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Studieboek - Anxiety disorders

32 important questions on Studieboek - Anxiety disorders

In what way is the anxiety response normal?

It is a normal, vital, largely unconscious reaction to threat: when we perceive danger, our body creates the fight, flight, or freeze response.

What is important for clients to realize about fear being a normal reaction?

That the anxiety response is fundamentally normal, but it has become exaggerated so that it is no longer working well for them. Therefore, the goal of therapy is not to eliminate the response, but to manage it

In what ways can pathological fear arise that can happen in the same person? (2)

1. The risk is overestimated
2. The ability to cope is underestimated

Why is the term 'perceived threat' often used?

Because two people in the same situation can perceive their physiological responses in different ways

What is the healthy linear process of dealing with anxiety? (5)

1. Trigger
2. Perceived threat
3. Anxiety response
4. Succesful coping reaction
5. Resolution of anxiety

What is the unhealthy process of dealing with anxiety? (6)

1. Trigger
2. Perceived threat
3. Exaggerated or inappropriate anxiety response
4. Unhelpful coping reaction
5. Strategy does not fully resolve the situation
6. Anxiety remains active or latent, which adds up to the perceived threat

What are normal psychological symptoms of anxiety and what symptom mirrors this in an anxiety disorder? (3)

1. Sense of threat - overestimation of threat or underestimation to cope
2. Apprehension - fear of losing control, going crazy or of suffering from health problems (continuous checking)
3. Temporarily exaggerated thinking - habitual exaggeration thinking (catastrophizing/selective attention/all or nothing)

What are normal physical symptoms of anxiety and what symptom mirrors this in an anxiety disorder? (6)

1. Increased heart rate - palpitations
2. Muscular tension - fatigue/trembling/muscular pain
3. Increased breathing - dizziness/light-headedness/de-realization/de-personalization
4. Changes in the digestive system - nausea/urge to go to the lavatory
5. Changes in blood circulation - blushing/paleness/unpleasant skin sensations
6. Increased sweating - excessive sweating

How can panic disorder be described?

There is a repeated experience of panic attacks. The symptoms are often experienced as terrifying and are misinterpreted as signs of impending or current ill health. Can occur with or without agoraphobia.

What is the difference between panic disorder and hypochondriasis?

That the concerns and preoccupations are more chronic

What is the difference between somatic symptom disorder and illness anxiety disorder?

In the first, the client worries about chronic somatic symptoms, while in the latter the clients experiences heightened somatic sensations and intense anxiety about the possibility of an undiagnosed illness

How can a social phobia be described?

There is a marked and persistent fear of social or performance situations in which a person feels scrutinized by others and fears embarrassment or humiliation. The fear is restricted to social situations and focused on physical symptoms and behavioral performance. Avoidance is a common coping strategy, which helps to maintain the problem, or because symptoms impair performance.

How can generalized anxiety disorder (GAD) be described?

Having persistent and excessive worries, fears, and negative thoughts about the future leads to distress and/or impairment. It is often associated with irritability, muscle tension and sleep problems

How can obsessive-compulsive disorder (OCD) be described?

Having recurrent obsessions and/or compulsions. Even though sufferers realize their fear is unfounded, they are compelled to act.

What is acute stress disorder (ASD)?

When somebody, in the first four weeks after a traumatic event, experience anxiety symptoms, have a sense of re-experiencing the event, and have a marked avoidance of stimuli that trigger recollections of the trauma. Noteworthy is that the majority of ASD cases remit naturally.

How can post-traumatic stress disorder be described?

When an event is deemed seriously threatening to oneself or others, an enduring sense of danger can persist (also shame, disgust, or anger). Symptoms include intrusive memories, avoidance, negative cognitions and mood, and hyperarousal.

What are the processes that maintain distorted beliefs about the (irrational) dangerousness of certain situations

1. Safety-seeking behaviors
2. Focus of attention
3. Spontaneous imagery
4. Emotional reasoning
5. Memory processes
6. Interpretation of reactions to a threat event (exaggerated conclusions and prolonged worrying - distracting)

When are safety-seeking behaviors dysfunctional?

If the outcome is interpreted as only coming about because of the behavior, the person cannot develop the confidence of being able to apply functional coping

In what way can the way in which attention is being focused become dysfunctional?

Increased focus of attention emphasizes the fear, whereas attention directed away results in the fears not being faced, thus making it impossible to review and test the beliefs

In what way is emotional reasoning seen as a maintaining process?

Emotional reasoning refers to the process that 'if I feel it, then it must be so.' This is why anxious clients rate situations as more dangerous than control subjects

In what way can memory processes be seen as maintaining processes?

Distortions of memory like selective recall can account for the perpetuation of anxiety. Anxious people tend to have a more negative or traumatic recall of their own past experiences. This also prevents from seeing the bigger, more balanced picture.

What are the steps in treatment for anxiety in order to break the general maintenance cycle? (5)

1. Trigger
2. Accurately perceived threat
3. Alternative response: behavioral experiment
4. Fear is managed: experience of coping
5. Old belief changes to a realistic belief (cycle is disrupted)

How can the cycle be broken by tackling fears? (2)

1. Reducing safety-seeking behaviors and using increasingly challenging BEs
2. Help the client question their fear beliefs by an initial cognitive emphasis by data-gathering

What are important things to consider when thinking about which intervention to use? (4)

1. Match the relevant components of the maintenance cycle with the techniques accordingly
2. Physical strategies are useful when the physical consequences of being anxious impair performance or when the physical activity becomes aversive or is avoided
3. Behavioral strategies are good in tackling avoidance and can be used in self-monitoring and planning, as well as activity scheduling
4. Cognitive approaches are relevant for helping clients 'stand back' from their problems to (re-)evaluate various (unhelpful) perspectives

What are specific problems when working with anxious clients? (7)

1. Self-fulfilling prophecies: cognitive (anxiety might impair clear thinking)
2. Self-fulfilling prophecies: physical (physical effects can impair performance)
3. The power of avoidance
4. 'I am anxious all of the time'
5. 'I do all the things that we agree, and my anxiety does not decrease'
6. Not actually facing the fear (applies to both the therapist and the client)
7. Reliance on medication to manage anxiety (low motivation to engage in CBT strategies)

How can the cognitive self-fulfilling prophecy be countered?

Graded approach to facing difficult situations, backed up by strategies to reduce stress levels can help clients to manage anxiety levels, thus bettering the ability to think clearly.

How can the physical self-fulfilling prophecy be tackled?

By self-calming strategies followed by facilitating clients through a series of graded and systematic BEs to build a body of positive data

What strategies can be done to counteract avoidance? (4)

1. Thorough questioning to clarify the complexities of avoidance
2. Encourage self-monitoring, including monitoring of long-term consequences
3. Sharing a formulation in which the disadvantages of avoidance are clearly illustrated
4. Negotiate a graded reduction in use of avoidance

How can the thought of 'I am anxious all of the time' be tackled?

The statement rarely stands up to self-monitoring: daily thought records and activity grids can reveal variations in physical tension and visual intrusion. It can be used to establish patterns and correlates and ultimately to manage them

How can the thought of 'I do all the things that we agree, and my anxiety does not decrease' be tackled? (3)

1. Look for subtle forms of avoidance and safety-seeking behaviors
2. Consider the rate at which the feared situation is faced
3. Check if others are helping to maintain the problem

How can the problem of the client not actually facing their fears be tackled? (2)

1. Ensure that the client does not equate feeling anxious with failing or mental/physical threat, and that the feeling is to be expected during a BE
2. Ensure a shared rationale that makes clear the advantages of tolerating the discomfort of the task and address unhelpful assumptions concerning BEs

How can the problem of the client relying too much on medication to manage anxiety be managed?

Explore assumptions about drugs and CBT and engage them in BEs if necessary to develop more confidence in the psychological approach

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Positive Clinical Psychology

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