412 Anxiety Flashcards
1
Q
who is least/most likely to use mental health services
A
- people with severe and non-severe anxiety do not seek treatment (though girls and older adolescents are slightly more likely)
2
Q
why are people with anxiety less likely to seek treatment
A
- some fear and anxiety is normal (becoming distressed when separated from parents, short-lived specific fears, must assess if it’s causing distress/disability)
- some anxiety is adaptive (stranger anxiety, test anxiety)
- may not be as upsetting to adults (no causing disruption, may be associated with favourable characteristics like less aggression)
3
Q
core features of anxiety
A
- focus on threat or danger
- anxiety is future-oriented (anxious apprehension)
- strong negative emotion or tension (physical sensations, cognitive shifts like worry, behavioural patterns like avoidance)
4
Q
different anxiety diagnoses
A
- vary on content of threat and balance of symptoms (cognitive like worry vs. physical)
- specific phobia
- separation anxiety
- generalized anxiety
- social anxiety
- panic disorder
- agoraphobia
- selective mutism
5
Q
epidemiology of separation anxiety
A
- often seen in school ages
- high levels of comorbidity (with other anxiety or depressive disorders)
- small percentage of people will persist into adulthood (figure of attachment may change), while others will grow out of it or switch to another anxiety disorder
6
Q
selective mutism
A
- failure to speak in situations when speaking is expected, even though they may speak in other settings
7
Q
common obsessions and compulsions
A
- contamination, harm to self or others, symmetry
- counting, checking, washing
8
Q
prevalence of anxiety disorders
A
- any anxiety disorder in childhood/adolescence = 32%
- specific phobia: 19%
- social anxiety: 9%
- separation: 8%
- GAD: 2%
- PD: 2%
- OCD: 1-2%
- mutism: 0.7%
9
Q
epidemiology of anxiety disorders
A
- girls 2:1 boys (as age of onset increases, gender disparity increases)
- OCD has a 2:1 male to female ratio that is present throughout development
- contextual cultural experiences can shape anxiety presentation
- lower SES (single parent, lower parental education) = more anxiety
- ethnicity: more common in Black youth, but White youth receive more treatment (race-based sensitivity)
- comorbidity tends to be the norm (with other anxiety disorders and depression)
- usually, anxiety disorders precede depression (internalizing symptoms are highly related)
10
Q
race-based sensitivity
A
- worry/anxiety/physiological arousal about the idea that someone could discriminate against you in the future
- anticipating people treating you differently because of your race, which contributes to your anxiety
11
Q
comorbidity anxiety and depression
A
- symptom overlap (GAD and MDD; fatigue, sleep disturbance, irritability, concentration)
- negative affectivity high in both anxiety and depression, but depression is low in positive affectivity and anxiety can still have high positive affectivity
12
Q
clinical correlates of anxiety
A
- academic difficulties; high IQ but symptoms interfere with functioning (worry impacts concentration, school refusal)
- social difficulties: becoming increasingly rejected with age because of shyness, more likely to experience peer victimization, perceive their friendships to be of lower quality
13
Q
developmental course of anxiety disorders
A
- fears, worries, rituals can be developmentally appropriate (worries get more complex as you age)
- young children may not realize that their fears/behaviours are excessive/atypical, but may get embarrassed as they age
- earlier stages of development = inability to verbalize distress, so behavioural symptoms are more common
- different anxiety disorders have different ages of onset
14
Q
anxiety disorders age of onset
A
- separation: 7-8
- OCD: 9-12 (though some kids can present earlier 6-10)
- GAD: 10-14
- social and PD in adolescence
15
Q
homotypic continuity
A
- stability
- a disorder predicts itself over time
- separation anxiety becomes social anxiety
16
Q
heterotypic continuity
A
- disorder predicts onset or worsening of a different disorder over time
- social anxiety becomes depression
17
Q
heritability of anxiety
A
- tendencies toward anxiety are inherited (diathesis)
- children of parents with anxiety disorders are 5x more likely to have anxiety disorders
- twin studies indicate 33% of variability is heritable
18
Q
what could be the inherited biological predisposition for anxiety
A
- temperament
- behavioural inhibition: fear and distress in response to novel situations, withdrawal
- negative emotionality
19
Q
two-stage model of fear acquisition
A
- stage 1: develops through classical conditioning (pairing US-CS so that the CS will reliably provoke the CR)
- stage 2: avoidance behaviour maintains fear through operant conditioning (avoidance = relief = negative reinforcement of avoidance & reinforces the idea that the fear is valid)
20
Q
maintenance model of OCD
A
obsessive intrusive thought = appraised as important = anxiety and disgust = act to neutralize = reduces distress = reinforcement of important appraisals & more likely to have more intrusive thoughts (because you spent so much cognitive time and energy on them)
21
Q
social information processing model of anxiety
A
- encoding biases: attention to threat and reading ambiguous situations as more threatening
- threat intensity, personal relevance of threat, current mood, contextual factors will moderate attentional biases (not constantly more attentive to threat)
- interpretation biases: interpreting ambiguous events negatively and catastrophizing mildly negative events which can lead to avoidance
22
Q
family factors in youth anxiety
A
- modeling: parents demonstrating anxious responses to children (parent showing fear = child learns to also display fear)
- information transmission: kids being told that something is dangerous (parents over-emphasizing danger)
- low expectations: parents not believing that their kids have the ability to cope
- parental reinforcement of problematic behaviour
23
Q
study about family factors in youth anxiety
A
- kids referred for anxiety, ODD, or control group presented with ambiguous situations and give a first answer, then discuss with parents and give a final answer
- parents talked their kids into giving avoidant responses (maybe they had low expectations about their ability to respond in other ways)
- direct transmission of information
- same pattern in kids with ODD: parents socializing and modeling aggressive solutions
- passive GxE (creating environments that foster anxiety) and evocative GxE (reacting to kid’s anxiety and providing avoidant solutions)
24
Q
SSRIs
A
- stop the reuptake of serotonin into the presynaptic neuron
- some evidence of effectiveness, but not much research in youth
- reduction of symptoms, moderate effect sizes
25
core components of effective treatments for anxiety
- reducing cognitive biases by encouraging positive self-talk about anxious symptoms and thoughts that go with them + coping self talk, identifying and challenging automatic thoughts
- reduce bodily tension though diaphragmatic breathing, progressive muscle relaxation, guided imagery
- exposure and habituation (facing fears in a controlled way)
26
novel cognitive interventions
- re-training attention threat bias
- dot-probe task to train attention away from threat (potentially promising)
- kids assigned to attention-bias modification, neutral-neutral, placebo conditions in a double-blind study
- only people in the ABM condition showed decreases in threat bias, anxiety severity and symptoms
27
exposure therapy
- habituating the CS so that anxiety will decrease naturally (without avoidance)
- CS presented without the US to extinguish the relationship between CS-CR
28
graded exposure
- start small and work up to higher levels of anxiety
- develop a hierarchy of fears ranked from easiest to hardest (subjective anxiety)
- start toward the bottom of the ladder, rate anxiety during each exposure, and keep practicing until habituation to move up the ladder
- first exposure = strong reaction, then anxiety will decrease so that the next reaction will be lower (peak anxiety will be lower and will decrease faster)
29
flooding
- can be very effective
- start with an intense confrontation with the most feared stimulus
- not very tolerated, so clinicians opt for graded (less likelihood of dropout)
- if the person cannot tolerate it, so they avoid or fail, they're unlikely to benefit
30
CBT for OCD
- normalize OCD and intrusive thoughts (1: psychoeducation)
- create a hierarchy of obsessions (can get very granular)
- exposure response prevention
- teaching to place less importance of intrusive thoughts, limiting compulsions
31
Child/Adolescent Anxiety Multimodal Study (CAMS)
- testing efficacy of SSRIs, CBT, combined in youth with GAD, separation, social anxiety (treated for 12 weeks, clinician blind ratings of severity)
- all treatments were better than placebo group
- combined was better than SSRIs or CBT alone
- CBT was equal to SSRIs
- these patterns were maintained at follow-up
- moderator: anxiety diagnosis (combined was best for all 3, SSRIs were better for social anxiety - maybe taking the edge off, CBT was better for GAD - skills learned might generalize)
- CBT for SOC didn't include exposure to peers which could influence the results
32
CAMELS (Extended Long-term Study)
- 3-11 years post-Tx
- improvements in functioning (family functioning especially) during CAMS led to long-term improvement in anxiety
- improvements in anxiety during CAMS led to improvements in functioning
- patterns were true across all conditions
33
Pediatric OCD Treatment Study (POTS)
- youth with OCD assigned to SSRIs, placebo, CBT, CBT+SSRI
- severity rated blindly
- combined was better than other conditions
- CBT equivalent to meds
- effect sizes were different based on the site
- Duke: combined was better than meds, which was better than CBT
- Penn: combined and just CBT were equivalent and both better than meds
- clinicians were better at giving CBT at Penn, and there was no added benefit of giving meds
