4 - Anxiety-Related Disorders Flashcards
What does the diagnosis of anxiety-related disorders depend on?
Patterns of symptoms (nature, frequency, severity and duration)
What are the two keywords related to anxiety-related disorders?
Preoccupation and avoidance
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?
Associated with anticipation of future problems; involves more general or diffuse emotional response; the degree of concern is out of proportion to the threat
What is the cognitive activity associated with anxiety?
Excessive worry; relatively uncontrollable sequence of negative emotional thoughts concerned with future threats or danger (overlapping components of fear, anxiety and worry)
Anxiety can be helpful as it can facilitate actions to prevent threat, but when can it be maladaptive?
When a person allows it to limit their living (avoidance)
Describe the prevalence of anxiety-related disorders in Australia
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
What are the main features of all anxiety-related disorders?
Physiological symptoms; avoidance symptoms; disturbances in attention (intrusive thoughts,; attentional biases; re-experiencing symptoms); subjective feeling of anxiety
What are the essential features of specific phobia?
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)
List some specific phobic specifiers
Animals (spiders/snakes); natural environment (storms/heights); blood-injection injury (needles); situational (public transport/enclosed places); other (loud sounds/vomiting); dentophobia
What are the essential features of social anxiety disorder?
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)
What are the clinical features of social anxiety disorder?
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)
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?
Persistent concern about additional attacks or their consequences; significant maladaptive changes in behaviour (avoidance)
3.5% of the population experience panic attacks without what?
Meeting criteria for a panic disorder
How is a panic attack characterised?
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)
Agoraphobia is marked by fear or anxiety about two or more of which essential features?
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
How is generalised anxiety disorder (GAD) characterised by DSM-5?
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
What kind of cognitive biases do people with GAD show?
Significantly less tolerance for uncertainty; underestimate their ability to cope with difficult or ambiguous circumstances; overestimate the likelihood of negative consequences
What may contribute to the development of GAD?
Early experiences of uncontrollability and unpredictable negative events
List some other anxiety disorders
Separation anxiety disorder; selective mutism; substance/medication induced; anxiety disorder due to another medical condition; other specified or unspecified anxiety disorder
What is body dysmorphic disorder?
They fixate on a part of their body where there’s a slight or no imperfection
What’s hoarding disorder?
Find it difficult to let things go or dump things even if they’re rubbish
Describe trichotillomania
Hair pulling disorder; can lead to baldness
Describe excoriation
Skin picking to the degree where it causes damage
Describe the obsessions involved in obsessive-compulsive disorder (OCD)
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
Describe the compulsions involved in OCD
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
How does one meet the DSM-5 criteria for OCD?
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
Describe the prevalence of OCD
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)
What are the three forms of obsessions common to OCD
Thoughts; images; impulses
What’s the typical content of obsessions?
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)
List some common obsessions in order of prevalence
Multiple obsessions; contamination; pathological doubt; somatic obsession; need for symmetry; aggressive; sexual; other
What features are not considered obsessions?
Worrying about real life issues; depressive ruminations; recurrent sexual fantasies; jealousy; preoccupation with a new car/boyfriend, etc; cravings to steal/gamble, etc
List some common compulsions in order of prevalence
Multiple compulsions; checking; washing; counting; need to ask/confess; symmetry/precision; hoarding
What are the essential features of post-traumatic stress disorder (PTSD)
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)
One or more of what kind of intrusions must be present to be diagnosed with PTSD?
Involuntary and intrusive distressing memories; distressing dreams; dissociative reactions (flashbacks); distress or reactivity to cues that resemble traumatic events
People with PTSD tend to avoid stimuli associated with the event. What are some negative alterations in cognitions and mood that they may show?
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
According to DSM-5, people with PTSD must experience 2 or more of which physiological arousal symptoms?
Irritability or anger outbursts; reckless or self-destructive behaviour; hypervigilance; exaggerated startle response; difficulty concentrating; sleep disturbance
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?
Intrusive symptoms; negative mood; dissociative, avoidance and arousal symptoms (and show clinically significant distress or impairment)
Describe the essential features of adjustment disorder
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
What’s the aetiology of anxiety from a psychodynamic perspective?
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
What’s the aetiology of anxiety from a evolutionary perspective?
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
What evidence has been found in twin studies to suggest that genetic predisposition contributes to the aetiology of anxiety disorders?
Higher concordance rates for MZ twins than DZ; they’re modestly to moderately heritable; heritability varies across different disorders
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 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)
Which neurotransmitters function to dampen stress/anxiety response?
Seretonin and GABA
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?
Cortical-striatal-thalamic circuit (prefrontal cortex, thalamus and basal ganglia; related to filtering out irrelevant information and preservation of behaviour)
Which social factors have been correlated with anxiety disorders?
Stressful life events; childhood adversity; parenting style; child temperament and behavioural inhibition; attachment relationships and separation anxiety
How do fears and phobias develop according to Classical conditioning theory?
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)
How does operant conditioning explain the development of anxiety disorders?
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
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?
Learning through modeling; learn to avoid stimuli if one observes others showing a strong fear response to such stimuli
How do cognitive processes (i.e. perceptions, memory and attention) play a role in development and maintenance of anxiety disorders?
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
Describe catastrophic misinterpretation
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)
Describe how attentional bias to threat play a role?
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
How does thought suppression impact on anxiety disorders?
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
Describe the fear of fear model
Panic attack > increased physical arousal and worry about another attack > vigilance of body symptoms > catastrophic misinterpretation of physical sensations > panic attack (perpetuates the cycle)
Describe the process leading to psychological rigidity according to the Acceptance and Commitment Therapy (ACT) model
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
What do biological models (which associate anxiety with a depletion of serotonin in synapses) focus on in treatement?
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
What do Benzodiazepines focus on, and how effective are they?
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
Compare tricyclics effects to antidepressants
Tricyclics have shown benefits but significant side effects (weight gain, dry mouth, difficulty sleeping, nervousness); antidepressants (SSRIs) have fewer unpleasant side effects
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?
Interpersonal conflicts, role transitions and complicated grief; it’s found to be effective for social anxiety disorder
What does psychoeducation focus on?
Teaching people that anxiety is common, typically short-lived and normal; can be adaptive and functional; can never eliminate anxiety altogether
What do relaxation techniques address?
The physiological component of anxiety
What approach does cognitive therapy take?
Looking at cognitions as mediators; identification of anxiety-provoking cognitions (thought monitoring); cognitive restructuring (target negative, unrealistic interpretations common to anxiety sufferers)
What does exposure therapy address?
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)
What does an acceptance rationale drawn from ACT seem to increase, and how effective is ACT?
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
What steps does ACT focus on in order to attain psychological flexibility rather than rigidity and avoidance?
Defusion; acceptance; being in contact with present moment; establishing values; taking committed action; seeing the self as context
Anxiety is often comorbid with depression. In which order they usually occur?
Anxiety usually precedes depression
What 3 factors does Anxious Apprehension consist of?
High levels of diffuse negative emotion; Sense of uncontrollability; Shift in attention to a primary self-focus or a state of preoccupation
When excessive worriers are asked to describe their thoughts, what do they emphasise?
The predominance of verbal, linguistic material rather than images
More than 50% of people who meet the criteria for one anxiety disorder also meet the criteria for what?
At least one other form of anxiety disorder or mood disorder
What percentage of people who qualify for a diagnosis of anxiety disorder ever seek psychological treatment?
Only about 25%
Compare the average onset age for anxiety disorders to depression
It’s much younger for anxiety disorders
Are relapse rates higher for men or women?
Women
What’s been speculated to contribute to gender differences in prevalence and course of anxiety disorders?
Differences in child-rearing practices or the way men and women respond to stressful life events; or differences in hormone functions or neurotransmitter activities
Although anxiety tends to reduce among middle aged adults, when may it increase?
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
From the evolutionary perspective, how can each type of anxiety disorder be viewed?
As the dysregulation of a mechanism that evolved to deal with a particular kind of danger
What has been observed as a relatively frequent triggering event for the onset of agoraphobic symptoms?
Interpersonal conflict
Describe the preparedness model
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
What does evidence suggest about people who believe they’re less likely to control events in their environment?
They’re more likely to develop global forms of anxiety
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?
Amygdala
Which brain circuit may be associated with biased attention to threat cues?
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
What’s the difference between situational exposure and interoceptive exposure?
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
Describe what’s involved in a decatastrophising procedure
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
What kind of treatment is preferable for patients with a diagnosis of panic disorder with agoraphobia?
Exposure, because of high relapse rates after withdrawing from medication
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?
CBT, as difficulties can be encountered when medication is discontinued
How can hoarding disorder be differentiated from other obsessive type disorders?
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
What makes trichotillomania and excoriation distinct from OCD?
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
Which two OCD-related disorders appear to be the most common?
Hoarding and excoriation
Which neural circuits are overly active in people with OCD?
Basal ganglia, orbital prefrontal cortex and anterior cingulate cortex
What’s the most effective form of psychological treatment for patients with OCD?
Exposure and response prevention; SSRIs are also beneficial
