11. anxiety and obsessive-compulsive disorders

3 core components of the interpersonal theory of suicide + describe

• thwarted belongingness - indiv feels like they don’t belong, lack social connection, and are isolated

• perceived burdensomeness - indiv feels like a burden to others and that they are worth more dead than they are alive

• acquired capability for suicide - fearlessness about death/suicide and access to means to carry it out

what does overlap between thwarted belongingness and perceived burdensomeness indicate? what about all 3?

desire for suicide

suicide attempt

how does anxiety lead to depression?

anxiety → avoidance → life shirks → depression → hopelessness → suicidal ideation

separation anxiety (SAD) - peak/onset age, classic fear/worry, prevalence, key treatments

7-8 yrs

being away from parents/home; school refusal

4-10%

CBT + parent training

specific phobia - peak/onset age, classic fear/worry, prevalence, key treatments

7-9 yrs

animals, blood, etc; avoidance + tantrums

~20%

exposure/graduated

social anxiety disorder - peak/onset age, classic fear/worry, prevalence, key treatments

early-mid adolescence

embarrassment in front of peers

6-12% lifetime, girls 2x

CBT (group best)

generalized anxiety disorder (GAD) - peak/onset age, classic fear/worry, prevalence, key treatments

early adolescence

excessive worry abt everything minor accompanied by at least one somatic symptom

~2-5%, equal boys/girls

coping cat CBT

describe the 3 interrelated anxiety response systems

• physical system - brain sends messages to the sympathetic nervous system, fight/flight response

• cognitive system - activation leads to feelings of apprehension, nervousness, difficulty, concentrating, and panic

• behavioral system - aggression is coupled w a desire to escape the threatening situation

anxiety

future-oriented mood state that can occur in absence of realistic danger

fear

present-oriented emotional reaction that occurs in the face of a current danger and is marked by a strong escape tendency

panic

a group of physical symptoms of fight/flight response, unexpectedly occurs in the absence of obvious danger or threat

examples of cognitive errors and biases in anxiety disorders

• perceptions of threats activate danger-confirming thoughts

• children w conduct problems select aggressive solutions in response to a perceived threat

• see themselves as having less control over anxiety-related events than other children

negative affectivity

persistent negative mood is related to both anxiety and depression

positive affectivity

persistent positive mood is negatively correlated w depression, but is independent of anxiety

classical psychoanalytic theory of anxiety

anxieties and phobias are seen as defenses against unconscious conflicts rooted in the child’s early upbringing

behavioral and learning theories + name a specific one

fears and anxieties learned thru classical conditioning and maintained thru operant conditioning - two-factor theory

attachment theory

fearfulness is biologically rooted in the emotional attachment needed for survival

BI temperament

a low threshold for novel and unexpected stimuli, which places an indiv at greater risk for anxiety disorders

which behavioral system is overactive in anxiety disorders?

behavioral inhibition system (BIS)

what is the primary neurotransmitter system implicated in anxiety disorders?

GABA-ergic system

parenting practices of anxious children

parents of anxious children are seen as overinvolved, intrusive, or limiting child’s independence

behavior therapy

main technique is exposure to feared stimulus while providing children w ways of coping other than escape and avoidance

graded exposure + type of therapy

child is exposed to each situation they find distressing, beginning w the least distressing and moving up the hierarchy

behavior therapy

what type of test does graded exposure use to rank fears?

Subjective Units of Distress Scale (SUDS)/fear thermometer

systematic desensitization + type of therapy

3 steps

• teach the child to relax

• construct an anxiety hierarchy

• present the anxiety-provoking stimuli sequentially while the child remains relaxed

behavior therapy

flooding + type of therapy

exposure is carried out in prolonged and repeated doses (massed exposure), and the child remains in the anxiety-provoking situation until anxiety lvls diminish

behavior therapy

response prevention + type of therapy

prevents child from engaging in escaping or avoidance stimuli

participant modeling and reinforced practice + type of therapy

participant modeling - therapist models desired behavior (e.g., approaching the feared object)

reinforced practice - therapist guides child in practicing this behavior and reinforces the child’s efforts

behavior therapy

what is the most effective procedure for treating most anxiety disorders?

CBT

coping cat + type of treatment

directed at decreasing negative thinking, increasing active problem solving, and providing the child w a functional coping outlook

CBT

FEAR plan

F = feeling frightened? (recognize physical symptoms of anxiety)

E = expecting bad things to happen? (recognize anxious cognitions)

A = attitudes and actions that will help (coping self-talk and behavior to use when anxious)
R = results and rewards (evaluating performance and administering self-reward for effort

behavior lens principle

states that child psychopathology reflects a mix of actual child behavior and the lens through which it’s viewed by others in a child’s culture