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A Behavioral Perspective of Anxiety

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Jessica Lafferty

on 27 April 2015

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Transcript of A Behavioral Perspective of Anxiety

Anxiety
Prevalence:
Scarcity of Behavioral Research
Definitional issues
Anxiety as phenomena vs. category
Mentalistic explanations of anxiety widely accepted by public
Hesitation to study private events
Commonly Diagnosed Anxiety Disorders
Obsessive-Compulsive Disorder (OCD)
Post-traumatic Stress Disorder (PTSD)
Generalized Anxiety Disorder (GAD)

Assessments Used
to Diagnose Anxiety Disorders
Beck Anxiety Interview (BAI
Depression Anxiety Stress Scale (DASS)
Generalized Anxiety Disorder 7 (GAD-7)
A Behavioral Perspective of Anxiety
Between 10.8% and 28.8% lifetime prevalence rate
"Psychological equivalent of a fever" --Friman, Hayes, & Wilson
Theories of Anxiety
Classical conditioning
Two-factor/safety-signal theory
Operant conditioning
Current theories
Role of language
Derived relational responding
Transformation of functions
Classical
conditioning
Combination of classical and operant conditioning theories
Two-factor &
Safety-Signal Theories
Operant Conditioning
S1
S2
“(1)…an emotional state, somewhat resembling fear and (2) the disturbing stimulus which is principally responsible does not precede or accompany the state but is ‘anticipated’ in the future" --W.K. Estes & B.F. Skinner
(Aversive)
Anxiety
Current Directions
Role of language
Derived Relational Responding
Transformation of Function
Beck Anxiety Inventory
Depression Anxiety Stress
Scale (DASS)
42 item questionairre
Self-administered
Measures magnitude
Focus is on physiological arousal, panic, and fear
Higher scores indicate higher severity of anxiety
Few limitations
Sound clinimetric properties
Generalized Anxiety
Disorder 7 (GAD-7)
7 item scale
Strong psychometric properties
Good clinical utility
Could lead to earlier detection and treatment of GAD
(Kertz, Bigda-Peyton, & Bjorgvinsson, 2013)
Behavioral Treatments for Anxiety
Cognitive Behavioral Therapy
Acceptance and Commitment Therapy
Dialectical Behavioral Therapy
Exposure Therapy
Response Prevention Therapy
Virtual Reality


Behavioral treatments for anxiety include the following:

A short term, goal-oriented psychotherapy approach to problem solving.
The goal is to change patterns of thinking or behavior that are behind people’s difficulties,
and by doing so, change the way the person feels.
It is used to treat a wide variety of difficulties, including anxiety, depression, and substance abuse.
Focuses on changing a person’s internal dialog

Offshoots of CBT

Developed in the late 1980’s to treat borderline personality disorder.
Theorizes that some people react more intensely to every day stressors.
Therapist teaches coping skills and adaptive strategies in weekly sessions.

Dialectical Behavior Therapy

ACT Hexaflex

Stands for Acceptance and Commitment Therapy
Mindfulness-based psychotherapy
Theorizes that greater well-being can be attained by overcoming
negative thoughts and feelings
Addresses coping mechanisms people have learned.

About ACT:

ACCEPTANCE AND COMMITMENT THERAPY

Often used to treat post traumatic stress disorder.
Enables client to face and gain control of fear learned in a traumatic situation.
Can be done with either a flooding technique or a desensitization technique.
Often uses relaxation techniques to help clients face stressful situation.
Can use either real situations or virtual reality.



Exposure Therapy

Often used with exposure therapy.
Focus is on controlling response and not making typical response.
For example, a person with social anxiety gives a speech
and is encouraged to not exhibit typical avoidant responses.
Also used to treat Tourette’s syndrome and the tics that result.


Response Prevention

There are differences in the brains of people
diagnosed with anxiety and those who are not.
GAD is thought to be caused by reduced communications between different parts of the brain, especially the amygdala.
During a traumatic situation, certain stimuli become paired with bad outcomes.
When the trigger is experienced again, the same reaction will follow.


Classically conditioned as a fear response
.

Where does anxiety come from?

How has behavior analysis addressed the issue of anxiety?


Behavior analysis has addressed anxiety by operationally defining it as a classically conditioned fear response.

By looking further into the behavior associated with anxiety, behavior analysts have developed specific,
short term therapy solutions to intervene in this situation.

Behavioral analysis has addressed anxiety in the variety of ways that were previously discussed in this presentation.



How has behavioral analysis addressed the issue of anxiety?

References
Anderson, P.L., Price, M., Edwards, S.M., Obasaju, M.A., Schmertz, S.K., Zimand, E. &
Calamaras, M.R.(2013) Virtual reality exposure therapy for social anxiety disorder: A
randomized, controlled trial. Journal of Clinical and Consulting psychology,81, (5), 751-
760.
Avdagic, E., Morrissey, S.A., & Boschen, M.J. (2014). A randomized controlled trial of
acceptance and commitment therapy and cognitive behavioral therapy for generalized
anxiety disorder. Behavior Change, 31, (2), 110-130.
Creamer, M., Foran, J., & Bell, R. (1995). The Beck Anxiety Inventory in a non-clinical sample.
Behaviour Research and Therapy, 33(4), 477-485.
Dymond, S., & Roche, B. (2009). A contemporary behavior analysis of anxiety and avoidance.
The Behavior Analyst, 32,(1), 7-27.
Estes, W., & Skinner, B. (1941). Some quantitative properties of anxiety. Journal of
Experimental Psychology, 390-400.
Friman, P.C., Hayes, S.C., Wilson, K.G. (1998). Why behavior analysts should study emotion:
The example of anxiety. Journal of Applied Behavior Analysis, 31, (1), 137-156.
Kertz, S., Bigda-Peyton, J., & Bjorgvinsson, T. (2013). Validity of the Generalized Anxiety
Disorder-7 Scale in an acute psychiatric sample. Clinical Psychology & Psychotherapy,
20, (5), 456-464.

References
Kessler, R.C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005). Lifetime prevalence
and age-of-onset distrubutions of DSM-IV disorders in the national comorbidity survey
replication. Archives of General Psychiatry, 62, 593-602.
Kircanski, K. & Peris, T.S.(2015) Exposure and response prevention process predicts treatment
outcome in youth with OCD. Journal of Abnormal Child Psychology, 43, 543-552.
Parkitny, Luke et al. (2010). The Depression Anxiety Stress Scale (DASS). Journal of
Physiotherapy, 56, (3), 204
Sommers, J.M., Goldner, E.M., Waraich, P., & Hsu, L. (2006). Prevalence and incidence studies
of anxiety disorders: A systematic review of the literature. Canadian Journal of
Psychiatry, 51, 100-113.
Sulkowski, M.L., Jacob, M.L., &Storch, E.A. (2013) Exposure and Response Prevention and
Habit Reversal Training: Commonalities, Differential Use, and Combined Applications.
Journal of Contemporary Psychotherapy,43, 179-185.
VanElzakker, M.B., Dahlgren, M.K., Davis, F.C., Dubois, S., & Shin, L.S.(2013) From Pavlov
to PTSD: the extinction of conditioned fear in rodents, humans, and anxiety disorders.
Neurobiology of Learning and Memory,113, 3-18.


CBT
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