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Abnormal > Anxiety > Flashcards

Anxiety Flashcards

1
Q

Is the experience of anxiety in abnormal anxiety different to the normal experience of anxiety?

A

No- not qualitatively different

BUT excessive or inappropriate occurence

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2
Q

Which systems are involved in the experience of anxiety

A
  • Physical- sympathetic nervous system (sweating, heart rate) mobilises resources to deal with threat
  • Cognitive- threat perception, appraisal, attentional shift and hypervigilence- difficulty concentrating on other info
  • Behavioural- avoidance, agression
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3
Q

Eliciting conditions in normal anxiety

A

Objective threats: physical or social
Specific ‘prepared’ stimuli (Seligman)- evolutionary e.g. insects
Novel Stimuli

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4
Q

Process of Anxiety

A

Threat appraisal-> expectancy of harm-> elicits anxiety

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5
Q

What underlies threat appraisal? And what gives rise to these biases?

A 
Perceived probability and cost of threat
Past experience (conditioning) Observational learning and Instruction
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6
Q

Trait anxiety- individual differences

A

Tendency to perceive threat in ambiguous situations
Intensity and duration of the anxiety response
(Inappropriate or excessive occurrence)
Overestimation of cost or probability of harmful outcome

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7
Q

Main overestimation for physical and social fears

A

Physical: overestimation of probability
Social: overestimation of cost

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8
Q

What characterises Anxiety Disorders?

A

Internal dysfunction- anxiety in situations that aren’t objectively dangerous
Socially inappropriate/harmful- interferes with everyday social or occupational activities- dysfunctional
Categorised according to focus of anxiety

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9
Q

DSM-IV Anxiety Disorders

A 
Separation Anxiety Disorder
Specific Phobia
Social Phobia- fear of neg. social eval.
Generalised Anxiety Disorder
Panic Disorder (with or without agoraphobia) 
Posttraumatic Stress Disorder
Acute Stress Disorder
Obsessive- Compulsive Disorder
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10
Q

DSM-V Anxiety Disorders

A 
Separation Anxiety Disorder (child or adult)
Selective Mutism
Specific Phobia
Social Anxiety Disorder
Panic Disorder
Agoraphobia
Generalised Anxiety Disorder
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11
Q

Differences between the DSMs

A

Selective Mutism added
Agoraphobia its own disorder
PSTD- in own chapter: Trauma- and Stressor-Related Disorders. with Acute, Adjustment, Reactive Attachment Disorder and Disinhibited Social Engagement
OCD- in own chapter with trich (used to be with gambling), hoarding, excoriation (new to DSM), body dysmorphic (used to be in somatoform disorders)

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12
Q

What are anxiety disorders comorbid with?

A

each other, depression and substance use

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13
Q

What are the underlying vulnerabilities?

A

Generalised Biological: genetics, neuroticism- genetic loading
Generalised Psychological: trait anxiety, perceived lack of control, depression
Specific Psychological: past experience, observation or instruction

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14
Q

Biological Treatments- don’t treat underlying disorder, just symptoms

A

Barbiturates (Amobarbital, Phenobarbital)- used to use (dangerous)
 Quick acting, but relapse very common (80-90%)
 Highly addictive, can lead to OD, interact with alcohol
Benzodiazepines (Valium, Xanax, Rohypnol)  Quick acting, but relapse very common
 Less addictive, but interact with alcohol
SSRIs (antidepressants, e.g., Prozac, Zoloft)  Slower acting
 Fewer side effects
 Relapse common (20-60%)

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15
Q

CBT aims:

A

Reduce biased threat appraisal

Increase biased coping appraisal

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16
Q

Cognitive Techniques

A

thought-diaries to identify automatic thoughts

thought challenging: socratic questioning, evidence against, pros and cons of having the thought/ belief

17
Q

Behavioural Techniques

A

Exposure to stimuli (reduce probability of harm) and outcomes (reduce judgements of cost)
in vivo vs imaginary and flooding vs systematic desensitisation

18
Q

Do clinicians still treat PTSD and OCD like anxiety disorders

A

Yes, the distinction isn’t too important- closely related to anxiety

19
Q

Required symptoms for Panic Attack

A

4 (or more): heart racing, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dixxiness, chills or heat sensations, paresthesias (numbness or tingling), derealization (feelings of unreality) or depersonalization (detached from oneself), fear of losing control, fear of dying

20
Q

When do Panic Attacks occur?

A

Can occur in a terrible situation- normal.
Can occur in any anxiety disorder and some others
Particularly, specific and social phobias and PTSD- in these cases they are CUED by something
UNCUED occur in Panic Disorder

21
Q

How many unexpected (uncued) panic attacks are needed for Panic Disorder Diagnosis?

A

2

22
Q

Panic Disorder Criteria

A

 At least two unexpected panic attacks
 Persistent concern or worry about additional
panic attacks or their consequences
 A significant maladaptive change in behavior related to the attacks
 Symptoms persist one month or more
Its the catastrophic misinterpretation of sensations that causes a full blown attack. Fear of lack of control

23
Q

Prevalence of Panic Disorder
Median age of onset
Course
Comorbidity

A 
12-month prevalence: 2-3% 
Lifetime prevalence: 3.5-4.7%
20-29 years 
chronic but waxing and waning 
Other anxiety disorders, alcohol use and depression 10-65%
24
Q

Specific Phobia prevalence

A

7-9% lifetime prevalence. Less than 1% seek treatment

25
Q

Agoraphobia

A

not a fear of the external environment, but the fear of panic and its consequences in these environments- not being able to escape if a panic attack occurs
2.3% lifetime prevalence
Onset in 20s

26
Q

Cognitive Theory of Panic (Clark 1988)

A

Results from the fear of bodily sensations
Misinterpreting their consequences e.g. stroke, heart attack
Maintenance of misinterpretations: safety behaviours to prevent harmful event

27
Q

Agoraphobia- 5 fears

A 
Public transport
Open spaces
Enclosed spaces
Standing in line or being in a crowd 
Being outside of home alone
28
Q

Risk factors of Agoraphobia

A

High dependent behaviour in childhood
Doubting ability- weaker beliesf in coping ability
Separation Anxiety, School Phobia
Physical concerns: dizziness and fainting
Social evaluative concerns

29
Q

Treatment of Agoraphobia

A

Anxiolytics (Barbiturates, Benzodiazapines)
Antidepressants
Cognitive restructuring
Exposure (to interoceptive stimuli/ panic and to avoided situations)
Reduce safety seeking behaviours
CBT is effective in 80-85% of clients with Panic Disorder

30
Q

Generalised (GAD)

A

one of the most commonly experienced anxiety disorders, with a lifetime prevalence of 5%- more common in women

31
Q

Generalised (GAD)

A

one of the most commonly experienced anxiety disorders, with a lifetime prevalence of 5%- more common in women
First introduced in DSMIII (1980)
Excessive, uncontrollable worry occuring more days than not for at least 6 months
At least 3 of 6 somatic symptoms

32
Q

Somatic Symptoms for GAD

A 
restlessness
irritability
muscle tension
difficulty concentrating
sleep disturbance
fatigue
33
Q

Problem Solving Theories

A

Problem solving in pathological worriers results in no solution
Good at defining problems- see a lot of problems
Good at negatively evaluating solutions- coming up with reasons why solutions aren’t good
Never come up with good solution- never stop worrying because never solve problem- uncontrollable feeling
This may be Type 1 worry

34
Q

Metacognitive Theory

A

Type 1- worrying to cope with threat
Type 2- worry + negative beliefs about worrying
Worrying will lead you to death, drive you crazy, inability to sleep- worrying about worrying
Ineffective thought-control strategies- suppressing doesn’t work

35
Q

Avoidance Theory (Thomas Borkavek?)

A

Images are aversive so switch to verbal thinking to reduce autonomic arousal symptoms
Worry- cognitive avoidance- in words rather than images to avoid symptoms- interferes with emotioanl processing
But fear structures remain there in memory structures- avoidance maintains anxiety
Experiential Avoidance- avoid internal experiences- low distress intolerance- want to stay at nonemotional level
Difficulties in emotion regulation- identifying, tolerating and modulating emotion

36
Q

Treatment of GAD

A
  • Biased threat perception- probability and cost judgments-more general way than in other anxiety disorders
  • Problem solving theories- ‘structured problem solving training’- positive solution evaluation and solution selection
  • Metacognitive- beliefs about worry- other ways to deal with problem than worry- is it really true that your worry is uncontrollable?
  • Avoidance- exposure to vivid images of feared event, emotional experience (distress- mindfulness is exposure to thoughts without judgement) or uncertainty
37
Q

Treatment of GAD

A
  • Biased threat perception- probability and cost judgments-more general way than in other anxiety disorders
  • Problem solving theories- ‘structured problem solving training’- positive solution evaluation and solution selection
  • Metacognitive- beliefs about worry- other ways to deal with problem than worry- is it really true that your worry is uncontrollable?
38
Q

Effectiveness of treatment

A

modest- 50-60% improvement at follow-up

not very good at treating GAD because causes are diverse

Abnormal (9 decks)

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