Social and Childhood Anxiety and GAD

Question 1

state the two components to the automatic nervous system.

Answer 1

• sympathetic nervous system (creates)

- parasympathetic nervos system (inhibits)

Question 2

outline sections in clark and well’s cognitive model of SAD.

Answer 2

• social situation
• activates assumptions
• perceived social danger
• processing self as social object
• safety behaviours
• cognitive and somatic symptoms

Question 3

state the two ways how people can process themselves as social objects.

Answer 3

• observer perspective

- field perspective

Question 4

give examples of safety behaviours.

Answer 4

• avoiding eye contact
• gripping tightly onto glass
• wearing dark clothing to hide sweat

Question 5

give examples of cognitive biases.

Answer 5

• attentional biases (focus on the bad things that reinforce phobia)
• misinterpretations

Question 6

outline CBT for SAD.

Answer 6

• identify and challenge irrational beliefs
• behaviour experiments (catastrophes unlikely to come true)
• feedback
• homework

Question 7

what was the effect size for CBT for SAD.

Answer 7

large effect size , d = 1.04, effective.

Question 8

what is the prevalence for SAD?

Answer 8

• 12% in adults
• 0.32% in children
• onset in adolescence

Question 9

describe the DSM-5 diagnosis for SAD.

Answer 9

• persistent fear of 1+ social performance situations
• evokes immediate reaction
• irrational
• avoidance
• minimum 6 months duration
• not better explained by another diagnosis

Question 10

what is the heritability of SAD.

Answer 10

.65

Question 11

define pre and post-mortem.

Answer 11

pre- mortem is where the person reviews likely runs of events and recollection of past failures before the interaction, post-mortem is where the person negatively processes the event after the interaction.

Question 12

children can all the anxiety disorders adults have plus one more…

Answer 12

separation anxiety.

Question 13

which childhood disorder has the highest prevalence?

Answer 13

separation anxiety - 1.09%-20.2%

Question 14

what is the min and max found of children with anxiety disorders?

Answer 14

min - 3.19%

max - 41.9%

Question 15

state consequences of anxiety disorders.

Answer 15

• depression, substance misuse, psychosis, underachievement at school, poor relationships
• anxiety in children often does not get spotted until its very serious.

Question 16

describe heritability causes for childhood anxiety.

Answer 16

• first degree relative with pain disorder, 5 times more likely to develop panic disorder
• anxious parents, twice as likely to develop anxiety
• shared environment

Question 17

state findings from twin and adoption studies on childhood anxiety.

Answer 17

• panic 30-40% heritable
• GAD 31.6%
• phobias 20-40%

Question 18

variations of heritability is due to…

Answer 18

• severity being measured
• type of anxiety being measured
• whose reporting anxiety
• age

Question 19

describe how parents can contribute to childhood anxiety.

Answer 19

vicarious learning
overprotective parents:
- reduced opportunity to develop coping skills
- reduced opportunities to take risks and succeed or fail
- reduced opportunities to learn to cope with feeling scared
- think the world is dangerous and so scary things should be avoided

Question 20

which comes first: anxiety or overprotective parenting?

Answer 20

we don’t know!!

Question 21

give evidence that parents are not the cause of childhood anxiety.

Answer 21

• parenting only accounted for 4% of variance in child anxiety, studies may overestimate the relationship between variables.

Question 22

how is CBT improved for children?

Answer 22

• treating septic disorders rather than general

- one-to-one better than group

Question 23

what is the best kind of treatment for anxiety?

Answer 23

CBT and sertaline (80.7% improvement)

- although no treatment groups ended up significantly better than others.

Question 24

outline CBT in treating children.

Answer 24

• explain fight-flight response
• explain role of avoidance
• gradual exposure (steps model)

Question 25

describe the DSM-5 diagnosis of GAD.

Answer 25

- excessive, uncontrollable worry - distress/functional impairment - 3+ : restlessness, fatigued, difficultly concentrating, sleep disturbance - minimum 6 months

Question 26

state exclusion criteria of diagnosis of GAD.

Answer 26

- focus of the anxiety and worry is confined to another axis 1 disorder e.g specific phobias - if disturbance is a result of medical condition, or effects of a substance - worry occurs during a mood disorder, developmental disorder, psychotic disorder

Question 27

what is the epidemiology of GAD?

Answer 27

- prevalence 3.7% - highest in highest income countries 5% - comorbidity 81%

Question 28

why is studying GAD important?

Answer 28

- one of the most prevalent and problematic disorders in primary care - highly comorbid with other MH conditions - high burden on health care services - long-term impact on cardiovascular health - CBT effective for approx 50%

Question 29

define aspects of the model of pathological worry GAD.

Answer 29

- cognitive biases: attention bias, interpretation bias | - attentional control: limited capacity resource allows us to exert goal-directed control over allocation of attention.

Question 30

which cognitive model involves top-down and bottom-up processes in leading to perception of threat (GAD).

Answer 30

model of pathological worry.

Question 31

give evidence for the model of pathology.

Answer 31

- habit to attend to threat promotes worry - making negative interpretations of ambiguous information promotes worry - engaging in imagery when worrying (vs verbal worry) reduces worry.

Question 32

define aspects of the intolerance of uncertainty model.

Answer 32

- greater need for certainty | - uncertainty perceived as more unpleasant (less well able to tolerant 'not knowing'.

Question 33

state positive beliefs of worry according to IU model.

Answer 33

- worry is seen as useful | - worry is necessary to prevent surprise at negative future outcomes.

Question 34

describe negative problem orientation according to the IU model.

Answer 34

- dysfunctional attitudes relating to problem-solving process - perceptions of problems as threats - lack of confidence in problem-solving abilities

Question 35

what is meant by cognitive avoidance in the IU model.

Answer 35

- using worry to avoid emotional arousal | - worry serves to suppress negative intrusive thoughts

Question 36

give evidence for the IU model.

Answer 36

- experimentally increasing IU also increases worry - individuals with GAD had positive beliefs about worry to a greater extent than the general population - individuals with GAD have greater negative problem orientation than people with other anxiety disorders.

Question 37

describe the avoidance model of GAD.

Answer 37

- worry focuses on possible, but non-existent future bad things that may happen - as perceived danger does not exist, there is no effective flight/fight response - humans are left with only mental attempts to solve the problem

Question 38

how does worry serve as an avoidant response in the avoidance of GAD model?

Answer 38

- to avoid distressing negative imagery associated with more distress in short-term - to avoid physiological arousal - to avoid thinking about more distressing topics.

Question 39

give evidence for the avoidance model of GAD.

Answer 39

- people who experience GAD display increased muscle tension at rest - worry is primarily a verbal-linguistic process than imagery-based - worry is reinforced by positive beliefs about worry.

Question 40

name and describe the steps of the NICE 'focus of intervention' stepped-care.

Answer 40

1. preventions of GAD 2. diagnosed GAD that has not improved after step 1 3. inadequate response to step 2 or marked functional impairment 4. complex treatment-refractory, very marked functional impairment

Question 41

name and describe the 'nature of the intervention' steps in the NICE stepped-care model.

Answer 41

1. identification and assessment, education, treatment options, monitoring 2. low-intensity psychological interventions, self-help materials 3. high-intensity intervention (CBT) or drug 4. specialist treatment, including inpatient care.

Question 42

state core treatment components of CBT in targeting intolerance of uncertainty.

Answer 42

- 12-16 sessions - psychoeducation about CBT - worry awareness training - coping with uncertainty - re-evaulating beliefs about usefulness of worry - improving problem orientation and solving ability - processing core fears through imaginal exposure - relapse prevention

Question 43

what happens during psychoeducation?

Answer 43

- collaboration between therapist and patient - focuses on 'here and now' - homework between sessions - blueprint at end - reinforce therapy gains as a relapse-prevention technique.

Question 44

how is worry awareness trained?

Answer 44

worksheet, state: - date and time - describe situation - 'your worry' - how anxious (0-10 scale) - classify (practical or hypothetical worry)

Question 45

describe how to help cope with uncertainty as a treatment method.

Answer 45

- explain to patient what IU is and how feeds into the worry process - present dilemma to patient, give options t reduce uncertainty or/and increase intolerance

Question 46

give examples of behavioural experiments to seek out uncertainty.

Answer 46

- sending email without checking for errors - not seeking reassurance about a decision from others - completing 'challenging your beliefs' worksheet.

Question 47

how does treatment approach improve problem orientation?

Answer 47

- work on idea problems are a normal part of everyday life - target appraisal of problems as threatening e.g could be an opportunity? - maintaining progress and 'incase of a setback' worksheets e.g 'what have I learnt? what could I do differently?'.

Question 48

state the steps of applied relaxation for GAD.

Answer 48

1. worry awareness and self-monitoring 2. relaxation training 3. cognitive therapy 4. imagery rehearsal of coping strategies

Question 49

focus on progressive muscle relaxation is based on the premise that...

Answer 49

... chronic worry is associated with deficiency in parasympathetic tone and excessive muscle tension.

Question 50

training in progressive muscle relaxation involves...

Answer 50

... systematically tensing and relaxing muscle groups in order to learn the difference between the two. eventually individuals create relaxing by recalling how muscles felt when relaxed.