Anxiety

How do types of anxiety develop through age?

Separation anxiety → specific phobia → generalised anxiety → social phobia → agoraphobia → panic

What are the four components of behavioural inhibition?

• Fear of Novelty (fear or cautiousness in new or unfamiliar situations

• Withdrawal (Quietness, shyness or retreat in novel social settings

• Physiological reactivity (heightened physiological responses in response to novel stimuli

• Consistency over time

What is behavioural inhibition?

A risk factor for development of anxiety disorders, especially in children

How can behavioural inhibition develop into anxiety?

• wrong parenting context (parent responding differently compared to a sibling that isn’t inhibited- either frustration or more anxious themselves over child’s clinginess)

• Hudson & Rapee model: genes influence vulnerability and if child has anxious parent; parent anxiety both genetical and environmental factor

• Anxious parents more likely to support avoidance (‘come here’, ‘stay away’, ‘be careful’)

Heritability factors of anxiety disorders?

• Mutation of the 5-HTTLPR gene related to reduction u=in serotonin activity and increase in anxiety-related traits

• Genes associated with GABA system

• Genes associated with Corticotropin-releasing hormones (CRH)

• Genes associated with brain-derived neuro-tropic factor (BDNF)

According to Gregory & Eley (2007), what % of the variance in anxiety is due to genes?

30%

What do studies on attention bias and anxiety disorders find?

Attentional bias in anxiety groups opposed to non-anxiety groups when processing threat related information

What info is there about anxiety disorders and interpretation bias?

• Consistent evidence for a negative interpretation bias in anxious adults

• relationship b/t interpretation bias and anxiety in children, moderated by match b/t anxiety type and scenario content

What is cognitive bias medication (CBM)?

Attempts to change how people interpret ambiguous situations and encourages people to interpret ambiguity in non-negative way

Been found to decrease anxiety and positive training decreased negative affect

How does overly controlling parenting affect anxiety?

De Wilde & Rapee (2008): mothers of children aged 7-13 asked to be overly controlling or minimally controlling during a speech prep task→ overly controlled children showed greater anxiety

Transgenerational transition of anxiety?

Murray et al. (2008): infants who were behaviourally inhibited and had mothers with social phobia showed increased avoidance of stranger even when stranger’s approach was gradual

CBT approach to anxiety?

Premise that negative thoughts, beliefs, and behaviours contribute to maintenance of anxiety.

Aims to help individuals identify and challenge thoughts and learn coping strategies

Highly effective in reducing anxiety symptoms and preventing relapse

What are the key components of CBT for anxiety?

• Psychoeducation of child and caregivers

• Managing somatic reactions (e.g. relaxation training, breathing exercises)

• Cognitive restructuring

• Problem-solving

• Systematic exposure to feared situations or stimuli

• Relapse prevention plans

Pharmacotherapy for anxiety?

SSRIs: increasing serotonin levels in brain to help regulate mood and anxiety

SNRIs: Used to treat anxiety disorders- increase serotonin and norepinephrine

Benzodiazepines: short term or acute relief of anxiety symptoms (generally avoided for long term) and reduce physical symptoms- don’t address cognitive or behavioural patterns of anxiety

Buspirone: anxiolytic often prescribed for general anxiety disorder and considered safer long term alternative to benzodiazepines

Beta-blockers: control physical symptoms of anxiety in specific situations like public speaking

Mindfulness and relaxation techniques for anxiety?

Mindfulness-based stress reduction: teaching mindfulness meditation practices to help individuals become more aware of their thoughts and feelings without being overwhelmed

Mindfulness-based cognitive therapy: combines mindfulness with cognitive therapy to help break cycle of negative thinking- effective for preventing relapse

Relaxation techniques: progressive muscle relaxation, deep breathing exercises, guided imagery helps manage physiological symptoms, esp. in context of panic attacks or acute anxiety episodes

Exposure-based therapies for anxiety?

Especially effective for treating specific phobias and ptsd:

Graduated exposure: gradually exposed to feared stimuli, starting with less anxiety-provoking scenarios working up to more challenging situations- helps reduce avoidance behaviour and promotes habituation to anxiety

VR exposure therapy: safely experience simulated scenarios in a controlled setting

Why is CBT not the most effective for children with anxiety?

• Group nature more aversive for children

• Long standing nature of disorder

• Challenging condition for relationship b/t child and therapist

• More likely to experience negative feedback from others

What are the NICE guidance for treatment of anxiety?

• Delivered by competent practitioners

• psychological treatments: based on manuals

• high-quality supervision

• use routine sessional outcome measures

• monitoring and eval. of treatment adherence and practitioner competence

NICE guidance for CBT for children?

• 8-12 sessions; 45 mins (90 mins for group)

• psychoeducation, exposure to feared or avoided social situations, training in social skills

• psychoeducation and skills training for parents to promote and reinforce child’s exposure to feared or avoided social situations and development of skills

CBT vs Medication for childhood anxiety

• CBT reduced primary anxiety symptoms more than fluoxetine

• Combo of sertraline and CBT sig. reduced clinician-reported primary anxiety symptoms and response more than either treatment alone