Abnormal Week 4 Flashcards
Disorders formally classed as anxiety disorders but are now in seperate chapters of the DSM - 5
PTSD
OCD
The two distinguishable components of anxiety
phsyiological
cognitive
A (sometimes considered) 3rd component of anxiety
a behavioural component involving avoidance and other safety behaviours
anxiety tends to be ____ focused
future
___________ about many themes is a main compoanent of generalized anxiety disorder
persistent uncontrollable
Sarason’s Reactions to Tests scale has two subscales tapping into ___ and ____ components
phsiological and cognitive components
the inability to concentrate due to mind wandering
test-irrelevant thinking
anxiety must be _________________ in order for necessary clinical intervention (difference between normal and abnormal anxiety
chronic, relatively intense, associated with role impairment, and causing distress for self or others
is there a difference in gender prevelance in anxiety disorders
yes, anxiety is more common in women than in men
Is there enough mental health services for everyone with anxiety
no, there is not enough mental helath services for every with clinical anxiety to get help; let alone other mental illnesses
the disorders with the earliest median age (15-17) onset
phobias and seperation anxiety
the disorders with the lastest median age of onset
panic anciety disorder
GAD
major depression
anxiety that results from not having contact or the possibilty of losing contact with attachment figures
seperation anxiety
fear or avoidance of objects or situations that do not present any real danger
specific phobia
fear and avoidance of social situations due to possible negative evaluation from others
social anxiety disorder
recurrent unexpected panic attacks involving sudden onet of phsyiological symptoms accompanied by terror and feelings of impending doom
panic disorder
fear of being in piublic place with no escape
agorphobia
persistent, uncontrollable worry, often about minor things
generalized anxiety disorder
failure to speak in one situation (usually school) when able to speak in other situations (usually home)
selective mutism
Is seperation anxiety soley in children
no, it has recently been found more prevalent in adults
anxiety disorders and associated with _______ and suicide attempts
suicide ideation
ther term “specific phobia” implies that the person suffers _____
intense distress and social or occupational impairment because of the anxiety
the greek god who frightened his enemies
phobos
acrophobia
fear of heights
ergasiophobia
fear of working
pnigophobia
fear of chocking
taphephobia
fear of being alive
no mobile phone phobia; why? 4 dimensions of the fear?
nomophobia
- maybe way of compensating for other anxieties
1. inability to communicate
2. being disconnected
3. inability to access info
4. inconvenience
_______s tend to focus on the content of the phobia and see the phobic object as a symbol of important unconscious fear
psychoanalysts
_______ tend to ignore the content of the phobia and focus ont he functino of the phobia
behaviourists
the DSM-5’s subtypes of specific phobias
blood-injection-injury situations animals natural environment other
why is reasearch lacking on specific phobias
the avoidance associated with the phobias - ppl avoid rather than seek treatment or address it in any way
the mean duratino of specific phobias
20 years
do most people have 1 phobia
people often have 2+ phobias
are phobias culturally varied
yes ex: in china they have a fear of being cold
3 feared and avoided situations of socially anxiety disorder
- public speaking or other performance types
- social interactions
- being observed in public
Prior to DSM, social anxiety disorder could be classified as either ____ or ____
generalized or specific
people with generalized social phobia were found to have :
earlier age of onset
- more comorbidity with other disorders (depression, alcohol abuse) GAD, specific phobas, panic disorder, avoidant personality, mood disorders
- more severe impairment
- vulnerable to week related problems
most children diagnosed with ___ are diagnosed with SAD
selective mutism
the osnet of SAD generlaly takes place during
adolescence
changes to the DSM-5 for social anxiety include
- perofrmance only specifier, change in name from social phobia –> social anxiety disorder
does SAD vary cross cultures?
yes, in japna there is a syndrome that is an extreme fear of embarrasing others; causing others to feel anxious, rather than ourselves
are all parts of ____
- avoidance conditioning
- modelling
- prepared learning
- the role of diathesis
- social skill deficeits
behavioural theories of SAD and specific phobia
reactions are learned responses - main account of phobias are aquired - is called:
avoidance conditioning
the two parts of avoidance conditioning
- via classical conditioing: learn to fear neutral stimulus if paired with painful/ frightening event
- can learn to reduce fear by escaping/ avoiding the now conditioned stimulus, which reinforces the conditioned simulus
a person can learn fears from imitating the reactions of others
modelling - of behaviour theory
vicarious learning :____
learning by observing others actions to stimuli or what they have to say
some stimuli is more likeli than others to become classically conditioned stimuli, since an organisms is physiologically prepared to be sensitive to that object/ situation
prepared learning
according to preepardness theory is every stimulus capable of becoming a source fo fear
no
a tendency to believe similar traumatic experiences will pccur in the future - which may be important in developing a phobia
a cognitive diathesis/ predisposition - role of diathesis
why should people not be completely regarded as a valid theory of phobias
some peopel do not report direct exposure or a traumatic event to their phobia
the use fo safety behvaiours during a speech preformance may be reponsible for
poorer performance rankings
parent and child reports of social skills did not differ compaing ____ and _____ but they did have some observable behaviours
SAD and GAD
_____ views focus on how thought processes can serve as a diathesis on how thoughts can maintain a phobia or anxiety
cognitive views
sopeople with SAD see their positive attributes as _____
; and they ____ negative experiences more
being less important than negative; and they remeber negative experinces better
cognitive models link social anxiety with
1.
2.
3.
- an attentiional bias to focus on negative social ino and interpret ambigous situations as negative
- perfectionistic standards for accepted social performances
- a high degree of public self-consciousness
David clark’s model of SAD on SAD treatment
not exposure but behavioural experiments and role plays
challening _____ is the important therapuetic goal of “widening the bandwidth”
interpretatinos that social blunders cost much more than people withouth SAD believe they will cost
a type of cognitve processing, ruminative in nature, that focuses on the past social situations; changing it, doing things different
post-event processing (PEP)
biological theories of SAD and specific phobias focus on ___ and ___
the autonomic NS and genetic factos
stability-lability
a dimensino of autonomic activity
labile indivudals
jumpy individuals whose autonomic system is readily aroused
temperament is ___ influenced
genetically
psychoanalytic therores account for phobic behaviour:
phobias are a defence against anxiety produced by repressed ID impulses, the anxiety is displaced from the feared ID impulse and moved to an object/situation that has a symbolic connection to it
a feeling of being outside ones body
depersonalization
a feeling ther world’s not being real; as well as fears of losing control, going crazy or even dying
rerealization
how many symptoms out of how many symptoms do you need to meet in order to be diagnosed for a panic attack?
4 out of a possible 13
do panic attacks often have situational triggers or no
they do
when the relationship with the stimuli that triggered a panic attack is present but not strong; what do they often occur with
situationally predisposed panic attack; SAD
when can panic attacks occur
whenerv; even in a seemingly beeign states ie. sleeping or relazing
waking up in a state of panic is referred to as
a nocturnal panic attack
what is a cued/expected panic attack
a panic attack where there is a strong association with the trigger of the panic attack
what type of panic attack is required for a diganosis of panic disorder
uncued/ unexpected panic attacks ; out of the blue
the change in behaviour that often occurs as a result of the panic attacks usually involves
avoidance
why would people who have panic attacks avoid exercise
they want to avoid the sensations they fear
more than ____% of people diagnosed as having one of the many anxiety disorders also experience panic attacks
80%
research into panic attacks perhaps being a marker for severe psychopathology independent of panic dosrder has led to what chnage to the DSM
a panic attak specifier in the DSM -5
ex: social anxiety disorder with panic attacks
a cluster of fears centring on public places and being unable to escapse or find help should one become incapacitated
agoraphobia
to be diagnosed with agoraphobia, a perosn would have to :
- be anxious about at least two types of situations out of the following 5: public transportation, open spaces, enclosed spaces, lines/crowds, and being out of the house alone
the primarily concern of someone with agoraphobia
having panic like symptoms andnot being able to escape the situation, but it could also be a fear of incontinece or other embarrasing symptoms
if avoidance to one type of sitation where a panic attack could be dangerous or embarrasing it is classified as a _____
- if avoidance covers two situations than a diagnosis of_____ if given
panic disorder - 1
agoraphobia - 2+
agoraphobia much more common in __ than ___
women than men
What can casue some people to develop panic disorder in a minority of cases (biological theory)
physical sensations caused by an illness that can be terrifying for the individual
is panic disorder heritable? proof?
another biological theory suggests panic is caused by an overactivity in the _____ system
another biological theory suggests panic is caused by an overactivity in the _____ system
noradrenergic (neurons that use norepinephrine as a NT)
The overactivity in the noradrenergic system focuses on a nucleus in the pons called the ________ which when overstimulated in monkeys, caused them to have a panic attack, and when stimulated in humans by the drug yohimbine, induced panic attacks in ppl with panic disorder
its a peptide; induces anxiety-like symptoms in rats; can be blocked by benzodiazepines; hypothesized the hypersensitivity to CCK may cause panic disorder, at least in part
The role of cholecystokinin (CCK)in panic disorder
its a peptide; induces anxiety-like symptoms in rats; can be blocked by benzodiazepines; hypothesized the hypersensitivity to CCK may cause panic disorder, at least in part
noradrenergic overactivity idea: problem with gamma-aminobutyric acid (GABAG) neurons that generally _____ noragrenergic activity
inhibit
The prinicipal psychological theory of agoraphobia is the _________ hypothesis, which means __________
fear-of-fear; means agoraphobia is not a fear of public places ut a fear of having panic-like symptoms in these public places
The prinicple hypothesis of the development of panic attacks may be the _________ is predisposed to be overly active, coupled with the psychological tendency to be _________________
autonomic nervous systems (ANS)
- upset by these sensations
The viscious panic attack disorder circle
fear panic attack –> increased ANS activity –> sensatinos interpreted in catastrophic ways–> rasied anxiety level –> ANS activity increased –> eventually full blown panic attack
Telch and collegues did a student with students with no history of panic attakcs divided into two groups (high score; low score) on Anxiety sensitivity indexx - higher scores = sensations interpreted to have harmful consequencses
- what did they find?
a heightened tendency to be afraid of fear sensations appears to play an important role in panic attacks - unexplained physiological arousal in someone fearful of these sensations leads to panic attacks
anxiety sensitivity predicted______ andis a risk factor in the development of _______
predicted spontaneous panic attacks and is a risk factor in the development of numerous clinical syndrome (related most closely with panic disorder but also other disorders)
anxiety sensitivity was correlated with greater activity in the following brain regions while processing emotional faces :______and ___________ which are both involved in _____
anterior cingulate cortex and the insula; both involved in processing the threat
anxiety sensitivity and enviro or genetic causes
joint enviro and genetic causes; but genetics play bigger role in extreme levels of anxiety sensitivity
how would the environment contribute to anxiety sensitivity
people with high anxiety ansitvity maay have learned to catastrophize their bodily sensations via parental modelling and parental reinforcement
what therapy helps high anxiety sensitvity
CBT- cognitive behavioual therapy invented by beck when he was freaking 95 years old wtf
what is the anxiety equation
(consequences x prob x immenence)/ self-efficacy
what is sefl-efficacy
not self-esteem; how well you handle a particular situation; varies over situations
the problem with avoidance
keeps person from living consequences; never develop self-efficacy
what is the fear network
much of what the brain does is unconscious; first step in perceiving is automatic ; only after the fact do you put meaning with the situation
the fear network refers to the ___ system which is comprised of ______
limbic system which is comprised of thalamus amygdala hippocampus hippothalamus
what does the thalamus do
sensory relay staition, directs sense info to appropriate cortex areas
what does the amygdala do
two functions:
1) generates fight or flight response/ activates it
2) helps decide what situations are relevent to focus threat attention to
what it the hippocampus responsible for
memory; short term–> long term
association with the frontal lobe; compares new stimuluses to old stimuluses
what does the hypothalmus do
regulates basic drives; regulates ANS; sends info to adrenal gland which secrete different hormones
anxious people have an overactive ___
amygdala
therapy can restore the size of the ___
hippocampus
_____ shrinks the size of the hippocampus
cortisol
a person who is persistently anxious, often about minor things in daily life may have
generalized anxiety disorder
when does GAD usually begin
mid teens
as _____ rises, anxiety rises in people with GAD
uncertainty
people with GAD are often drawn to what stimuli
stimuli that suggests possible physical harm or social misfortune
there is a theory for people with GAD that worry distracts from _____, negatively reinforcing symptoms of GAD
negative emotions
- worry does not produce much emotional arousal versus emotions
is there a genetic component to GAD
probably, twin studies show there are both heritable and environmental components and the genetic influence was about the same for both men and women
there has been white matter abnormalities in the ____ and ____ of GAD clients
amygdala and cingulate cortex
GAD may result from defects in the _____ system since this is usually self regulating and goes off in normal fear reactions
GABA system
benzodiazepines work for GAD clients by what
enhancing the release of GABA
the psychoanalytic theory for GAD
unconscious conflict between ego and id impulses - usually sexual or aggressive in nature… ego cannot allow because it unconsciously fears punishment will follow
what is in vivo exposure
- is it effective
- problems with this?
when a person is exposed to their feared situations or stimuli
- better than imagining
- effective but high dropout rate and low treatment acceptance
what is VR exposure
- critical elements?
- effectiveness?
- problems with this?
virtual reality exposure
- successful for anxiety including specific phobia, social anxiety disorder, panic disorder and agoraphobia
- critical elements:
1. it occurs in real time
2. feels like you’re
actually there
- found to be just as effective as in vivo exposure
what is AR exposure
augmented reality exposure
- combines VR and physical world
- used in treatment of small animal phobias
Modelling as anxiety treatment
fearful clients are exposed to filmed or live demonstrations of other people interacting fearlessly with phobic object
flooding as anxiety treatment
the client is exposed to source of phobia at full intensity - usually last resort
what is Ost’s one session exposure treatment for phobias
highly intensive and can last many hours
why is there skepticism surrounding cognitive treatment for specific phobias
because the phobic fear is often already recognized by the individual as excessive or unreasonable
what is cognitive treatment good for
social anxiety disorder - as people with this often have adequate social skills but do not use them because of self-defeating thoughts
what is panic-control therapy
3 components:
1. relaxation training
2. combo of Ellis- and beck-
type CBT interventions
3. exposure to internal cues
that trigger panic
(interoceptive exposure)explain interoceptive exposure
client practices behaviors in room which elicits feelings associated with panic
components (breathe through straw, spin in chair) :
1. client experiences them under safe conditions
2. client applies learned cognitive strategies so sensations become less threatening
CBT is generally more successful than drug treatments to treat anxiety disorders ? T or F?
True!
- create lasting change
what treatments are becoming more and more popular for anxiety disorders
mindfulness and acceptance-based treatments
what is lovingkindness
a type of mindfulness meditation that involves being kind to oneself and then extending that kindness to others
biological approach to treating anxiety
drugs
barbiturates
first major category of anxiety treatment drugs but were highly addictive and have a great risk of a lethal dose
what are valium and Xanax examples of
benzodiazepines
are benzodiazepines addictive? how long should they be used for?
yes; short term
monoamine oxidase inhibitors are used for
SAD
Selective serotonin reuptake inhibitors are used for
SAD, GAD, panic disorder
Serotonin norepinephrine reuptake inhibitors are used for
SAD, GAD, panic disorder
Azapirones are used for
GAD
alcohol self-medication was highest for what illness
GAD
drug affects on fear related memory
DSC (d’cycloserine) makes “good exposures better and bad exposure worse”
- tries to eliminate fear for a limited amount of time
psychoanalytic approaches to anxiety
- phobias
- panic disorder
phobias - regarded as symptomatic of underlying conflict, so phobias usually not dealt with directly, however they do recognize that it is important to exposed client to what is feared
panic disorder - psychodynamic psychotherapy
