Anxiety Flashcards
3 key elements of emotion
- Subjective experience (feeling in head)
- Physiological response
- Behavioral response (Not always present)
Def: Anxiety
Forward oriented emotion, elevated apprehension, tension, sense of dread, lack of control
Def: Worry
Thoughts about possible negative outcomes that are intrusive and difficult to control
Def: Fear
Reaction to an immediate or present threat, alarm reaction
- Action tendency elicited by external events (threat) or feeling state (terror)
Tripartite Model of Anxiety
Behaviour, cognition, physiology
How does anxiety effect performance
Low anxiety = poor performance
Aroused anxiety levels= average performance
Mildly high anxiety = excellent performance
high anxiety = Poor performance
Rest and digest
Activation of the parasympathetic nervous system
- Pupil constriction
- Saliva stimulation
- Airways constriction
- Heart beat slow
- Stimulation of digestion
- Gallbladder stimulation
- Intestine stimulation
- Bladder constriction
- Increased blood flow to reproductive system
Fight or flight response
Activation of sympathetic nervous system
- Pupil Dilation
- Saliva inhibition
- Airways dilation
- Increased heart rate
- Digestion inhibition
- Liver glucose release
- Intestine inhibition
- Adrenal glands release epinephrine and norepinephrine
- Bladder relaxation
- Decreased blood flow to reproductive system
Stress hormone response
- Hypothalamus releases corticotropin- release factor (CRH)
- CRH signals to pituitary to secrete adrenocorticotropic hormone (ACTH)
- ACTH signals adrenal cortex to release hormones including cortisol
- When threat is gone, hippocampus` turns cascade off
Panic Atacks
DEF: Discrete period of intense fear or terror that has sudden onset and reaches a peak quickly
- Can include both cognitive and physical symptoms
- Sometimes has a trigger or cue, sometimes spontaneous
-28% of people experience panic attacks occasionally
Panic Disorder
Recurrent, unexpected panic attacks
Often believe they have life-threatening illness
- 3-5% lifetime prevalence
- Emerges late adolescence to early 30s
CRITERIA:
One attack followed by 1 month of:
- persistent concern about additional attacks or consequences
- significant maladaptive change in behaviour
How does pandemic related anxiety effect individuals
Posttraumatic stress, general stress. anxiety, health anxiety and suicidality
What are some of the symptoms of panic attacks
Heart palpitations, trembling, shortness of breath, dizziness, intense dread, and fear of dying
Locus Ceruleus
An area of the brain stem that plays a part in the emergency response and may be involved in panic attacks by lowering the threshold for stimulus in the limbic system to trigger a response
What are 3 cognitive factors that are correlated with the development of a panic disorder
- Pay close attention to bodily sensations
- Misinterpret these sensations in a negative way
- Engage in snowballing catastrophic thinking, exaggerating symptoms and their consequences
What are the two major theories the etiology of Panic disorder
Biological and cognitive
Biological Approach to panic disorder etiology
- 43-48% heritability
- Flight-or-fight may be poor regulated through neurotransmitter dysfunction
- Differences in limbic system (e.x. lesions)
- Fluctuations in progesterone may impact certain neurotransmitter systems causing increased FoF response
Cognitive Approach
- People have higher interoceptive awareness
- can result in the snowball effect when having physiological symptoms
- Lead to interoceptive conditioning
- Misinterpreting sensations in a negative way leading to catastrophic thinking
Def: Interoceptive awareness
Paying closer attention to bodily sensations
Def: Interoceptive Conditioning
Associate feeling of elevated physiology with panic attack causing a panic attack to result
Anxiety Sensitivity
Belief that bodily symptoms have negative consequences
Sanderson, Rapee & barlow CO2 experiement
- 2 randomly assigned groups: one thinks they have control over CO2 other doesnt
- given CO2 enriched air and measured panic attacks
- 20% of those who thought they were in control
- 80 % of those who didn’t
Generalized Anxiety disorder
- Anxiety about ordinary everyday situation
- Anxiety is intrusive and causes distress or functional impairment and often encompasses multiple domains
- Associated with physical symptoms such as sleep disturbance, chronic restlessness, muscle tension, GI symptoms and headaches
What is the prevalence of GAD in Canada
8.7 life time prevalence
Emotional and cognitive factors of GAD
EMOTIONAL
- Experience intense negative emotions, highly reactive to negative situations, feel their emotions are not controllable
COGNITIVE
- make maladaptive assumptions many of which reflect concern of losing control
Biological Factors of GAD
- Heightened activity of SNS
- Greater reactivity to emotional stimuli in the amygdala (may be associated with abnormalities in GABA)
- May result in part to disrupted coordination of brain activity
- Recent research suggests decreased connectivity between the amygdala and prefrontal cortex is present among those with GAD
Social Anxiety Disorder
An anxiety disorder in which the individual experiences intense fear of public humiliation or rejection and therefore tends to avoid social situations
- Most prevalent mental illness and contributes to the development of other psychiatric disorders
Symptoms of social anxiety disorder
- heightened fear, anxiety and avoidance of social interactions and situations
- In social situations may tremble, perspire, feel confused and dizzy, heart palpitations or panic attack
How does social support effect those with social anxiety disorder
- development of close friendships and other kinds of social support reduce the risk of developing social anxiety symptoms
- higher levels of perceived social support is associated with more favorable prognosis in treatment of social anxiety
Prevalence of social anxiety
- Most common form of anxiety and third most common mental health problem
- Lifetime prevalence of 8% in Canada
- 1 in 7 internationally
What time in life is social anxiety most likely to develop
Preschool years or adolescence
- When people become self-conscious and concerned about other’s opinions
- Chronic if untreated
Cognitive perspectives on social anxitey
COGNTIVE OVER PHYSIOLOGICAL
- excessively high standards for their social performance
- focus on negative aspects of social interactions
- evaluate their own behaviour harshly
- anxious feelings due to social situations
- safety behaviours may make social interactions lower quality
Agoraphobia
Fear of places where one may have trouble escaping or getting help
- Can sometimes be diagnosed alongside panic disorder
- 50% of people with agoraphobia have history of panic attacks
- other 50% have history of some disorder
- Have a tendency to turn to substance abuse
Agoraphobia Symptoms
- Fear of leaving home alone
- Fear of enclosed spaces
- Fear of using public transportation
- Fear of open spaces
- Fear of crowds or waiting in line
Treatment for panic disorders
- Pharmaceutical options
- CBT: confront situations or thoughts that arouse anxiety
- challenge and change thoughts
- Extinguish anxious behaviours
Steps of CBT for panic disorder
1.Learn relaxation and breathing exercise
2. Identify catastrophizing cognitions about bodily sensations (may induce symptoms in session to work through in real time)
3. Practice relaxation wile experiencing symptoms
4. Challenging catastrophizing thoughts
5. Systematic desensitization to expose clients to feared situations
Specific Phobias
- Unreasonable or irrational fears of specific objects or situations
- Disproportionate to actual danger
- may include avoidance or endurance with intense fear or anxiety
- Lifetime prevalence of 6.4% in Canada
Four major specific phobia categories
- Natural environment (most common height)
- Animals (Most common snakes and spiders)
- Situations
- Blood-injection-injury
Biological approach to specific phobias
20-40% heritability
Behavioral approach to specific phobias
MOWRER’S TWO-FACTOR THEORY
- Classical conditioning leads to fear of stimulus
- operant conditioning maintains fear (negative reinforcement)
PREPARED CLASSICL CONDITIONING
- evolution has prepared us to fear stimuli that were dangerous in our ancestral past
Prepared classical conditioning study
- Only 1-2 shocks for participants to start expressing fear to evolutionary feared stimuli and more difficult to extinguish
- 4-5 shocks for participants to start expressing fear to random stimuli and easier to extinguish
Behavioral therapies for specific phobias
- Systematic desensitization therapy
- Virtual reality treatment
- Flooding
Flooding
Intensively exposes client to feared stimulus until anxiety and/or fear is extinguished