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Anxiety Disorder
more than a normal amount of reaction; more intense, more persistent and maladaptive
-must cause sig distress, hurts socially & academically
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What is Anxiety
The real or percieved normal reaction to threat
-normal to have anxiety
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Triple Response Model Components
- Cognitive
- Motor Variables
- Physiological
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Triple Response Model:
Cognitive
Fear related thoughts.
ex. easter bunny = scary, breaking into house and may steal you
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Triple Response Model:
Motor Variables
"fight or flight" when youre scared you either run or stay and fight or freeze ("play dead")
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Triple Response Model:
Physiological
activation of the sympthathetic nervous system.
ie. sweating, increase in heart ratem blood pressure, shake, plams & feet get colder(blood rushes toward center), dry mouth, butterflies
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Cognitive-Behavioral Theory: Pathways to fear
- -Genetic predisposition (Seligman)
- -Respondent Conditioning (Watson)
- -2-factor theory (Mowrer)
- -Social Learning (Rachman)
- -Information Transmission (Rachman)
- -Maladaptive thoughts (Beck)
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Cognitive-Behavioral Theory: Pathways to fear
Respondent Conditioning
- How fears are developed in the first place
- ex. little albert
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Cognitive-Behavioral Theory: Pathways to fear:
2-Factor Theory
- How fears are maintained.
- ex. operant conditioning. Fearful behaviors are rienforced
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Cognitive-Behavioral Theory: Pathways to fear:
Social Learning
Watching and learning fear through social modeling
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Cognitive-Behavioral Theory: Pathways to fear:
Information Transmission
- Other people telling you to be scared.
- ex. a snake head shaped like a diamond is poisonious
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Cognitive-Behavioral Theory: Pathways to fear:
Maladaptive Thoughts
Cognitive Theories. Thoughts make the anxiety more extreme. Distorted anxiety can lead to more intense anxiety.
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What are Panic Attacks?
NOT a disorder.
- Discrete period of intense fear/discomfort when 4+ of these occured w/in 10 minutes:
- increased heart rate, sweating, trembling, shortness of breath, feeling of choking, chest pain, nausea, feeling dizzy, de-realization, fear of dying, fear of losing control, numbness, chills or hot flashes
- *Physiological symptoms taking over your body
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Panic Disorder
- -recurrect UNEXPECTED panic attacks.
- -one of the attacks followed by one month of one of these...concern about additional attacks, worry about attacks implications, sig. change in behavior
- -with or w/o agoraphobia
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Agoraphobia
- NOT a disorder, but a specific phobia
- -anxiety about places in general from which escape may be difficult. (ie. crowds, lines, bridges)
- -situations are avoided or endued with distress(or dont go)
- **you can diagnose agoraphobia w/o history of panic disorder
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Specific Phobia
- -fear cued by specific object or situation
- -exposure provokes anxiety--may lead to a situational panic attack.
- -person recognizes fear is excessive(except children)
- -phobic situation is avoided (or endured w.stress)
- -causes impairment
- -for children it must last at least 6 months(no time length for adults)
- -specific types: animal, natural environment, blood-injection-injury, situational, other
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Post-Traumatic Stress Disorder
- Exposed to traumatic event that:
- -involved threat to physical integrity
- -involved intense fear, helplessness, horror
- *event is reexperienfced in at least one way:
- -recurrect recollections (play)
- -dreams(may be nonspecific)
- -feeling like its recurring
- -intense psychological distress
- -physiological reactivity to cues(sand reminds of iraq)
- *persistent avoidance of thoughts, places, diminished interest in acitivities, cant recall parts of event, feeling of detachment, flat affect, sense of foreshortened future
- *in kids must last 1 month
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Acute Stress Disorder
- similar to ptsd
- symptoms must last between 2 days & 4 weeks
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Obessive-Complusive Disorder (OCD)
- Obsesions:
- persistent intrusive thoughts/images,worries, attempts to ignore or suppress, not believed that thoughts were put in by someone elses idea
- *and/or compulsions:
- repetitive behavior or mental acts that the person feels driven to do, behavior or mental acts are unrealistic attempts to reduce distress
- *recognize the excessiveness (in children)
- *causes impairment
**dont need obsessions & compulsions (only one)
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Generalized Anxiety Disorder
- *excessive anxiety and worry occuring more days than not about severl events for 6+months
- *1+the folling(children), 3+(adults)
- restlessness,easily fatigued, diff concentrating, irritability, muscle tension, sleep disturbance
- *causes impairment
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Social Anxiety Disorder (social phobia)
- fear of acting in an embarrassing way during a social or performance istuation in which person is exposed to unfamilliar people or scruitiny by others
- exposure provokes anxiety - may lead to situational panic attack, person recognizes that the fear is excessive, social situations avoided
- *causes impairment
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Seperation anxiety Disorder
- excessive anxiety about seperation from home or caregivers
- *distress about seperation, worry about people, worry about event that may lead to seperation, reluctance to go to school, reluctance to be w/o major caregiver, reluctance to sleep w/o caregivers, nightmares about seperation, physical symptoms about seperation
- 4+weeks (onsent before 18)
- causes impairment
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selective mutism
- failure to speak in specific social situations
- causes impairment(achievement or social
- 1+month
- not due to lack of knowledge or comfort w/ language
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school refusal (school phobia)
- NOT a dsm diagnosis
- multiple functions
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K-SADS
Schedule for affective disorders and schizophrenia for school-age children
assessment of anxiety
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ADIS
Anxiety Disorders Interview Schedule
Assessment of anxiety
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RCMAS
Revised children's manifest anxiety scale
self report questionnaire for anxiety
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MASC
- Multidimensional Anxiety Scale fo Children
- -self report questionnaire for anxiety
- -areas of assessment: physical symptoms, harm avoidance, social anxiety, seperation/panic
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Behavior avoidance test
- observational assessment for anxiety
- -confront feared object/situation for up to 5 mins
- -measures time or distance
- -use a fear thermometer
- -exposes child to feared object
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Anxiety Self-Monitoring
- Daily Diary
- -time; situation; what did you do; thoughts; how afraid (0-10)
- -must sell child on diary (explain purpose and possible reward program)
- -write down every anxious thought
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is it healthy for parents to encourage their kids to ignore anxiety?
NO
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TF-CBT
- Trauma Focused-Cogntive Behavioral Therapy
- **WELL ESTABLISHED**
- -treatment for anxiety disorders
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School-based CBT
- **PROB EFFICACIOUS**
- -treatment for anxiety disorders
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treatment for OCD
- NO well established treatments
- *prob efficacious:
- -CBT(exposure based)
- -CBT(exposure based w/ SSRI-sertraline)
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Treatments for phobic & most anxiety disorders
- *no well established
- *prob efficacious
- -CBT(individual, group, group w/ parents)
- -social effectiveness training for social phobia
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Barrett et al. (1996)
- -79 children w/ anxiety disorders
- -ages 7-14
- -12 sessions w/ manual based treatment
- *RESULTS:
- -lowest % that still met criterian for anxiety disorder at the end of treatment was CBT+family, then CBT, then waitlist/control
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Barrett et al. (2001) 6 year follow up
- -only 14 % had an axiety disorder
- -no difference between CBT group & CBT+family group
- -waitlist got treatment after completion of study so no stats on that
- *could suggest thta parents are necessary to include
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Barrett et al. (2004)
- -77 children w. OCD
- -ages 7-17 years
- *results:
- -none of the children got better w/o some type of intervention
- -CBT-individ & CBT-group both had a small number of participants that still had disorder at post-treatment (less than 20% for both)
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Barrett et al. (2005) 1.5 year follow-up
- CBT-individ: 30% still had OCD
- CBT-group: 16% still had OCD
- *Groups help to see diff forms of ocd & ways to cope & can help them manage theirs later. Helps promote generalization
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basic "core four" components of modular cognitive-behavioral therapy for childhood anxiety disorders
- **all kids get these in some form
- -create a fear ladder(fear heirarchy)
- -learning about anxiety(education)
- -exposure(practice)
- -maintenance (relapse prevention) <-good for group therapy to generalize
- *cherry picks which components each kid gets, depending on what the anxiety is for.
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Fear Ladders "fear thermometer"
- about 10 situations (only ideas)
- -child & therapist decide together)
- -Subjective Units of Distress (SUDs)*
- -from 0-10 how anxious would it make you feel to do these activities
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SUDs
Subjective Units of Distress
*aka fear ladder
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children & parents learning about anxiety
- -parts: feelings, thoughts actions
- -everyone has it
- -anxiety=alarm w/ stages (1"yellow light"=warning danger might be coming. 2"red light"=warning danger is here)
- -some anxiety is good (protects us)
- -some anxiety is bad (false alarm)
- -goal is to manage false alarms
- -can test to see if your fears are false alarms w. practice
- -practice can be gradual(start at bottom of ladder)
- *never make clients do something you cant do
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systematic desensitization
- *moving up the ladder to progressively more anxious behavior
- -in vivo (real life) exposure
- -imaginal (talk therapy)
- -virtual reality (cant expose, so you put a virtual reality mask on to experience it)
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Participant Modeling
when you watch others get exposed to what makes you anxious
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Flooding
- when you are exposed to top level of your fear ladder right away.
- -expose someone until they calm down
- *not typically used
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Panic disorder - exposure method
introceptive exposure: have the person purposefully have the symptoms of a panic attack (breath out of a straw, spin in a chair dizzy)
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agoraphobia - exposure method
go to the places
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specific phobia - exposure method
expose them to the object or situation
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ptsd - exposure method
expose them to related stimuli
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GAD (general anxiety disorder) - exposure method
"worry chair" - have scheduled times of the day where you are able to worry & you are forced to worry only during that time
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Maintenance & relapse prevention for anxiety disorder
- -praise accomplishments in therapy
- -make connections between gains & practice
- -emphasize the need for continued exposure in everyday life
- -discuss lapse & relapse (just bc you have a slip doesnt mean all is lost. Have a plan for how to handle when you slip)
- -gradually decrease sessions
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cognitive restucturing
- -probability overestimation (thinking it will happen more than it would)
- -catastophic thinking (thinking that something that happens is worse than the others)
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parents role in decreasing anxiety
- -active ignoring to decrease attention for fearful behavior
- -increase praise for brave behavior
- -rewards to increase motivation
- -t.o. when disruptive behaviors interfere
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STOP
name brand version of CBT for children:
- Scared? (identify feeling scared)
- Thoughts (identify anxious thoughts)
- Other (generate other thoughts)
- Praise (self-praise)
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FEAR
name brand version of CBT for children:
- Feeling frightened? (recognize fear)
- Expecting bad things to happen (recognize the fearful self-talk)
- Attitudes/Actions that will help (develop & use coping skills)
- Results & Rewards (self-Evaluation & self-reward)
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Relaxation training:
- -deep breathing (belly breaths)
- -Progressive Muscle Relaxation (PMR): tighten & relax each muscle in body
- -imagery (imagine calm scenarios)
- -biofeedback (can see how much the sun is & how much more relaxed they are
- -hand warming exercise (imagine hands are tucked in a warm place)
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Treatment for Adults w/ specific phobia
- WELL ESTABLISHED
- *exposure therapies
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Treatment for Adults w/ generalized anxiety disorder
- WELL ESTABLISHED
- *cognitive & behavioral therapies
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Treatment for Adults w/ Social Anxiety Disoerder & public speaking
- WELL ESTABLISHED
- *cognitive & behavioral therapies
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WELL ESTABLISHED Treatment for Adults w/ ocd
- -exposure & response prevention (prob effic in kids)
- -cognitive therapy
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Treatment for Adults w/ Panid Disorder
- WELL ESTABLISHED
- *cognitive behavioral therapy
- PROB EFFICIACIOUS
- *Applied relaxation
- *psychoanalytic treatment
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Treatment for Adults w/ PTSD
- WELL ESTABLISHED
- *prolonged exposure
- *cognitive processing therapy
- *eye movement desensitization & reprocessing (purple hat theory) rapid eye movement while imagining fear
- PROB EFFICACIOUS
- *Stress Innoculation Therapy (CBT)
- NO RESEARCH SUPPORT
- *psychological debriefing
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Acceptance Commitment Therapy (ACT)
- -behavioral therapy
- -CBT (actively talk back to anxious thoughts)
- -act (do active things in your life)
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Freud's view on human nature
- -negative
- -sinners
- -psychopathology
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seligman's view on human nature
- -positive
- -moraility
- -alturism
- -positive psychology
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what does the "experience machine" tell us?
- that if we could be happy all of the time, most of us wouldnt want it. down time helps us appriciate the good times.
- -theres room in our life for sadness and depression
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where does happiness come from?
- -pleasures (tv, spa, chocolate)
- -gratifications (playing a sport, reading a book, volunteering)
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Unipolar Depressive Disorders
- -major depression
- -dysthymic disorder
- -depressive - NOS
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Bipolar disorders
- -bipolar I
- -bipolar II
- -Cyclothymic
- -bipolar - NOS
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Mood Disorders
- -Unipolar Depressive Disorders
- -Bipolar Disorders
- -Mood Disorder -NOS
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Major Depressive Episode
- 5 symptoms present in same 2 week period and are diff from previous fuctioning:
- -depressed all day
- -disinterest in activites
- -weight loss
- -insomnia or hypersomnia
- -psychomotor agitation
- -loss of energy
- -guilt
- -inability to concentrate
- -suicidal ideation
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major depressive disorder
- *single episode (mild, moderate, severe)
- -one major episode, no manic/hypomanic/mixed episodes
- *recurrent (mild, moderate, severe)
- -2+ major depressive episodes, no manic/hypomanic/mixed episodes
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Dysthymic Disorder
*milder than major depressive disorder but lasts longer
- *depressed mood for most of day for at least 2 years (youth=1year)
- *while depressed 2+: poor appitite, insomnia,low energy, low self-esteem, poor concentration, feelings of hopelessness
- *neevr w/o symptoms for 2 straight months
- *less than 21 years-old = early onset
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depressive disorder -NOS
- *"minor depressive disorder ": fewer than the 5 required symptoms
- *"recurrent brief depressive disorder" : episodes lasting 2 days up to 2 weeks...once a month for 12 months
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Hankin et al. (1998) prevalence of major depressive disorder by Gender
- pretty even until age 15 (more females)
- -10% of females have it by age 18
- -females are more likely to have it
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Bertelsen et al (1977) concordance rates for twins w/ mood disorders
- if a monozygotic twin has M.D. than its very likely the other will
- *genes play a big role
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Norepinephrine for mood disorder
- not enough=depressed
- too much=mania
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serotonin for mood disorders
reduction can trigger a fall in norepinephrine levels
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biological research on mood disorders
- -mostly done w. adults
- -directionality: correlational study, depressed behavior caused the changes in neurotransmitters
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behavioral theories of depression
- *lack of positive rienforcement (not valued by family or peers and lack the social skills to obtain social positive rienforcement)
- *learned helplessness (repeated experiences with uncontrollable events, depressive attributional stule:stable, internal, global)
- *modeling (depressed caregivers have depressed children)
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depression in caregivers
- depressed parents tend to be:
- -less positive affect, war & praising
- -controlling, impatient & irritable
- -use coercive discipline techniques
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Seiner & gelfand (1995) on depressed mothers
- non-depressed mothers kept a "still face"
- -children physically withdrew from mothers
- *observable impact of nonwarmth on children
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cognitive theory: Beck
- -dismiss positive events
- -remember negative events more readily
- -negative automatic thoughts about: self, future & world
- -self-fulfilling prophecy: how you think about yourself can lead you to have this occur
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Beck's cognitive distortions
- -all-or-nothing thinking
- -overgeneralization
- -mental filter
- -discounting positives
- -jumping to conclusions
- -minimization or magnification
- -emotional reasoning
- -"should" statements
- -labeling
- -personalization/blame
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cognitive modeling
- what you say in front of(and to) your children can become their thoughts
- *how kids learn cognitive distortions
- *never, ever or always can lead to cognitive distortions
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EBT's for depression in youth
- WELL ESTABLISHED:
- CBT, group CBT, group CBT for children +parent, terpersonal psychotherapy
- PROB EFFICACIOUS:
- -self control therapy (school-based cbt, social skills training)
- -penn prevention program (cbt model, social problem solving
- -behavior therapy
- -coping with depression (CWD-A)
- -CBT for adolescents, & + family, group CBT+parents
- -interpersonal Therapy (IPT-A)
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Cognitive-Behavioral Therapy
- -Cognitive component :recognizes distoritions & modifies distortions w/ rational responses
- -behavioral component :weekly activity schedule (behavioral activation- good to have things to look forward to), social skills training
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Increasing optimism by ABCDE
- Adversity (when bad things happend)
- Belief (negative beliefs)
- Consequences (emotions)
- Disputation (knowing how to make it better)
- Energization (positive & focused)
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Learning Disputation
- "im the worst student in this class"
- *find evidence
- *consider more causes
- *decatastophize: even if you are, is it the end of the world?
- *consider usefulness: how is it a bad thing?
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Daily mood record components
date |situation| thought| belief (0-100)| Distortion| Rational Response
*if you go dark & negative you need to talk those feelings out and have rational responses
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Treating depressed children: ACTION
- Always find something to do to feel better
- Catch the positive
- Think about it as a problem to be solved
- Inspect the situation
- Open yourself to the positive
- Never get stuck in the negative much
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Interpersonal Therapy
- -Grief (helf mourn & reestablish interests)
- -interpersonal disputes (make a plan & change communication)
- -role transitions (understand gained/lost & learn new skills)
- -interpersonal deficits (reduce isolation & improve social skills)
- -single-parent families (understand feelings & define roles/expectations)
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humaistic approach for depression
- client centered, not eddective of a stand alone treatment but is good combined w/ many things
- *therapeutic alliance: the more the client feels, the more successful treatment will be.(evidence based)
- *supportive therapy
- *reflective listening
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Treatment for Adolescents with Depression Study (TADS)
- -439 adolescents, ages 12-17
- -diagnosed with MDD
- -12 weeks of treatment
- RESULTS:
- teens responded to medicine
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Robert Leahy on Pain
- *pain points to meaning(important part of life, tells us whats important in our lives)
- *pain tells tou what you value
- *pain helps you overcome adversity(motivate to make changes)
- *too much medicine doesnt give you a chance to feel pain
- *pills dont teach skills* cant change the way you act or react to a situation
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cognitive therapy & neurotransmitters
- peoples neurotransmitters in brain change after getting cognitive therapy the same way meds would.
- *med are easiest & quickest , but short lived
- *cognitive therapy changes for a more sig way & longer lasting
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concordance rates in bipolar disorder
more genetically based than the others
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manic episode
- a period of abnormally and persistently elevated, expansive or irritable mood lasting 1+ week & 3 symptoms:
- -inflated self-esteem, decreased need for sleep, more talkative, racing thoughts, sitractibility, increased goal directed activity, excessive involvement in activities that have painful consequesnces
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mixed episodes
simultaneously major depressive & manic episodes
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hypomanic episode
- -similar to manic episode but only 4+days & no sig impairment
- -unequivocal change in functioning
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bipolar I
presence/ history of at least 1 manic or mixed episode
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bipolar II
presence/history of 1+ major depressive episode & 1+ hypomanic episode & no manic or mixed episodes
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cyclothymic disorder
1 year of the presence of numerous periods w/ hypomanic symptoms and numeroud periods with depressive symptoms
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bipolar disorder - NOS
very rapid alternation between manic symptoms and depressive symptoms that meet symptom thershold criteria but not min duration criteria
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non-episodic irritability
- not occuring for a long period of time, but just very irritable
- *predominately male
- *most dont grow up to have bipolar as an adult
- *more likely to develop unipolar depressive and anxiety disorders as adults
- *cannot be differentiated between oppositional defiant disorder (most extreme 15% odd cases)
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temper dysregulation disorder with dysphoria for non-episodic irritability
- *severe recurrent temper outbursts in response to common stressors (3 or more per week)
- *mood between outbursts is negative
- *12+ months in duration
- * at least 6 years-old
- *no mania lasts longer than 1 day
- *not better accounted for by bipolar
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interventions for bipolar
- *Phamaceuticals: mood stabilizers, antipsychotics
- *psychosocial: family-focused treatment for adolescents, multi-family psychoeducation
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probably efficacious treatments for bipolar
- *family focused treatment for adolescents
- *multi-family psychoeducation
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FFT-A for bipolar
- family-focused treatment for adolescents
- *21 session, 9 month outpatient intervention with four phases:
- -assessmrnt of child & fam
- -psychoeducation of coping with m.d. & how to prevent mania or depression
- -comm enhancing skills training
- -problem-solving skills training
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child & family-focused cognitive-behavioral therapy: RAINBOW
- Routine to encourage stable schedule
- Affect regulation and anger control
- I can do it - positive self talk
- No negative thoughts
- Be a good friend & balanced lifestyle
- Optimal problem solving
- Ways to get support
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Adjustment Disorders
- -emotional or behavioral symptoms
- -response to stressors
- -within 3 months of stressors onsent
- -clinically sig distress or impairment
- -not already an axis I disorder
- -not normal bereavement(loss of loved one)
- -not longer than 6 months after stressor are terminated
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adjustment disoder subtypes
- -with depressed mood
- -with anxiety
- -with mixed anxiety & depressed mood
- -with disturbance of conduct
- -with mixed disturbance of emotions & conduct
- -unspecified
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Physical Abuse
- *an intentional act that causes injury: bites, bruises, done fractures, burns
- *or creates a substantial risk of physical injury: choking/smothering, shaking/throwing, threatening
- *acts of torture
- *inflits excessive corporal punishment
- *female genital mutilation
- *giving a controlled substance to a child under 18
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PTSD is common for kids that have been abused
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Reactive attachment disorder of infancy or early childhood
- *inappropriate social relatedness (failure to respond in social interactions or inability to exhibit selective attachments--overresponding to everyone)
- *grossly pathogenic care of child (disregard for emotiona needs, diregard for physical or repeated changes in caregiver
- *must begin before age 5
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subtypes of reactive attachment disorder
- *inhibited type (failure to respond)
- *disinhibited type (no selective attachments
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Tretament for abusing parents
- *parent training
- *anger management
- *social support
- *treat psychopathology
**want to keep families together & help parents not abuse
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treatment for abused children
- *under researched*
- -play therapy, family therapy, group therapy, cognitive & behavioral therapies
- *treating the subsequent psychopathology
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EBTs for exposure to traumatic events
- WELL ESTABLISHED
- *Trauma focused CBT
- PROB EFFIC.
- *school-based CBT
-
core values of trauma focused CBT
- Components bases
- Respectful of cultural values
- Adaptable & flexible (pick & choose treatment)
- Family focused
- Therapeutic relationship is central (alliance)
- Self-efficacy is emphasized (take charge of your life
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core components of TR-CBT
- Psychoeducation & parenting skills
- Relaxation
- Affective Mdulation
- Cognitive coping & processing
- Trauma Narrative (exposure through narrative)
- In vivo mastery of trauma reminders
- Conjoint child-parent sessions
- Enhancing future safety & development
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Affective Modulation
- Goal: enhance feelings identification & expression skills
- *generate lists of all emotions & last time felt
- *practice identifying feelings with games
- *positive self-talk
- *enhancing sense of safety
- *problem solving & social skills
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Trauma Narrative
- Goal: unpair thoughts, reminders or discussions of the traumatic event from overwhelming negative emotions
- *gradually describe events (details, thoughts & emotions)
- *results in a complete written narrative
- *share narrative with parent
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Cutting and/or boarderline personality disorder
- *children that have been abused
- *dialectical behavior therapy, mindfulness component variation of CBT
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Personality disorders criteria
- *pattern of inner experience and behavior that deviates markedly from the expectations of the individs culture (cognition, affectivity, interpersonal functioning, impulse control)
- *pattern is inflexible
- *clinically sig distress or impairment
- *stable & of long duration
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diagnosing a personality disorder
- -individ. must be under 18 & feautres present for at least 1 year
- -the one exception is APD, which cannot be diagnosed in individs under 18
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Personality disorders: Cluster A "odd or eccentric"
- *Paranoid Personality (distrust & suspiciousness)
- *Schizoid Personality (detachment from social relationships)
- *schizotypal personality disorder (acute discomfort w/ close relationships, cog or perceptual distortions)
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Personality disorders: Cluster B "dramtic, emotional or erratic"
- *APD (violation of rights of others)
- *Borderline personality disorder (instability or interpersonal relationships, self-image & affects)
- *histrionic personality disorder (excessive emotionality & attention seeking)
- *narississtic personality disorder (grandiosity, need for admiration & lack of empathy)
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Personality disorders: Cluster C "anxious or fearful"
- *avoidant P.D.(social inhibition, feelings of inadequacy & hypersensitivity)
- *dependant personality disorder (need to be taken care of)
- *obsessive-compulsive P.D. (proccupation w/ orderliness, perfectionism, & control)
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Substance Dependence
- *maladaptive impairment & distress
- *12+ month period w/ 3+:
- -tolerance, withdrawl, more taken than intended, persistent desire to cut down, take a lot of time, gived up positive activities, continues despite related problems
-
Substance Abuse
- maladaptive impairment & distress
- *12+ month period w/ 1+:
- -failure to fulfill obligations, physically hazardous, recurrent legal problems, recurrent social problems
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factors that influence readiness to change
- Feedback (clear & specific)
- Responsibility(putting responsibility on them)
- Advice (what you think they can change)
- Menu of Options (of what to do)
- Empathetic
- Self-efficacy enhancement (that they can do this)
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S-O-R-C Analysis
- Stimuli (friends, time of day you are most likely to use drugs)
- Organism(heredity)
- Response (whats the drug & how much)
- Consequences (why are they doing it)
*want to figure out why its happening
-
stubstance abuse treatment
- stimulus control
- set goals
- self monitor
- deal with cravings
- address cog distortions
- adaptive alternative behaviors
- drink/drug refusal skills
-
well established & prob effic treatment for substance abuse for adolescents
- WELL ESAB
- *multidimensional family therapy
- *functional family therapy
- *group cbt
- *individual cbt
- PROB EFF.
- *brief strategic fam therapy
- *behavioral family therapy
- *multisystemic therapy
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ACRA
adolescent community reinforcement approach
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empirically supported therapy relationships
- *theraputic alliance
- *empathy
- *goal consensus & collaboration
- *cohesion in group therapy
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Parasomnias
- abnormal events
- *nightmare disorder
- *sleep terror disorder (dazed but you dont remember having a nightmare, just wake up in a startled state)
- *sleepwalking disorder
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Dyssomnias
- amount, quality, timing
- *primary insomnia
- *primary hypersomnia (excessive sleepiness)
- *narcolepsy(randomly falling asleep throughout day)
- *breathing-related sleep disorder
- *circadian rhythm sleep disorder
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top ranked behavior problems in 3 year olds
4 out of the top ten for boys & girls were sleep related
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Assessments of sleep problems
- *always ask about sleep
- *keep a sleep record (for 2 weeks)
- -time child goes to bed
- -time child falls asleep
- -wake up in the middle of the night
- -wake up in the morning
- -when the nap during the day
-
Establish a bedtime routine
*develops good sleep hygeine**
- example routine:
- 7:50 bedtime
- change diaper
- put jammies on
- sit on floor & read a book
- sing song outside of crib
- sing song in crib
- say "heres you blanket & nightlight is on..go to sleep we love you"
*put in crib sleepy but not asleep*
-
establish a consistent sleep schedule
- wake up at 7:30 (dont let them sleep in)
- nap from 10-11
- nap from 2-3
- go to bed at 8
- feed at 5am & go back to sleep
-
avoid negative sleep associations
*falling asleep originally that is not availible if you wake up in the middle of the night. ie. being rocked to sleep, music (cd runs out, binky (falls out & cant find it)
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Bedtime environment conducive to sleep
- nonstimulating
- dark
- quiet
- comfortable temp
-
"crying it out"
- *unmodified systematic ignoring
- *systematic ignoring with parental presence
- *graduated systematic ignoring
-
"crying it out": unmodified systematic ignoring
- *unless child is ill or in danger just ignore the cries
- *fastest way to break habit
- **put baby in crib & walk out of room**
- WELL ESTABLISHED
-
"crying it out" systematic ignoring with parental presence
- child cries in crib but you sit in the room with them & day by day parent moves closer to the door
- PROB EFFICIACIOUS
-
"crying it out" graduated systematic ignoring
- immeadiate parent response for shorter duration or parent waits longer before responding OR parent quick checks at reg intervals but leaves room after checking
- *WELL ESTABLISHED
-
well established treatment for night terrors
- scheduled awakenings.
- -parents wakes up child 15 prior to childs expected awakening
- -puts child back to sleep
- -gradually faded
-
faded bedtime procedure
- *set initial bedtime for when child is likely to fall asleep
- *fade bedtime up to normal
- **want bedtime to be when they are likely to be tired & fall right asleep. that way they are conditioned to fall right asleep when they lay on their bed
-
the sleep fairy
- book that goes over rewards
- *if child falls asleep w/o calling out for the parent the fairy comes in the middle of the night & puts a prize under the pillow.
- -eventually fade out prizes
-
bedtime pass
child can call out for one thing (pass) but if they dont call out at all then they get a prize or privelidge in the morning
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Anorexia Nervosa Criteria
- *refusal to maintain body weight (less than 85% of that expected)
- *intense fear of gaining weight
- *disturbance in body perception
- *absence of at least 3 consectuive menstrual cycles (in postmenarcheal females)
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Types of Anorexia
Restricting type: weight loss through dieting & excessive exercise & they have not regularly enagged in binge-eating or purging behaviors
Binge-eating/purging type: during the current episode the person has regularly engaged in binge-eating or purging behavior
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Whats the difference between anorexia & bulimia
individuals with BN are able to maintain a body weight at or above a minimally normal level
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Bulimia Nervosa Criteria
- *recurrent episodes of binge eating by eating in a discrete period of time, and a sense of lock of control over eating
- *recurrent inappropriate compensatory behavior in order to prevent weight gain (vomitting, laxatives, etc)
- *on average at least twice a week for 3 months
- *self eval is unduly influenced by body shape & weight
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types of Bulimia
- *Purging type: during episode the person has reg engaged in self-induced vomitting or the misuse of laxatives, diuretics or enemas
- *nonpurging type: during the current episode the person has used other compensatory behaviors such as fasting or excessive exercise, but has not regularly engaged in the misuse of laxatives, diuretics or enemas
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treatments for eating disorders
- WELL ESTABLISHED
- *maudsley method of family therapy (for adolescents)
- *CBT for adults with bulimia
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Tics
- *sudden, rapid, recurrent, nonrythmic stereotyped motor movement or vocalization
- *motor=eye blinking, head rolling, etc
- *vocal=throat clearing
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chronic motor or vocal tic disorder
- chronic motor or vocal tics
- *at least a year
-
tourette's disorder
- 2+ motor & 1+ vocal tics
- *at least a year
-
Transient tic disorder
- begining of the disorder (w/in first 12 months)
- *between 4weeks-12 months
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types of tics
- motor:
- -simple: eye blink, nose wrinkle, etc
- -complex=hand gestures, jumping, facial contortions
- Vocal:
- -simple: throat clearing, grunting, sniffling
- -complex: words, phrases, repeat self
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Sensory urges
*precedes the tic*
- -urges are relieved by the tic
- -efforts to suppress often intensify tic
- -common areas of the urge (shoulders, hands, abdomen, throat
-
trichotillomania
- *impulse control disorder*
- -recurrent pulling out of ones hair resulting in noticeable hair loss
- -sense of tension before pulling or when resisting
- -pleasure/relief when pulling hair out
- -distress of impairment
- *could also be eyelashes or arm hair
-
assessment of tics/trichs
- -operationality: frequency, rank order
- -identify antecedents & consequences: setting, social reinforcement, automatic reinforcemnt
- -establish ongoing assessment plan
- *more likely in times of anxiety or stress
-
well established treatment for tics/trichs: habit reversal
awareness training
- habit reversal*
- -awareness training
- -describe the behavior
- -describe preceding sensations/behaviors
- -acknowledge therapist simulations
- -acknowledge actual (situational) tic/trich
- *kids are often oblivious
-
well established treatment for tics/trichs: habit reversal.
competing response training
- -choose a competing response (slow & deliberate)
- -practice the response
- -do the competing response when...you notice a warning sign, you start doing the behavior
-
well established treatment for tics/trichs: habit reversal.
social support training
- -identify the support person
- -acknowledge correct implmentation of competing responses
- -prompt competing response
-
medication for tourettes
- haloperidol*
- -effective in 80% of patients
-
enuresis
- -repeated voiding of urine into bed or clothes
- -2+ times a week for 3+ months (or sig distress/impairment)
- -must be 5+ years old
- -specifify if nocturnal, diurnal or both
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encopresis
- -repeated passage of feces into inappropriate places
- -1+ times a month for 3+ months
- -must be 4+ years old
- -code as "w/" or "w/o constipation & overflow incontinence". do they have a blockage with constipation
-
enuresis & encopresis
- *primary: never had control over it
- *secondary: had control before and then lost it
-
effective treatment for bedwetting
- *bedwetting alarm
- *self-monitoring
- *motivational system
- *relapse program
-
bed-wetting alarm
- superior to med & other treatments*
- -lay on a pad & when it gets wet it sounds an alarm to wake you up
-
motivational system
get a reward every time you get up to go to the bathroom
-
relapse prevention
- -family support agreement
- -overlearning (fluid challange. drink a lot right before bed to imcrease possible bed wetting)
- -fade alarm
-
encopresis treatment
- -continued monitioring
- -use of lubricant
- -demystification (education)
- -scheudled sits (if they have to go or not)
- -reward for participating in treatment
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