Anxiety Flashcards
what is anxiety
intense fear of events/situation that are avoided/endured with sense of dread/distress
what is anxiety motivated by
future events which are more abstract
what is fear motivated by
imminent threats
similarities between fear and anxiety
arousal via sympathetic nervous system (involuntary response to dangerous or stressful situation)
what is the resulting feeling from anxiety
long, sustained affective state which is diffused
epidemiology of anxiety
most commonly experienced psych condition in US
lifetime prevalence of anxiety
29%
is anxiety comorbid, and with what
50% with anxiety meet criteria for another anxiety disorder
66% meet criteria for another psych disorder
60% with depression
sex differences in anxiety
2:1 female to male ratio
sex differences in anxiety explaineed
women more likely to get help
more factors which induce anxiety
- trauma exposure, mood amplification
heritability of anxiety
20-40% of anxiety disorder
environmental factors and anxiety
childhood trauma increases risk
cultural context influence prevalence and focus
common criteria of anxiety
interferes with functioning - should cause impairment
not caused by drug or medical condition
should persist for 6 months
symptoms cannot be explained by another disorder
specific phobia ?
form of anxiety targeted on specific stimulus or situation
specific criteria for anxiety
- marked/disproportionate fear constantly triggered by specific objects or situations
- object/situation is avoided or endured with intense anxiety
lifetime prevalence of specific phobias
7-15%
when and how do specific phobias begin
in childhood
avg age 8
often linked to specific experiences
social anxiety disorder - criteria
marked and disproportionate fear consistently triggered by exposure to potential social security
exposure to trigger leads to intense anxiety about being evaluated negatively
triggering situations are avoided or endured with intense anxiety
what are the effects of social anxiety disorder
more serious as socialising is crucial for navigating a normal and healthy life
poeple miss out on experiences, social connections, relationships
ruminate extensively about future scenarios and possible outcomes
when does social anxiety disorder begin
usually adolescence but sometimes childhood
not from one event but broad childhood experiences which could subsume variety of social experiences
panic disorder
recurrent and unexpected panic attacks
the misfiring of fear system, symptoms begin and cycle, brings on onset of panic attack
criteria of panic disorder
at least 1 month of concern/worry about experiencing attacks or fearing the consequence
maladaptive behvaioural changes
what are panic attacks
unexpected and uncontrollable episodes of terror, apprehension, sense of dread, accompanied by physiological changes
physiological changes of panic attacks
breathlessness, dizziness, nausea, palpitations
how common are panic attacks
25%
agoraphobia
consistent fear and anxiety about situations where it would be embarrassing or difficult to escape if anxiety symptoms occurred
characteristics of agoraphobia
situations are either avoided or suffered using maladaptive coping mechanisms, or with intense anxiety
what was agoraphobia formerly noted as
special case of panic disorder
why is agoraphobia now its own disorder
only 50% of sufferers of this have panic attacks
generalised anxiety disorder - characterising feature
the phenomena of worry, diffused and spread to many contexts
why is GAD difficult to treat in therapy
because there is not immediate stimuli to target like in specialised anxiety disorders
chronicity of GAD
half patients experience perseverance over 8 years
GAD and comorbidity
~80% of patients meet criteria for other anxiety disorders
GAD - special criteria
- excessive anxiety and worry at least 50% of days about a number of events
- hard to control the worry, not active and intentional rumination
- diffused experience - no specific target
anxiety and worry are associated with what
restlessness
easily fatigued
difficulty concentrating / mind going blank
irritability
muscle tension
sleep disturbance
what is the key framework for causes of anxiety disorders
associative learning
what is associative learning
how people learn from events which occur in environments
- connections made with events which occur together
fear extinction
process where association between condition stimulus and uncondition stimulus is unlearnt over time
DSM 5 - pathological anxiety, why do anxieties remain
due to maladaptive avoidance
- the adaptation to life style perpetuates the fear over time
what is Mowrer’s 2 factor model
Pavlovian conditioning - learning gets fear started
instrumental conditioning - keeps the fear alive
what is instrumental conditioning
how we act in the context of rewards
positive reinforcement
desired behaviour elicits reward
negative reinforcement
desired behaviour, no punishment
trait vulnerability
stressors which increase risk for mood disorders
people are more or less susceptible to developing phobia
anxiety and fear conditioning
anxious people tend to be more fearful of neutral stimuli, if in threatening context
more likely to develop fear than healthy people
slower to extinguish fear
stimulus generalisation
process whereby neutral stimuli that are distinct from, but similar to, original conditioned stimulus can partially elicit conditioned response
amygdala - brains fear circuit
important for fear acquisition, storage and expression to what is already learned
medial PFC - brains fear circuit
works with amygdala, important for learning and controlling for fears
extinguishing fear
general risk factors for GAD
behavioural inhibition
neuroticism
attention to threat
negative bias
behavioural inhibition - GAD
tendency to become distressed and withdraw when faced with novel situation
neuroticism - GAD
tendency to experience frequent and intensive negative affect
increases risk for future anxiety and depression
attention to threat - GAD
paying more attention to negative cues in environment
negative bias - GAD
interpreting of neutral stimuli as negative
risk factors for SAD
2 factor theory
negative self evaluations
catastrophizing
monitoring performance
negative self evaluations - SAD
negative view of self, and of what might happen
monitoring performance - SAD
feeds into reinforcing cycle, interferes with performance in social interactions
risk factors for panic disorder
2 factory theory
physiological factors
triggers
physiological factors - panic disorder
noradrenaline is attention related,
stress triggers noradrenaline release - increase activity of SNS
increases likelihood of having panic attack
drugs increase noradrenaline cause panic attacks
triggers for panic disorder
situations which induce symptoms and internal states
interpretation of physical symptoms - panic attacks
states of breathlessness
triggers for agoraphobia
exteroceptive (places) rather than interoceptive (bodily states)
risk factors for GAD
generalised distress and worry
strong association with MDD
intolerance of uncertainty - worry more
reinforcing properties of worry - distracts from real and intense emotions
behavioural treatment for phobias
exposure therapy, start with manageable task and increase intensity
- prevent safety behaviours
cognitive treatment for phobias
challenging beliefs about fear and possible damage
- build coping abilities, prevent fear of consequence
CBT approach for GAD
relaxation training, cognitive restructuring, mindfulness
GAD - relaxation training
accesses interaction of physiology and psych
learning to relax self (muscles etc)
GAD - cognitive restructuring
reduce catastrophizing and discuss realistic consequences
reduce negative bias
decrease time spent worrying
GAD - mindfulness
being in the present
response rate of CBT on ADs
~50%
anxiolytics
drugs which reduce anxiety
main types of AD medication
benzodiazepines (valium, xanax)
antidepressants
issues with benzodiazepines for ADs
induces tolerance so increase needed over time to maintain effects
can lead to dependence