Sigmund Freud

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2 Sigmund Freud

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6 Expression of intrapsychic anxiety due to unresolved emotional conflict from childhood Unacceptable desires, strangulated affect after past trauma, displacement, avoidance Psychoneurosis : (phobias or situational anxiety), OCD and hysteria unconscious conflict

7 Repressed material is expressed in a different way In Phobias the unacceptable ideas are projected (ex. Oedipus Complex Little Hans) In OCD they are expressed as substitute symptoms.fear of contamination In Hysteria they are expressed in the body

8 The seat of Anxiety is the Ego The ego detects something unpleasant arising from within or without A Signal arises there is DANGER The danger is that the ego will be rendered Helpless This brings back memories of when the ego was helpless as a baby

9 The signal of anxiety triggers a withdrawal from the dangerous external situation or repression of the internal unacceptable ideas The ego was helpless at: Birth when mother went away..object loss when mother was angry..withdrawal of love when the child felt humiliated..castration anxiety when the child was unable to claim mother or compete with father for mother.. Superego anxiety

10 Hysteria is related to a withdrawal of love Phobias are displaced forbidden impulses In OCD, There is a very powerful superego and strong id impulses with an ego caught in the middle. There are excessive ambivalent feelings with a war between loving and hostile feelings. But the superego berates the ego producing XS guilt. The ego reacts by reaction formation. XS cleanliness I m innocent Sexuality is repressed and regresses to an earlier anal sadistic stage.. Preoccupation with dirt

11 Acknowledgements for slides to Dr Sally Standart, and NCBTC

12 situation thinking Behaviour emotions Physical reactions

13 Our bodies and minds are designed to attend to threat Survival is a common task for all living creatures Over millions of years we have evolved ways of detecting and reacting to threats Humans are motivated to get safe, limit potential damage Menu of safety strategies responses that can be activated quickly and automatically when needed include Physiological systems- physical reactions Emotions Behaviours (fight/ flight/ freeze/ submit) Cognitive Processes ( better safe than sorry)

14 People experience anxiety disorders when they think situations are more dangerous than they really are Goals of treatment are to help person consider alternative, less frightening explanations And then help them to gather their own evidence that supports these new, less frightening explanations Needs to be individualised, based on jointly derived alternative explanation (i.e. formulation)

15 First stage of treatment is to help people identify the particular situations in which they feel anxious Identify the thoughts/ behaviours/ and physical symptoms that happen in these situations This forms the basis for understanding what the patient is experiencing It also forms the basis for diagnosis

16 With a partner - think about a feared situation that you feel comfortable discussing. Discuss What thoughts/ images/ memories might go through your head How you might feel physically How you might act, or how you might want to act if you were asked to go into that situation in 5 minutes time.

17 I m going to die It s going to bite me I m going to make a fool of myself I ll do it wrong Overestimating risk Jumping to the worst conclusion Images of worst case scenario

18 Better safe than sorry Selective attention- scan for threat Crude analysis Dichotomous (black and white) thinking Overgeneralisation Disqualify positive- can t risk false hope Sensitive to nonverbal signals Helps select appropriate behavioural response We may do this quickly, before it s in our conscious awareness.

19 Types of thinking in anxiety are understandable Designed to keep us safe Although this is the intended consequence in anxiety disorders this type of thinking has unintended effects Leads us to overestimate risk unhelpfully, and inaccurately Lead to behaviours that stop us finding out that things are not as bad as they seem.

20 We respond to threat with the adrenaline flight /fight response Unfortunately in the modern world the threats we are facing are not physical Often the fight / flight response isn t helpful to us in responding to the threats we experience In anxiety disorders are bodies are reacting in a normal way to a perceived threat

21 Heart beating fast Breathing fast Sweaty palms, feeling hot Butterflies, nausea, needing to go to the toilet Shaking Feeling dizzy, faint, unsteady on your feet Tightness in the throat Numbness or tingling in the fingers, lips, toes.

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23 Face it with anxiety Fight Flight Avoid Go in with assistance

24 Benefits Can be protective depending on what the threat is Short term relief of anxiety Disadvantages Don t get disconfirmatory experiences Can lead to an increasingly restricted life In order to avoid the thing you may have to cut out things that give you pleasure/ satisfaction/ reward, eventually could lead to depression.

25 Behaviours designed to allow you to deal with the threat E.g. if scared of dogs- take someone with you, make sure dogs always shut away. Benefits Help you feel safe in the circumstance of the perceived threat Disadvantages Can prevent experiences that show you that the situation is safe after all You can attribute lack of disaster to the safety behaviour not the lack of danger. (e.g. dog didn t attack because friend there, not because dog wouldn t have attacked anyway)

26 Anxiety is a normal response to threat In CBT we are interested in the specifics of what people think, feel physically and what they do in situations in which they feel anxious. This helps us to understand the threat that people are perceiving, and their reactions to it In anxiety disorders people get stuck Ways of thinking E.g. Overestimating risk, Misinterpreting situations/events as dangerous Behaving in ways that keep them safe in the short term, but prevent learning that situations aren t as bad as they think in the long term. So cognitive and behavioural processes help to keep the anxiety disorder going ( maintaining factors)

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