Quiz 5
What are 2 types of settings/situations involved in agoraphobia? What is the source of perceived threat for a person with agoraphobia? Note the strategies of avoidance, companion, or endurance. What is meant by "panic-like symptoms"?
Two or more of the following situations: using public transportation, being in open spaces, being in enclosed places, standing in line or being in a crowd, or being outside of the home alone. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. "Panic-like symptoms" refer to any of the 13 symptoms included in the criteria for panic attack, such as dizziness, faintness, and fear of dying.
When is a diagnosis of substance/medication-induced anxiety disorder given? (p. 226) (See "Associated Features" p. 228-9). When does "anxiety disorder due to another medical condition" apply?
When panic attacks or anxiety is predominant in the clinical picture and there is evidence from the history, physical examination, or laboratory findings of both 1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication and 2. The involved substance/medication is capable of producing the symptoms in Criterion A. "Anxiety disorder due to another medical condition" applies when there is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
What are some of the major symptoms of a panic attack? How many symptoms are required? How quickly does it reach its peak? When are panic attacks used as a specifier?
An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur: Palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea; dizzy & light-headed; chills or heat sensations; paresthesias; derealization or depersonalization; losing control or "going crazy"; fear of dying. Used as specifier when the presence of a panic attack is identified (and is coded with the other mental disorder or medical condition); not used for panic disorder.
What is the most effective treatment for GAD? What are a couple of cognitive and behavioral components?
CBT is the most effective treatment for GAD. This approach requires good therapist-client collaboration and emphasizes an inductive/Socratic method of teaching in which questions are the primary form of intervention. Between session assignments are also important to reinforce new skills. Cognitive restructuring and reducing symptoms of anxiety by increasing relaxation techniques as well as, to be effective, treatment must also address affective and interpersonal deficits. Focus on interpersonal problems with a focus on how the client contributes to maintaining maladaptive schemas. Emotional processing and exposure to feared stimuli should be included in the treatment plan and in many cases will probably be related to feared emotional processing
What is the treatment of choice for panic disorder? What is involved in psychoeducation, interoceptive exposure, and cognitive restructuring?
Cognitive behavioral therapy has become the treatment of choice for panic disorder. Psychoeducation about what is "normal" is an important first step in the treatment process. Reducing the misinterpretation of certain bodily sensations is part of CBT for panic disorder. Interoceptive exposure has been found to be an effective component of CBT for the treatment of panic disorder. (e.g. - creating panic-like sensations by spinning in a chair, rapid breathing, brisk exercise, breathing through a straw). The reduction of catastrophic cognitions results in a reduction of symptoms in the majority of cases.
What is involved in a specific phobia (Criteria A)? Examples? How do the terms "almost always," "actively avoided or endured," and "out of proportion" apply? Duration?
Criteria A: Marked fear or anxiety about a specific object or situation (e.g. flying, heights, animals, receiving an injection, seeing blood). The phobic object almost always provokes immediate fear or anxiety. The phobic object or situation is actively avoided or endured with intense fear or anxiety. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context. Lasts 6 months or more.
What are the first 2 DSM criteria for social anxiety disorder (social phobia)? Note the terms "almost always," "avoided/endured," and "out of proportion." What is the "performance only" specifier?
Criteria A: Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions, being observed, and performing in front of others. Criteria B: The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e. will be humiliating or embarrassing) Criteria C: The social situations almost always provoke fear or anxiety. Criteria D: The social situations are avoided or endured with intense fear or anxiety. Criteria E: The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context. Performance only specifier if the fear is restricted to speaking or performing in public.
Differentiate between expected and unexpected panic attacks.
Expected panic attacks are attacks for which there is an obvious cue or trigger, such as situations in which panic attacks have typically occurred. Unexpected panic attacks are those for which there is no obvious cue or trigger at the time of occurrence.
What are the most effective treatment approaches for phobias? What are some common components of exposure based treatments (e.g., use of hierarchy, relaxation)? Are extended 3-hour sessions useful?
Exposure-based interventions are the most effective treatment approaches for specific phobias, which are the most treatable of all anxiety disorders. For exposure based treatments: creation with the client of a fear hierarchy, a list of 10 feared stimuli related to the phobia. Then, this list is rated on a scale of 1 to 100 for the level of fear it evokes. Imaginal or in vivo desensitization is then used to lessen the fear. First, relaxation techniques are taught, or any behavior that is incompatible with fear. Then, one item at a time is presented, with the least-feared stimulus first, while the client is instructed to use relaxation skills to reduce the anxiety to a manageable level for that item. In this way, the entire hierarchy of feared stimuli is presented, one at a time, until the anxiety connected to that item is reduced. For some specific phobias, one extended 3-hour session can be as effective as five sessions of exposure.
How can therapists help by "normalizing," reassuring, and providing psychoeducation?
Individuals with anxiety and panic disorders usually have a history of unsuccessful attempts to reduce their anxiety and control the panic attacks. They may feel angry at having this problem, defeated from multiple unsuccessful attempts at treatment. Normalizing these reactions as well as reassuring clients that treatment can be effective can help provide motivation to engage in yet another treatment. Psychoeducation about the symptoms and treatment is often a good first step. Psychoeducation is helpful because people who understand the physiology of a panic attack are less likely to be terrified when another occurs.
What is the concern about the use of medication in treating phobias and other anxiety disorders?
Medication is not usually indicated in the treatment of specific phobia because its use reduces the person's ability to benefit from exposure-based treatment. Can prevent the person's anxiety from reaching the level necessary for them to benefit from the treatment.
How common are panic attacks? How many people meet the criteria for panic disorder?
Panic attacks are very common, the 12-month prevalence rate in the United States is over 12% of the adult population, and it has been estimated that as many as 50% of adults will experience at least one panic attack in their lifetime.
Why is it important to involve parents in the treatment of children with separation anxiety disorder? What therapeutic intervention is the "treatment of choice" for childhood anxiety disorders?
Parental involvement in treatment of children with mental disorders usually increases treatment efficacy. [Interventions for children that also involve parents tended to reduce anxiety and have other important benefits.] Cognitive behavioral therapy is the treatment of choice for childhood anxiety disorders.
How treatable are specific phobias compared to other anxiety disorders?
Prognosis for specific phobia is the best of any anxiety disorders, with 70 to 85% of people experiencing significant improvement.
Are the panic attacks in panic disorder expected or unexpected? Is one attack sufficient? In addition to panic attacks, what else has to occur for 1 or more months (Criterion B)? What has to be "ruled out" to arrive at the diagnosis of panic disorder (Criterion D)?
Recurrent panic attacks are unexpected. The term recurrent means more than one. Criteria B: At least one of the attacks has been followed by 1 month (or more) of one or both of the following: 1. Persistent concern or worry about additional panic attacks or their consequences (losing control, "going crazy"). 2. A significant maladaptive change in behavior related to the attacks (behaviors to avoid having panic attacks). Criteria D: The disturbance is not attributable to the physiological effects of a substance or another medical condition.
How common is social anxiety disorder?
Social anxiety disorder affects about 6.8 million adult Americans and is the third most common mental condition after depression and alcohol use disorder.
What are a couple of psychoactive substances that can produce panic attacks?
Stimulants (cocaine, amphetamines, caffeine), cannabis, or withdrawal from depressants (alcohol, barbiturates)
What are characteristics of generalized anxiety disorder? (p. 222) How does this diagnosis seem different from specific phobia or social anxiety disorder?
The essential feature of generalized anxiety disorder is excessive anxiety and worry (occurring more days than not for at least 6 months) about a number of events or activities. Different because involves negative evaluation in social anxiety disorder (social phobia) or fear of social situations where individual is exposed to scrutiny by others // specific phobia involves a specific object or situation.
What is the essential feature of separation anxiety disorder? What is the necessary duration of symptoms?
The essential feature of separation anxiety disorder is excessive fear or anxiety concerning separation from home or attachment figures. The anxiety exceeds what may be expected given the person's developmental level. Lasting 4 weeks in children and adolescents and typically 6 months or more in adults.
What are a couple of preferred characteristics of a therapist working with social anxiety disorder? Describe the components of the treatment plan for social anxiety disorder.
Working with such clients requires empathy, collaboration, and care not to appear critical or rejecting. Therapists may need to slow down the process, examine their own beliefs about change, and praise clients for their efforts and progress. Treatment generally consists of 12 to 20 weeks of treatment and includes the following components: · Psychoeducation about the cause and onset and maintenance of fears in social anxiety disorder · Exposure to gradually more fearful situations · Cognitive restructuring to recognize and self-manage troublesome thoughts · Between session assignments