Assessment
Why is it important to take family history into account when assessing for anxiety disorders?
Genetic Factors
Having a family history of anxiety significantly increases the client's likelihood of developing an anxiety disorder.
What therapeutic treatment modality is most supported by outcome research for both Anxiety & Depression?
CBT
honorable mentions:
- ACT
- aspects of DBT
- systemic/family therapies
From the perspective of Behavioral Theories, what are the main causes of Anxiety & Depression?
Anxiety:
- Avoidance Learning & Prevention of relearning
- Skills deficits
- Learned through parental influences
Depression:
- Low overall rate of activity
- Avoidance of social activities
- Social Skill deficits
What are key dimensions that are shared between Anxiety & Depression? (list 2-4)
1. Physiology
2. Cognitions
3. Behaviors
4. Emotions
Percy Jackson is 5 year old boy afraid of the monsters hiding under his bed. What type of theories/techniques would you apply to help resolve his fears?
As long as it makes sense, you win.
- magical solutions (toys)
- psychodynamic work
What kind of behavioral information may be indicative of anxiety in children? (list 3)
- quavering/inaudible voice
- trembling
- fidgeting
- avoiding eye contact
- biting fingernails
- avoiding challenging situations/tasks
What other treatment modality could you try with your client if their Anxiety or Depression is resistant to CBT treatment?
Psychodynamic Therapy
From the perspective of Cognitive Theories, what are the main causes of Anxiety & Depression?
Distorted ways of thinking/perceiving
Anxiety
- Fear Dominated Biases/thinking
- pessimism about the magnitude/likelihood of negative events
- Secondary Anxiety
Depression
- Negative views/interpretations of the self, events, world, & future
What kind of distorted cognitions do people with depression experience? (list 2)
Characterological self blame: blaming situations/events on personal shortcomings
Ignoring the context of their behaviors
Overlooking extraneous factors
Selectively focusing on negative information
Overgeneralizations from negative experiences
Harry Potter is an 11 year old boy who feels guilty and responsible for the death of his parents. What techniques/strategies would you use to help Harry reduce his levels of guilt?
As long as it makes sense, you win.
example answer
- cognitive restructuring
- responsibility pie
- reattribution
What kind of assessment question could you ask to distinguish between Generalized Anxiety Disorder and Specific Phobias?
- "Is there something specific you are worried about? Or is it just everything?"
- "What are you afraid of"
- "Do you have any worries?"
Jon Snow is a 4 year old who is has a Specific Phobia of dogs. What kind of exposure activities would you use with Jon Snow? Please list 4 activities of increasing intensity.
example answer:
- playing with dog stuffed animals
- look at pictures of dogs
- watch dogs from a distance
- pet a dog
From the perspective of Systemic Theories, what are the main causes of Anxiety & Depression?
Parental Influences
- Modeling
- Less social support
- Overprotectiveness
- Messages
What are some of the physiological sensations that present with anxiety disorders? (list 5)
- muscle tension
- elevated heart rate
- increased blood pressure
- sweating
- rapid breathing/shortness of breath
- stomach discomfort
- down regulation of digestion/immune system functioning
Little Bo Peep is a 17 year old girl who was brought in after parents noticing her self injurious behaviors, what techniques would you apply in this situation?
As long as it makes sense, you win.
example answers:
- parental supervision
- further suicide risk assessment
- increase clinical contact
- safety planning/contracts
What are behavioral observations to look out for when assessing for depression? (list 3)
- sad/flat affect
- slow motor movement
- feelings of weariness/unhappiness
- irritable/angry behavior
How could you incorporate stuffed animals/toys as a "magical solution" for a child who is afraid of "the monster in [their] closet" ?
Imbuing the stuffed animals/toys with magical or protective powers
ie.
leaving toy soldiers by the bend
sleeping with stuffed animals for protection
From the perspective of Psychodynamic Theories, what are the main causes of Anxiety & Depression?
The Unconscious
Anxiety
- Unconscious "magical thinking" leading to illogical/irrational fears
- Misapplication of past learning experiences
- Fear/shame/guilt from unacceptable impulses
Depression
- Internal/Unconscious dynamics
- Maladaptive defense mechanisms
- Self criticism due to feelings of guilt, inadequacy, or failure
-
What emotions are typically present with anxiety disorders? Depressive disorders? (list 2 for each)
Anxiety:
- nervousness
- tension
- panic
- fear
Depression:
- presence of negative feelings (hopelessness, helplessness, etc.)
- absence of positive feelings (apathy, emptiness, nubmess, etc.)
- sadness
- irritability
- guilt
- shame
- loneliness
Arwen is a 3 year old who was brought in by her parents for separation anxiety related issues. What techniques would you apply in this situation.
As long as it makes sense, you win.
example answers:
- Hansel & Gretel techniques
- Exposure
- Tokens
What other terms might children use to describe depressed feelings? (list 3)
children might use terms such as:
- sad
- down
- bummed out
- crummy
- bored
Would you invite the client's parents/family to be present and involved during sessions? Please give a reason for why or why not?
as long as it makes sense, you win.
From the perspective of Neurobiological Theories, what are the main causes of Anxiety & Depression?
Brain structure/functioning
Anxiety
- differences in amygdala sizes
- impaired HPA functioning resulting in abnormal levels of autonomic nervous system arousal.
Depression
- Neurotransmitter activity (Low levels of Serotonin; receptor dysfunction).
- Dysfunction in the hippocampus
Compare and contrast how these dimensions might present for a child vs. an adolescent with depression.
example answer:
Children: more likely to express negative emotions as anger and irritability; may present with disruptive behaviors.
Teenagers: more likely to experience and express "typical" negative emotions such as sadness, shame, and guilt.
Gamora is a 13 year old who reports feeling sadness, worthlessness, a lack of pleasure in activities, fatigue, & loss of appetite. What techniques could be applied in this situation?
example answers:
- Behavioral activation
- cognitive restructuring
- Reattribution
- Self Esteem & Values
- Testing with Evidence