Chapter 6 Anxiety Disorders TRUE OR FALSE 1. Research indicates that Hispanic American children have higher rates of separation anxiety disorder than European American children. Answer: True 2. Anxiety is future oriented, whereas fear is a reaction to an immediate threat. Answer: True 3. Worry is a behavioral response to anxiety. Answer: False 4. Several classic studies indicate that normal children do not exhibit a large number of fears. Answer: False 5. Surveys of normal children have revealed that parents may overestimate the prevalence of fears in their children. Answer: False 6. It is most commonly reported that both the number and intensity of fears experienced by children decreases with age. Answer: True 7. Within the internalizing syndrome of the empirical taxonomy based on Achenbach's instruments, there are separate subcategories for anxiety and depression. Answer: False 8. Phobia is the term often employed to describe fears that are quite intense, continue longer than expected, and interfere with functioning. Answer: True 9. An 8-year-old boy who is afraid of the water does not realize that his fear is excessive and unreasonable; therefore, he would not meet the DSM-IV criteria for specific phobia. Answer: False 10. Specific phobias are among the most commonly diagnosed anxiety disorders in children and adolescents. Answer: True 11. Concerns about being negatively evaluated are common among youngsters with social phobia. Answer: True 12. Becca, a high school freshman, must give an oral report in order to pass her social studies course. She has been nervous and upset. On the day of the scheduled presentation, she does not come to school. Becca may be experiencing social anxiety disorder. Answer: True 13. Selective mutism is a separate DSM-IV-TR disorder. Answer: True 14. Most youngsters with social phobia do not meet the criteria for other disorders. Answer: False 15. Based on the case study of Bruce reported in the textbook, the boy with selective mutism, selective mutism is an easily treated disorder. Answer: False 16. Separation anxiety is reportedly common in older adolescents. Answer: False 17. All youth who have separation anxiety exhibit school refusal. Answer: False 18. School refusal and truancy can be differentiated by fear, parental knowledge of the absence, and the existence of other conduct problems. Answer: True 19. In regard to youth who refuse school, it is best to recommend home schooling versus attempting to have them resume regular classroom attendance. Answer: False 20. Somatic (physical) complaints (e.g., stomachaches) are symptoms that occur among youngsters with separation anxiety disorder, but not among those with generalized anxiety disorder. Answer: False 21. Generalized anxiety disorder is one of the most common anxiety disorders among adolescents. Answer: True 22. According to the case study in the textbook of John who had Generalized Anxiety Disorder, having low self esteem is a common side effect of this disorder. Answer: True 23. Panic attacks are a DSM-IV diagnosis. Answer: False 24. Research on the children kidnapped from Chowchilla, CA, found that 73% of the children had moderate to severe reactions to the event. Answer: True 25. Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are the same; however, one occurs in children and one occurs in adults. Answer: False 26. Many children who experience child abuse also meet the diagnostic criteria for posttraumatic stress disorder (PTSD). Answer: True 27. LaGreca et al. studied children who experienced Hurricane Andrew in Florida. After 10 months, less than 10 percent of the children reported re-experiencing symptoms. Answer: False 28. The number of hours watching televised reports of the September 11, 2001 terrorism attacks was correlated with stress symptoms. That is, the more hours watched, the greater the symptoms reported. Answer: True 29. The DSM-IV-TR diagnostic criteria for obsessive-compulsive disorder requires that youngsters realize that these thoughts and behaviors are unreasonable. Answer: False 30. Based on the case study of Sergei (the 17 year old with OCD), it is evident that symptoms of OCD tend to remain fairly stable in young people, making the disorder easier to manage. Answer: False 31. Childhood obsessive-compulsive disorder (OCD) is often recognized only when symptoms are very severe. Answer: True 32. Prior to adolescence, boys are more likely to be diagnosed with OCD than girls. Answer: True 33. OCD is often comorbid with tic disorders. Answer: True 34. There is clear evidence that developmental rituals are early manifestations of OCD. Answer: False 35. There is little evidence of a genetic contribution in anxiety disorders. Answer: False 36. Part of the basis for a biological explanation of obsessive-compulsive disorder (OCD) is research that indicates that both OCD and Tourette syndrome occur in the same individuals. Answer: True 37. Depression and anxiety are both characterized by low levels of positive affect. Answer: False 38. Effortful control is the ability to employ self-regulative processes. Answer: True 39. According the research reported in the textbook, ethnicity does not impact the reporting of anxiety symptoms. Answer: False 40. The most widely used measure to assess anxiety in children and adolescents is a heart rate monitor. Answer: False 41. The assessment of the subjective component of anxiety disorders may be more difficult for child clients than assessment in adults. This may be due, in part, to the difficulty parents and clinicians have in reliably identifying emotional discomfort in children. Answer: True 42. Exposure to anxiety provoking situations is a central element of successful fear reduction. Answer: True 43. The main difference between the FEAR program and the FRIENDS program is family involvement. Answer: True 44. Pharmacological treatment for anxiety in youth is probably the treatment of first choice. Answer: False 45. According to the FDA, Selective serotonin reuptake inhibitors (SSRIs) may increase depression or suicidality in youth. Answer: True 46. To date, prevention programs for anxiety have not been very effective. Answer: False MULTIPLE CHOICE 47. A general definition of anxiety as a complex pattern of three types of reactions to a perceived threat usually refers to which of the following responses? A. Physiological responses B. Unconscious responses C. Aggressive responses D. Covert responses Answer: A 48. Which of the following is true regarding fears, worries and anxiety in youth? A. As children get older they are less likely to worry about threats to well-being. B. Boys are more likely than girls to report fears and worries. C. The most common fears do not vary across cultures. D. There are no cultural differences in how anxiety is expressed (i.e., the prevalence rates of specific anxiety disorders). Answer: C 49. In the DSM-IV system, which of the following is an anxiety disorder? A. Separation anxiety disorder B. Overanxious disorder C. Acute fear disorder D. Avoidant disorder Answer: A 50. Which of the following is true regarding the prevalence rate of anxiety disorders? A. Anxiety disorders are the least common disorders experienced by children and adolescents. B. Young people are likely to meet the criteria for more than one anxiety disorder. C. Young people typically outgrow their anxiety disorder. D. Boys are more likely than girls to be diagnosed with an anxiety disorder. Answer: B 51. Susan is 8 years old and exhibits an excessive and persistent fear of bearded men. She cries, clings to her mother, and is nauseous whenever she sees bearded men. She will not go to church since many members of the congregation have beards. She also does not want to go shopping or to restaurants for similar reasons. Susan would most likely receive a DSM-IV diagnosis of A. social phobia. B. specific phobia. C. separation anxiety disorder. D. neurotic anxiety. Answer: B 52. Based on the case study of Carlos presented in your book, which of the following is likely true regarding specific phobias? A. In order for phobias to develop, an individual must have a history numerous negative experiences with the feared object. B. If there has only been one bad experience with an object, the phobia is not severe. C. Phobias tend to resolve without treatment. D. Phobias can generalize to broad categories of objects (e.g., all buttons). Answer: D 53. Children and adolescents with social phobia A. often fear situations such as public speaking or performing in front of others. B. only exhibit fear or anxiety when interacting with adults. C. exhibit social fears all the time, even when interacting with familiar adults. D. develop selective mutism after having the diagnosis for 6-9 months. Answer: A 54. Which of the following is accurate regarding the diagnosis of social phobia in an adolescent? A. The adolescent will not recognize that the fear is excessive or unreasonable. B. The distinction between normal and abnormal social anxiety may be particularly difficult. C. The disorder is likely overdiagnosed in adolescents diagnosed in this age group. D. Young people with social anxiety are typically on anxious in one or two social situations (e.g., meeting new people or performing in front a group). Answer: A 55. An 8-year-old boy, Ben, refuses to go to school, complains of stomachaches and nausea on school days, and experiences extreme anxiety in this and other situations requiring interactions with peers. Ben would most likely receive a DSM-IV diagnosis of A. separation anxiety disorder. B. specific phobia. C. social phobia. D. generalized anxiety disorder. Answer: C 56. A youngster receiving a DSM-IV diagnosis of social phobia A. is likely to meet the criteria for another DSM diagnosis. B. is likely to have a general absence of appropriate social skills. C. is likely to have a problem with age-appropriate social relations with familiar people. D. may exhibit this problem only in interactions with adults. Answer: A 57. Selective mutism might be conceptualized as an extreme form of: A. social anxiety. B. school anxiety. C. language disorder. D. depressive disorder. Answer: A 58. Amy is a kindergarten girl who, since preschool, does not speak at all in school or with her peers. She does easily speak with family members or when she is alone. Others describe her as fearful and clinging. Which of the following best fits Amy? A. Developmental language disorder B. School phobia C. Avoidant disorder D. Selective mutism Answer: D 59. The DSM-IV-TR diagnosis of separation anxiety disorder requires A. refusal to go to school plus two out of seven other symptoms. B. refusal to go to school plus three of seven other symptoms. C. any three of eight listed symptoms. D. evidence of actual prolonged separation from the mother plus three of eight listed symptoms. Answer: C 60. The most widespread explanation for cases of school refusal is A. psychological disturbance in the mother. B. anxiety concerning academic performance. C. separation anxiety. D. traumatic experiences at school. Answer: C 61. An 8-year-old girl, Cindy, refuses to go to school, complains of stomachaches and nausea on school days, but readily goes to other children’s homes and to other activities away from home. Cindy expresses anxiety regarding aspects of the school situation. She would most likely receive a DSM diagnosis of A. school refusal disorder. B. specific phobia. C. separation anxiety disorder. D. social phobia. Answer: B 62. Which of the following statements regarding school refusal is true? A. School refusal only occurs during the elementary school years. B. School refusal has a better prognosis in older youngsters. C. School refusal in young children is likely to be related to conduct disorder. D. School refusal in adolescents is likely to be associated with a mixed presentation of anxiety and depression. Answer: D 63. Heather is a 13-year-old who has been diagnosed with generalized anxiety disorder. It is likely that Heather A. exhibits anxiety concerning one particular kind of situation. B. has excessive concerns with her competence and performance. C. has symptoms that are likely to be transitory (short term). D. does not show other signs of significant impairment in her functioning. Answer: B 64. Which of the following pairs of symptoms is required for a DSM-IV-TR diagnosis of generalized anxiety disorder? A. Excessive anxiety or worry and difficulty concentrating B. Excessive anxiety or worry and difficulty controlling worry C. Difficulty controlling worry and irritability D. Difficulty concentrating and disturbed sleep Answer: B 65. Research on generalized anxiety disorder (GAD) indicates that A. GAD often co-occurs with other disorders. B. the intensity of the symptoms tends to decrease with age. C. separation anxiety is a common co-occurring disorder in adolescents with GAD. D. it is theorized to be under diagnosed. Answer: A 66. A(n) _________ is a discrete period of intense fear or terror that has a sudden onset and reaches a peak quickly. A. anxiety attack B. compulsion C. panic attack D. parathesia Answer: C 67. A panic attack that occurs "out of the blue" is described as a(n) A. cued panic attack. B. uncued panic attack. C. pseudo panic attack. D. depressive panic attack. Answer: B 68. Severe cases of panic may lead to a youngster becoming terrified of leaving home for fear of being alone or of a situation where an uncontrollable or embarrassing attack may occur. This pattern is known as A. agoraphobia. B. separation anxiety. C. domestic panic. D. attachment panic. Answer: A 69. Which of the following is true regarding panic disorder in children? A. Children report more cognitive symptoms than adults. B. Children experience only cued panic attacks. C. Children may report a general fear of becoming sick rather than specific physical symptoms. D. Panic disorder is more prevalent in children than adolescents. Answer: C 70. Which of the following regarding panic attacks and youth is true? A. Adolescents with panic attacks do not experience very much distress or impairment. B. Adolescents with panic attacks are not likely to seek treatment. C. Most youth with panic have no history of anxiety. D. Many youth with panic disorder in clinical settings have a family history of panic attacks. Answer: D 71. Research suggests that _________ may serve as a precursor to panic disorder. A. medical fears and specific phobias B. orderliness and obsessive-compulsive disorder C. shyness and social phobia D. separation concerns and separation anxiety disorder Answer: D 72. A(n) _________ is usually defined as an event outside of everyday experience that would be distressing to almost anyone. A. panic attack B. obsession C. trauma D. parathesia Answer: C 73. Mark experiences an event that poses a serious threat of injury or loss of his life. He subsequently experiences feelings of fear and helplessness that clearly interfere with his functioning. He also reports dissociative symptoms. The entire set of symptoms lasts for about three weeks. Mark is most likely to receive the DSM-IV diagnosis of A. specific phobia. B. acute stress disorder. C. panic type stress disorder. D. posttraumatic stress disorder. Answer: B 74. Which of the following is required for a diagnosis of posttraumatic stress disorder? A. Re-experiencing, avoidance, and arousal B. Panic, depression, and dissociation C. Withdrawal, aggression, and delusions D. Fear, rejection of others, dissociation Answer: A 75. _________ is an alteration in self-awareness that includes numbing, detachment or appearing to be in a daze. A. Trauma B. Derealization C. Dissociation D. Depersonalization Answer: C 76. Which of the following symptoms is least likely to occur in a young child who has experienced a traumatic event during a train trip? A. Sleep difficulties B. Fears regarding other forms of transportation C. Fears related to small animals and other objects D. Dependent, clinging behavior Answer: C 77. Which of the following is true regarding PTSD? A. Avoidance is the most common symptom. B. Children and adolescents tend to experience the same pattern of symptoms. C. Symptoms can differ depending on the nature of the traumatic event. D. The degree of exposure to the traumatic event is irrelevant. Answer: C 78. Based on the work of LaGreca et al., following Hurricane Andrew, which of the following statements regarding the developmental course of symptoms of posttraumatic stress disorder is accurate? A. All attempts to cope, both negative and positive, resulted in persistent symptoms. B. Symptoms of avoidance and general numbing increased over time. C. Symptoms of arousal increased over time. D. Substantial numbers of children continued to report "re-experiencing" symptoms. Answer: D 79. As a result of the Oklahoma City bombing, A. youngsters in the area experienced both immediate and continuing symptoms of posttraumatic stress. B. the majority of youngsters in the area no longer experienced symptoms after two months’ time. C. only those youngsters who had lost an immediate family member continued to experience symptoms two months after the bombing. D. youngsters showed no correlations between television exposure to the event and PTSD symptoms. Answer: A 80. Sam, age 6, experiences repeated and persistent thoughts concerning infection and illness, which he does not think are unusual or unreasonable. These thoughts A. may be compulsions. B. are not compulsions since they are not viewed as unreasonable. C. may be obsessions. D. are not obsessions since they are not viewed as unreasonable. Answer: C 81. In order to diagnose OCD: A. obsessions must be related to dirt and germs. B. the obsessions and compulsions must be highly time consuming and interfere with life. C. a child must have both obsessions and compulsions. D. parents and children must agree that there is a problem. Answer: B 82. Which of the following represent the common “themes” associated with OCD? A. Aggressive thoughts or images and being good B. Cleanliness, grooming, averting danger, and pervasive doubting C. Fear of not being prepared for disaster and hoarding or collecting D. Aggressive thoughts or images and counting Answer: B 83. Which of the following statements regarding the epidemiology of obsessive-compulsive disorder is accurate? A. Obsessive-compulsive disorder occurs in about 10 percent of the general population of adolescents. B. Onset for boys tends to be postpubertal. C. Onset for girls tends to be prepubertal. D. Mean age of onset is about 10 years of age. Answer: D 84. _________ is a chronic disorder characterized by vocal and motor tics and related urges. A. Tourette’s Syndrome B. Obsessive Compulsive Spectrum C. Multimodal Tic Disorder D. Repetitive Movement Disorder Answer: A 85. Regarding the etiology of anxiety disorders such as specific phobias, it is most likely that they are A. largely genetically determined. B. due to direct experience. C. due to indirect experience. D. multiply determined. Answer: D 86. In regard to biological influences of anxiety, A. the influence of genetics is greatest for adolescents. B. serotonin has been linked to anxiety and panic. C. GABA is elevated in the brains of anxious individuals. D. the influence of genetics is higher for anxiety than other psychological disorders. Answer: B 87. Which brain structure has been linked to anxiety? A. Amygdala B. Cerebellum C. Basal ganglia D. Thalamus Answer: A 88. The evidence for a genetic influence is probably greatest for which anxiety disorder? A. Post traumatic stress disorder B. Obsessive-compulsive disorder C. Separation anxiety disorder D. Specific phobia Answer: B 89. Brain imaging studies and other findings suggest that obsessive-compulsive disorder (OCD) is linked to the anatomy of the A. basal ganglia. B. cerebral cortex. C. frontal cortex. D. thalamus. Answer: A 90. Kagan's findings regarding children who are extreme on the dimension of behavioral inhibition to the unfamiliar indicate that A. inhibited children tend to have decreased autonomic system reactivity. B. fears in the inhibited children are usually associated with prior trauma, whereas fears in the noninhibited children are not. C. inhibited children were more likely than noninhibited children to meet the criteria for multiple anxiety disorders. D. inhibited children were particularly at risk for the development of depression. Answer: C 91. Which combination is most likely to result in anxiety? A. Low positive affect and high negative affect B. High effortful control and low positive affect C. Low effortful control and high negative affect D. High effortful control and high negative affect Answer: C 92. Research suggests that parents may influence the development of anxiety in several ways. Which of the following is a possible method of parental influence? A. Parents ignore anxious behavior. B. Parents reinforce active methods of coping. C. Parents assume their children can handle anxiety-provoking situations. D. Parents are overprotective and intrusive. Answer: D 93. Which of the following would be the least likely to be used to assess the subjective component of a child's fear or anxiety? A. Global self-ratings by the child B. A behavioral avoidance test C. The Revised Fear Survey Schedule for Children D. The Revised Children's Manifest Anxiety Scale Answer: B 94. Systematic desensitization A. is a combination of relaxation and exposure. B. is a form of contingency management. C. is a cognitive behavioral intervention. D. requires an in vivo experience to be effective. Answer: A 95. _________ involves observation followed by the fearful child joining the model in making gradual approaches to the feared objects. A. In vivo exposure B. Imaginal exposure C. Participant modeling D. Symbolic modeling Answer: C 96. _________ ensures positive consequences follow exposure to but not avoidance of the feared stimulus. The youth is rewarded for improvement. A. Relaxation training B. Reinforced practice C. Rehearsal D. Repeat modeling Answer: B 97. Which of the following is a correct indication of what the acronym FEAR stands for, as employed by Kendall in his Coping Cat Workbook? A. F – Feeling frightened B. E – Exposure to feared stimulus C. A – Associate with brave people D. R – Repeat after me, “I am calm and relaxed” Answer: A 98. In treating youngsters with obsessive-compulsive disorder, the treatments for which there are the best empirical support are A. exposure with response prevention and antianxiety medications. B. exposure with response prevention and selective serotonin reuptake inhibitors (SSRIs). C. systematic desensitization and antianxiety medications. D. systematic desensitization and selective serotonin reuptake inhibitors (SSRIs). Answer: B 99. Most anxiety prevention programs have included A. systematic desensitization. B. modeling. C. contingency management. D. cognitive behavioral methods. Answer: D BRIEF ESSAY QUESTIONS 100. Describe the tripartite model of anxiety, and give examples of each response. Answer: The tripartite model of anxiety, proposed by Thomas Borkovec and his colleagues, suggests that anxiety can be categorized into three components: cognitive, physiological, and behavioral. Here's an overview of each component along with examples: 1. Cognitive Component: This involves the thoughts, worries, and cognitive processes associated with anxiety. • Examples: • Excessive worry about future events (e.g., "What if I fail the exam?") • Rumination (repetitively thinking about negative thoughts or past events) • Intrusive thoughts (unwanted and distressing thoughts) Cognitive anxiety often involves a preoccupation with potential threats or negative outcomes, leading to heightened alertness and mental arousal. 2. Physiological Component: This relates to the physical sensations and physiological responses triggered by anxiety. • Examples: • Increased heart rate • Sweating • Muscle tension • Shallow or rapid breathing • Nausea or butterflies in the stomach These physiological responses are often part of the body's natural "fight-or-flight" response to perceived threats or stressors. 3. Behavioral Component: This encompasses the behavioral responses and actions that individuals engage in when experiencing anxiety. • Examples: • Avoidance behaviors (e.g., avoiding social situations or places that trigger anxiety) • Safety behaviors (e.g., seeking reassurance, carrying a lucky charm) • Agitation or restlessness • Impaired performance (e.g., difficulty concentrating or making decisions) Behavioral responses to anxiety can vary widely depending on the individual and the specific triggers of their anxiety. The tripartite model emphasizes that anxiety is a multidimensional construct involving interactions between cognitive, physiological, and behavioral components. Individuals may experience all three components simultaneously or primarily experience one or two components depending on the context and nature of their anxiety. This model has been influential in understanding and treating anxiety disorders, as interventions often target one or more of these components to alleviate symptoms and improve functioning. 101. Explain the general prevalence of worries and fears. Include gender, age, and cultural information. Answer: Worries and fears are common human experiences that vary in prevalence based on factors such as gender, age, and cultural background. Gender Differences: Research suggests that there are differences in the types of worries and fears experienced by men and women. Women tend to report higher levels of anxiety-related worries, such as concerns about relationships, health, and safety. Men, on the other hand, may express more worries related to financial stability, career success, and performance-related concerns. Age Differences: Worries and fears also change across different stages of life: • Children and Adolescents: Common fears include fear of the dark, monsters, and separation anxiety. Social fears such as rejection or bullying are also prevalent. • Young Adults: This age group often experiences worries related to academic performance, career choices, and relationship issues. • Middle-Aged Adults: Concerns may shift towards financial stability, health issues, and caregiving responsibilities. • Older Adults: Worries about health decline, loss of independence, and financial security become more prominent. Cultural Influences: Cultural norms and values significantly impact the types of worries and fears individuals experience. For example: • In collectivist cultures, there may be greater emphasis on family reputation and social harmony, leading to worries about familial expectations and community acceptance. • In individualistic cultures, concerns about personal achievement, independence, and standing out from others may be more common. • Cultural attitudes towards mental health and expression of emotions can also influence how worries and fears are acknowledged and managed within a society. Prevalence: Overall, worries and fears are nearly universal but vary widely in terms of intensity, frequency, and specific content depending on individual circumstances and cultural contexts. While some level of worry is normal and can even be adaptive, excessive worry that interferes with daily life may indicate an anxiety disorder or other mental health issue requiring professional attention. Understanding the general prevalence of worries and fears across different demographics helps in tailoring interventions and support systems to address these concerns effectively. 102. Discuss the importance of understanding cultural influences when examining child and adolescent psychopathology. How might culture impact prevalence rates, development of a disorder, assessment, and treatment? Answer: Understanding cultural influences is crucial when examining child and adolescent psychopathology because culture significantly shapes every aspect of a child's development, including their emotional and behavioral health. Here's how culture impacts various aspects of child and adolescent psychopathology: 1. Prevalence Rates: Culture influences the prevalence rates of specific disorders due to varying cultural norms, beliefs, and practices. For example, disorders like oppositional defiant disorder or conduct disorder may manifest differently across cultures. Some behaviors that are considered disruptive or problematic in one culture may be more accepted or interpreted differently in another. 2. Development of a Disorder: Cultural factors play a pivotal role in how disorders develop in children and adolescents. Cultural norms dictate parenting styles, family dynamics, peer interactions, and societal expectations—all of which can influence the emergence and progression of psychopathology. For instance, cultural attitudes towards education, gender roles, and familial responsibilities can contribute to the development of disorders like anxiety, depression, or eating disorders. 3. Assessment: Cultural competence in assessment is essential to accurately diagnose and understand psychopathology in children and adolescents. Assessment tools and techniques must be culturally sensitive and consider the cultural context in which the child or adolescent lives. This includes understanding cultural expressions of distress, language barriers, and the impact of acculturation or migration experiences on mental health. 4. Treatment: Effective treatment requires consideration of cultural factors to ensure interventions are appropriate and effective. Cultural beliefs about health and illness, treatment preferences, and stigma associated with mental health play significant roles in treatment adherence and outcomes. Therapeutic approaches need to be culturally responsive, involving collaboration with families and communities to integrate cultural values and practices into treatment plans. Examples of Cultural Impact: • Family Dynamics: In collectivist cultures, family relationships and obligations are central, influencing how disorders are perceived and managed within the family unit. • Stigma: Cultural stigma surrounding mental illness can affect help-seeking behaviors and access to mental health services. • Acculturation: Children and adolescents navigating between their cultural heritage and the dominant culture may experience unique stressors impacting their mental health. Importance: Ignoring cultural influences can lead to misdiagnosis, inappropriate treatment, and exacerbation of symptoms. It is crucial for clinicians and researchers to adopt a culturally informed approach that respects diversity, acknowledges cultural strengths, and adapts interventions to be inclusive and effective across diverse populations. In summary, understanding cultural influences is fundamental in the study and treatment of child and adolescent psychopathology as it shapes prevalence rates, development of disorders, assessment practices, and treatment outcomes. A culturally sensitive approach promotes accurate diagnosis, effective interventions, and improved mental health outcomes for children and adolescents from diverse cultural backgrounds. 103. Discuss the behavioral, cognitive, and somatic symptoms associated with social anxiety disorder. What are common consequences of this disorder? Answer: Social anxiety disorder (SAD), also known as social phobia, is characterized by an intense fear of social situations where the individual may be scrutinized or judged by others. This fear can lead to significant distress and impairment in various areas of life. The symptoms of SAD can be categorized into behavioral, cognitive, and somatic symptoms: Behavioral Symptoms: 1. Avoidance: Individuals with SAD often avoid social situations or endure them with intense anxiety. 2. Minimal social interaction: They may have difficulty initiating or maintaining conversations, participating in group activities, or speaking in public. 3. Excessive self-consciousness: There is a heightened awareness of oneself in social settings, leading to behaviors aimed at minimizing attention, such as avoiding eye contact or speaking softly. 4. Escape behaviors: When in anxiety-provoking situations, individuals may engage in behaviors like leaving early, finding excuses to exit, or seeking reassurance from others. Cognitive Symptoms: 1. Negative self-beliefs: Persistent thoughts about being inadequate, unlikable, or embarrassing oneself in social situations. 2. Cognitive biases: Individuals with SAD often have a tendency to interpret neutral or ambiguous social cues as negative or threatening. 3. Rumination: Excessive preoccupation with past social interactions, analyzing perceived mistakes or embarrassing moments. 4. Anticipatory anxiety: Intense worry or fear leading up to upcoming social events, sometimes weeks or days in advance. Somatic Symptoms: 1. Physical discomfort: Symptoms such as blushing, sweating, trembling, or nausea may occur in social situations. 2. Rapid heartbeat: Increased heart rate or palpitations are common during anxiety-provoking social interactions. 3. Muscle tension: Individuals may experience tightness in muscles, especially in the face and neck. 4. Panic attacks: In severe cases, panic attacks can occur, characterized by sudden onset of intense fear or discomfort, often accompanied by physical symptoms like chest pain or shortness of breath. Common Consequences of Social Anxiety Disorder: 1. Impaired social relationships: Difficulty forming and maintaining friendships, romantic relationships, or professional connections. 2. Academic or occupational impairment: Avoidance of classes, meetings, or job opportunities that involve social interaction can hinder academic performance or career advancement. 3. Negative self-esteem: Persistent feelings of inadequacy or low self-worth due to perceived social failures or rejection. 4. Substance abuse: Some individuals may turn to alcohol or drugs as a way to cope with social anxiety symptoms. 5. Isolation: Withdrawal from social activities or preferring solitary activities to avoid anxiety-provoking situations. 6. Depression: Chronic social anxiety can lead to depression, particularly if it results in significant impairment in daily functioning or social isolation. Effective treatment for social anxiety disorder typically involves cognitive-behavioral therapy (CBT), specifically exposure therapy and cognitive restructuring, along with medication such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Early intervention is crucial to prevent the long-term consequences associated with untreated SAD and to improve overall quality of life for individuals affected by this disorder. 104. Define school refusal. What are some reasons why a young person might refuse to go to school? Answer: School refusal refers to a child or adolescent's reluctance or refusal to attend school or difficulty remaining in school for an entire day. It is not simply a desire to skip school or avoid responsibilities, but rather a significant emotional distress or anxiety related to attending school. Reasons why a young person might refuse to go to school: 1. Anxiety and Social Phobia: Fear of social situations or performance anxiety, such as being judged by peers or teachers, can lead to avoidance of school. 2. Separation Anxiety: Fear of being separated from parents or caregivers, especially common in younger children or those transitioning to a new school. 3. Bullying: Experience of bullying or harassment at school, either physical or emotional, can make school a threatening or unsafe environment. 4. Academic Stress: Overwhelming academic pressure, fear of failure, or difficulty coping with academic demands can contribute to school avoidance. 5. Physical Health Issues: Chronic illnesses, physical symptoms (like headaches or stomachaches) exacerbated by anxiety, or undiagnosed medical conditions that cause discomfort in school settings. 6. Mental Health Disorders: Conditions such as depression, generalized anxiety disorder, or other anxiety disorders can manifest in school refusal behavior. 7. Family Issues: Conflict or instability in the home environment, such as family crises, parental separation, or abuse, can lead to emotional distress that affects school attendance. 8. Learning Difficulties: Struggles with learning disabilities or academic challenges that lead to frustration or embarrassment in the classroom. 9. School Environment: Issues with teachers, peer relationships, or school policies that contribute to feelings of isolation, rejection, or alienation. 10. Traumatic Events: Experience of trauma, such as witnessing violence or experiencing a significant life event (like a loss or relocation), can disrupt a child's sense of safety and routine at school. It's important to note that school refusal is a complex issue often involving a combination of factors. Understanding the underlying reasons requires a thorough assessment by parents, educators, and mental health professionals to develop an appropriate intervention plan that addresses both the emotional needs of the child and any systemic issues contributing to their reluctance to attend school. Early intervention and supportive strategies can help reduce school refusal and support the child's academic and emotional well-being. 105. What are the 3 criteria for diagnosing panic disorder? List 5 of the 13 possible symptoms for a panic attack. Answer: To diagnose panic disorder, according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), the following three criteria must be met: 1. Recurrent Panic Attacks: The individual experiences recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes and includes at least four of the specified symptoms. 2. Concern About Panic Attacks: Persistent concern or worry about having additional panic attacks or their consequences (e.g., losing control, having a heart attack, "going crazy"). 3. Behavioral Changes: Significant changes in behavior related to the panic attacks, such as avoiding situations where panic attacks have occurred in the past. Five possible symptoms of a panic attack include: 1. Palpitations, pounding heart, or accelerated heart rate 2. Sweating 3. Trembling or shaking 4. Sensations of shortness of breath or smothering 5. Feeling of choking Other symptoms that may be present during a panic attack include: • Chest pain or discomfort • Nausea or abdominal distress • Dizziness, lightheadedness, or feeling faint • Chills or heat sensations • Numbness or tingling sensations (paresthesias) • Feelings of unreality or detachment from oneself (derealization) • Fear of losing control or "going crazy" • Fear of dying It's important to note that the symptoms of panic disorder can be extremely distressing and disruptive to daily life. Diagnosis and treatment typically involve a comprehensive evaluation by a mental health professional to differentiate panic disorder from other conditions and to develop an appropriate treatment plan, which may include psychotherapy (such as cognitive-behavioral therapy) and/or medication (such as antidepressants or benzodiazepines in some cases). 106. What are the three categories of symptoms required for the DSM-IV diagnosis of posttraumatic stress disorder? Give two examples for each category of symptoms. Answer: The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) categorized symptoms of posttraumatic stress disorder (PTSD) into three main categories. These categories are based on the individual's response to experiencing or witnessing a traumatic event. Here are examples for each category: 1. Re-experiencing Symptoms: These symptoms involve reliving the traumatic event, which can occur in various ways, such as through intrusive memories, nightmares, or flashbacks. Examples: • Flashbacks: Feeling as though the traumatic event is happening again, with vivid and distressing sensory perceptions. • Nightmares: Recurrent and distressing dreams related to the traumatic event, often causing awakening with intense distress. 2. Avoidance Symptoms: Individuals with PTSD may avoid reminders of the traumatic event, including thoughts, feelings, people, places, or activities that evoke memories of the trauma. Examples: • Avoiding triggers: Avoiding situations or places that remind the individual of the traumatic event (e.g., avoiding driving if the trauma involved a car accident). • Emotional numbness: Feeling detached or estranged from others, or experiencing a reduced range of emotions. 3. Hyperarousal Symptoms: These symptoms reflect heightened arousal or sensitivity to potential threats, often leading to increased vigilance, irritability, and difficulty concentrating or sleeping. Examples: • Hypervigilance: Feeling constantly on guard or "jumpy," with an exaggerated startle response. • Irritability or outbursts of anger: Feeling easily angered or provoked, often with difficulty controlling temper. It's important to note that the DSM-IV criteria for PTSD have been updated in the DSM-5, which includes four main symptom clusters (intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity). The DSM-5 criteria provide a more comprehensive framework for diagnosing PTSD, reflecting advances in understanding the disorder and its various manifestations. 107. Discuss the factors that appear to influence a youth’s initial reactions to trauma as well as the severity and duration of the symptoms. Answer: A youth's initial reactions to trauma, as well as the severity and duration of their symptoms, are influenced by a complex interplay of factors. These factors can broadly be categorized into pre-trauma, peri-trauma, and post-trauma factors: 1. Pre-Trauma Factors: • Predisposing Vulnerabilities: Individual characteristics such as genetics, temperament, and pre-existing mental health conditions (e.g., anxiety, depression) can influence how a youth responds to trauma. For example, a child with a history of anxiety may be more susceptible to developing PTSD after a traumatic event. • Previous Trauma: Past experiences of trauma can increase vulnerability to developing PTSD or exacerbate symptoms in response to subsequent traumas. • Family Environment: Supportive family relationships and a stable home environment can buffer against the impact of trauma, whereas a history of family dysfunction, abuse, or neglect may increase vulnerability. • Cultural Factors: Cultural beliefs, values, and norms shape how trauma is perceived, expressed, and coped with. Cultural factors can influence whether and how symptoms of PTSD manifest. 2. Peri-Trauma Factors: • Nature of the Trauma: The type, intensity, and duration of the trauma play a significant role. Events that involve life-threatening situations, interpersonal violence, or betrayal tend to elicit stronger reactions and increase the likelihood of PTSD. • Proximity to Trauma: Direct exposure to trauma (e.g., being physically present during a car accident) versus indirect exposure (e.g., learning about a loved one's traumatic experience) can impact the intensity of a youth's reaction. • Perceived Life Threat: The perception of imminent danger or threat to one's life or physical integrity during the trauma can intensify the stress response and subsequent symptoms. 3. Post-Trauma Factors: • Social Support: The availability and quality of social support following the trauma can influence recovery. Supportive relationships with family, friends, and community members can mitigate the impact of trauma and aid in coping. • Coping Strategies: Effective coping mechanisms, such as problem-solving skills, emotion regulation strategies, and seeking professional help, can reduce symptom severity and duration. • Post-Trauma Stressors: Additional stressors or disruptions in the aftermath of trauma, such as loss of social support, financial strain, or ongoing safety concerns, can exacerbate symptoms and prolong recovery. Other Influencing Factors: • Developmental Stage: Developmental factors influence how children and adolescents process and respond to trauma. Younger children may have difficulty understanding and expressing their emotions, while adolescents may struggle with identity issues and peer relationships. • Neurobiological Factors: Changes in brain function and neurotransmitter systems following trauma can impact the development and persistence of PTSD symptoms. Understanding these factors is essential for assessing and supporting youth who have experienced trauma. Early intervention, trauma-informed care, and supportive environments can mitigate the impact of trauma and facilitate recovery in children and adolescents. Tailored interventions that address the specific needs and contexts of youth are crucial for promoting resilience and minimizing the long-term effects of trauma. 108. Describe the brain circuits and neurotransmission linked to anxiety. Include the portion of the brain most often thought to be associated with anxiety. Answer: Anxiety involves complex interactions within brain circuits and neurotransmitter systems that regulate emotional responses and stress. The brain regions most often associated with anxiety include the amygdala, the hippocampus, and the prefrontal cortex. 1. Amygdala: The amygdala is a key structure in the brain's limbic system involved in processing emotions, particularly fear and anxiety. It plays a central role in the detection and response to threats. When stimulated or activated by perceived threats, the amygdala initiates a cascade of physiological and behavioral responses associated with anxiety, such as increased heart rate, sweating, and heightened alertness. 2. Hippocampus: The hippocampus, another limbic system structure, plays a role in processing memories and contextual information. It interacts closely with the amygdala to regulate emotional responses to stimuli, including those that trigger anxiety. Dysfunction in the hippocampus can impair the brain's ability to contextualize and regulate fear responses, contributing to heightened anxiety. 3. Prefrontal Cortex (PFC): The prefrontal cortex, particularly the ventromedial prefrontal cortex (vmPFC) and the dorsolateral prefrontal cortex (dlPFC), is involved in regulating emotions, decision-making, and cognitive control. It modulates the activity of the amygdala and other limbic structures to regulate emotional responses. Dysfunction or imbalance in prefrontal cortical activity can lead to difficulties in emotion regulation and increased vulnerability to anxiety disorders. Neurotransmitter Systems Linked to Anxiety: Several neurotransmitter systems play critical roles in anxiety regulation: • GABA (Gamma-Aminobutyric Acid): GABA is the primary inhibitory neurotransmitter in the brain. It helps to reduce neuronal excitability and has an anxiolytic (anti-anxiety) effect. Dysfunction in GABAergic neurotransmission is associated with increased anxiety symptoms. • Serotonin: Serotonin is involved in mood regulation, emotional processing, and anxiety. Low levels of serotonin or dysregulation of serotonin receptors have been implicated in various anxiety disorders. • Norepinephrine: Norepinephrine is involved in the body's stress response and arousal. Increased norepinephrine activity is associated with heightened alertness and vigilance, contributing to anxiety symptoms. • Glutamate: Glutamate is the primary excitatory neurotransmitter in the brain. It plays a role in synaptic plasticity and the regulation of anxiety-related circuits. Dysregulation of glutamatergic transmission is implicated in anxiety disorders. Neurotransmission and Anxiety: The interactions between these neurotransmitter systems and brain regions form intricate circuits involved in anxiety. For example: • Hyperactivity in the amygdala, combined with hypofunction in the prefrontal cortex, can lead to exaggerated fear responses and impaired regulation of emotions. • Imbalances in serotonin and GABAergic systems can contribute to heightened anxiety states. • Dysregulation in the balance between excitatory (e.g., glutamate) and inhibitory (e.g., GABA) neurotransmission can disrupt the normal functioning of anxiety-related brain circuits. In summary, anxiety disorders involve dysregulation within specific brain circuits and neurotransmitter systems. Understanding these neurobiological mechanisms is essential for developing effective treatments and interventions aimed at regulating emotional responses and alleviating symptoms of anxiety. 109. Describe three pathway theory of psychosocial influences proposed by Rachman. Give an example of each. Answer: The three-pathway theory proposed by Rachman outlines different pathways through which psychosocial influences can contribute to the development and maintenance of psychological disorders, particularly anxiety disorders. These pathways help explain how various factors interact to influence an individual's vulnerability to and experience of anxiety. Here are the three pathways along with examples for each: 1. Pathway 1: Direct Conditioning • Description: This pathway suggests that anxiety and fear can be acquired through direct conditioning experiences, where a neutral stimulus becomes associated with fear or anxiety due to pairing with a traumatic or aversive event. • Example: A child develops a fear of dogs after being bitten by a dog (direct experience of trauma). The sight or sound of a dog subsequently triggers anxiety and avoidance behaviors. 2. Pathway 2: Vicarious Conditioning • Description: Vicarious conditioning involves learning to fear a stimulus by observing others' fearful reactions or through media representations of fear-inducing events. • Example: A teenager develops a fear of flying after witnessing their parent's extreme anxiety during a turbulent flight. The teenager may then avoid air travel due to the learned association between flying and fear. 3. Pathway 3: Information Transmission • Description: Information transmission refers to the acquisition of fears or anxieties through verbal or non-verbal communication from others, such as parents, peers, or authoritative figures. • Example: A child develops a fear of thunderstorms after hearing stories from their grandmother about the dangers of lightning strikes. The child's fear is reinforced by the grandmother's anxious reactions during thunderstorms. Explanation: These pathways illustrate how psychosocial influences can shape an individual's emotional responses and behavioral patterns. Rachman's theory emphasizes the role of learning processes—both direct experiences and observational learning—in the development and maintenance of anxiety disorders. Each pathway highlights different mechanisms through which fears and anxieties can be acquired, reinforced, and generalized across different contexts. Understanding these pathways is important in clinical practice as it informs therapeutic approaches, such as exposure therapy (targeting direct conditioning), cognitive restructuring (addressing maladaptive beliefs acquired through vicarious conditioning), and psychoeducation (correcting misinformation acquired through information transmission). By addressing the specific pathways through which anxiety has been acquired or reinforced, therapists can tailor interventions to effectively reduce anxiety symptoms and improve overall well-being. 110. Briefly explain how parenting practices and peer relationships can influence anxiety. Answer: Parenting practices and peer relationships play significant roles in shaping the development and expression of anxiety in children and adolescents. Here’s how each can influence anxiety: Parenting Practices: 1. Parental Modeling and Anxiety Expression: • Children often learn how to respond to stress and anxiety by observing their parents' behaviors. If parents model anxious behaviors or display high levels of anxiety themselves, children may internalize these behaviors and develop similar patterns of anxiety. 2. Parental Overprotection and Control: • Overly protective or controlling parenting styles can limit a child's opportunities to learn effective coping skills and problem-solving strategies. This can increase dependency and fearfulness in children, contributing to anxiety disorders. 3. Inconsistent or Harsh Discipline: • Inconsistent discipline or harsh punishment can lead to feelings of unpredictability and insecurity in children. This uncertainty can heighten anxiety levels and impair emotional regulation. 4. Lack of Emotional Support and Validation: • Parents who are dismissive of their child's emotions or fail to provide adequate emotional support may hinder the child's ability to manage stress and regulate emotions. This can contribute to heightened anxiety responses. 5. Parental Reassurance-Seeking and Accommodation: • When parents excessively accommodate their child's anxiety (e.g., by constantly reassuring or avoiding anxiety-provoking situations), it can inadvertently reinforce anxious behaviors and impair the child's ability to face fears. Peer Relationships: 1. Social Comparisons and Peer Pressure: • Peer relationships provide opportunities for social comparison and may exacerbate feelings of inadequacy or fear of rejection in children who are already prone to anxiety. Negative peer interactions or bullying can significantly impact self-esteem and increase anxiety levels. 2. Social Skills Development: • Positive peer relationships can promote the development of social skills and self-confidence, which are protective factors against anxiety. Conversely, difficulties in forming friendships or social isolation can contribute to feelings of loneliness and anxiety. 3. Peer Influence on Coping Strategies: • Peers can influence how children cope with stress and anxiety. Positive peer support and adaptive coping strategies learned from friends can help children manage anxiety more effectively. On the other hand, maladaptive coping strategies or peer pressure to engage in risky behaviors can increase anxiety levels. 4. Peer Rejection and Exclusion: • Experiences of peer rejection or exclusion can lead to feelings of social anxiety and heightened sensitivity to social interactions. Fear of social judgment or criticism may develop as a result of negative peer experiences. In summary, parenting practices and peer relationships interact with genetic predispositions and individual temperament to shape the risk for developing anxiety disorders in children and adolescents. Positive parenting behaviors that promote emotional regulation, autonomy, and resilience can mitigate the impact of anxiety-promoting factors, while supportive peer relationships can enhance social competence and emotional well-being. Identifying and addressing these influences early can be crucial in preventing or reducing anxiety symptoms in youth. 111. Anxiety is described as a complex pattern of three types of reactions to a perceived threat. What are the three types of reactions? Give an example of how each might be assessed. Answer: Anxiety is often described as a complex pattern involving three types of reactions to a perceived threat. These reactions include cognitive, physiological, and behavioral responses. Here’s an explanation of each type and an example of how they might be assessed: 1. Cognitive Reactions: • Description: Cognitive reactions involve thoughts, beliefs, and perceptions related to the perceived threat. These can include catastrophic thinking, excessive worry, and hypervigilance. • Assessment Example: A clinician might assess cognitive reactions by asking a person about their thoughts during anxiety-provoking situations. For instance, during a social situation, asking questions like, "What thoughts were going through your mind when you started feeling anxious?" or "What do you believe will happen if others notice your anxiety?" 2. Physiological Reactions: • Description: Physiological reactions involve the body's physiological responses to anxiety, such as increased heart rate, sweating, muscle tension, and gastrointestinal distress. • Assessment Example: Physiological reactions can be assessed through physical examinations, self-report measures, or physiological monitoring devices. For example, a clinician might ask a person to monitor and report their heart rate and sensations of tension during anxiety-provoking situations. 3. Behavioral Reactions: • Description: Behavioral reactions involve actions or behaviors that a person engages in response to anxiety. These may include avoidance behaviors, safety behaviors, or compulsive rituals. • Assessment Example: Assessing behavioral reactions involves observing or asking about specific behaviors during anxiety-provoking situations. For example, observing if a person avoids social gatherings or asking them about specific actions they take to reduce anxiety, such as checking doors multiple times or avoiding certain places. Overall Assessment Approach: • Comprehensive assessment of anxiety often involves evaluating all three types of reactions to gain a thorough understanding of the individual's anxiety profile. Clinicians may use structured interviews, self-report questionnaires (e.g., Beck Anxiety Inventory), behavioral observations, and physiological measurements to assess the cognitive, physiological, and behavioral dimensions of anxiety. Understanding these reactions helps in formulating a treatment plan tailored to address each individual's specific anxiety symptoms and their underlying mechanisms. 112. Describe relaxation training and systematic desensitization. Answer: Relaxation training and systematic desensitization are therapeutic techniques commonly used in cognitive-behavioral therapy (CBT) to help individuals manage anxiety and phobias. Here’s a description of each technique: 1. Relaxation Training: Relaxation training involves teaching individuals various relaxation techniques to reduce physiological arousal and anxiety symptoms. These techniques aim to promote a state of calmness and relaxation in response to stressors or anxiety-provoking situations. Common relaxation techniques include: • Deep Breathing: Involves slow, deep breaths to promote relaxation and reduce physiological arousal. • Progressive Muscle Relaxation (PMR): Involves systematically tensing and then relaxing different muscle groups in the body to release tension and promote relaxation. • Visualization (Guided Imagery): Involves imagining oneself in a peaceful or calming environment to reduce stress and anxiety. • Mindfulness Meditation: Focuses on being present in the moment and non-judgmentally observing thoughts, feelings, and sensations to reduce stress and anxiety. Example of Relaxation Training: • A therapist teaches a client deep breathing techniques. The client practices diaphragmatic breathing by inhaling deeply through the nose, holding the breath for a few seconds, and exhaling slowly through the mouth. The therapist guides the client in using this technique during stressful situations to reduce anxiety symptoms and promote relaxation. 2. Systematic Desensitization: Systematic desensitization is a behavioral therapy technique used to reduce anxiety responses to specific feared objects or situations (phobias). It involves a step-by-step process of gradually exposing the individual to the feared stimulus while simultaneously teaching them relaxation techniques. The goal is to replace anxiety responses with a relaxation response through repeated exposure. Steps in Systematic Desensitization: • Hierarchy Development: The therapist works with the client to create a hierarchy of anxiety-provoking situations related to the phobia, ranging from least to most anxiety-inducing. • Relaxation Training: The therapist teaches the client relaxation techniques, such as deep breathing or progressive muscle relaxation. • Exposure: The client is exposed to the feared stimulus starting from the least anxiety-provoking situation in the hierarchy. During exposure, the client practices relaxation techniques to manage anxiety. • Gradual Exposure: Over successive sessions, the client progresses through the hierarchy, gradually facing more anxiety-provoking situations until anxiety responses are reduced or eliminated. Example of Systematic Desensitization: • A person with a fear of heights (acrophobia) works with a therapist to create a hierarchy of anxiety-inducing situations, starting with looking at pictures of heights. The therapist teaches relaxation techniques, and the client practices relaxation while gradually progressing to more challenging tasks, such as standing on a low platform or looking out of a window on an upper floor. Purpose and Effectiveness: Relaxation training and systematic desensitization are effective in treating anxiety disorders, phobias, and stress-related conditions by teaching individuals to manage their physiological and psychological responses to anxiety-provoking stimuli. These techniques empower individuals to confront fears gradually while learning to stay calm and relaxed, ultimately reducing anxiety and enhancing overall well-being. 113. Name five treatment strategies that are often included in cognitive-behavioral treatments for anxiety disorders in children and adolescents. Answer: Cognitive-behavioral therapy (CBT) is highly effective in treating anxiety disorders in children and adolescents. It typically includes several key treatment strategies that target cognitive patterns, behavioral responses, and emotional regulation. Here are five treatment strategies commonly included in CBT for anxiety disorders in children and adolescents: 1. Cognitive Restructuring: • Description: Cognitive restructuring involves identifying and challenging irrational or distorted thoughts and beliefs that contribute to anxiety. It aims to replace negative thinking patterns with more realistic and balanced thoughts. • Example: A therapist helps a child with social anxiety disorder identify and challenge thoughts like, "Everyone will laugh at me if I speak in class," by exploring evidence for and against this belief and developing more accurate and supportive thoughts, such as, "It's okay to make mistakes, and most people are focused on themselves, not me." 2. Exposure Therapy: • Description: Exposure therapy involves gradual and systematic exposure to anxiety-provoking situations or stimuli in a controlled and supportive environment. This exposure helps individuals confront their fears and learn that their anxiety decreases over time. • Example: A therapist helps a child with specific phobia (e.g., fear of dogs) gradually approach dogs starting with looking at pictures of dogs, then watching videos of dogs, and eventually petting a calm and friendly dog in a safe setting. 3. Behavioral Activation: • Description: Behavioral activation focuses on increasing engagement in positive and rewarding activities to counteract avoidance behaviors and reduce symptoms of anxiety and depression. • Example: A therapist works with an adolescent with generalized anxiety disorder to schedule and participate in enjoyable activities (e.g., sports, hobbies, social outings) that promote a sense of accomplishment and pleasure, thereby reducing anxiety symptoms. 4. Relaxation Techniques: • Description: Relaxation techniques, such as deep breathing, progressive muscle relaxation, guided imagery, and mindfulness meditation, are taught to help children and adolescents manage physiological arousal and reduce anxiety symptoms. • Example: A therapist teaches a child with panic disorder how to use deep breathing exercises to calm their body and mind during panic attacks or anxiety-provoking situations. 5. Parental Involvement and Supportive Parenting Practices: • Description: Involving parents in treatment can enhance its effectiveness by teaching them strategies to support their child's progress and promote adaptive coping skills. • Example: A therapist educates parents about anxiety disorders and teaches them techniques to reinforce adaptive behaviors, provide emotional support, and reduce accommodation of anxiety-related behaviors (e.g., reassurance-seeking, avoidance). These treatment strategies are often integrated into a comprehensive CBT approach tailored to the individual needs and developmental level of the child or adolescent. CBT helps empower young individuals to understand and manage their anxiety effectively, leading to improved functioning and quality of life. 114. What is exposure with response prevention? How does one enhance generalization and prevent relapse? Give an example of an imaginal exposure that might be used. Answer: Exposure with response prevention (ERP) is a therapeutic technique primarily used in the treatment of anxiety disorders, particularly obsessive-compulsive disorder (OCD) and specific phobias. It involves systematically exposing individuals to feared stimuli or situations (exposure) while preventing them from engaging in their usual avoidance or safety behaviors (response prevention). The goal of ERP is to help individuals confront their fears, experience anxiety, and learn that their anxiety decreases over time without engaging in compulsions or avoidance behaviors. Enhancing Generalization and Preventing Relapse in ERP: 1. Generalization: • To enhance generalization, exposures should be conducted in a variety of settings and contexts similar to real-life situations where the fear may arise. • Encouraging the individual to practice exposures independently and gradually in different environments helps generalize the learning that anxiety decreases with prolonged exposure. 2. Preventing Relapse: • Continued practice of exposures over time, even after initial symptom reduction, helps consolidate gains and prevent relapse. • Encouraging the individual to identify and plan for potential triggers or stressors that could lead to anxiety re-emergence and practicing coping strategies in advance can help maintain progress. Example of Imaginal Exposure: Imaginal exposure is a specific type of ERP where the individual is asked to vividly imagine feared situations or scenarios. This technique is particularly useful for fears or anxieties related to specific thoughts, memories, or hypothetical situations. Here’s an example of imaginal exposure for someone with OCD related to contamination fears: • Example Scenario: A person with contamination OCD fears that touching doorknobs will lead to illness. • Imaginal Exposure: The therapist guides the individual to vividly imagine touching a series of doorknobs in their home or another setting. During the exposure, the individual is asked to describe in detail the thoughts, images, and feelings that arise, including the fear of contamination and the urge to engage in washing or avoidance behaviors. • Response Prevention: Throughout the imaginal exposure, the individual is instructed to refrain from washing their hands or engaging in any other compulsive behaviors to neutralize the anxiety. • Enhancing Generalization: After mastering imaginal exposures in therapy sessions, the individual may be encouraged to practice similar exercises independently at home or in other environments where contamination fears may arise, such as public places or friends' homes. Imaginal exposure allows individuals to confront their feared thoughts and images in a controlled setting, helping them to reduce anxiety and gradually learn that their feared outcomes are unlikely or manageable without ritualistic responses. Through systematic practice and generalization, individuals can apply these skills across different situations, thereby promoting lasting relief from anxiety symptoms. Test Bank for Abnormal Child and Adolescent Psychology Rita Wicks-Nelson, Allen C. Israel 9781317351344, 9780205036066, 9780205901128
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