Week 10 Flashcards
What are the emotional, cognitive, behavioral and physical components of anxiety?
Emotional: fright, nervousness, anxiety
Cognitive: hypervigilance, rumination, poor concentration
Behavioral: Fight or flight behavior avoidance
Physical: muscle tension, pounding heart, dry mouth
Role of fear structures and avoidance in the development/maintenance of anxiety?
Fear activates cognitive fear structure that maintain information about the feared stumulus, fear responses and meaning of stimuli repsonses. When another stimulus is encountered that RESEMBLES the feared stimulus, fear structure is activated again. Fear structure is maintianed by avoidance behaviors that prohibit learning. Fear structure becomes pathological when relationship among stimuli, responses don’t match reality.
Theory of panic/triple vulnerability model
Panic is an acquired fear of the physical sensations, particularly sensations associated with autonomic arousal
Describe the cycle of panic attack chronicity
Fear of interoceptive cues → Catastrophic misappraisals → Ongoing distress about physical sensations → Increased anxiety → Increased physiological arousal (back to the beginning)
Difference between in vivo exposure vs. imaginal exposure vs. interoceptive exposure
- In vivo: usually graded tasks* + removal of safety signals
- Interoceptive exposure: exposure that is deliberately designed to elicit the physical symptoms that are anxiety - producing to the individual. Can induce using sodium lactate, CO2 inhalants, exercise, office chairs and cocktail straws
Advantage, if any, of combining CBT with medications?
- Older studies showed no advantage of combining medications with CBT. IN FACT, people on medications alone or meds with CBT fared worse compared to non-medicated subjcts
- Newer Studies: say it might be helpful to add paroxetine
- —–Benzodiazepines: worse outcomoes
What are components of CBT for panic? Be able to identify and briefly describe.
Treatment components
- Education : about physiological, behavioural and cognitive aspects of panic/anxiety
- Self- monitoring: of panic attacks and mood enhances self-awareness, increase accuracy of data
- Breathing retraining: unclear how important, no deemphasized
- Applied Relaxation: like PMR. Mixed evidence, but may provide a sense of control/mastery
- Cognitive Restructuring: again mixed evidence. Less effective when not combined with exposure. Targets body misappraisals, distorted thoughts “Thoughts are not facts
Theoretical mechanisms of exposure (i.e. habituation, extinction, emotional processing, self-efficacy)
Habituation
Extinction
Emotional Processing
Self Efficacy
What would treatment look like using an exposure hierarchy?
The Hierarchy
- Brainstorm external and internal stimuli that are feared and avoided
- Rate each item using the SUbjective Units of Discomfort (SUD) scale
Conduct exposures in a gradual and systematic manner
- Begin with moderately fear-provoking stimuli
- Assess patient’s fear during exposure using the SUD scale
- Address each expsure collaboratively, in a controlled and prologned manner
- Progress to a higher item after the patient shows a reduced fear response to a lower item
Eliminate Safety behavior
- To the extent possible, reduce or eliminate any unnecessary behaviors that may conribute to learning conditional, rather than unconditional, safety
Challenge cognitive distortions
- Identify probability overestimation (overpredicting low-probablility outcomes_ and catastrophizing (inflating the magnitude of aversive outcomes)
- Ask the patient to examine the evidence for and against these beliefs
- Instruct the patient to generate and practice more adaptive ways of thinking
Be able to discuss the virtual reality article: research question, treatment groups, findings, limitations?
Research Question: Is virtual reality expousure therapy more effective to in vivo exposure for social anxiety disorder
Treatment groups: participants with a principal diagnosis of social anxiety disorder who identified public speaking as their primary fear were recruited from the community. Participants were randomly assigned and completed 8 sessions of manualized virtual reality exposure therapy, exposure group therapy, or wait list.
Findings: People completing either active treatment significantly improved on all but one measure (length of speech for expsoreu group therapy and self reported fear of negative evaluation for VR exposure therapy) There were not differences between the active treatmetns on any process or outcome measure at any time, nor differences on achieving partial or full remission.
Limitations: equating two treatments delivered in different formats – VRE as an individual treatment and EGT as a group treatment. The participants EGT may have recieved a stroner “dose” of exposure than those in VRE. May not be generalizable.
What are components of CBT for panic? Be able to identify and briefly describe.
Treatment Components
Education
Education : about physiological, behavioural and cognitive aspects of panic/anxiety
What are components of CBT for panic? Be able to identify and briefly describe.
Treatment Components
Self-monitoring
Self- monitoring: of panic attacks and mood enhances self-awareness, increase accuracy of data
What are components of CBT for panic? Be able to identify and briefly describe.
Treatment Components
Breathing retraining
Breathing retraining: unclear how important, no deemphasized
What are components of CBT for panic? Be able to identify and briefly describe.
Treatment Components
Applied Relaxation
Applied Relaxation: like PMR. Mixed evidence, but may provide a sense of control/master
What are components of CBT for panic? Be able to identify and briefly describe.
Treatment Components
Cognitive Restructuring
Cognitive Restructuring: again mixed evidence. Less effective when not combined with exposure. Targets body misappraisals, distorted thoughts “Thoughts are not facts
