Low-intensity CBT Skills and Interventions. Группа авторов
repetitive behaviours or mental acts carried out in response to an obsession or according to some personal rule, experienced as unpleasant and cause anxiety
Recognition that these are coming from one's own mind: rather than being implanted in one's mind by someone or something else
Attempts to prevent or resist obsessions or compulsions: although over time that resistance may become minimal
Recognition that obsessions or compulsions are excessive or unreasonable at some point over the course of the disorder.
Common symptoms:
Thoughts of being responsible for harming others or for the occurrence of unwanted or terrible events.
Specific Phobias
Specific phobias are amongst the most common anxiety disorders with one in eight adults experiencing a phobia at some point in their lives, although many people with these conditions do not seek treatment (Kessler et al., 2005).
Key Point
Core symptoms:
Persistent fear of a specific situation or object that poses little or no actual danger
The presence of the phobic situation or object always provokes marked anxiety
The situation/object is nearly always avoided.
Common symptoms:
Panic attacks in presence of the phobic situation/object.
Common phobic situations or objects include animals such as spiders, activities such as flying or using a public toilet, experiences such as being in closed spaces or going to the dentist. Specific phobias can also be associated with particular contexts or procedures, such as procedural anxiety related to medical procedures or common events in this context, such as the sight of blood, needles or vomiting.
Diagnosis of CMDs Not Treated with LICBT
There is no NICE evidence base recognised for the treatment of CMDs such as social anxiety disorder, health anxiety and post-traumatic stress disorder. However, it is helpful to be able to recognise the key symptoms associated with these to inform stepping up (Chapter 4).
Social Anxiety Disorder
Social anxiety disorder (social phobia) is a commonly experienced anxiety disorder (Kessler et al., 2005). It is often co-morbid with other CMDs, particularly depression, agoraphobia with or without panic disorder, and alcohol misuse disorders (Kessler et al., 2005).
Key Point
Core symptoms:
Marked and persistent fear or embarrassment of being ill-judged by others when faced with a social or performance-related situation
Exposure to the feared performance or social situation will almost certainly lead to marked anxiety and may lead to a panic attack, although situations may be endured with the use of safety behaviours that attempt to mitigate the feared outcomes (Clark, 2001).
Common symptoms:
Avoidance of situations where one could be the focus of attention.
In identifying social anxiety disorder vs depression, LICBT practitioners should consider why someone has withdrawn from social situations and which type of symptoms came first.
Key Point
Differentiating social anxiety disorder and depression
If fear of judgement from others underlies social withdrawal or preceded low mood, social anxiety disorder diagnosis is likely.
If a lack of interest or enjoyment in activities, or fatigue that has led to withdrawal from social situations or preceded fear of scrutiny by others, a diagnosis of depression is more likely.
Health anxiety
Health anxiety (hypochondriacal disorder) is relatively rare among anxiety disorders.
Key Point
Core symptoms:
Persistent preoccupation with the possibility of having one or more serious progressive illnesses
Preoccupation with normal or common bodily experiences, such as headaches, which are interpreted as signs of severe illness.
Common symptoms:
Frequent contact with health professionals to request investigations in the belief or conviction that one has a severe and undiagnosed progressive physical illness
Negative results from such investigations do not lead to prolonged change in belief or behaviour.
Post-Traumatic Stress Disorder (PTSD)
PTSD may develop in response to an event where a person considers themselves or someone close to them to have been at threat of serious harm or death. The traumatic event is considered to be exceptionally threatening or catastrophic and likely to cause distress in almost anyone.
Key Point
Core symptoms:
Experiencing a traumatic event
Re-experiencing the traumatic event – having vivid intrusive memories, flashbacks or repeated nightmares about the event
Avoiding or wanting to avoid reminders of the event or things associated with the event.
Common symptoms:
Difficulty fully recalling some important aspects of the traumatic event
Increased psychological sensitivity or arousal – difficulty falling or staying asleep, irritability, angry outbursts, concentration difficulties, hypervigilance or easily startled.
Symptoms must have occurred within six months of the traumatic event. Delayed onset PTSD, where symptoms occur beyond six months, is considered a separate diagnosis and is often preceded by other signs of mental distress including alcohol misuse. Experiencing a traumatic event does not necessarily lead to PTSD, and other mental health problems can be more common following traumatic events, including depression, panic disorder, agoraphobia and alcohol misuse (Fear et al., 2010). These are also commonly co-morbid with PTSD (McFarlane and Papay, 1992).
Mixed Anxiety and Depressive Disorder
Across mental health services, significant variation exists in the use of a probable diagnosis of mixed anxiety and depression (MADD).
Key Point
Core symptoms:
Symptoms of both depression and anxiety are present
Neither is predominant
Symptoms are not sufficient to meet diagnostic criteria for a depressive episode or any anxiety disorder.
Reaching this probable diagnosis should rarely be used in mental health services as many service users will come with symptoms sufficient for a diagnosis of depression or at least one anxiety disorder. In these circumstances a probable diagnosis of MADD does not apply.
Validity of Diagnostic Systems