26.8 - Anxiety Disorders and Psychological Therapies Flashcards
What is anxiety?
A survival mechanism for dealing with real dangers.
What are the features of anxiety?
- Attention focuses on the perceived danger
- Increase in arousal ( heart rate, sweating, butterflies in stomach, more blood to muscles) in preparation for flight/ fight
- Strong urge to avoid
When does anxiety become problematic?
When the danger that triggers it is imagined.
When are anxiety disorders diagnosed?
When the anxiety is:
- Out of proportion to the danger
- Persistent
- Disabling
What are the main types of anxiety?
[IMPORTANT]
- Generalised anxiety
- Panic disorder
- Social anxiety
- Phobic anxiety (specific)
- PTSD
- OCD
What is generalised anxiety disorder?
[IMPORTANT]
When a person has excessive worry about several different things.
What is panic disorder?
[IMPORTANT]
When a person has repeated unexpected attacks of anxiety.
What is social anxiety?
[IMPORTANT]
A type of phobias characterised by marked fear and avoidance of social interaction.
What is phobic anxiety?
A type of phobia characterised by marked fear and avoidance of a specific thing, such as spiders, etc.
What is PTSD?
[IMPORTANT]
A form of anxiety characterised by unwanted, distressing memories of a traumatic event.
What is OCD?
A type of anxiety characterised by distressing thoughts or images with “putting right” actions.
What is the prevalence of anxiety disorders?
10%-18% prevalence in 12 month period (common)
What fraction of people with anxiety disorders require treatment?
Around 2/3rds
What are some gender differences in anxiety disorders?
There are higher rates in women than men for community samples (but not some clinical samples).
What are some common co-morbidities with anxiety disorders?
They are commonly seen alongside depression and substance abuse.
Are anxiety disorders genetic?
- They do sometimes run in families
- But genetic vulnerability is broader than just anxiety disorders. It can be across many different mental illnesses.
Give some clinical data regarding the recovery of patients with anxiety disorders.
- The recovery varies based on the type of anxiety disorder:
- It varies from 33% to 70% over 12 years (Bruce, 2005)
Give some experimental data regarding the cost to society of untreated anxiety disorders and depression.
It is around 7% of GNP (Layard & Clark, 2014)
Describe how you can test whether a treatment for anxiety disorders works.
Run a randomised control trial:
- Develop a measure of symptoms for pre-treatment and post-treatment -> It is best to include patient and independent assessor
- Compare the treatment group with a placebo group (and possibly also a group taking an existing treatment)
- Assess the participants at pre-treatment, post-treatment and at follow-up
Note: The trial must be pre-registered, to prevent investigators/companies hiding negative results.
What are the main treatments for anxiety disorders?
Medications:
- Benzodiazopines (only for short-term distress, due to high risk of developing dependence)
- Anti-depressants (especially SSRIs and SNRIs)
Psychological Treatments:
- Cognitive-behaviour therapy & cognitive therapy
What is cognitive behaviour therapy (CBT) and how can it be used in treating anxiety disorders?
- Brief (8-16 sessions) program where the patient is very active
- Based on cognitive model of emotional disorders
- It aims to change problematic beliefs (e.g. that a certain stimulus is triggering) and related behaviours (rather than original causes).
Describe the symptoms of panic disorder.
- Repeated attacks of anxiety, accompanied by marked bodily sensations
- Attacks come out of the blue
Describe a theory for how panic disorder arises.
Cognitive theory of panic disorder (Clark, 1986):
- Panic attacks result from catastrophic misinterpretation of benign body sensations
- Sensations that are misinterpreted are mainly those involved in normal anxiety responses (e.g. a fast heart rate caused by runnin)
- Misinterpretation involves believing the sensations indicate an immediate physical or mental disaster (e.g. the fast heart rate caused by running may be misinterpreted as a sign of danger)
On the diagram, the “Interpretation of Sensations as Catastrophic” is crucial for the deleterious cycle to continue.
What are some reasons why panic disorders may persist?
- Selective attention to bodily cues -> The people become more attentive to their bodily cues, so that they are more sensitive to triggers of another panic attack
- Safety behaviours -> Safety behaviours (e.g. lying down and taking deep breaths during a suspected heart attack) may reinforce the idea that the threat perceived during the panic attack was real and that the individual was ok only because of their safety behaviour
Describe how cognitive behavioural therapy can be used for panic disorders.
- Identify catastrophic interpretations of bodily sensation (e.g. identifying that the patient perceives a fast heart beat as a heart attack)
- Generate alternative, non-catastrophic interpretations of bodily sensations (e.g. identifying that the fast heart beat may be caused by exertion, not by a heart attack)
- Test out validity of catastrophic and noncatastrophic interpretations by discussion & behavioural experiments.
Draw an example of the cycle of panic attacks that a patient with panic disorder may have.
Give some examples of behavioural experiments that can be used to treat panic disorders.
- Inducing the fear sensations (e.g. fast heart beat) to show the patient that they have an innocuous cause -> e.g. Showing the patient word pairs like “breathless-suffocate” can cause them to have a panic attack, proving to them that this is not a dangerous situation
- Convincing the patient to drop their safety behaviours (e.g. lying down) during fear sensations to prove that they are not dangerous -> e.g. Going for a run to increase heart rate
Give an example of a RCT for panic disorder treatment.
What are some reasons why social anxiety persists?
Clark and Wells (1995) suggest:
- Shift to internal focus of attention
- Use of internal information to infer how one appears to others (images and feelings)
- Safety behaviours (e.g. Using a certain tactic to be more interesting, and then believing that this was the only reason why the social interaction didn’t ‘go wrong’. Also can be harmful because the safety behaviour may actually make the social interaction less natural.)
Describe how cognitive behavioural therapy works for social anxiety. What are the different steps?
- Developing a personal version of the model that explains how the patient is trapped in a cycle of social anxiety
- Experiential exercise -> Have the patient have a conversation with someone using their normal safety behaviours, and then try again using the opposite of their safety behaviours
- Video feedback -> To correct negative self-image
- Attention training -> To shift the patient’s focus on to the other person
- Behavioural experiments -> To test the patient’s fearful predictions in social situations while dropping safety behaviours and/or enacting feared outcomes
- Surveys -> To discover other people’s view of feared outcomes
- Memory work -> To reduce impact of early social trauma.
What are some types of treatment that cognitive therapy is more effect than in treating anxiety disorders?
Describe the risk factors for anxiety disorders.
- Anxiety disorders are a result of both genetic and environmental factors, with genetic heritability for general anxiety disorder estimated to be 31.6% (Hettema, 2001).
- The mechanism for this is not yet fully understood, but it may involve variation in genes such as glutamic decarboxylase 1, which may influence GABA production.
- In terms of environmental factors, childhood events and experiences are likely to underlie later life outcomes.
- Namely, these include trauma, parenting style (with more overprotective parents often raising more anxious children), exposure to fears that can be learned, and attachment to parents/carers. The risk factors and causes of each of the different types of anxiety disorder also differ, such as the trauma that precedes PTSD.
What therapy is given for PTSD?
-Exposure therapy (expose to situations which cue recall trauma)
-Group therapy (safe place to relive trauma)
-SSRIs to reduce depressive symptoms that accompany it
-Anxiolytics to reduce heightended arousal
-Sleep aids
What biological factors contribute to PTSD development? (6)
-Amplification of HPA axis = changes to endocrine signalling and prolonged stress
-Increased hippocampal activity = flashbacks
-deficits in arousal and regulating sleep
-family history
-endogenous opioid system which regulates pain = dsyfunction
-increased SNS activation rather than cortisol = acute and instense state for extended periods of time
What are the risk factors for PTSD?
Children who have gone through extreme trauma are more likely to develop PTSD based off another trauma
Experiencing trauma itself
Genetic (60% concordance)
Which types of trauma are more likely to lead to PTSD?
Interpersonal trauma
- Rape
- violent muggings
(unlike accidents or environmental disorders)
How does PTSD present differently in children than adults?
Children are less likely to show distress and instead use play to express their memories.
What are the clinical symptosm of PTSD? (General + 6)
Symptoms of an acute stress response persist for over a month
-presents with disturbing thoughts, feelings, or dreams related to a prior mental or physical trauma (ranging from traffic collisions and warfare to abuse) experienced by the patient
-intrusive thoughts
-avoidance of environments which remind them of trauma
-hyperarousal or vigilance
-insomnia
-irritability
What is the prevalence of PTSD in the population?
8-9%
What are the risk factors for a phobia?
genetic link
traumatic events
What are possible clinical symptoms of phobias?
*Catastrophise
*Sweating
*Trembling
*Increased HR
*Increased avoidance of associated location
What percentage of the population have phobias?
most common anxiety disorder (10%)
