monitoring, and unhelpful coping (e.g. thought suppression)
- CAS is driven my metacognitive beliefs (beliefs about thinking)

Question 7

What are the types of metacognitive beliefs (related to MCT treatment for anxiety disorders)

Answer 7

1. Negatives (NMC): uncontrollability/ dangerousness of worry
   - I cannot control my worrying
   - Worrying will harm my mind/body
2. Positives (PMC): benefits/usefulness of worrying => This does not have benefits actually
   - Worrying helps me cope
   - If I worry I’ll be prepared
3. Evidence:
   - Sun et al. (2017)’s meta-analysis: NMC seen across psychological disorders.
   - Capobianco et al. (2020)’s systematic review: NMC positively associated with increased anxiety and depression across physical illnesses

Question 8

Describe the metacognitive model of Generalised Anxiety Disorder (GAD)?

Answer 8

1. Mechanism:
   - Type 1 worry = worry about social, self and world (not sufficient to cause GAD) -> leads to various emotions
   - Type 2 worry (meta-worry): worry ABOUT worry -> affect and influence by behaviours, thought control and emotions.
   - GAD develops when negative metacognitive beliefs are activated.
2. Why? Control processes that maintain psychological distress
   - More thinking
   - Suppression of trigger thoughts
   - Reassurance seeking
   - Avoidance

Question 9

What is the MCT (treatment) for GAD? What is it efficacy?

Answer 9

1. Key steps of MCT:
   - Challenge uncontrollability metabeliefs (NMC) -> evidence, hypotheticals, worry postponement
   - Challenge danger metabeliefs (NMC) -> try to lose control of worry
   - Challenge positive metabelief (PMC) -> Worry modulation experiment
2. Efficacy of MCT: Normann & Nexhmedin (2018) systematic review of 25 studies + 15 controlled trials
   - MCT significantly more effective than waitlist
   - MCT significantly more effective than CBT and follow-up
   => MCT is highly effective in treating disorders of anxiety and depression and may be superior to CBT