Psy4270 Assessing Anxiety & Trauma

Front 1

Define anxiety.

Back 1

An emotion characterized by apprehension and anticipation of future danger or misfortune accompanied by a feeling of dysphoria or somatic symptoms of tension

Front 2

When is anxiety problematic?

Back 2

When it moves from normal levels to a severity that impairs functioning

Front 3

What is the criteria for GAD?

Back 3

A: Excessive anxiety and worry more say tat not for at least 6 months about a number of event sand activities
B: Worry is difficult to control
C: Associated with >= 3 (>=1 children) of the following symptoms, with some more days than not (6):
1. Feeling wound-up, tense, or restless
2. Easily becoming fatigued or worn-out
3. Concentration problems
4. Irritability
5. Significant tension in muscles
6. Difficulty with sleep

Front 4

What are three types of assessments of anxiety?

Back 4

1. Clinical Interviews
2. Self-report measures
3. School Refusal Measures

Front 5

What are the three ‘gold standard’ clinical diagnostic interviews used to assess for the presence of anxiety disorders in children?

Back 5

1. K-SADS: Kiddie Schedule for affective Disorders & Schizophrenia
2. ADIS-C: Anxiety Disorders Interview Schedule for Children
3. SCID: Structured Clinical Interview for DSM Disorders

Front 6

What are three self-report measures used to assess for the presence of an anxiety disorder?

Back 6

1. BAI: Beck Anxiety Inventory
2. GAD-7: Generalised Anxiety Disorder 7
3. SCARED-R: Screen for Child Anxiety Related Emotional Disorders

Front 7

Describe the BAI

Back 7

- Beck Anxiety Inventory
- 21 items, 3-point scale
- each item is descriptive of subjective, somatic, or panic related symptoms of anxiety
- Symptoms are assessed over the past week
- Internal consistency > .9
- Concurrent validity with STAI

Front 8

Describe the GAD 7

Back 8

- GAD component of the Patient Health Questionnaire
- 7 items, 3-point scale
- score range 0-21
- Good capacity to detect GAD, PTSD. Panic Disorder and Social Phobia

Front 9

Describe the SCARED-R

Back 9

- 66 items, 3-point scale (almost never, sometimes, always)
- DSM-IV linked subscales (i.e. panic disorder, separation anxiety disorder, GAD, social phobia, OCD, specific phobias (animals, situation and blood), PTSD)

Front 10

What must be screened when assessing the somatic symptoms of anxiety?

Back 10

Screen for medical disorders that better explain the somatic symptoms of anxiety

Front 11

Define school refusal.

Back 11

- severe difficulty attending school
- sever emotional upset
- at home with parents knowledge
- Absence of antisocial characteristics
- Reasonable efforts by parent to enforce attendance

Front 12

What are 4 school refusal assessment tools?

Back 12

1. School Refusal Assessment Scale
2. Self-Efficacy Questionnaire for School Situations (SEQ-SS) – developed by Monash
3. Fear Thermometer
4. Self-Statement Assessments

Front 13

What are four possible functions of school refusal assessed but he School Refusal Assessment Scale?

Back 13

1. Avoidance of specific fearful situations or general over-anxiousness in the school setting
2. Escape from aversive social situations associated with social anxiety, or a specific performance related situation ie public speaking
3. Attention getting or separation anxiety behaviour in which attention seeking behaviours are performed with the aim of gaining permission to stay at home
4. Tangible reinforcement as a consequence of pleasant activities other than school

Front 14

Describe the Self-Statement Assessment for measuring school refusal.

Back 14

- Asks the child to provide information in response to certain statements such as going off to school, how clever you are etc
- A qualitative measure which may provide insight into the problem

Front 15

What is Trauma?

Back 15

Psychic trauma occurs when a sudden unexpected intense external experience overwhelms the individuals’ coping and defensive operations, creating the feeling of utter helplessness

Front 16

What are the eight criteria for PTSD?

Back 16

Criterion A: Stressor
Criterion B: Intrusions
Criterion C: Avoidance
Criterion D: Cognitions & Moods
Criterion E: Arousal & Reactivity
Criterion F: Duration
Criterion G: Functional Significance
Criterion H: Exclusions

Front 17

Describe Criterion A: Stressor in PTSD.

Back 17

Exposure to actual or threatened death, serious injury, sexual violence in one or more of the following ways:
1. Direct experience
2. Witnessing event occurring in others
3. Learning of trauma in close family member
4. Experiencing repeated/extreme exposure to aversive details of traumatic events

Front 18

Describe Criterion B: Intrusions in PTSD

Back 18

Presence of one or more of the following intrusion symptoms associated with the event(s):
1. Recurrent, involuntary and intrusive distressing memories. (Note: children > 6 repetitive play may occur in which themes or aspects of the trauma are expressed)
2. Recurrent distressing dreams in which the content and/or affect of dream are related to the event. (Note: children may have frightening dreams without recognizable content)
3. Dissociative reactions; feel act as if event were recurring (Note: in children trauma-specific reenactment may occur in play)
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
5. Marked physiologic reactivity to internal or external cues that symbolize or resemble aspects of the traumatic event

Front 19

Describe Criterion C: Avoidance in PTSD

Back 19

Persistent avoidance of stimuli associated with the trauma beginning after the trauma, as evidences by one or both of the following:
1. Avoidance of or efforts to avoid distressing memories, thoughts or feeling about traumatic event.
2. Avoidance of or efforts to avoid external reminders (e.g., people, places) that arouse distressing memories, thoughts feelings about traumatic event

Front 20

Describe Criterion D: Cognitions & Mood in PTSD

Back 20

Negative alterations in cognitions and mood associated with the event as evidences by two or more of the following:
1. Inability to remember important aspects of the traumatic events (dissociative amnesia not drugs or injury)
2. Persistent exaggerated negative beliefs, expectations about oneself, others world
3. Persistent, distorted cognitions about the cause or consequence of the event that lead to blame to self or others
4. Persistent negative emotional state
5. Markedly diminished interest or participation in significant activities
6. Detachment or estrangement from others
7. Persistent inability to experience positive feelings

Front 21

Describe Criterion E: Arousal & Reactivity in PTSD

Back 21

Marked alteration I arousal and reactivity associated with traumatic events beginning/worsening after event as evidences by 2 or more of the following:
1. Irritable behaviour and angry outbursts, typically expressed as verbal or physical aggression
2. Reckless or self-destructive behaviour
3. Hypervigilance
4. Exaggerated startle response
5. Problems Concentrating
6. Sleep Problems

Front 22

Describe Criterion F: Duration in PTSD.

Back 22

Duration of the disturbance (symptoms in B, C, D and E ) is more than a month

Front 23

Describe Criterion G: Functional Significance

Back 23

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Front 24

Describe Criterion H: Exclusions in PTSD

Back 24

Disturbance not due to effects of substance or medical condition

Front 25

What are some other diagnoses, other than PTSD, often emerge following a trauma?

Back 25

- Depressive Disorder
- GAD
- Substance Abuse
- Phobias

Front 26

Describe the Impact of Events Scale

Back 26

- 22 items, 5-point scale
- Anchored to a specific event
- Adult measure
- Good ability to discriminate btw traumatized and non-traumatised individuals
- Linked with DSM-IV PTSD
- Contains 3 subscales

Front 27

What are the three subscales on the Impact of Events Scale Revised?

Back 27

1. Intrusion – others keep making me think about it and I thought about it when I didn’t mean to
2. Avoidance – I stayed away from reminders of it and I tried to remove it from my memory
3. Hyperarousal – I have trouble concentrating and I felt watchful and on-guard

Front 28

Describe the Child PTSD Symptom Scale

Back 28

- self-report measure of PTSD severity in children 8-18 years
- 24 items, 4-point scale
- linked to a named event
- maps to DSM-IV
- Contains functioning impairment items
- Three 3 subscales
- Scores >= 11 indicate PTSD
- Good inter consistency and test-retest reliability

Front 29

What are the 3 subscales on the Child PTSD Symptom Scale?

Back 29

1. Re-Experiencing
2. Avoidance
3. Hyperarousal

Front 30

What are three screening tools used for detection of PTSD?

Back 30

1. Impact of Events Scale Revised
2. Child PTSD Symptom Scale
3. University of California at Los Angeles Child PTSD Reaction Index

Front 31

Describe the University of California at Los Angeles Child PTSD Reaction Index.

Back 31

- screens for traumatic events and maps to DSM-IV PTSD but not diagnostic
- child version 7-12 years, adolescents 13+ and parents version
- screens for lifetime exposure

Front 32

Define dissociation.

Back 32

A attempt to protect oneself against an overwhelming stressor by altering self-awareness

Front 33

Finish this sentence “dissociation exists on a continuum from…”

Back 33

Normal (daydreaming, absorptions, involvement in fantasy worlds) to pathological (amnesia, fugue states, derealisation, depersonalization)

Front 34

What is a common measure used to screen for dissociative experiences in adolescents?

Back 34

Adolescent Dissociative Experience Scale

Front 35

Describe the Adolescent Dissociative Experience Scale.

Back 35

- self report measure
- 28 items, 11-point scale
- reasonable psychometric properties
- useful but may not uncover dissociation
- normal youth who excessively daydream or are involved with fantasy may score highly
- contains four subscales (dissociative amnesia, absorption and imaginative involvement, passive influence, and depersonalization/derealisation)