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The different components of stress:
Triple Response Model (Lange, 1968)
- Cognitive
- Motor Variables
- Physiological
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Theory on how fear is developed:
Cognitive-Behavioral Theory
- Genetic Predisposition - Evolution (Seligman)
- Respondent Conditioning (Watson)
- 2 Factor Theory (Mowrer)
- Social Learning (Rachman)
- Information Transmission (Rachman)
- Maladaptive Thoughts (Beck)
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Theory on fear being developed:
Genetic Predisposition - Evolution (Seligman)
Some people are "biologically more anxious" than others.
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Theory on fear being developed:
Respondent Conditioning (Watson)
The Little Albert experiment
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Theory on fear being developed:
2 - Factor Theory (Mowrer)
- 1 factor is respondent conditioning (how the fear is developed)
- 2 factors is the reason fears are maintained: Skinner's operant conditioning (it is reinforced)
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Theory on fear being developed:
Social learning (Rachman)
Modelling from adults or watching other people
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Theory on fear being developed:
Information Transmission (Rachman)
Other people tell you what to be afraid of
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Theory on fear being developed:
Maladaptive Thoughts (Beck)
Chaning irrational/distorted thoughts.
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Common examples of Specific Phobia in Youth
- Small Animals (dogs, cats)
- Darkness
- Thunder/lightning
- Injections
- Loud noises
- Sleeping aline (that is not S.A.D.)
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Common examples of Obsessions in Youth
- Germs/contamination
- Fear of harm: to self & to others
- Scrupulosity: excessive religiosity, scrutiny of one's thoughts
- Forbidden thoughts: aggressive, sexual
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Common examples of Compulsions in Youth
- Washing/cleaning
- Repeating/redoing
- Checking
- Touching
- Counting
- Ordering/arranging
- Hoarding
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Prevalence Rates in Youth
- SAD 8% Females Ch
- GAD 8% Equal Adl
- Spfc. Phobia 6% Equal Both Ch & Adl
- Panic Dis. 5% Females Adl
- SAD 4% Equal Adl
- OCD 2% Males Adl
- PTSD 2% Females Adl
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Assessing Anxiety Disorder for Children:
- Structured Interviews
- Questionnaires (Self-Report)
- Observations
- Anxiety Self-Monitoring
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Assessment for Anxiety: Interviews
- Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS)
- Anxiety Disorders Interview Schedule (ADIS)
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Assessment for Anxiety: Questionnaires (Self-Report)
- Fear Survey Schedule for Children - Revised
- Revised Children's Manifest Anxiety Scale (RCMAS)
- Multidimentsional Anxiety Scale for Children (MASC):
- - Physical Symptom (Tense/Restless; Somatic/Autonomic)
- - Harm Avoidance (Perfectionism; Anxious Coping)
- - Social Anxiety (Humiliation/Rejection; Performing in Public)
- - Separation/Panic
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Assessment for Anxiety: Observations
- Behavioral Avoidance Test:
- - Fairly flexible
- - Confront feared object/situation for up to 5 min
- - Measure time or distance
- - Use a fear thermometer
The idea is to expose the child to the feared object, then you observe and measure it: how lng are they willing to hold it, are they getting better overtime or not. It is not a structured test.
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Assessment for Anxiety: Self-Monitoring
- Daily Diary -- THEY WOULD DO IT!
- -- Time, situation, what you did, thoughts, how afraid (0-10)
- -- Must "self" child on diary
- for kids: set up a rewards program for them to do.
- usually commonly done with adolescents than little children.
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Well-Establised for Traumatic Events in Children
Trauma-Focused CBT (TF-CBT)
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Probably Efficacious for Traumatic Events in Children
School-Based CBT
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Well-Establised for OCD in Children
None
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Probably Effucacious for OCD in Children
- CBT (exposure-based)
- CBT (exposure-based with SSRI-sertraline)
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Well-Establised for Phobic and [most] Anxiety Disorders in Children
None
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Probably efficacious for Phobic and [most] Anxiety Disorders
- CBT (individual)
- CBT (group)
- CBT (group with parents)
- CBT (group) for social phobia
- Social Effectiveness Training for Social Phobia
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Basic "Core Four" Components (Chorpita, 2007)
- Fear Hierarchy : Create a fear ladder
- Education : Learning about anxiety
- Practice : Exposure
- Relapse Prevention : Maintenance
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Make an example Fear Ladder!
- younger, older,
- vary by time
- vary by intensity
- imagine / actually doing it
- picture / toy thing / real thing
- jarak
- phone call / talk
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Learning about Anxiety for Children and Parents
- Parts of anxiety = feelings, thoughts, actions
- everyone has anxiety
- Anxiety = alarm with stages
- stage 1 = warning that danger might be coming (yellow light)
- stage 2 = warning that danger is here (red light)
- Some anxiety is good (protect us)
- Some anxiety is bad (false alarm)
- Goal is to help manage false alarms
- You can test to see if your fears are false alarms with practice
- Practice can be gradual
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Exposure (practice) possibilities
- Systematic Desensitization: In vivo (in real life), imaginal, virtual reality
- Participant Modeling
- Flooding
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Disorder -- Exposure: Panic Disorder
"Interoceptive Exposure"
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Disorder -- Exposure: Agoraphobia
Places
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Disorder -- Exposure: Specific Phobia
Object / Situation
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Disorder -- Exposure : PTSD
Related Stimuli
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Disorder -- Exposure : OCD
"Exposure with Response Prevention"
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Disorder -- Exposure : GAD
- "Worry Chair"
- -- setting aside a time to worry, and that is the only time allowed to worry.
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Disorder -- Exposure: Social Phobia
Social situations
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Disorder -- Exposure: Separation
Seperating
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Disorder -- Exposure: Mutism
Speaking
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Maintenance and relapse prevention for Anxiety Interventions
- Praise accomplishements in therapy
- Make connection between gains and practice
- Emphasize the need for "continued exposure in everyday life"
- Discuss "lapse" vs. "relapse"
- Gradually decrease sessions
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Additional possible components for Youth
- Cognitive Restructuring : Probability Overestimation, Catastrophic Thinking
- Social Skills : Meeting New People, NonVerbal Communication
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Additional possible components for Parent
- Active ignoring to decrease attention for fearful behavior
- Increase praise for brave behavior
- Rewards to increase motivation
- Time-Out when disruptive behaviors interfere
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Additional possible components for Parent
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