Anxiety - Pennsylvania State University. Presentation_0.pdf · Anxiety Fear Lives in the Hearts of...
Transcript of Anxiety - Pennsylvania State University. Presentation_0.pdf · Anxiety Fear Lives in the Hearts of...
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AnxietyFear Lives in the Hearts of Men and Women and
Danger is a Universal Human Experience
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Anxiety: A Universal Concern
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Why So Little Interest from Behavior Analysts?
Imprecise term
Metaphorical Categorical error
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Imprecise Term
• Difficult to Define– Freud (1917)– Sidman (1964)– Levitt (1967)– McNaughton (1989)– Barlow (2002)– Friman (2007)
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A Behavior Analytic Definition
• Negatively reinforced behavior emitted in the presence of events that evoke or elicit the biology of stress or fear but that pose minimal risk of harm.
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Fear of stuff that is really unlikely to hurt you.
My definition
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Metaphorical Basis
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Categorical Errors
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Anxiety as “Category”
• Specific – Conditioned
suppression– Conditioned
activation
• General – Mental– Physiological– motoric
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Some Common Occasions for Anxiety
1. Impossibility of escape
2. Anticipation of punishment
3. Separation from support
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Pavlov’s Contribution
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Signs of Clinical Anxiety
• Impairment
– Excessive:
• Avoidance
• Emotion
• Catastrophizing
• Need for control
• Unresponsive to reason
• High frequency
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Select Anxiety Disorders
• Separation-Anxiety Disorder
• Specific Phobia
• Social Phobia
• Panic Disorder
• Agoraphobia
• Generalized Anxiety Disorder
• Obsessive-Compulsive Disorder
• Post-Traumatic Stress Disorder
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Downside of Avoidance
1. Reinforces notions of danger
2. Generalizes
3. Shrinks life
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Fear and Non-fear Based Avoidance
• Avoidance is the cardinal behavioral component of anxiety
• Avoidance is a cardinal behavioral component of ASD
• Not all avoidance is fear based
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The Threat-based Stress Response
• Prepares body for action
• Bodily
– Release stress hormones
– Obtain fuel
– Metabolize
– Distribute
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Prevalence of Anxiety in the ASD Population
• Prevalence 40%
• Overlap Between ASD and Anxiety
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Developmental Implications of ASD and Anxiety
• Secure attachment
• Interactive play
• Learning interpersonal boundaries
• Learning formal social roles and rules
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Signs of Anxiety in Social Interactions
• Bossiness
• Scripting
• Frustration at shifts in play
• Interrupting the play of others
• Avoiding play altogether
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Signs of Anxiety in the Play of Young ASD Children
• Excessive:
– ordering
– movement of objects
– body movements
– echolalia
– emotional reactions
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Signs of Anxiety in Elementary School Aged ASD Children
• Excessive
– Need for control
• Correcting, bargaining, arguing, taking over play
– Social avoidance
– Emotional reactions
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Signs of Anxiety in ASD Adolescents
• Social confusion
• Low distress tolerance
• Dependence on adults
• Excessive emotional reactions
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Parent and Caretaker Anxiety
• Helicoptering
• Cocooning
• Low distress tolerance
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Unintentional Danger/Anxiety Signals
• Questioning
• Checking
• Overprotection
• Reduced independence
• Enabling avoidance
• Attention to fear
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Dilemmas for Parents and Caregivers
• Encourage participation, exposure, and bravery or…
• Allow avoidance or withdrawal
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Dilemmas for Professionals
• Encourage participation, exposure, and bravery or…
• Allow avoidance or withdrawal
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Strategies for Parents and Caregivers
1. Praise and attend to brave behavior; ignore more non brave behavior
2. Model brave behavior and use role reversal
3. Allocate responsibility; encourage independence; allow mistakes
4. Emotional coaching
5. Set reachable goals and use proportional rewards
6. Create opportunities for change
7. Schedule worry time
8. Incorporate intense or unusual interests
9. Exposure, extinction, desensitization
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Strategies for Professionals
• Medication
• Behavioral treatment
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Medication
• Three primary types
– Benzodiazepines
– Antidepressants
– Beta blockers
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Behavioral Treatment
Health education
Externalization
Relaxation
Irrational thinking
Escape extinction
Incentives
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Health Education
• What is anxiety?
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Externalization
• To name it is to tame it
• Give it a name
– Goofy
– Disparaging
– Insulting
– Sarcastic
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Relaxation• 4 X 4 X 4 X4
• Progressive muscle relaxation
• Focused breathing
• Meditative practices
• Mindfulness
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Target Irrational Thinking
• All or nothing
• Magical thinking
• Filtering
• Overgeneralization
• Magnification
• Emotional reasoning
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Incentives
Grab bag
Dot to dot
Points
Privileges
Praise
Etc.
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Exposure Based Treatments
• Escape extinction
• Exposure and response prevention
• Systematic desensitization
• Behavioral and emotional inoculation
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Exposure Treatment
Real Life Examples
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Effective Treatment
Actual Examples
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Obsessive Compulsive Disorder and Tourette’s Syndrome
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Ditto
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Clinical Description
• Above average IQ
• Suspicious of adults
• Socially anxious
• Pervasive fear of public failure
• Uncomfortable with attention
• Controlling; manipulative
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Social Phobia and Conduct Disorder
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Insect Phobia
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Initial Graduated Exposure Steps
• Holding jar with crickets
• Touching cricket with foot
• Close eyes for 60 sec in room with crickets
• Pick up cricket with tissue
• Pick up cricket with gloved hand
• Hold a cricket for 20 sec with bare hand
• Allow cricket to crawl on pants leg
• Allow cricket to crawl on bare arm
• Hold cricket in each hand for 20 sec
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Typical Treatment
• Demystify
• Change parenting/caregiving
• Name it
• Exposure steps
• Incentives
• Relaxation
• Breathing skills
• Sell it