6- Anxiety

Question 1

What are the most common type of psychological disorder?

Answer 1

Anxiety disorders

Question 2

How many people approximately suffer from an anxiety disorder at some point in their life?

Answer 2

30%

Question 3

How many more people suffer from anxiety disorders than mood disorders?

Answer 3

Twice as much

Question 4

How many anxiety disorders are recognised by the DSM-5?

Answer 4

9

Question 5

How is fear characterised in specific phobias?

Answer 5

Persistent and irrational

Question 6

What are specific phobias of?

Answer 6

Specific objects, activities or behaviours

Question 7

How is social anxiety disorder characterised?

Answer 7

By overwhelming fear of social situations

Question 8

How is generalised anxiety disorder characterised?

Answer 8

General anxiety that is not directed towards anything specific

Question 9

How is panic disorder characterised?

Answer 9

By reoccurring and unexpected panic attacks

Question 10

How is agoraphobia characterised?

Answer 10

By anxiety in situations where the person perceives their environment as unsafe

Question 11

How are panic attacks characterised?

Answer 11

Feeling of sudden and intense fear and anxiety

Question 12

8 physical symptoms of a panic attack

Answer 12

1. Rapid irregular heart rate
2. Sweating
3. Trembling
4. Breath shortness
5. Chest pain
6. Nausea
7. Dizziness
8. Dry mouth

Question 13

How long do panic attacks usually last?

Answer 13

Less than 30 minutes

Question 14

How many anxiety disorders involve panic attacks?

Answer 14

Most

Question 15

Are panic attacks always triggered by a disorder?

Answer 15

No, they can occur spontaneously

Question 16

When is the peak of anxiety?

Answer 16

A panic attack

Question 17

What are physical symptoms of anxiety and panic similar to?

Answer 17

A fear response

Question 18

What is activated in the fear response?

Answer 18

The sympathetic autonomic nervous system

Question 19

4 responses triggered by the ‘fight-or-flight’ mechanism

Answer 19

Increased heart rate
Increased blood pressure
Depressed digestive functions
Mobilised glucose reserves

Question 20

What understanding is also required in order to understand anxiety disorders?

Answer 20

Understanding of brain circuits that control fear responses and the sympathetic autonomic nervous system

Question 21

Response controlled by the parasympathetic nervous system

Answer 21

‘Rest-and-digest’

Question 22

How is the sympathetic nervous system controlled?

Answer 22

By activation of the ‘HPA axis’

Question 23

What does the HPA axis stand for?

Answer 23

H= hypothalamic
P= pituitary
A= adrenal cortex

Question 24

5 stages of the HPA axis

Answer 24

1. Hypothalamus decides if a stimulus is stressful
2. CRH released, stimulates pituitary gland to release hormones
3. Stimulates adrenal cortex
4. Hormone release
5. Physical symptoms of anxiety/panic

Question 25

Where is the amygdala in the brain?

Answer 25

Small brain region next to the hippocampus

Question 26

Where does the amygdala receive sensory information from?

Answer 26

The cortex, thalamus and hippocampus

Question 27

How does the amygdala trigger the fear response?

Answer 27

Sending projections to the hypothalamus

Question 28

When is the amygdala critical?

Answer 28

In the fear response

Question 29

Where is sensory info from the thalamus and cortex processed, and where is it next passed on to?

Answer 29

Processed in basolateral nucleus, passed on to central nucleus

Question 30

How has the involvement of the amygdala in fear conditioning been demonstrated?

Answer 30

In recording studies of mice and fMRI studies in humans

Question 31

When is the amygdala activated?

Answer 31

When seeing fearful faces

Question 32

What do patients with amygdala damage show and why?

Answer 32

Show much lower fear levels as they process face stimuli differently

Question 33

What brain damage did SM have?

Answer 33

Complete bilateral amygdala damage

Question 34

How was SM described?

Answer 34

As very outgoing, extremely friendly and uninhibited

Question 35

What was SM impaired in and why?

Answer 35

Recognising negative social cues (including fear in facial expression) as she doesn't pay much attention to the eye region

Question 36

What was SM unable to detect?

Answer 36

Environmental threats

Question 37

How did SM display that she had no memory deficit?

Answer 37

She could remember events, they just didn't cause her to change behaviours

Question 38

How was no fear response damaging for SM?

Answer 38

Meant that fear conditioning wasn't established

Question 39

What is a common MRI finding of people with anxiety disorders?

Answer 39

Overactivity of amygdala to negative stimuli

Question 40

What is the process of fear conditioning?

Answer 40

Repeatedly presenting a neutral stimulus with an aversive unconditioned stimulus, causing a fear response to the conditioned stimulus

Question 41

How do patients with amygdala damage respond to fear conditioning?

Answer 41

Don't show a normal physiological fear response to a conditioned stimulus, but remember the outcome of that stimulus

Question 42

What response do patients with hippocampal damage show in response to fear conditioning?

Answer 42

A physiological response but no recollection

Question 43

What is the amygdala associated with?

Answer 43

Emotional association and response

Question 44

What is the hippocampus associated with?

Answer 44

Fear memories

Question 45

What is the amygdala important for?

Answer 45

Processing fear and triggering the HPA axis (causing physical symptoms of anxiety and panic)

Question 46

What is caused by amygdala damage?

Answer 46

Reduced fear response

Question 47

What is seen regarding the amygdala in anxious patients?

Answer 47

Amygdala overactivity

Question 48

What is the hippocampus important for?

Answer 48

Fear memories

Question 49

What was the early treatment of anxiety disorders?

Answer 49

Benzodiazepines

Question 50

How do benzodiazepines work?

Answer 50

Increase GABA activity

Question 51

What is GABA and what does it produce?

Answer 51

An inhibitory neurotransmitter, produces sedative/anxiolytic effects

Question 52

What do benzodiazepines cause in the brain?

Answer 52

Reduced amygdala activity

Question 53

Why has drug treatment shifted away from benzodiazepines?

Answer 53

Due to dependence concerns

Question 54

What are now the first treatment choice for most anxiety disorders?

Answer 54

Selective Serotonin Reuptake Inhibitors (SSRIs)

Question 55

What do SSRIs do?

Answer 55

Increase levels of serotonin

Question 56

What does a single dose of SSRIs decrease?

Answer 56

Amygdala activation

Question 57

What does SSRI treatment reduce?

Answer 57

Amygdala activation and hippocampal activity under stress conditions

Question 58

What is extinction?

Answer 58

Conditioned fear responses are reduced when feared conditioned stimulus is repeatedly presented by itself

Question 59

How does exposure therapy suppress fear inhibition?

Answer 59

Repeated exposure to CS only generates an inhibitory memory

Question 60

What occurs in fear conditioning?

Answer 60

CS is repeatedly presented by itself

Question 61

What is the result of fear extinction?

Answer 61

Conditioned fear response disappears over time

Question 62

How is it shown that extinction does not equal forgetting?

Answer 62

Memory for association is inhibited but not erased by fear extinction

Question 63

What brain area is involved in extinction?

Answer 63

Ventromedial prefrontal cortex

Question 64

What is shown in the brain after exposure therapy for a specific phobia?

Answer 64

Amygdala overactivation disappears after therapy and there is increased frontal cortex activity

Question 65

Why is there increased frontal cortex activity after exposure therapy?

Answer 65

Greater cognitive control of amygdala fear response

Question 66

How do the PFC and the amygdala interact?

Answer 66

PFC inhibits the amygdala

Question 67

What is a similarity between all anxiety disorders?

Answer 67

All characterised by an excessive fear response

Question 68

How could physical anxiety symptoms be explained?

Answer 68

By HPA activation

Question 69

When is the amygdala important?

Answer 69

For fear processing and activation of fear response

Question 70

What brain activity is often key in anxiety disorders?

Answer 70

Amygdala overactivity

Question 71

What are common treatment options for anxiety disorders?

Answer 71

Benzodiazepines and SSRIs

Question 72

How do treatments for anxiety disorders act?

Answer 72

To reduce amygdala activity