Week 1 Flashcards
(35 cards)
What is the role of case conceptualization? and Why is it important for treatment?
Through case conceptualization you can understand the client. This helps you also with determine which intervention is needed.
What is the Yerkes-Dodson Law?
It describes the relationship between anxiety (arousal) and performance. It says that performance often improves with increased arousal (anxiety), but only up to a point. beyond that point, too much arousal (anxiety) starts to impair performace.
The curve:
- it’s an inverted U-shaped graph
- X-axis: level of anxiety/arousal
- Y-axis: performance
- The peak shows the optimal level of arousal, where performance is at his best
- too little anxiety = under-stimulation, boredom > low performance
- too much anxiety = overwhelming stress, panic > also low performance.
- Normal fear aligns with that optimal arousal zone, where fear motivates and sharpens performance
- Abonormal fear refers to anxiety levels that are too high, pushing someone over the peak and reducing their ability to function effectively
What is important to determine when someone has a specific phobia?
You need to understand what aspect of the feared object is feared. For example a spider, you can be afraid of his speediness, sudden movements, size, skin contact, harmfulness etc.
What are anxiety disorders?
Excessive and inappropriate enaxiety that causes the individual significant impairment in functioning.
The distinction among these disorders is primarily in regard to the nature of the feared stimulus and the anxiety response produced by it.
The symptoms can not be better explained by another disorder.
Which anxiety disorders are there?
- Separation anxiety disorder
- Selective mutism
- Specific phobia
- Social anxiety disorder
- panic disorder
- Generalized anxiety disorder
- Agoraphobia
- anxiety disorder due to medical condition
- Substance/ medication-induced anxiety disorder
- Unspecified anxiety disorder
Describe the prevalence of anxiety disorders
- 9.9% of children experiences an anxiety disorder before the age of 16
- most prevalent are GAD, SAD, SOP and specific phobia
- More prevalent in girls than boys (2:1)
What causes anxiety?
- Negative experience (experienced learning)
- Modelling - you see someone else experience fear for a certain object or in a certain situation
- Informative learning - someone instructs you to fear a situation/ object
Examples:
- bullying
- parenting
- parental anxiety
- Inhibited temperament
- trauma
- coping
- self-perception
- attachment issues
- low SES
- stress
- genetic disposition
Name some causal mechanims of anxiety
- Maladaptive cognitive strategies
- Classical/operant conditioning
- Negative core beliefs
- Negative automatic thoughts
Name some protective factors of anxiety
- Effortful control
- sensitive parenting style
- secure attachment
- parental recognition of problems
- positive friendships
- mental health care
Which evidence-based interventions are there for children with anxiety?
Level 1 - best support (meest effectief)
- Cognitieve gedragstherapie (CBT) for child and parent
- Exposure en modelleren
- aandachtstraining
- psycho-educatie
- opvoedondersteuning
Level 2 - good support
- CBT in combinatie met mindfulness, oudertraining, motivational interviewing
- Sociale vaardigheden training
Level 3 - moderate support
Level 4 - minimal support
What are the most effective components within CBT? And what are the different components?
CBT uses multiple techniques:
- exposure:
– imaginal exposure
– in vivo exposure
– Done both inside and outside of therapy sessions
other CBT techniques:
- cognitive restructuring
- modeling
- psychoeducation
- relaxation
- problem solving
- Relapse prevention
‘
The effectiveness per component of CBT:
Technique Effect Size
Exposure .80 ✅ Highest impact
Relaxation .42
Cognitive techniques .38
Modeling .33
Psychoeducation (Child) .27
Therapist Praise/Rewards .25
Self-Monitoring .24
Self-Reward/Self-Praise .20
Problem Solving .17
Psychoeducation (Parent) .15
Maintenance/Relapse Prevention .13 🔽 Lowest impact
With children it is important that you first give psycho-education and then exposure. They need to built the skills first before exposure.
It is also difficult that parents often don’t want exposure for their children, because they want to protect them. And don’t like it to see their children scared.
Leg het proces van een evidence-based behandeling (CBT) uit
input > start > middle > end > outcome
- input; het kind komt met bepaalde problemen binnen
Evidence-based therapie doesn’t work for every child it depends on: type of anxiety disorder, age, IQ, comorbiditeit
- Start: beginfase van de therapie
it starts often with psycho-education: uitleg over angst en hoe therapie werkt en rapport building: vertrouwen creëren tussen kind en therapeut.
Zonder goede start is effectiviteit van latere interventies beperkt. - middle: kerninterventies
skill building and working towards exposure. Worden eerst vaardigheden geleerd hoe het kind kan omgaan met angst. Dit is ter voorbereiding op exposure. examples: gedachten uitdagen, relaxation techniques - end: afronding en nazorg
intensievere exposure en relapse prevention. Het kind leert nu zelfstandig hoe hij/zij het best met de angst kan omgaan na de therapie. - outcome: resultaat
Leg uit wat het ABC-schema is
Het model helpt de client en de therapeut inzicht te krijgen in hoe gedachten, gevoelens en gedrag samenhangen in reactie op situaties. Het wordt gebruikt om:
- inzicht te krijgen in hoe iemand reageert op stressvolle situaties
- Automatische gedachten en gedragspatronen te herkennen
- Verandering mogelijk te maken door op B of C te interveniëren
A = antecedent
- de aanleiding of trigger: een situatie, gebeurtenis of object
B = Behaviour
- Interne reactie:
1. Emotie
2. Gedachten
3. Gedrag
Deze 3 beïnvloeden elkaar
C = Consequent (resultaat)
wat gebeurde er door je gedrag?
- werd het probleem opgelost of groter?
- Werd de angst sterker of juist minder?
Ga samen na wat zou je anders kunnen denken/doen de volgende keer (cognitieve herstructurering)
What is emotive education?
it helps children to:
1. recognize and understand their own emotions
2. regulate their emotional responses
3. develop empathy for others
4. build positive relationships
5. make responsible decisions
Core components:
- self-awareness: what am I feeling and why?
- Self-regulation: how can I calm myself down when I’m upset?
- Social awareness: how does someone else feel right now?
- relationship skills: communication, cooperation, conflict resolution
Explain the CBT triangle
The CBT triangle is the interconnection between cognitions, emotions and behaviour.
Cognitions influence how we feel and act. Emotions influence what we think and how we behave. Behavior also feeds back into our emotions and thoughts. These 3 constantly interact and reinforce each other.
Explain the techniques that target the CBT triangle.
Cognitions:
- Cognitive restructuring
- Self monitoring
- MDE
Emotions;
- Emotive education
- Relaxation
- Emotive imagery
Behaviour:
- Exposure
- Assertiveness training
- Rewarding
- Roleplay
Explain the steps of cognitive restructuring
- explain the exercise
- Identification of the maladaptive thought
- Identification of the strength and impact of the thought
- Technique to challenge this thought (pie chart, court, socratic dialogue, etc.)
- Identify a more realistic/ constructive thought
- Identification of the strength and impact of the new thought
- Check the reliability of the new thought vs. old thought
The new thought has to become so strong that there is little room for the old thought.
Name some typical characteristics of forms of CBT for the treatment of anxiety
- Structured sessions: therapie is opgebouwd in duidelijk geplande sessies met vaste doelen per sessie
- Parental involvement: ouders worden actief betrokken via ouderbijeenkomsten, meegeven van opdrachten, ondersteuning bij thuis toepassen
- Psychoeducation: uitleg geven hoe de angst werkt en wat je gaat doen in therapie etc.
- De-mystification of anxiety: angst wordt onttoverd van iets engs naar iets begrijpsbaars; angst is normaal en kan veranderen.
- Fear hierarchy: samen met het kind wordt een angstladder gemaakt; van minst naar meest spannende situaties
- Cognitive components: werken aan gedachten zoals herkennen van negatieve gedachten en het uitdagen en vervangen van deze gedachten
- Relaxation components: aanleren van ontspanningstechnieken: diepe buikademhaling, spierontspanning, mindfulness
- Exposure components: geleidelijke blootstelling aan angstsituaties.
Leg de CBT techniek ‘coping cat’ uit.
Coping Cat is een gestructureerd behandelprotocol dat kinderen helpt om:
1. Hun angst te begrijpen
2. Angstige gedachten te herkennen en uitdagen
3. Nieuwe, helpende vaardigheden aan te leren
4. Geleidelijk en veilig om te gaan met spannende situaties (exposure)
ZIE AFBEELDING voor de FEAR-stappen.
What is depressive mood?
The inability to experience fun or feel good general feeling of disinterest and loss of motivation.
Mood problems have an signal function for your surroundings. But when they do become too intense, people are likely to isolate themselves from friends and family so they don’t get comforted anymore, the signal isn’t signaling to someone. People with intense mood problems feel ashamed and guilty.
mood problems often involve:
- depressive feelings
- Saddness
- feeling empty; emptiness is one of the worst feelings I know. Because you just feel nothing. Not anything at all. And that’s even worse than feeling bad, sad or shattered. It’s just so much better to really feel.
- Miserable
- Gloomy
- blue
- unhappy
Are mood problems part of normal development?
Feelings such as sadness, loneliness, bereavement etc. are part of normal life, just as much as anxiety is. These emotions or feelings can be problematic if:
- intensity is high
- Duration is long
- Impairment is significant
What is meant by depressive disorders
Disruptive mood dysregulation disorder, major depressive disorder (including major depressive episode), persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, substance/medication- induced depressive disorder, depressive disorder due to another medical
condition, other specified depressive disorder, and unspecified depressive disorder.
Describe major depressive disorder
Five (or more) symptoms present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
- Depressed mood (Note: In children and adolescents, can be irritable mood.)
- Markedly diminished interest or pleasure
- Significant weight loss when not dieting or weight gain (Note: In children, consider failure to make expected weight gain.)
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day.
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt.
- Diminished ability to think or concentrate, or indecisiveness.
- Recurrent thoughts of death (not just fear of dying.
Clinically significant distress or impairment in social, occupational, or other important areas of functioning
Descrive persistent depressive disorder
This disorder represents a consolidation of DSM-IV-defined chronic major depressive disorder and dysthymic disorder.
- Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
- Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
- Presence, while depressed, of two (or more) of the following:
— Poor appetite or overeating.
— Insomnia or hypersomnia.
— Low energy or fatigue.
— Low self-esteem.
— Poor concentration or difficulty making decisions.
— Feelings of hopelessness.
- During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.
- Criteria for a major depressive disorder may be continuously present for 2 years.
- There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
- The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
- The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. , hypothyroidism).
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
