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PSYC3102 > 4 - Anxiety-Related Disorders > Flashcards

4 - Anxiety-Related Disorders Flashcards

1
Q

What does the diagnosis of anxiety-related disorders depend on?

A

Patterns of symptoms (nature, frequency, severity and duration)

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2
Q

What are the two keywords related to anxiety-related disorders?

A

Preoccupation and avoidance

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3
Q

Fear is experienced in the face of real, immediate danger, usually builds quickly in intensity, and helps behavioural responses to real threats. How can anxiety be differentiated from this?

A

Associated with anticipation of future problems; involves more general or diffuse emotional response; the degree of concern is out of proportion to the threat

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4
Q

What is the cognitive activity associated with anxiety?

A

Excessive worry; relatively uncontrollable sequence of negative emotional thoughts concerned with future threats or danger (overlapping components of fear, anxiety and worry)

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5
Q

Anxiety can be helpful as it can facilitate actions to prevent threat, but when can it be maladaptive?

A

When a person allows it to limit their living (avoidance)

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6
Q

Describe the prevalence of anxiety-related disorders in Australia

A

The most common type of mental disorders; higher rates in women than men; across all age groups but decrease with age; PTSD and social phobia are the most prevalent

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7
Q

What are the main features of all anxiety-related disorders?

A

Physiological symptoms; avoidance symptoms; disturbances in attention (intrusive thoughts,; attentional biases; re-experiencing symptoms); subjective feeling of anxiety

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8
Q

What are the essential features of specific phobia?

A

Marked fear or anxiety about specific object or situation; exposure to fearful stimulus provokes instant anxiety; phobic stimulus is actively avoided or endured with intense fear/anxiety; it’s out of proportion to the actual danger; females more affected (rates vary across phobic stimuli)

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9
Q

List some specific phobic specifiers

A

Animals (spiders/snakes); natural environment (storms/heights); blood-injection injury (needles); situational (public transport/enclosed places); other (loud sounds/vomiting); dentophobia

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10
Q

What are the essential features of social anxiety disorder?

A

Marked fear/anxiety about one or more social situations in which the person’s exposed to possible scrutiny by others; fear they’ll show anxiety that’ll be negatively evaluated (embarrassment/humiliation/rejection)

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11
Q

What are the clinical features of social anxiety disorder?

A

Belief that others see them as inept, foolish or stupid; hypersensitive to criticism; non-assertive; low self-esteem; common comorbidity with anxiety; safety behaviours common (avoiding eye contact; talk to safe people; cover face); take observer perspective vantage point for social memories; information processing biases (negative interpretations of social events; less likely to detect positive responses; anticipatory/post-event processing)

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12
Q

According to DSM-5 criteria, a panic disorder is characterised by recurrent unexpected panic attacks. At least one attack has to be followed by one month or more of what?

A

Persistent concern about additional attacks or their consequences; significant maladaptive changes in behaviour (avoidance)

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13
Q

3.5% of the population experience panic attacks without what?

A

Meeting criteria for a panic disorder

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14
Q

How is a panic attack characterised?

A

An abrupt surge of intense fear or discomfort in which 4 or more physiological symptoms develop rapidly and peak within minutes (e.g. hot flushes/numbness/fear of dying/shortness of breath/chest pain/nausea)

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15
Q

Agoraphobia is marked by fear or anxiety about two or more of which essential features?

A

Using public transport; being in open/enclosed spaces; standing in line or in a crowd; being outside of the home alone; being in places from which escape might be difficult or embarrassing

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16
Q

How is generalised anxiety disorder (GAD) characterised by DSM-5?

A

Excessive anxiety and worry about numerous events or activities; difficult to control worry; experience in 3 or more of: restlessness; easily fatigued; difficulty concentrating; irritability; muscle tension; sleep disturbance; and worry or physical symptoms cause significance interference

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17
Q

What kind of cognitive biases do people with GAD show?

A

Significantly less tolerance for uncertainty; underestimate their ability to cope with difficult or ambiguous circumstances; overestimate the likelihood of negative consequences

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18
Q

What may contribute to the development of GAD?

A

Early experiences of uncontrollability and unpredictable negative events

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19
Q

List some other anxiety disorders

A

Separation anxiety disorder; selective mutism; substance/medication induced; anxiety disorder due to another medical condition; other specified or unspecified anxiety disorder

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20
Q

What is body dysmorphic disorder?

A

They fixate on a part of their body where there’s a slight or no imperfection

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21
Q

What’s hoarding disorder?

A

Find it difficult to let things go or dump things even if they’re rubbish

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22
Q

Describe trichotillomania

A

Hair pulling disorder; can lead to baldness

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23
Q

Describe excoriation

A

Skin picking to the degree where it causes damage

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24
Q

Describe the obsessions involved in obsessive-compulsive disorder (OCD)

A

Thoughts, images or impulses; repetitive, intrusive and uncontrollable (rebound effects); not just excessive worries about real life problems; cause anxiety or distress; compel them to ignore, suppress or neutralise the obsessions in some way

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25
Q

Describe the compulsions involved in OCD

A

Repetitive overt behaviours (e.g. hand-washing, checking) or covert mental acts (praying, counting, repeating words); goals are usually to undo obsession, to prevent harm from obsession or alleviate anxiety; obsessions not connected in a realistic way with what they’re designed to prevent or are clearly obsessive

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26
Q

How does one meet the DSM-5 criteria for OCD?

A

Either obsessions, compulsions or both; causing distress, are time consuming (>1hr/day), or significantly interfere; content not restricted to another Axis 1 disorder (e.g. food obsession in eating disorder); not due to substance or medical condition; specify if with good, fair, poor or absent insight/delusional beliefs

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27
Q

Describe the prevalence of OCD

A

Females slightly more affected; onset childhood/teenage (>35 rare); gradual, insidious onset; chronic, constant or waxing/waning course (only 15% have 3 month symptom free)

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28
Q

What are the three forms of obsessions common to OCD

A

Thoughts; images; impulses

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29
Q

What’s the typical content of obsessions?

A

Violence (impulse to attack; violent images); sex (impulse to stare at someone’s genitals; thought: what if I’m a paedophile?); blasphemy and sacrilege (sexual image of deity; thought: unworthy of salvation)

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30
Q

List some common obsessions in order of prevalence

A

Multiple obsessions; contamination; pathological doubt; somatic obsession; need for symmetry; aggressive; sexual; other

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31
Q

What features are not considered obsessions?

A

Worrying about real life issues; depressive ruminations; recurrent sexual fantasies; jealousy; preoccupation with a new car/boyfriend, etc; cravings to steal/gamble, etc

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32
Q

List some common compulsions in order of prevalence

A

Multiple compulsions; checking; washing; counting; need to ask/confess; symmetry/precision; hoarding

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33
Q

What are the essential features of post-traumatic stress disorder (PTSD)

A

Exposure to actual or threatened death or serious injury, or sexual violence via: directly, witnessing, learning about it happening to someone else, or experiencing repeated or extreme exposure to aversive details (e.g. first responders to an accident)

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34
Q

One or more of what kind of intrusions must be present to be diagnosed with PTSD?

A

Involuntary and intrusive distressing memories; distressing dreams; dissociative reactions (flashbacks); distress or reactivity to cues that resemble traumatic events

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35
Q

People with PTSD tend to avoid stimuli associated with the event. What are some negative alterations in cognitions and mood that they may show?

A

Inability to remember important aspects of the trauma; persistent negative beliefs (e.g. the world is dangerous); distorted view about cause or consequences (self blame); persistent negative emotional state (fear/anger/horror); diminished interest in activities; feeling detached or estranged; inability to express positive emotions

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36
Q

According to DSM-5, people with PTSD must experience 2 or more of which physiological arousal symptoms?

A

Irritability or anger outbursts; reckless or self-destructive behaviour; hypervigilance; exaggerated startle response; difficulty concentrating; sleep disturbance

37
Q

To be diagnosed with acute stress disorder, symptoms need to last from 3 days to 1 month following exposure to traumatic events. These must include 9 or more symptoms from which 5 categories?

A

Intrusive symptoms; negative mood; dissociative, avoidance and arousal symptoms (and show clinically significant distress or impairment)

38
Q

Describe the essential features of adjustment disorder

A

Marked emotional/behavioural symptoms in response to an identified stressor occurring within 3 months of stressor onset; clinically significant symptoms (distress out of proportion to severity/intensity of stressor; sig. impairment in functioning); doesn’t meet criteria for another disorder; not normal bereavement; symptoms don’t persist for more than additional 6 months after termination of stressor

39
Q

What’s the aetiology of anxiety from a psychodynamic perspective?

A

Anxiety arises from psychic conflict between unconscious sexual or aggressive wishes and corresponding threats from superego (anxiety is a signal indicating an impulse is about to be acted on, triggering defences (repression) to prevent recognition of the impulse and reduce anxiety; when impulse too strong, anxiety overwhelms the system

40
Q

What’s the aetiology of anxiety from a evolutionary perspective?

A

Anxiety developed as a means of enabling protective behaviour to be activated at appropriate times; it’s part of an adaptive system; problem regulating the system which evolved to deal with particular threat

41
Q

What evidence has been found in twin studies to suggest that genetic predisposition contributes to the aetiology of anxiety disorders?

A

Higher concordance rates for MZ twins than DZ; they’re modestly to moderately heritable; heritability varies across different disorders

42
Q

Animal studies show which two neural pathways to be responsible for detecting and responding to threat or danger, which may play a role in phobic and panic disorders?

A

A subcortical pathway which activates fight or flight response; a path which leads to cortex, and provides for more slower, detailed analysis of information; (these pathways may be triggered at inappropriate times)

43
Q

Which neurotransmitters function to dampen stress/anxiety response?

A

Seretonin and GABA

44
Q

In a biological model of OCD, patients were asked to focus on the content of their obsessions. Which neural region showed higher activity, and what is this area related to?

A

Cortical-striatal-thalamic circuit (prefrontal cortex, thalamus and basal ganglia; related to filtering out irrelevant information and preservation of behaviour)

45
Q

Which social factors have been correlated with anxiety disorders?

A

Stressful life events; childhood adversity; parenting style; child temperament and behavioural inhibition; attachment relationships and separation anxiety

46
Q

How do fears and phobias develop according to Classical conditioning theory?

A

As a result of pairing a neutral stimulus and an aversive experience which provokes a fear reaction (doesn’t explain maintenance of fear response and why some develop it while others don’t)

47
Q

How does operant conditioning explain the development of anxiety disorders?

A

Avoidant behaviours negatively reinforced; avoidance maintains anxiety - never have the opportunity to face fears, learn to tolerate anxiety, or challenge maladaptive beliefs about remaining in a situation

48
Q

Conditioning fails to explain how some people develop anxiety disorders in the absence of a directly aversive experience. So how does vicarious/observational learning explain development of anxiety disorders?

A

Learning through modeling; learn to avoid stimuli if one observes others showing a strong fear response to such stimuli

49
Q

How do cognitive processes (i.e. perceptions, memory and attention) play a role in development and maintenance of anxiety disorders?

A

More likely to interpret ambiguous situations as dangerous, resulting in physiological and cognitive distress; maladaptive thoughts/beliefs can impact on memory, attention and information processing which further perpetuates anxiety

50
Q

Describe catastrophic misinterpretation

A

It’s linked particularly to panic disorder; misinterpreting bodily sensations as catastrophic events (sign they’re about to have a heart attack increasing anxiety/arousal)

51
Q

Describe how attentional bias to threat play a role?

A

Those prone to excessive worry/panic are sensitive /hypervigilant to cues that signal future threats; once attention is overly focussed on cues; performance of adaptive, problem-solving beahviours disrupted; worry cycle activated

52
Q

How does thought suppression impact on anxiety disorders?

A

Struggling to suppress/control thoughts which provoke anxiety; yet the more a thought is pushed away, the more intrusive and anxiety-provoking it can become

53
Q

Describe the fear of fear model

A

Panic attack > increased physical arousal and worry about another attack > vigilance of body symptoms > catastrophic misinterpretation of physical sensations > panic attack (perpetuates the cycle)

54
Q

Describe the process leading to psychological rigidity according to the Acceptance and Commitment Therapy (ACT) model

A

Fusion (thoughts become fused with awareness - empowers the thought) > non-accepting/closed avoidance > dominance of conceptualised past and feared future > lack of values, clarity or contact (don’t follow goals) > inaction or disorganised activity > attachment to conceptualised self; no safe place

55
Q

What do biological models (which associate anxiety with a depletion of serotonin in synapses) focus on in treatement?

A

SSRIs which block the neuron’s normal reuptake mechanism, allowing serotonin to remain in the synapse, and increasing the likelihood that it will land on the post-synaptic receptor

56
Q

What do Benzodiazepines focus on, and how effective are they?

A

GABA transmission; widely used prior to 90s (e.g. valium, xanax); effects more evident early in treatment; side effects include sedation, mild impairment in psychomotor skills and cognitive abilities (memory/attention); risk of addiction most adverse effect

57
Q

Compare tricyclics effects to antidepressants

A

Tricyclics have shown benefits but significant side effects (weight gain, dry mouth, difficulty sleeping, nervousness); antidepressants (SSRIs) have fewer unpleasant side effects

58
Q

Amongst psychodynamic treatments, free association and dream interpretation uses psychoanalysis to discover/work through internal conflicts, but there’s limited empirical evidence. What does interpersonal therapy target?

A

Interpersonal conflicts, role transitions and complicated grief; it’s found to be effective for social anxiety disorder

59
Q

What does psychoeducation focus on?

A

Teaching people that anxiety is common, typically short-lived and normal; can be adaptive and functional; can never eliminate anxiety altogether

60
Q

What do relaxation techniques address?

A

The physiological component of anxiety

61
Q

What approach does cognitive therapy take?

A

Looking at cognitions as mediators; identification of anxiety-provoking cognitions (thought monitoring); cognitive restructuring (target negative, unrealistic interpretations common to anxiety sufferers)

62
Q

What does exposure therapy address?

A

The behavioural component; designed to overcome avoidance; about facing fears; gradual and repeated exposure using exposure hierarchy; (imaginal/in vivo; gradual/flooding); exposure with response prevention (ERP)

63
Q

What does an acceptance rationale drawn from ACT seem to increase, and how effective is ACT?

A

The willingness of clients to complete exposure tasks (pulling different treatments together); It’s generally as effective as CBT in treating anxiety disorders and treating treatment resistant clients

64
Q

What steps does ACT focus on in order to attain psychological flexibility rather than rigidity and avoidance?

A

Defusion; acceptance; being in contact with present moment; establishing values; taking committed action; seeing the self as context

65
Q

Anxiety is often comorbid with depression. In which order they usually occur?

A

Anxiety usually precedes depression

66
Q

What 3 factors does Anxious Apprehension consist of?

A

High levels of diffuse negative emotion; Sense of uncontrollability; Shift in attention to a primary self-focus or a state of preoccupation

67
Q

When excessive worriers are asked to describe their thoughts, what do they emphasise?

A

The predominance of verbal, linguistic material rather than images

68
Q

More than 50% of people who meet the criteria for one anxiety disorder also meet the criteria for what?

A

At least one other form of anxiety disorder or mood disorder

69
Q

What percentage of people who qualify for a diagnosis of anxiety disorder ever seek psychological treatment?

A

Only about 25%

70
Q

Compare the average onset age for anxiety disorders to depression

A

It’s much younger for anxiety disorders

71
Q

Are relapse rates higher for men or women?

A

Women

72
Q

What’s been speculated to contribute to gender differences in prevalence and course of anxiety disorders?

A

Differences in child-rearing practices or the way men and women respond to stressful life events; or differences in hormone functions or neurotransmitter activities

73
Q

Although anxiety tends to reduce among middle aged adults, when may it increase?

A

As people move into their 70s and 80s, due to problems associated with loneliness, increased dependency, declining physical and cognitive capacities, and changes in social and economic conditions

74
Q

From the evolutionary perspective, how can each type of anxiety disorder be viewed?

A

As the dysregulation of a mechanism that evolved to deal with a particular kind of danger

75
Q

What has been observed as a relatively frequent triggering event for the onset of agoraphobic symptoms?

A

Interpersonal conflict

76
Q

Describe the preparedness model

A

Human beings seem to be prepared to develop intense, persistent fears only to a select set of objects or situations; this isn’t to say the fears are innate, but rather can be learned and maintained very easily

77
Q

What does evidence suggest about people who believe they’re less likely to control events in their environment?

A

They’re more likely to develop global forms of anxiety

78
Q

Which brain region plays a central role in detecting threats in the environment, and stores the kind of unconscious, emotional memories generated through prepared learning?

A

Amygdala

79
Q

Which brain circuit may be associated with biased attention to threat cues?

A

The subcortical pathways between the thalamus and amygdala may be responsible for misinterpreting sensory information, which then triggers the hypothalamus and activates a variety of autonomic processes

80
Q

What’s the difference between situational exposure and interoceptive exposure?

A

Situational is used to treat agoraphobic avoidance where the person repeatedly confronts the situations they avoid; Interoceptive is aimed at reducing their fear internal bodily sensations associated with the onset of panic attacks

81
Q

Describe what’s involved in a decatastrophising procedure

A

It’s a cognitive approach where the therapist asks the client to imagine what would happen if the worst-case scenario actually happened; after careful analysis they eventually agree that their negative predictions are exaggerated and based on cognitive errors

82
Q

What kind of treatment is preferable for patients with a diagnosis of panic disorder with agoraphobia?

A

Exposure, because of high relapse rates after withdrawing from medication

83
Q

Although evidence suggests that the combination of psychotherapy and medication is better in the short-term, which treatment may be better for long-term outcomes?

A

CBT, as difficulties can be encountered when medication is discontinued

84
Q

How can hoarding disorder be differentiated from other obsessive type disorders?

A

The thoughts are not necessarily intrusive or unwanted; the behaviours are associated with positive emotion; anxiety increases when forced to get rid of their possessions

85
Q

What makes trichotillomania and excoriation distinct from OCD?

A

Hair-pulling and skin-picking seem to regulate negative emotional states but are not specifically triggered by intrusive thoughts; they often report being in a trance-like state and unaware of what they’re doing

86
Q

Which two OCD-related disorders appear to be the most common?

A

Hoarding and excoriation

87
Q

Which neural circuits are overly active in people with OCD?

A

Basal ganglia, orbital prefrontal cortex and anterior cingulate cortex

88
Q

What’s the most effective form of psychological treatment for patients with OCD?

A

Exposure and response prevention; SSRIs are also beneficial

PSYC3102 (6 decks)

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