2: Anxiety Disorders Flashcards
Why is anxiety thought to be normal?
- Xp by most people
- bodily changes are our natural FoF response
What are the 6 different subtypes of anxiety disorder?
- Phobias
- Panic disorder
- GAD
- OCD
- PTSD
- Acute stress disorder
What are the 2 separate categories of phobia?
- Specific phobias
2. Social phobias (AKA Social anxiety disorder)
What is a specific phobia?
- where there is a persistent + excessive fear of a particular object/ situation
What is thought to be the lifetime prevalence of specific phobias?
12-20%
What are the 5 separate subtypes of specific phobias?
- Animals
- Natural environment
- Blood-injection-injuries
- Situational (enclosed space, flying)
- Other types
What is the fear of blood called?
Haematophobia
What is the fear of germs called?
Microphobia
What is the fear of Heights called?
Acrophobia
What is the fear of Snakes called?
Ophidiophobia
What is the fear of Water called?
Aquaphobia
Who seem to be at a greater risk of specific phobias, men or women?/
WOMEN
- animal + situational phobia
- no difference in blood-injection-injuries
Fredrikson et al (1996)
What fears are thought to be the most prevalent?
varies between height, dental + spider
What is a social phobia (social anxiety disorder)?
individual has an intense + persistent fear of being under scrutiny or embarrassing themselves in social situations
- negative opinions of themselves + possible outcome of social situations
What are the most common social phobias (APA, 2011)
- Fear related to meeting new people
- Speaking in public
- Using public bathrooms
What is the lifetime revalance of social phobias?
12.1%
What are safety behaviours?
anxiety relieving strategies employed by those suffering from social phobias
Give examples of social phobias and safety behaviours
- Taking to strangers - babbling - speak quickly, rehearse sentences
- Drinking in front of others - losing control - use both hands + grip tightly
- Eating in public - vomiting - eat small amounts
What are the different way phobias are thought to be aquired?
- Biological
- Preparedness theory
What is the preparedness theory?
- suggests humans have an innate tendency to be afraid of certain objects/ situations that could potentially harm us
- avoiding = better chance of survival
What is a problem with the preparedness theory?
Cannot explain phobias associated with modern living
- fear of elevators/ costumed characters
What other biological theories are there other than preparedness theory?
- relating to heightened sensitivity of brain regions involved in fear network
= Amygdala
= Medinal prefrontal cortex
= Thalamus
What evidence is there to suggest that sharing of negative information can result in phobias/ increased fear (Rachman, 2002)?
children given more negative comments about animals = more likely to fear than neutral/ positive info
Why is Agoraphobia related to panic disorder?
= fear or market place
- but actually fear of having a panic attack in these situations
- more frequent in women
What are the different treatments available for phobias?
- Bio-based
- anitaxniety
- antidepressants - Psychological based
- Emotion
- Cognition
- Behavioural
- CBT
- Psychoeducation
What are the 2 main types of medication used to treat phobias by altering neurotransmitter systems?
- Antianxiety - Anxiolytics
- benzodiazepines - Antidepressants
- SSRI
- good for social phobias
What are the 2 ways in which the physiological reaction produced by fears are treated with (Emotions)?
- Relaxation technique
- muscle tension
- reduced reactivity to phobic stimuli - Breathing techniques
- help control for hyperventilation
- reduce phobic reactivity
In cognitive therapy of phobia, what aspects of cognition is being treated?
- Their attentional focus on the feared stilmuli
- they are quick to notice anything that looks vaugly simmilar - Dispropotyional harm they think they will xp
What are the different therapeutic techiniqes used to alter maladaptive behavioural pattern seen in phobia?
- Exposure therapy
- Systematic-desensitisation
* * relaxation technique
- Flooding + implosion therapy
* * wait till initial body fear response has died down
What is psychoeducation?
- provision of knowledge + training about a particular disorder
- to facilitate better understanding + recovery
What is a panic attack?
individual becomes extremely anxious,
- xp physical discomfort + heart palpitations, trembling, shortness of breath
- may feel they are dying
What is panic disorder?
panic attacks are recurrent + unexpected
- continual fear of having additional attacks = changes in behaviour associated with fear
eg avoiding situation ==> agoraphobia
What is the lifetime prevalence of panic disorders?
4.7%
twice as prevalent in women + Caucasians
What are the different biological exp for the cause of panic disorder?
- Genetic predispositoin
- however hard to find specific gene = genetic + enviornmental interaction shift - Brain structure abnormalities
- brain region associated with fear response hypersensitive (hippocampus, amygdala + thalamus) - disturbance of neurotransmitter serotonin
- tho unsure if deficit or excessive = disorder
What are the different psychological exp for the cause of panic disorder?
- Anxiety Sensitivity (AS)
- hypersensitive to bodily sensations
- attribute changes to imminent harm eg heart attack (Schmidt et al, 2010)
- can predict future development of panic disorder + other anxiety disorders - Catastrophic thinking
- belief worst will always happen
- socially embarrass when they detect changes in bodily sensations
= more changes in body = vicious cycle
= CC
What is introspective conditioning?
type of CC where changes in bodily state result in feelings of fear + panic causing someone to think they are having a heart attack
- changes become conditioned stimulus = fear + panic (conditioned response)
What is the most successful + commonly used psychological treatment for panic disorder (Roy-Byrne et al, 2006)?
CBT - psychoeducation - cognitive reconstruction - exposure to changes in bodily sensations - exposure to feared stimulus = minimise anxiety + fear
What is thought to be the most successful treatment for panic disorders?
CBT + medication
- antidepressants = SSRI
- anti-anxiety = Benzodiazepines
What is the heritable estimate of panic disorder (Hettema, Neale + Kendler, 2001)?
43%
What are the psychological explanation for the acquisition of GAD?
- Negative schema
- negative interpretation of everything
- catastrophe
- selective abstraction - only looking at the negative points - metacognitive model
- worrying about worrying - focus Intolerance of uncertainty
What evidence is there supporting that GAD indidivuals have a negatie schema?
Rinck (2010)
- more likely to associate neutral words w/ negative attributes = underlying negative cognitive schema
What is the metacognitive models of GAD ( Wells, 2005/9)?
exp for the origin of GAD
- having negative beliefs about the controllability + consequences of worrying
- concerned about worrying being out of control + that serious health consequences might result from excessive worry
How does Dugas + Robichaud explain the cause of GAD being due to focus of uncertainty?
need 100% certainty to avoid worry + anxiety
- they know plane won’t crash but need to be 100% sure
Antidepressants + anti-anxiety are used to treat GAD. How have they been recommmended to use and why?
Antidepressant = for LT as anti-anxiety has high dependency risk
- initially should use both
What are the 2 psychological therapies which have been found to be effective in the treatment of GAD?
- CBT
- found to be as effective as medication - Applied relaxation
What is applied relaxation?
- individual trained to identify physiological changes they xp whilst worrying/
- apply relevant relaxation technique (breathing etc)
How is OCD defined?
presence of obsessions + compulsions
Obsession - reoccurring + persistent thoughts, images + impulses can = anxiety
Compulsions - behaviours which they feel the need to do in order to relieve distress caused by obsession
What is the lifetime prevalence of OCD?
- 6%
- but obsession + compulsion exist separately in 13% of gen population
Examples of O + C?
O = contamination of germs from touching something C = wearing gloves/ washing hands
O = need for order/ symmetry C = not allowing people in room/ touch belongings
What is the genetic heritability of OCD?
50% = strong
- but still lacking solid evidence for single/ genes
What neuroanatomical areas have been strongly associated with OCD?
- Orbitofrontal cortex
- Caudate nucleus
- Thalamus
all have increased metabolism in disorder may = excessive worrying/ repetitive behaviours (Markarian et al, 2010)
What evidence is there to support the role of abnormal levels of neurotransmitters have a role in the development of OCD?
Medication increasing serotonin in brain (SSRI) = successful treatments (Simpsons, 2010)
- 60/70% respond to treatment
What are the key cognitive features of OCD thought to have an important role in the aquisition + maintainance of OCD?
- Over-importance of thoughts
- believe that thinking but lead to action
- thinking of being violent mean they will become violent - Inflated responsibility
- believe they are responsible for preventing from negative events from happening - Intolerance of uncertainty
- need for certainty
The repeated pairing of what 2 things is thought to = OCD?
obsessive thought + anxiety-relieving compulsion
CC
What is the downside of using medication for the treatment of OCD?
- Can take 1 month to start taking effect
2. Sometimes need in high dosage = high risk of side effects (Fenske + Schwenk, 2009)
What psychological treatments are used for OCD?
CBT
Psychoeducation
- thought to be more effective than medication as it is more longer lasting, lower relapse rate
What are the symptoms of PTSD?
- Reliving the traumatic event via intrusive memories = psychological distress + physiological reaction
- effort to avoid triggers
- increased physical arousal = difficult to sleep + outburst of anger
Although genes involved in PTSD are not clear, what evidence is there suggesting a genetic link?
Children of holocaust survivors w/ PTSD more likely to develop PTSD vs children of holocaust survivors without PTSD (Yehuda, Halligan + Bierer, 2001)
What part of the brain is thought to have heightened sensitivity in PTSD?
Amygdala - key brain region involved in fear response
- may have stemmed from chronic stress (Ressler, 2010)
The pairing of what 2 factors is suggested to = PTSD?
Traumatic event = fear + any cues
What aspect of cognition is thought to be factors contributing to the acquisition of PTSD (Ehlers + Clark, 2000)?
- negative pattern on thinking
- threat continually perceived
- self-blame for traumatic events - Trauma memory not being integrated to autobiographical memory
- since they xp lots of confusion + detachment during traumatic event
= unintentional/ expected triggering of trauma memory
What is the primary bio treatment for PTSD?
Antidepressant medication = SSRI
- found to be effective in 59% patients (Stein, Ipser + Seedat, 2009)
- increase serotonin which may diminish activity of the amygdala
What are the primary psychological treatment for PTSD?
- Trauma-focused CBT
- memory + meaning of event - Eye movement desensitisation + reprocessing
- Focus on coping w/ symptoms of disorder
How is TBCBT carried out?
- Confront stimulus - imagine/ or reality
- Asked to describe/ relive event
= habituated xp = no fear response
What sis Foa et al (1999) when female victims of sexual assaults were asked to imagine + describe the assault taking place on a daily basis?
effective at reducing PTSD symptoms
What is eye movement desensitisation + reprocessing?
- Focus on memory, emotions + thoughts associated w/ traumatic event
- Move hand in front of face to induce eye movement
= induce a neurobiological state which facilitates integration of traumatic memories into LT memory = reducing negative emotions associated w/ memory
What is the difference between acute stress + PTSD?
- duration of episodes shorter
- Feelings of detachment from reality more common
- 80% of acute stress go on to have PTSD (Murray, Ehlers + Mayou, 2002)
What % of soldiers who returned from serving at Afghanistan met the criteria for PTSD?
20%
Ramchand et al, 2010
