anxiety Flashcards
1
Q
anxiety disorders
A
- excessive fear and anxiety
- behavioural disturbances, impacts daily functioning
- fear: emotional response to real or perceived threat (triggers fight or flight)
- anxiety: anticipation of future threat (muscle tension, vigilance in preparation for future danger)
2
Q
anticipatory (adaptive) anxiety
A
- task orienting thoughts and helpful behaviours
- ie. focusing on the task at hand, sitting down and studying for an exam which contributes to dealing with a future challenge
3
Q
excessive (maladaptive) anxiety
A
- task-interfering thoughts and maladaptive behaviours
- ie. i’m going to fail this exam; “i can’t do this” (unhelpful thought), combined with procrastination or avoidance (maladaptive behaviours)
- can also result in overpreparedness
4
Q
clinically significant anxiety
A
- endurance: has to 6 months
- intensity: elevated compared to peers
- interference: impairment of functioning, can be within individual or within the family
5
Q
fear
A
- immediate alarm reaction to perceived danger
- might not always be a physical threat; if far, it can still manifest as a perceived threat
- ie. judgement
6
Q
panic attack
A
- abrupt experience of intense fear or discomfort, accompanied by severe changes in physiology
- 5-20 minutes
- ie. heart palpitations, chest pain, shortness of breath
- often lead to development of panic disorders due to fear of having more of them
7
Q
cued panic attacks
A
expected, when you know a situation will bring it about and why it’s happening
8
Q
uncued panic attacks
A
unexpected, no clue when/why/where it will happen
9
Q
causes of anxiety (biological)
A
- genetic heritability (predisposition)
- NTs (high NE and low GABA/seretonin/dopamine)
- behavioural inhibition system
- fight or flight system
10
Q
causes of anxiety (psychological)
A
- classical conditioning and operant conditioning
- dysfunctional beliefs and cognitive distortions
- anxiety sensitivity/temperament
11
Q
causes of anxiety (social)
A
- attachment to parents
- social modeling or gender roles
- stressful life events
- physical influences
12
Q
integrated model of causes of anxiety
A
- triple vulnerability theory
- biological vulnerability (heritable contribution to negative affect)
- generalized psychological vulnerability (sense that events are uncontrollable/unpredictable)
- specific psychological vulnerability (ie. physical sensations are potentially dangerous
13
Q
biological vulnerability (heritable contribution to negative affect)
A
- “glass half empty” kind of person
- irritable
- driven
14
Q
generalized psychological vulnerability
A
- tendency toward lack of self confidence
- low self esteem
- inability to cope
15
Q
specific psychological vulnerability
A
- health anxiety/illness anxiety disorder (hypochondria), fear of symptoms of health issues
- fear of social evaluation, inclined to avoid social situations
16
Q
suicide
A
- presence of anxiety disorder increases likelihood of suicidal thoughts and attempts
- relationship is stronger for those with panic disorder or PTSD
- in a study, 20% of people with panic disorder had attempted
- comparable risk to suicide attempt in individuals with major depression (because anxiety is very distressing)
17
Q
generalized anxiety disorder (GAD)
A
- excessive worry and anxiety about multiple events or activities
- consistent difficulty controlling the worry
- physiological symptoms (3 or more of 6) but children only need 1
- rates slightly higher for women
- mean age of onset is 30
18
Q
biological model of generalized anxiety disorder (GAD)
A
- high NE and low SER
- medications: benzos and buspirone (but not ideal as they’re very addictive), SSRIs, SNRIs
19
Q
CBT model of generalized anxiety disorder (cognitive avoidance model)
A
- the belief is that our worries have a verbal-linguistic nature that acts as an avoidance strategy to inhibit clear mental images and associated somatic and emotional activation
- rocking chair metaphor
20
Q
cognitive avoidance model treatment
A
- exposure: create mental or spoken images of what you’re afraid of
- 50-70% effective across 12-16 weeks
- applied relaxation alone can be as effective as this model
21
Q
CBT model of generalized anxiety disorder (metacognitive model)
A
- type 1 worry: worrying about regular things in the world (ie. an exam or a fight you had)
- type 2 worry: emerges from negative metacognitive beliefs about worry itself, may worry that worry is uncontrollable and dangerous
22
Q
metacognitive model treatment
A
- challenges negative beliefs about worry
- exposure to intense worry (worry 2)
- exposure to worried about scenarios (type 1)
23
Q
panic disorder
A
- recurrent, uncued, panic attacks
- at least one attack followed by a month of one or both: persistent concern of additional attacks or the resulting consequences
- significant changes in behaviour (like avoiding situations where they had the panic attack)
- rates slightly higher in women
- considered rare in childhood
- mean age of onset is 20
24
Q
panic disorder symptoms
A
- ie. pounding heart, sweating, trembling
- at least 4 of 13
25
agoraphobia
- significant and recurrent fear or anxiety about at least 2 situations: public transit, open spaces, enclosed spaces, lines or crowds, outside of home alone
- fear is due to fear of inability to find help or escape if panic starts
- rates significantly higher in women
- mean age of onset is 17-24
26
biological model of agoraphobia (CART)
- the belief is that subconscious hyperventilating leads to too much oxygen in the system, prompting panic attacks and more hyperventilation
- breathing reTRAINING to breathe in a more shallow way
27
biological model of CART con't
- high NP and low GABA/seretonin/dopamine
- medications: benzos, SSRIs, SNRIs
28
CBT model of PDA (panic control treatment model)
- belief is that individuals can develop learned alarms (things that trigger panic attacks) through conditioning and negative reinforcement
- leads to anxiety sensitivity and catastrophic thinking
29
CBT model of PDA (PCT model)
- teaches individual skills for controlling three components of anxiety: physical cognitive and behavioural
- physical: taught slow breathing, muscle relaxation
- cognitive: challenges negative thoughts, critically examine the probability of whatever they're thinking will happen
- behavioural: taught to engage with symptoms of anxiety
30
social anxiety disorder
- significant and recurrent fear or anxiety of one or more social situations where the individual may face scrutiny
- symptoms must be present for 6 months
- situations: social interactions any place they can be observed, performing, eating/drinking in front of others
- similar rates for men and women but more common in adolescent women than men
31
comorbidity of social anxiety disorders
- other anxiety disorders
- highly with major depressive disorder
- substance use disorders
32
biological model of social anxiety disorder
- disregulation of the amygdala (threat detector) and medial temporal lobe
- too little GABA/serotonin/dopamine
- medications: benzos, beta blockers (blocks adrenaline receptors so slows HR down), SSRIs, SNRIs
33
CBT model of social anxiety disorder
- belief that one cannot meet their own high standards, and that they believe everyone judges them and that they have poor social skills
- safety-seeking behaviours: holding a coffee cup to hide shaky hands, being wallflowers
- treatment: challenging the anticipatory anxiety/post-event feelings
34
temperament (behavioural inhibition)
- researchers found that it has been found to play a role in the etiology of anxiety of youth
- increased reactivity/negative emotionality with newness, hypervigilance, higher cns arousal, priming fight or flight
- BI in early childhood increases risk for development of anxiety disorders later
- subject to gene-environment interaction
35
temperament con't
- anxiety sensitivity
- common in adolescents with SAD
- fear of anxiety and its sensations
- more aware of subjective increases in physiological arousal
- more afraid of potential social implications of that arousal
36
specific phobias
- significant and recurrent fear or anxiety of specific objects or situations
- subtypes: animal, natural environment, situational, blood-injection injury, other
- symptoms must be present for 6 months
- rates are almost twice as high in women
- mean age of onset is 7-11
37
biological model of specific phobias
- prepared learning: why certain associations are learned more readily than others; like for survival much quicker than phobias about non-threatening things
- too low GABA so no system regulation
- medications: benzos but very situational
38
CBT model for specific phobias
- learned alarms can be true or false (true alarm: dog actually bites you, false alarm: an individual scared in the absence of serious danger, like being called in class)
- treatment: graded exposure (fear hierarchy), VR therapy
39
OCD (obsessions)
- recurrent and persistent thoughts, images or urges that are considered intrusive and unwanted
- ecodistonic: thoughts, impulses and behaviours that are distressing
- ecosintonic: thoughts and images that are aligned with your own beliefs and values
- individual makes repeated attempts to ignore, surppress, or neutralize the thoughts
40
OCD (compulsions)
- repetitive behaviours or mental acts in response to obsession or internal rigid rules
- unrealistically designed, or completed to an excessive degree, to prevent or reduce anxiety or future events
- ie. hand washing, ordered belongings, engage in mental acts
- no time frame criteria for oCD
- mean age of onset is 20
- rates similar for men and women
41
biological model for OCD
- heightened activity between the cortex, basal ganglia (associated with habitual behaviour) and thalamus
- high NE, low seretonin/dopamine
- medications: benzos, SSRIs, SNRIs
42
CBT model for OCD (integrated CB model)
- individuals with OCD consistently engage and experience cognitive distortions
- fear structures develop with excessive associations between stimuli and distress
- compulsions are repeated due to a lack of signs that a situation is safe
- treatment: exposure and ritual prevention; 20-30% of people will either dropout or refuse treatment
- limited effectiveness for obsession based OCD
43
CBT model for OCD (cognitive model)
- believes individuals with OCD engage of 5 basic assumptions related to responsibility: thoughts/actions are the same, causing harm is the same as not preventing harm, despite difficult events personal liability for harm continues, not engaging in harm related rituals is the same as having intention to harm, controlling one's thoughts is a personal obligation
- inflated sense of responsibility (responsibility and obligation to engage in OCD behaviours to prevent, critical for treatment)
- inflated sense of possibility and seriousness of harm
44
CBT model for treatment of OCD
- patient assessment (effectiveness is reduced when comorbid conditions are present)
- initiation of CBT (somehow convince someone to do scary things, explain process of CBT, motivational interviewing)
- fear hierarchy (behavioural aspect of CBT)
- exposure and response prevention exercise (engage in fear hierarchy)
- cognitive exercises (restructuring belief around responsibility/thoughts and implication of thoughts)
- ending CBT and relapse prevention
45
post traumatic stress
- anxiety disorders that occurs in response to a traumatic event such as physical injury or severe mental/emotional distress
- PTSD most commonly develops as a result of human on human violence because humans believe that others don't want to harm us so when they do, it's shocking
- ie. war, assault, car accidents, natural disasters, sudden death of a loved one
46
criteria A for PTSD
- exposure to actual or threatened death, serious injury, or sexual violence in one or more ways:
- direct experience, witnessing an event, learning about a traumatic event happening to a loved on, repeated exposure to aversive details of traumatic event (ie. post responders)
47
PTSD
- symptoms lasting less than a month is acute stress disorder
- symptoms normally occur within 3 months of traumatic events but sometimes delayed
- half of adults will recover fully on their own within 3 months
- rates are almost twice as high in women
- mean age of onset is 23
48
4 main categories of PTSD symptoms (criteria B-E)
- reliving
- avoiding
- negative conditions/mood
- increased arousal
49
criteria B of PTSD (reliving)
- one or more intrusion symptoms: recurrent distressing memories/dreams about trauma, dissociative reactions where the person feels like the event is recurring, intense/prolonged psychological distress at exposure to cues of the event, physiological reactions at exposure that cues trauma
50
criteria C (avoiding)
- at least one sign of avoidance of associated stimuli
- ie. avoid people, situations, etc. or anything that reminds them of the trauma
51
criteria D (negative cognitions/moods)
- at least two negative changes to cognition or mood
- ie. memory (struggling to recall the event), difficulty with concentration, mood changes (feeling blame/detachment)
52
criteria E of PTSD (increased arousal)
- at least two negative changes in arousal and reactivity, typically in the nervous system
- ie. sleep disturbances, more jumpy, increased BP or HR
53
biological model of PTSD
- areas designed to process threatening input are hypersensitive
- disregulation/hypersensitivity of the hypothalamic-pituitary-adrenal gland axis
- NE, seretonin, dopamine
- medications: SSRIs, SNRIs
54
CBT model of PTSD (dual representation model)
- we have two separate memory systems that run in parallel during memory formation: verbally accessible memories (VAMs) and situationally accessed memories (SAMs)
- VAMs: consciously encoded/processed, voluntarily recalled later
- SAMs: unconsciously processed sensory information, cannot be voluntarily recalled
- model states that during a traumatic event the VAMs system is impaired because conscious attention is now narrowly drawn to threat related information
55
dual representation model treatment
- exposure to activate and modify SAMs
- cognitive restructuring to modify VAMs because all the attention was so narrowly focused so we need to expand on them, create a story beyond the sensory experience (SAMs)
56
dual representation model etiology
-conditioning/reinforcement of primary emotions (ie. initial emotion such as fear) and development of secondary emotions (ie. a response emotion such as anger or shame)
- VAMs and SAMs
57
CBT model of PTSD (eye movement desensitization and reprocessing model or EMDR)
- eye movements (or auditory tones) accompanied by exposure and body scan
- bilateral stimulation (visual, auditory, or tactile)
