Treating Anxiety and Beyond Flashcards by D E

What is anxiety?

List 3 points

A basic emotion
A personality dimension
A psychological disorder

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Anxiety is known as a basic emotion

What does this mean? List 2 points

Normal response to danger or thoughts
Has multiple subsystems

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Anxiety is known as a basic emotion that has multiple subsystems

What are the 3 subsystems?

Cognitive
behavioural
Physiological

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One subsystem of anxiety is cognitive

Describe this subsystem

Worry, racing thoughts, hypervigilance, tunnel vision

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One subsystem of anxiety is behavioural

Describe this subsystem

Avoidance, fleeing, freezing

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One subsystem of anxiety is physiological

Describe this subsystem

Increased blood pressure, heart rate, sweating

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Which subsystem of anxiety does this apply to?

Increased blood pressure, heart rate, sweating

a. Behavioural
b. Physiological
c. Cognitive

b. Physiological

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Which subsystem of anxiety does this apply to?

Avoidance, fleeing, freezing

a. Behavioural
b. Physiological
c. Cognitive

a. Behavioural

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Which subsystem of anxiety does this apply to?

Worry, racing thoughts, hypervigilance, tunnel vision

a. Behavioural
b. Physiological
c. Cognitive

c. Cognitive

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Normal response to danger or thoughts

This is known as…?

Anxiety

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When does anxiety go from being a normal emotional reaction to a disorder?

List 3 points

When anxiety interferes with functioning
When anxiety is prolonged/excessive
When anxiety impairs quality of life

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What are the 3 chapters of anxiety disorders in the DSM-5?

Anxiety disorders
OCD and related disorders
Trauma and Stress related

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What are the 10 types of anxiety disorders?

Separation anxiety
Selective mutism
Specific phobia
Social anxiety disorder
Panic attack
Agoraphobia
Generalized anxiety disorder
Substance induced
Anxiety due to medical condition
Unspecified anxiety disorder

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What are the 9 types of OCD and related disorders?

Obsessive Compulsive Disorder
Body Dysmorphic
Disorder Hoarding
Trichotillomania (hair pulling)
Excoriation (skin picking)
Substance induced OCD
OCD related medical condition
Other specified OCD
Unspecified OCD

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Hair pulling OCD is known as…?

Trichotillomania

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What is Trichotillomania?

Hair pulling OCD

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Skin picking OCD is known as…?

Excoriation

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What is Excoriation?

Skin picking OCD

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What are the 7 types of trauma and stress disorders?

Reactive attachment disorder
Disinhibited social engagement disorder
Post traumatic stress disorder (PTSD)
Acute stress disorder (ASD)
Adjustment disorder
Other specified trauma and stressor disorder
Unspecified trauma and stressor disorder

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General form of anxiety, people worry about anything and everything

This is known as…?

Generalized anxiety disorder

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What is generalized anxiety disorder?

General form of anxiety, people worry about anything and everything

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How do we treat anxiety disorders?

List 2 ways

Cognitive theory (CBT)
Metacognitive Beliefs (MCT)

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According to the Cognitive Theory (Beck, 1976), how does dysfunction occur?

Dysfunction occurs from an individual’s interpretation of events which in turn influences behaviours important in maintaining emotional problems

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This approach to treating anxiety believes:

Dysfunction occurs from an individual’s interpretation of events which in turn influences behaviours important in maintaining emotional problems

This is known as…?

Cognitive Theory (Beck, 1976)

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According to the Cognitive Theory (Beck, 1976), how are emotional disorder maintained?

Emotional disorders are maintained by how individuals interpret events which influences behaviours that maintain emotional problems (i.e., anxiety/ depression)

This approach to treating anxiety believes: Emotional disorders are maintained by how individuals interpret events which influences behaviours that maintain emotional problems (i.e., anxiety/ depression) This is known as...?

Cognitive Theory (Beck, 1976)

Situation -> Negative Automatic Thoughts -> Reaction (emotion/behaviour) Which approach does this apply to? a. Cognitive theory (CBT) b. Metacognitive Beliefs (MCT) c. All of the above d. None of the above

a. Cognitive theory (CBT)

What are Negative Automatic Thoughts?

Things that trigger reactions

Things that trigger reactions This is known as...?

Negative Automatic Thoughts

What are the 3 forms of Negative Automatic Thoughts?

1. Verbal 2. Image 3. Involuntary, rapid and negative

Feeling worried, characterised by "what ifs" This is known as...?

Anxiety disorders

Feeling worried, characterised by "why" questions This is known as...?

Rumination

Future oriented a. Anxiety b. Rumination

a. Anxiety

Past oriented a. Anxiety b. Rumination

b. Rumination

According to the Cognitive Theory (Beck, 1976), what 2 things reflect the underlying beliefs and assumptions stored in memory?

1. Negative automatic thoughts 2. Distortions

According to the Cognitive Theory (Beck, 1976), negative automatic thoughts and distortions in processing reflect ...?

The underlying beliefs and assumptions stored in memory

Negative automatic thoughts and distortions in processing reflect the underlying beliefs and assumptions stored in memory These are also known as...?

Schemas

What are the 4 types of Unhelpful Thinking Styles (Cognitive Distortion)?

1. Overgeneralisation 2. Magnification or minimisation 3. Mind Reading 4. Arbitrary Inference

What are cognitive distortions?

Unhelpful Thinking Styles

Define overgeneralisation

Applying a conclusion to a range of situations based on isolated evidence

Define Magnification or Minimisation

Enlarging/reducing importance of events

Define mind-reading

Assuming people are reacting negatively to you despite a lack of evidence for this

Define Arbitrary Inference

Drawing a conclusion without sufficient evidence

Enlarging/reducing importance of events This is known as...? a. Overgeneralisation b. Magnification or minimisation c. Mind Reading d. Arbitrary Inference

b. Magnification or minimisation

Drawing a conclusion without sufficient evidence This is known as...? a. Overgeneralisation b. Magnification or minimisation c. Mind Reading d. Arbitrary Inference

d. Arbitrary Inference

Applying a conclusion to a range of situations based on isolated evidence This is known as...? a. Overgeneralisation b. Magnification or minimisation c. Mind Reading d. Arbitrary Inference

a. Overgeneralisation

Assuming people are reacting negatively to you despite a lack of evidence for this This is known as...? a. Overgeneralisation b. Magnification or minimisation c. Mind Reading d. Arbitrary Inference

c. Mind Reading

I'm so boring that I'm sending the audience to sleep This is known as...? a. Overgeneralisation b. Magnification or minimisation c. Mind Reading d. Arbitrary Inference

c. Mind Reading

She thinks I'm a horrible person This is known as...? a. Overgeneralisation b. Magnification or minimisation c. Mind Reading d. Arbitrary Inference

d. Arbitrary Inference

I'm never good at anything This is known as...? a. Overgeneralisation b. Magnification or minimisation c. Mind Reading d. Arbitrary Inference

b. Magnification or minimisation

Nothing good ever happens; everything is always bad This is known as...? a. Overgeneralisation b. Magnification or minimisation c. Mind Reading d. Arbitrary Inference

a. Overgeneralisation

According to the Cognitive Theory (Beck, 1976), what 2 things contribute to Negative Automatic Thoughts?

1. Situation 2. Schemas

Define schemas

Underlying beliefs and assumptions about self and world based on experience and used to organise and interpret new information that are stored in our memory

Underlying beliefs and assumptions about self and world based on experience and used to organise and interpret new information that are stored in our memory This is known as...?

Schemas

Schemas are also known as...?

Core beliefs

Schemas are often specific to a disorder What are the schemas for anxiety disorders?

Assumptions and beliefs about danger and lack of ability to cope

Assumptions and beliefs about danger and lack of ability to cope This is a schemas for which disorder?

Anxiety disorder

Interpreted as absolute truths This is known as...?

Schemas

Schemas bias information processing What does this mean?

Schemas influence how an individual behaves, thinks and feels

When can schemas be formed?

Through early learning experiences

True or False? Schemas tend to lie dormant and then become activated later in life when faced with events (e.g. PTSD would be activated after facing some kind of trauma)

True

Who proposed the panic model?

Clark (1986)

What did Clark’s (1986) panic model conclude?

Panic results from catastrophic misinterpretation (CM) of internal sensations

According to Clark (1986), panic results from...?

Catastrophic misinterpretation (CM) of internal sensations

1. Patient has an internal event (e.g. increase in heart rate) 2. This could be interpreted as something bad is about to happen This is known as...?

Panic disorder (based on the panic model)

Describe Clark's (1986) panic model List 5 points

1. Trigger stimulus (internal or external) 2. Perceived Threat 3. Apprehension (feeling anxious) 4. Body sensations 5. Interpretation of sensations as catastrophic

1. Trigger stimulus (internal or external) 2. Perceived Threat 3. Apprehension (feeling anxious) 4. Body sensations 5. Interpretation of sensations as catastrophic This is known as...?

Clark's (1986) panic model

Describe Clark's (1986) panic model when a person feels unreal

1. Felt Unreal 2. What if I panic? 3. Scared/anxious 4. Shaking, heart rate increases, breathless 5. I'm going to have a heart attack

How can we correct/challenge belief in catastrophic misinterpretation (CM) of internal sensations? List 3 ways

1. Providing corrective information 2. Socratic method 3. Behavioural experiments

Describe the socratic method

A form of argumentative dialogue between individuals, based on asking and answering questions What makes you think anxiety can cause a heart attack?

A form of argumentative dialogue between individuals, based on asking and answering questions What makes you think anxiety can cause a heart attack? This is known as...?

Socratic method

What behavioural experiments can help challenge belief catastrophic misinterpretation (CM) of internal sensations?

Hyperventiliation provocation

Recommended treatment in NICE Guidelines for treating psychological disorders This is known as...?

Cognitive Behavioural Therapy (CBT)

With Cognitive Behavioural Therapy (CBT), how many people recover from generalised anxiety disorder and depression?

50%

With Cognitive Behavioural Therapy (CBT), 50% of people recover from ___ and ___

1. Generalised anxiety disorder (GAD) 2. Depression (MDD)

With Cognitive Behavioural Therapy (CBT), there is higher recovery in ____ and _____ phobia

1. Panic 2. Social

What are the issues with Cognitive Behavioural Therapy (CBT)? List 5 points

1. Relapse rates, especially in depression 2. Some anxiety disorders are harder to treat (OCD, GAD) 3. CBT is no more effective than exposure 4. Addition of CBT to exposure does not improve outcomes 5. The efficacy of CBT appears to be falling

Cognitive Behavioural Therapy (CBT) has high relapse rates of...?

Depression

According to Springer et al.'s (2018) meta-analysis of GAD outcomes, how many post-treatment patients actually recovered with CBT?

Only 47.9%

According to Springer et al.'s (2018) meta-analysis of GAD outcomes, how many completer patients actually recovered with CBT?

Only 53%

True or False? CBT is more effective than exposure

False CBT is no more effective than exposure

True or False? Addition of CBT to exposure improves outcomes

False Addition of CBT to exposure does not improve outcomes

True or False? BDI effect size and remission rates negative association overtime

True

Who proposed the metacognitive therapy (MCT)?

Wells (2009)

What treatment for anxiety overcomes the theoretical limitations of CBT?

Metacognitive Therapy (MCT) (Wells, 2009)

Which anxiety treatment was developed systematically?

Metacognitive Therapy (MCT)

Which anxiety intervention was developed based on clinical trials and seeing how patients do within therapy sessions?

Cognitive Behavioural Therapy (CBT)

Which anxiety intervention was developed first in experiments before it was translated into larger scale studies and developed into a full therapy package?

Metacognitive Therapy (MCT)

Theory driven (S-REF Model) systematic development and estimation This is known as...?

Metacognitive Therapy (MCT)

Development of ____ is scientifically tested techniques and driven by a- priori theory

Metacognitive Therapy (MCT)

What are the 5 principles of Metacognitive Therapy (MCT)?

1. “Thoughts don’t matter but your response to them does” 2. Psychological distress is maintained by a style of thinking (the Cognitive attentional syndrome (CAS)) 3. CAS includes worry, dwelling (rumination), threat monitoring, unhelpful coping strategies (thought suppression) 4. CAS is driven by a set of beliefs -> Metacognitive beliefs 5. Metacognitive beliefs are beliefs about thinking

Metacognitive Therapy (MCT)

What are the 2 types of metacognitive beliefs?

1. Negative metacognitive beliefs 2. Positive metacognitive beliefs

What are negative metacognitive beliefs?

Uncontrollability/dangerousness of worry

What are positive metacognitive beliefs?

Benefits/usefulness of worrying

Benefits/usefulness of worrying These are known as...?

Positive metacognitive beliefs

Uncontrollability/dangerousness of worry These are known as...?

Negative metacognitive beliefs

I cannot control my worrying a. Negative metacognitive beliefs b. Positive metacognitive beliefs

a. Negative metacognitive beliefs

Worrying helps me cope a. Negative metacognitive beliefs b. Positive metacognitive beliefs

b. Positive metacognitive beliefs

If I worry I’ll be prepared a. Negative metacognitive beliefs b. Positive metacognitive beliefs

b. Positive metacognitive beliefs

Worrying will harm my mind/body a. Negative metacognitive beliefs b. Positive metacognitive beliefs

a. Negative metacognitive beliefs

Describe the findings of Sun et al (2017) meta-analysis of metacognitive beliefs in various psychological disorder

Negative Metacognitive beliefs regarding uncontrollability and danger were seen across psychological disorders

Negative Metacognitive Beliefs regarding ____ and ____ were seen across psychological disorders

1. Uncontrollability 2. Danger

_____ Metacognitive Beliefs regarding uncontrollability and danger seen across psychological disorders a. Negative b. Positive

a. Negative

Describe the findings of Capobianco et al (2020) systematic review of metacognitive beliefs in patients with physical illnesses

Negative Metacognitive Beliefs were positively associated with increased anxiety and depression across physical illnesses Even after controlling for age, gender, disease factors and cognition

Negative Metacognitive Beliefs were positively associated with ____ and _____ across physical illnesses Even after controlling for age, gender, disease factors and cognition

1. Increased anxiety 2. Increased depression

_____ Metacognitive Beliefs were positively associated with increased anxiety and depression across physical illnesses Even after controlling for age, gender, disease factors and cognition a. Negative b. Positive

a. Negative

_____ are a stronger predictor of anxiety and depression a. Negative automatic thoughts b. Schemas c. Metacognitive beliefs d. None of the above

c. Metacognitive beliefs

True or False? Metacognitive beliefs are more important than cognition

True

Describe the Metacognitive Model of Generalised Anxiety Disorder (GAD) List 5 points

1. Trigger 2. Positive meta-beliefs activated (strategy selection) - The idea that worrying is helpful 3. Type 1 worry 4. Negative meta-beliefs activated 5. Type 2 worry (meta-worry) 6. - Behaviour (e.g. Avoiding things, doing less activities associated with the worry) - Thought control - Emotion

What are the characteristics of GAD?

Uncontrollable worry

What is Type 1 worry?

Worry about social, self and world

What is Type 2 worry?

Worrying about the fact that you are worrying

Worrying about the fact that you are worrying This is known as...?

Type 2 worry

Worry about social, self and world This is known as....?

Type 1 worry

According to the Metacognitive Model of GAD, when does GAD develop?

When negative metacognitive beliefs are activated (beliefs that worrying is uncontrollable)

If you view worrying as helpful, you will use worrying as a strategy to dealing with negative thoughts What type of worrying is this?

Type 1

Belief that worrying is helpful What type of worrying is this?

Type 1

Belief that worrying is uncontrollable What type of worrying is this?

Type 2

What if I lose my place at uni? What if I can’t get a job? What if my parents get upset? What type of worrying is this?

Type 1

I could go crazy; I could lose my mind What type of worrying is this?

Type 2

Define behaviours

Control processes that maintain psychological distress, prolong maladaptive thinking, and maintain maladaptive metacognition

Control processes that maintain psychological distress, prolong maladaptive thinking, and maintain maladaptive metacognition This is known as...?

Behaviours

Behaviours are control processes that maintain ...? List 3 points

1. Psychological distress 2. Prolong maladaptive thinking 3. Maladaptive metacognition

What are the 4 types of behaviours related to (Type 2) worrying?

1. More thinking 2. Suppression of trigger thoughts 3. Reassurance seeking 4. Avoidance

What are the 5 stages of Meta-Cognitive Therapy for GAD?

1. Generate case formulation 2. Share case formulation 3. Challenge uncontrollability metabeliefs 4. Challenge danger metabeliefs (try to lose control of worry) 5. Challenge positive metabeliefs (worry modulation experiment)

Challenges schemas a. MCT b. CBT

b. CBT

Challenges metacognitive beliefs (the level above cognition) a. MCT b. CBT

a. MCT

List 5 ways MCT can challenge uncontrollability metabeliefs for GAD

1. Evidence 2. Hypotheticals 3. Worry postponement 4. Metaphors 5. Experiential exercises (free association)

Describe worry postponement

Teaching patients that they can develop control over the worrying by postponing it

Teaching patients that they can develop control over the worrying by postponing it This is known as...?

Worry postponement

Describe free association

Show patients that they have flexibility over their attention that by the time they get to the end, the first word they were asked to imagine would not be remembered

Show patients that they have flexibility over their attention that by the time they get to the end, the first word they were asked to imagine would not be remembered This is known as...?

Free association

Show patients that they have flexibility Iover their attention that by the time they get to the end, the first word they were asked to imagine would not be remembered What does this suggest?

Suggests that if you leave your thoughts alone, they tend to take care of themselves and you can move your attention around

What metaphors are used in the MCT for GAD to challenge uncontrollability metabeliefs?

e.g. Telephone; worries and negative thoughts are like a nuisance caller ringing, annoying, just want to distract you But do you have to answer the phone when they call?

e.g. Telephone; worries and negative thoughts are like a nuisance caller ringing, annoying, just want to distract you But do you have to answer the phone when they call? This is known as...?

Metaphors

Which stage of MCT for GAD does this apply to? Worry modulation experiment

Challenge positive metabeliefs

Which stage of MCT for GAD does this apply to? Try to lose control of worry

Challenge danger metabeliefs

Which stage of MCT for GAD does this apply to? Evidence, hypotheticals, worry postponement

Challenge uncontrollability metabeliefs

What is worry modulation?

Going back and forth between worrying

True or False? Dialogue within MCT is always about the content of their thoughts

False Dialogue within MCT is never about the content of their thoughts

Dialogue within MCT is never about the content of their thoughts Instead, it is about ...?

How patients are dealing with those thoughts and focus on the process and meta-level

How patients are dealing with those thoughts and focus on the process and meta-level a. CBT b. MCT

b. MCT

MCT has been evaluated systematically in 4 different types of studies What are they?

1. Case studies 2. Pilot studies 3. Uncontrolled trials 4. Randomised controlled evaluations

_____ has been evaluated systematically from case studies, to pilot studies, uncontrolled trials, and randomized controlled evaluations a. MCT b. CBT

a. MCT

Describe the results of Normann & Nexhmedin's (2018) systematic review and meta-analysis of the efficacy of metacognitive therapy List 3 points

1. 25 efficacy studies of MCT, 15 were controlled trials 2. MCT significantly more effective than waitlist (Hedges’ g = 2.06) 3. MCT significantly more effective than CBT (Hedges’ g = 0.69) and these results were maintained at follow-up(0.37)

True or False? MCT significantly more effective than waitlist

True

True or False? CBT is significantly more effective than MCT and these results were maintained at follow-up

False MCT is significantly more effective than CBT and these results were maintained at follow-up

MCT is highly effective in treating disorders of ...? List 2

1. Anxiety 2. Depression

True or False? CBT is highly effective in treating disorders of anxiety and depression and may be superior to MCT

False MCT is highly effective in treating disorders of anxiety and depression and may be superior to CBT

Treating Anxiety and Beyond Flashcards

(150 cards)