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Clinical Psychology > 3.2: Anxiety Disorders > Flashcards

3.2: Anxiety Disorders Flashcards

1
Q

Introduction to Anxiety:

A

Anxiety and stress are common part of everyday life, and as an adaptive emotion it can help us deal effectively with anticipated threats.
- Increasing arousal and reactivity, focus and attention – helps us solve problems.
Can also be maladaptive and significantly affect an individual’s life and functioning.

involves both physical and pscyhological symptoms

Overly anxious people find it hard to stop thinking negative and threatening thoughts, and this part is due to cognitive biases that have developed with the experience of anxiety.

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2
Q

Obsessive-compulsive disorder (OCD):

A

a disorder characterised either by obsession (intrusive thoughts) or by compulsion (ritualised behaviour)

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3
Q

Anxiety disorder

A

a psychological disorder characterised by an excessive or aroused state and feeling of apprehension, uncertainty, and fear.

  1. May be out of proportion to the threat posed by the situation or event (ie. Specific phobia)
  2. May be a state that the individual is constantly in (generalised anxiety, panic disorder)
  3. May persist chronically and be so disabling that it causes constant emotional distress to the individual who is unable to plan and conduct their normal day-to-day living.
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4
Q

Anxiety as a Comorbid Condition

A

Anxiety disorders diagnosed = subjectively experienced anxiety,

recurs as regular and chronic basis.

distressing and disrupts normal living.

  • Symptoms are common to a number of different anxiety disorders.
  • Common to suffer from more than one anxiety disorder.
  • When anxiety disorders are comorbid, they have a younger age of onset and stronger chronicity, also more likely associated with depression.
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5
Q

Specific Phobia

A

defined as marked fear or anxiety about specific object or situation.
- the phobic trigger elicits an extreme fear and often panic
- phobic individual develops strong avoidance strategies.
- they are not aware that fear is disproportionate to actual risk posed by phobic trigger.

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6
Q

DSM-5 Specific Phobia

A
  • irrational and disproportionate fear of phobis stimuli
  • phobic stimuli is avoided or tolerated with great fear or anxiety
  • symptoms cannot be better explained by other disorder and persist for at least 6 months
  • phobia causes significant distress to daily functioning
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7
Q

Theory explaining simple phobia

Biological

A

Amygdala: Central role in fear response; overactivation linked to phobias.
- linear relationship b/w subjective experience and amygdala activation

Evolutionary Preparedness:(seligman 1971) Predisposition to fear life-threatening stimuli (e.g., snakes, spiders).
- Poulton argues limited number of evolutionary releavant stimuli.

Genetics: Family history suggests heritable component.

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8
Q

Theory explaining simple phobia

Social:

A

Observational Learning: Phobias can develop by observing others’ fearful reactions.
- albert bandura

Cultural Influences: Cultural norms influence fear focus (e.g., fear of offending others in Japanese culture).

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9
Q

Theory explaining simple phobia

Psychological

A

Classical Conditioning: Phobias acquired through traumatic pairing of neutral stimulus with fear-inducing event (e.g., Little Albert experiment).
- criticism- there isnt always trauma before phobia onset.
- not all trauma leads to phobia

Cognitive Biases: Overestimation of danger and underestimation of coping ability.

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10
Q

Interventions simple phobia

A

Biological:

Medications: Benzodiazepines for short-term anxiety relief.

Psychological:

Exposure Therapy: Systematic desensitisation to phobic stimulus.

Cognitive Restructuring: Address irrational beliefs about danger.

Virtual Reality Therapy: Controlled simulation for inaccessible triggers.

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11
Q

Social Anxiety Disorder

A

characterised by a severe and persistent fear of social or performance situations.
- Individual’s fear behaving in a way that leads to embarrassment.

Common features:
- Conversation: fear of appearing inarticulate
- Public speaking: fear that trembling hands or voice will be noticed.
- Eating or drinking in front of others.
- Performing tasks in front of others.

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12
Q

DSM-5 social anxiety d.

A
  • distinct fear of social interactions, anxiety around recieving negative judgement or offending others.
  • social interactions are avoided or experienced with fear
  • the avoidace, fear, anxiety lasts 6 or more months and causes significant distress
  • anxiety cannot be better explained by effects of other condition or drugs
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13
Q

Theories explaining socia anxiety

biological

A

Heritability: Moderate genetic component.

Amygdala Overactivation: Heightened response to social threats.

possible inherited traits linked to SAD: submissiveness, anxiousness, social avoidance, introversion.

shared genetic vulnerability with other anxiety disorders: inheritance may predispose individuals to general anxiety disorders rather than SAD specifically.

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14
Q

Theories explaining socia anxiety

Social

A

Parental Influence: Overprotective or critical parenting styles.

Cultural Norms: Differences in social performance expectations

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15
Q

Theories explaining socia anxiety

Psychological

A

Cognitive Models: Negative self-evaluation and attention biases.
- negative predictions about future events
- shifts in attention to self, leads suffer to think they appear as anxious as they are- + negative evaluations

Post-Event Rumination: Reinforces social fears.
- negative post event rumination

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16
Q

Interventions, Social Anxiety Disorder

A

Biological:
SSRIs and SNRIs: Reduce social anxiety symptoms.

Psychological:
!!! CBT most important
CBT: Targets self-focused attention and negative thoughts.

Exposure Therapy: Gradual exposure to feared social situations.

Attentional Bias Modification (ABM): Redirects focus from perceived threats.

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17
Q

CBT for social anxiety disorder

aim and steps

A

The aim of cognitive therapy for social anxiety is to:

Reduce self-focused attention.
Challenge and modify negative beliefs.
Eliminate safety behaviours that maintain anxiety.
Reduce negative rumination post-event.
Therapy steps:

Educate the client on factors sustaining social anxiety.
Address and reduce safety behaviours through role-playing.
Train clients to shift focus externally.
Use video feedback to correct distorted self-perceptions.
Identify and restructure post-event rumination with cognitive techniques.

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18
Q

Agoraphobia

A

related to panic disoder

intense fear or avoudance of situations where escape might be difficult.
this can be fear of specific places or just fear of leaving the house (safe place).

ie crowded places
open spaces (parking lot)

people with agoraphobia become house bound to avouid these feared situations significantly impacting their life.

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19
Q

Agoraphobia DSM-5

A
  • distinct fear or anxiety about situation where individual is outside, in open spaces, or public places
  • avoidance of situation, or situation approached with intense fear that help will be unavailable, or panic, or other resultant symptoms occur
  • symptoms persisit for 6 months or more causing significant distress
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20
Q

Theories explaining agoraphobia

bio, socio, psycho

A

Biological:

Locus Coeruleus: Overactivation linked to panic and anxiety.

Heritability: Genetic predisposition to anxiety disorders.

Social:

Life Stressors: Triggered by traumatic or stressful life events (e.g., assault).

Family Dynamics: Overprotective upbringing may limit coping strategies.

Psychological:

Fear of Fear Hypothesis: Anxiety about anxiety symptoms leading to avoidance.

Conditioned Responses: Previous panic attacks create avoidance of similar contexts.

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21
Q

Interventions agoraphobia

A

Biological:
SSRIs and SNRIs: First-line medications.

Psychological:
Cognitive-Behavioural Therapy (CBT): Targets avoidance behaviour and catastrophic thinking.

Interoceptive Exposure: Simulates panic symptoms to reduce fear of them.

Relaxation Techniques: Manage physiological symptoms.

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22
Q

Panic Disorder

A
  • Repeat panic or anxiety attacks.

The attacks are associated with a number of symptoms: heart palpitations, dizziness, hyperventilation.

Individual may experience real feelings of terror, severe apprehension, and depersonalisation (feeling not connected to your body).

panic attack disorder is diagnosed when** recurrent, unexpected panic attacks keep occurring- followed by at least 1 month of worrying about having an attack.**
- For some it may be random, unpredictable.
- For some may be associated, classically conditioned

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23
Q

Panic Disorder DMS-5

A

reapeat panic attacks followed by at least one month of:
- worrying about further panic attacks/ consequence of attack (ie being out of control)
- significant, non-beneficial modification of behaviour, designed to avoid further attacks, such as avoidance of triggers

24
Q

Panic Attack DSM-5

A

a sudden feeling of extreme fear or distress which can originate out of a calm or stressed state.

symptoms intensify in a short time and include:
- fluctuating heart rate
- shortness of breath/ chest pain
- dissiness
- nausea

symptom of panic attacks are the manifestation of the SNS

25
Q

Theories of Panic Disorder

Biological

A

Norepinephrine Dysregulation: Overactivity in locus coeruleus, - Norepinephrine release activated biological reaction of panic attack
- sympathetic NS, fight/flight/freeze
- indiv w panic disorder, greater sensitivity of locus coereus

Suffocation Alarm Theory: Oversensitivity to carbon dioxide and suffocation cues.

Suggest that Co2 intake activate oversensitive suffocation alarm system leading to intense feeling of anxiety and terror

Supporting evidence:
- Panic disorder patients report, more frequent symptoms of shortness of breath when anxious.
- More frequent suffocating experiences than patients than other anxiety disorders

26
Q

theories for panic disorder

social

A

Stressful Life Events: Common trigger for onset.

27
Q

theories for panic disorder

psychological

A

fear of fear theory: Misinterpreting bodily sensations as life-threatening.
- Internal cues (dizziness) are perceived as a sign of a panic attack, causing fear and distress that trigger a panic attack.

Conditioning Models: Internal sensations become conditioned triggers.
- Internal cur acts as the conditioned stimulus (CS)
- Panic attack acts as the unconditioned stimulus (UCS)
Criticism: ambiguity regarding what consists a CS and UCS

28
Q

anxiety sensitivity and panic disorder

A

Anxiety sensitivity:
refers to fear of anxiety symptoms based on the belief that the symptoms have harmful consequences.

Anxiety sensitivity index (ASI)
Developed by Reiss, Peterson et al
Measures anxiety sensitivity through items like:
- Unusual body sensation scare me
- It scares me when I feel faint
Finding:
Panic disorder patient score higher on the ASI than non-clinical controls

ASI = risk factor for panic disoder

29
Q

Vicious cycle of panic disorder:

A
  1. Initial Bodily Sensation:
    o Example: Slight dizziness, heart palpitations.
  2. Catastrophic Misinterpretation:
    o Interpreted as a sign of serious danger (e.g., heart attack).
  3. Increased Anxiety:
    o Misinterpretation raises anxiety levels.
  4. Escalation of Symptoms:
    o Anxiety triggers more intense physical symptoms (e.g., hyperventilation, dizziness).
  5. Panic Attack:
    o Cycle reaches its peak, resulting in a full-blown panic attack
30
Q

interventions panic disorder

biological

A

Medications: SSRIs and benzodiazepines.

31
Q

inteventions panic disorder

psychological

A

exposure therapy: Help clients confront conditions that trigger panic attacks in a controlled, therapeutic setting
clinets apply cogntive and physical techniques to deal with symptoms.

breathing exercises: reduces hyperventilation

CBT: o Target the catastrophic misinterpretations of bodily sensations.
o Provide corrective information and experiences to challenge faulty emotional responses
o Therapist challenges the client’s belief that a pounding heart signals a heart attack.
o Provides evidence-based explanations:
 Stress and adrenalin do not necessarily harm the heart.
 Stress impacts primarily those with pre-existing heart conditions.

goal = shift to more rational understanding

32
Q

Generalised Anxiety Disorder (GAD)

A

GAD is characterised by chronic apprehension and anxiety about future events, leading to pathological worrying.
- Involved uncontrollable and excessive worrying that becomes disabling.

Features of worry in GAD
1. Chronic and pathological (extend major life issues, also about minor day to day issues).Worry is pervasive and extends across many aspects of life.
2. Perceived uncontrollability- often feel unable to control the onset or cessation of worry episodes- sense of helplessness exacerbates anxiety.
3. Catastrophising- worry escalates to worst possible outcome.

Catastrophising:
* A cognitive distortion where an individual magnifies a single concern or fact into its extreme, worst-case scenario.

33
Q

DSM-5, GAD

A
  • excessing, uncontrollable worry about various aspects of life.
  • accompanied by restlessness, fatigue, muscle tension, and difficulty concentrating
  • individual experiences fear regarding at least 2 or 3 different areas of activity and symptoms of anxiety or at leasgt 3 months
  • associated with behaviour such as asking for reassurance, avoidance of activity which causes anxiety
  • symptoms cannot be better explained
34
Q

Theories of general anxiety disorder

biological

A

gentics: moderate inheritability
ab 30%
inherited vulnerability is non-specific and not directly related to GAD.

neuropsychology: o Neuroimaging studies highlight the role of the prefrontal cortex (PFC) and amygdala:
 The amygdala mediates fear-related emotions.
 The PFC is responsible for emotion regulation and decision-making.
 GAD sufferers show reduced connectivity between the amygdala and PFC, impairing emotional regulation (Roy et al., 2013; Patriquin & Mathew, 2018).

explains difficulty inhibiting negative thoughts.

35
Q

theories general anxiety disorder

psychological

A
  1. Information Processing Biases:
    o GAD sufferers exhibit biases in attention, interpretation, and reasoning that maintain hypervigilance for threat and create further anxiety:
     Attention bias: Preferential focus on threatening stimuli
     Interpretation bias: Tendency to interpret ambiguous information as threatening
     Reasoning biases: Reinforce threatening interpretations of events (de Jong et al., 1997, 1998).

These biases:
- Maintain hypervigilance.
- Amplify perceived daily threats
- Contribute causally to worrying

36
Q

information processing bias

A

Cognitive distortions in how individuals interpret, attend to, and recall information, leading to dysfunctional thinking and behaviour.

37
Q

Attention Bias Modification (ABM):

A

A therapeutic method to reverse threat-related biases and reduce anxiety.

o Focuses on reversing attentional biases towards threat in anxious individuals.
o Uses experimental procedures to neutralise biases

38
Q

Interventions GAD
biological

A

SSRIs and SNRIs: First-line medications.

39
Q

Intervention GAD Psychological

A

CBT: Includes cognitive restructuring and relaxation training.
CBT is the most widely used structured psychological treatment for GAD, focusing on cognitive biases and dysfunctional beliefs about worrying.

Stimulus Control: Limits worry to specific times and places.
* Principle:
o Based on stimulus control from conditioning theory: behaviours are influenced by the environment in which they occur.
* Technique:
o Restrict worry to a specific time and location daily (e.g., “worry time” after waking).
o Limits the contexts that can elicit worrying (Borkovec et al., 1983).

40
Q

Obsessive Cumpolsive Disorder (OCD)

A

OCD is characterised by intrusive, repetitive thoughts (obsessions) and ritualised behaviours (compulsions) that cause significant distress and interfere with daily life.

  • Impact: Thoughts and behaviours in OCD are distressing, disruptive, and often disabling.
41
Q

key fetures OCD

A

Obsessions:
* Definition: Intrusive and recurring thoughts or images that are disturbing and uncontrollable.
* Common Themes:
o Fear of harm or distress to oneself or loved ones (e.g., partner or child).
o Fear of contamination (e.g., self or loved ones).
o Pathological doubting and indecision, often linked to repetitive checking behaviours.
o Unacceptable thoughts (e.g., immoral, violent, or sexual content

Compulsions:
* Definition: Repetitive or ritualised behaviours performed to prevent negative outcomes or reduce anxiety caused by obsessions.
* Common Types:
o Checking: Repeatedly verifying doors, windows, or appliances to ensure safety.
o Washing: Ritualised cleaning to avoid infection or contamination.

42
Q

OCD, DSM-5

A
  • presence of obsession or culpunsion
  • believes that if behaviour isn’t completed catastrophic consequences will occur
  • obsession and culpulsions take up at least one hour of the day
  • symptoms cannot be better explained
  • OCD is classified in a distinct chapter separate from anxiety disorders in DSM-5
43
Q

risk factors OCD

A
  1. Childhood Factors:
    o Isolation and poor peer relationships.
    o Negative emotionality in adolescence (characterised by interpersonal alienation, irritability, and high stress reactivity).
    o Childhood physical and sexual abuse (physical abuse specifically linked to OCD).
    o Problems at birth (e.g., haemorrhaging, respiratory distress).
    o Poor motor skills and lower IQ measures during childhood.
  2. Religious and Cultural Factors:
    o Religiosity:
     Religions often define taboos and ritualise behaviours, which may increase vulnerability to obsessions and compulsions.
     Strong emphasis on prohibited thoughts or actions can exacerbate OCD symptoms.
  3. Shared Risk Factors:
    o Many risk factors for OCD overlap with other anxiety-based disorders, such as childhood adversity or high stress reactivity.
44
Q

key points OCD

A
  • OCD often begins with subtle, gradual symptoms, particularly in adolescence or early adulthood.
  • Risk factors include a combination of genetic, environmental, and cultural influences.
  • Cultural practices and religiosity may uniquely contribute to OCD-specific symptoms due to their structured and ritualised nature
45
Q

OCD related disorders

A

body dysmorphic disorder

hoarding

Trichotillomania (Hair-Pulling Disorder):

skin picking disorder

46
Q

OCD aetiology

Biological factors

A

Genetics: moderate heritability- seretonin trasmitter gene

heterogeneity: symptoms can vary significantly

cognitive: attention shift difficuty, inhibition deficts, WM issue, executive function issue.

basal ganglia involvement, disorders involving basal ganglia increase risk of OCD

47
Q

Aetiology OCD

Psychological Factors

A

Memory Deficits
* Key Feature: Doubting is central to OCD, particularly related to compulsions (e.g., checking, washing).

inflated responsibility and thought-action focused.

rebound effect increases intrusive thoughts

48
Q

OCD interventions

A

Biological:

SSRIs: First-line pharmacological treatment.

Psychological:

Exposure and Response Prevention (ERP): Gold standard treatment.

CBT: Targets dysfunctional beliefs and reduces compulsive rituals.

49
Q

Post Traumatic Stress Disorder (PTSD)

A
  • Definition:
    o Persistent anxiety-based symptoms following exposure to a fear-evoking or life-threatening traumatic event.
    o Listed separately from anxiety disorders in DSM-5, emphasizing its primary cause: traumatic experience
50
Q

PTSD, DSM-5

A

Trauma exposure: Direct/indirect exposure to death, serious injury, or sexual violence.

Intrusive symptoms: Unwanted memories, distressing dreams, flashbacks, or severe reactions to trauma reminders.

Avoidance: Efforts to avoid thoughts, feelings, or reminders of the trauma.
Mood/cognition changes: Negative emotions, disconnection, memory gaps, loss of interest, and extreme negative beliefs.

Reactive behaviour: Recklessness, aggression, hypervigilance, concentration issues, sleep disturbances, or exaggerated startle response.

Duration: Symptoms persist for at least one month and cause significant impairment.

Exclusions: Not explained by other mental/medical conditions, drug use, or medication.

51
Q

Chronic nature and impact of PTSD + prevalance

A
  • Chronic Condition:
    o Symptoms can persist for years.
  • Social Consequences:
    o Marital problems, substance abuse, suicidal thoughts, sexual dysfunction, and stress-related violence.
    Prevalence:
  • Women are 2.4 times more likely to develop PTSD
  • Prevalence varies across ethnic groups
52
Q

(ASD) Acute Stress Disorder

A
  • Definition:
    o Short-term psychological/physical reaction to trauma (3 days to 1 month post-trauma).
  • Similarities to PTSD:
    o DSM-5 aligns ASD symptoms with PTSD, potentially making ASD a predictor for PTSD.
  • Debate:
    o ASD may represent a normal short-term reaction rather than a disorder (Harvey & Bryant, 2002).
53
Q

Theories for PTSD

Biological

A

Hippocampal Volume: Smaller hippocampus linked to PTSD.
- impaired stress hormone regulation
- difficulty locating memory and time

Genetics: Heritable component and epigenetic changes.
- 30-50% heritability
- low cortisol right after trauma = vivid memory consolidation

54
Q

theories PTSD

social

A

Trauma Exposure: Direct or indirect exposure to life-threatening events.

Social Support: Lack of support increases PTSD risk.

persoality traits (neuroticism, paranoia) increase risk.
emotion-focused, avoidant behaviour

55
Q

theories PTSD

Psychological

A
  1. Conditioning Theory:
    o Trauma (UCS) becomes associated with situational cues (CS).
    o Future exposure to these cues triggers fear and arousal.
    o Avoidance behaviors maintain PTSD by preventing extinction of fear associations.
  2. Emotional Processing Theory:
    o Severe trauma creates fear networks in memory.
    o Contextual cues (e.g., roads, hospitals) selectively activate fear.
    o Avoidance of fear-inducing cues strengthens associations and prevents recovery.
  3. Mental Defeat:
    o PTSD sufferers adopt a victim mindset:
     Negative self-perceptions.
     Belief in inability to control or process trauma.
    o Leads to:
     Maladaptive strategies (e.g., avoidance).
     Symptoms like reexperiencing, dissociation, and negative worldviews.
  4. Dual Representation Theory:
    o PTSD involves two memory systems:
     Verbally Accessible Memory (VAM):
     Consciously processed narrative memories integrated with autobiographical context.
     Situationally Accessible Memory (SAM):
     Vivid, uncontrollable sensory and bodily memories.
     Responsible for flashbacks.
    o PTSD flashbacks arise when SAM-dominant memories overwhelm VAM-based narrative processing.
56
Q

Biological interventions PTSD

A

SSRIs and SNRIs: Commonly prescribed medications.

57
Q

Interventions Psychological

A

Exposure Therapy: Confronts trauma-related memories and stimuli.
- * Involves confronting trauma-related memories, stimuli, and environments to:
1. Extinguish fear associations.
2. Disconfirm dysfunctional beliefs.

Eye Movement Desensitisation and Reprocessing (EMDR): Combines trauma focus with bilateral stimulation.
- * Mechanism:
o Reduces anxiety through deconditioning.
o Helps restructure memories positively (e.g., “I can handle this”).

Cognitive Restructuring: Alters maladaptive beliefs about the trauma.
- * Techniques:
1. Encourage disconfirmation of extreme beliefs through experience.
2. Directly alter PTSD-related cognitions using therapeutic exercises.
* Often combined with exposure therapy for enhanced effectiveness.

Clinical Psychology (10 decks)

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