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PSYC3018 > Anxiety > Flashcards

Anxiety Flashcards

1
Q

Definition of Anxiety

A
  • Often labelled ‘fear’ ‘panic’
  • The experience of anxiety is the same in normal and abnormal anxiety
  • Activated in response to perceived threat
  • Three interrelated anxiety systems:
    • Physical system.
    • Cognitive system.
    • Behavioural system.
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2
Q

Physical system

Anxiety

A
  • Fight/flight: sympathetic nervous system.
  • Mobilises resources to deal with threat.
  • Symptoms: sweating, heart rate, trembling etc
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3
Q

Cognitive system

Anxiety

A
  • perception of threat,
  • attentional shift and hypervigilance,
  • difficulty concentrating on other information.
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4
Q

Cognitive system

Anxiety

A
  • Escape/avoidance tendencies
  • Aggression
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5
Q

Importance of normal anxiety

A
  • Normal anxiety is necessary for survival.
  • Eliciting conditions:
    • Realistic/objective threat to self.
      • Physical vs social threat
    • specific ‘prepared’ stimuli
      • dangerous during the course of human evolution
      • insects, animals, heights, enclosed places, anger
    • novel stimuli.
  • Threat appraisal >> Expectancy of harm >> Automatically Elicits Anxiety.
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6
Q

Threat Appraisal

A

Generates expectancy of harm

  • Situation: public transport
  • Outcome: embarrassment
  • Outcome: accident, death
  • Outcome: germs, illness

Product of:

  • perceived probability
  • perceived cost

Often based on past

  • Experience
    • conditioning, reinforcement
  • Observational learning
  • Instruction
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7
Q

Abnormal Anxiety/Anxiety Disorders

A

Individual differences in

  • Trait anxiety
    • Tendency to perceive threat in ambiguous situations
    • Extent to which anxiety response is activated
  • Specific fears

>> ‘abnormal’ anxiety

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8
Q

How does Abnormal Anxiety differ from Normal Anxiety?

A

Abnormal anxiety is not qualitatively different from normal anxiety

  • Same three aspects:
    • physical,
    • cognitive,
    • behavioural
  • BUT: Excessive or inappropriate occurrence
    • Characterised by overestimation of threat:
      • Cost or probability of harmful outcome
      • Physical fears: mainly probability overestimation
      • Social fears: mainly cost overestimation
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9
Q

General definitions of Anxiety Disorders

A
  • Involve experience of anxiety/ fear/ panic
    • Physical
    • Cognitive
    • Behavioural
  • Reflect an internal dysfunction
    • anxiety in response to situations that are not objectively dangerous
  • Socially inappropriate/harmful/unexpected
    • Interfere with everyday social or occupational activities
  • Categorised according to focus of anxiety
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10
Q

DSM-IV Comorbidity

Anxiety Disorders

A

Anxiety disorders are highly comorbid with each other, depression, substance use

  • Generalised biological vulnerabilities
    • Genetics, Neuroticism
  • Generalised psychological vulnerabilities
    • Trait anxiety, low perceived control
      • >> Any anxiety disorder, depression
  • Specific psychological vulnerabilities
    • Focus of threat-related beliefs
      • Direct experience, observation, instruction
        • >> Specific Anxiety Disorders
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11
Q

Biological Treatments

Anxiety Disorders

A

Barbiturates (Amobarbital, Phenobarbital)

  • 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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12
Q

CBT

Anxiety Disorders

A
  • Aim to reduce (biased) threat appraisal
    • How likely is it that the event will happen?
    • How bad would it be if it did happen?
  • Increase (biased) coping appraisal
  • Cognitive Techniques:
    • Thought-diaries to identify automatic thoughts (mixed with mindfulness)
    • Thought challenging:
      • Socratic questioning
      • What’s the evidence (against) the thought/belief?
      • Pros and Cons of having the thought/belief
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13
Q

Behavioural Techniques

Anxiety Disorders Treatments

A
  • Behavioural techniques:
    • Exposure to feared stimuli (public transport)
    • Exposure to feared outcomes (negative evaluation)
      • in vivo vs imaginary exposure
      • Flooding vs Systematic desensitisation
  • Reduce (biased) threat appraisal:
    • Exposure to feared stimuli:
      • Reduces judgments of likelihood of harm
    • Exposure to feared outcomes:
      • Reduces judgments of cost
  • Exposure is essential in anxiety treatment
    • Avoidance maintains anxiety by stopping the person from learning that a specific stimulus/situation is not objectively dangerous
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14
Q

DSM5 Trauma- and Stressor-Related Disorders

A
  • Posttraumatic Stress Disorder
  • Acute Stress Disorder
  • Adjustment Disorders
  • Reactive Attachment Disorder
  • Disinhibited Social Engagement Disorder
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15
Q

DSM-5 Obsessive-Compulsive and Related Disorders

A
  • Obsessive-Compulsive Disorder
  • Hoarding Disorder
    • used to be a subtype of OCD
    • BUT respond to treatments differently
  • Trichotillomania (Hair-Pulling Disorder)
    • used to be classified as an Impulse-Control Disorder (along with gambling)
  • Excoriation (Skin-Picking) Disorder
  • Body Dysmorphic Disorder
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16
Q

DSM-5 Anxiety Disorders

A
  • Separation Anxiety Disorder
  • Selective Mutism
  • Specific Phobia
  • Social Anxiety Disorder (Social Phobia)
  • Panic Disorder
  • Agoraphobia
  • Generalized Anxiety Disorder

>> Ordered in the order of developmental progression

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17
Q

DSM-5 Panic Attack

A
  • Extremely severe anxiety/fear reaction
  • Can occur in the context of any anxiety disorder
    • Expected (cued) panic attack
      • Usually occur in context of other anxiety disorders
      • Specific phobias
      • Social phobia
      • Post-Traumatic Stress Disorder
    • Unexpected (uncued/spontaneous) panic attack
      • Person can not identify the source of fear
      • Occur in context of Panic Disorder
      • Two unexpected Panic Attacks are needed for diagnosis
18
Q

DSM-5 Panic Disorder

A
  • At least two unexpected panic attacks
  • Persistent concern or worry about additional panic attacks or their consequences
  • A significant maladaptive change in behaviour related to the attacks
  • Symptoms persist one month or more
    • 12-month prevalence: 2-3 %
    • median age of onset: 20-29 years
    • Course: chronic but waxing and waning
    • Comorbid with other anxiety disorders, alcohol use, and depression: 10-65%
19
Q

Cognitive Theory of Panic

A
  • Panic results from fear of bodily sensations
    • Misinterpreting their consequences
      • dizziness = impending stroke,
      • heart palpitations = impending heart attack
  • Bodily sensations can arise from anger, caffeine ingestion, physical activity, etc
  • Risk factors: neuroticism, anxiety sensitivity
  • Maintenance of misinterpretations:
    • ‘safety behaviours’
      • Protective actions to prevent harmful event
        • e.g., tense muscles, have friend present, etc
20
Q

Agoraphobia: DSM-IV vs DSM-5

A

DSM-IV Agoraphobia: response to panic

DSM-5 Agoraphobia:

A. Marked fear or anxiety about two (or more) of :

  • Using public transportation (cars, buses, trains, planes).
  • Being in open spaces (parking lots, markets, bridges).
  • Being in enclosed places (shops, theatres, cinemas).
  • Standing in line or being in a crowd.
  • Being outside of the home alone.

B. Escape might be difficult or help might not be available in the event of developing panic-like, or other incapacitating or embarrassing symptoms

21
Q

Possible causes of Agoraphobia

A
  • High degree of dependent behaviour
  • Weaker beliefs in own coping ability
  • Separation Anxiety, Shcool Phobia
  • Physical concerns
    • Dizziness
    • Fainting
  • More social evaluative concerns
22
Q

Biological Treatment of Panic - Agoraphobia

A
  • Anxiolytics, (Barbiturates, Benzos)
  • Antidepressants
23
Q

Psychological Treatment of Panic - Agoraphobia

A

Cognitive-Behavioural

  • Cognitive restructuring
  • Exposure
    • To interoceptive stimuli (Panic)
    • To avoided situations (Agoraphobia)
  • Reducing safety seeking behaviours
  • CBT is effective in 80-85% of clients with PD
24
Q

Generalised Anxiety Disorder (GAD)

A
  • First introduced in DSM-III-R (1980)
  • DSM-IV (1994) and DSM-5 (2013) definition:
  • Excessive, uncontrollable worry about a variety of events / outcomes
  • Occurs more days than not
  • For at least 6 months
  • At least 3 of 6 somatic symptoms:
    • Restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
      • Does not include autonomic arousal
  • Need to distinguish from other disorders that also involve excessive worry
25
Q

Normal Worry (GAD)

A
  • Occurs in response to perceived threat
  • Focus:
    • mainly social threat in adults
    • more about physical threat in older adults
  • Contains more verbal thought vs. imagery
  • Perceived positive aspects:
    • motivates action
    • helps to problem solve
    • avoid negative outcomes
    • distract from more distressing topics
  • Worry control:
    • Problem-solving, distraction, social support
26
Q

Problem Solving Theories (GAD)

A
  • Worrying involves problem-solving attempts
  • Problem-solving attempts of pathological worriers are ‘thwarted’
    • biased threat perception
    • don’t result in a solution
  • Social Problem Solving
    • Problem definition
    • Generation of alternative solutions
    • Solution evaluation (positive / negative)
    • Solution selection
      • Last two stages are problematic in high worriers
        • Evaluate solutions more negatively
        • Can never choose a satisfying solution
27
Q

Metacognitive Theory (GAD)

A

Worry (Type 1) and Metaworry (Type 2)

  • Type 1 Worry:
    • Perception of threat + positive beliefs about worry >> worry to cope with threat
    • possible exit by problem-solving or reassurance
  • Type 2 Metaworry:
    • Worry + negative beliefs about worry >> metaworry >> ineffective thought-control strategies >> increased anxiety and worry
      • Excessive and uncontrollable worry
      • Employ ineffective methods to suppress worry, BUT usually only exacerbates worry
28
Q

Avoidance Theory (GAD)

A

Worry: more verbal thought than imagery

  • Images of possible negative event are
    • highly aversive
    • cause anxiety symptoms (= sympathetic arousal)
  • Anxiety symptoms are highly aversive
  • Reduced imagery => reduced arousal/anxiety
    • Verbal thinking is much less aversive
    • GAD is associated with tension symptoms
  • Worry = cognitive avoidance
    • Cognitive avoidance interferes with emotional processing
    • Fear structures are maintained => keep worrying
29
Q

Experiential avoidance (GAD)

A
  • Worry is associated with
    • Fear of anxiety/Anxiety sensitivity
    • Distress intolerance
    • Experiential avoidance
      • Worriers avoid internal experiences
  • Difficulties in emotion regulation
    • Worriers have difficulties in
      • clearly identifying emotion
      • tolerating emotion
      • modulating emotion
30
Q

Intolerance of Uncertainty Theory (GAD)

A
  • Uncertainty:
    • reflects badly on a person
    • causes frustration and stress
    • prevents action
  • Worry to reduce uncertainty
  • Leads to preoccupation with details
  • Interferes with problem-solving
  • Worriers aim to reduce uncertainty to zero
    • only stops once zero uncertainty is achieved
    • not possible
31
Q

Treatments of GAD

A
  • Biased threat perception
    • probability and cost judgments
  • ‘Problem-solving’
    • Structured problem-solving training
  • ‘Metacognitive’
    • Challenge beliefs about worry (positive and negative)
  • ‘Avoidance’
    • Exposure to vivid images of feared event
    • Exposure to emotional experience / distress (role for mindfulness)
    • Exposure to uncertainty
  • Treatment effects have been modest
    • About 50 – 60 % improvement at follow-up
32
Q

DSM-5 Trauma- and Stressor-Related Disorders

A
  • Posttraumatic Stress Disorder
  • Acute Stress Disorder
  • Adjustment Disorders (e.g. new job, someone dies, a baby is born)
  • Reactive Attachment Disorder (childhood)
  • Disinhibited Social Engagement Disorder (childhood)
33
Q

DSM-5 Post-Traumatic Stress Disorder

A

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

  • Directly experiencing the traumatic event(s).
  • Witnessing, in person, the event(s) as it occurred to others.
  • Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
  • Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse)

>> Different to other disorders: there has to be a CAUSE

B. Intrusion symptoms (1 or more needed)

  • Memories, dreams, flashbacks of the event

C. Persistent avoidance of stimuli (1+)

  • memories etc, or external reminders of the event

D. Negative changes in cognition, mood (2+)

  • Fear, negative beliefs about self, others, the world

E. Changes in arousal, reactivity (2 +)

  • Anger, recklessness, self-destructive acts, sleep disturbance

Duration of symptoms is 1 month or more

34
Q

Immediate post-trauma phase of PTSD

A
  • 50-60% of people experience traumatic event
  • About 25% develop post-traumatic problems
    • PTSD, depression, anxiety, substance abuse.
    • PTSD prevalence: 5-11%
  • Normative response to trauma is to get over it.
    • People are distressed immediately after traumatic event
    • A perfectly normal reaction
    • Distress drops substantially within 3 months in about 75% of people.
    • Even for the 25% who develop PTSD also get better by themselves over time
      • Medication helps speed up the recovery process
35
Q

Pre-trauma factors

Risk for later problems in PTSD

A
  • Childhood trauma
  • Prior psychiatric history
  • Family instability
  • Substance abuse
  • Social/economic disadvantage
36
Q

Trauma factors

Risk for later problems in PTSD

A
  • Degree of life threat (injury, death) or loss
  • Severity of exposure to traumatic elements
  • Location of trauma (safe place vs elsewhere)
  • Individual’s role in the trauma (victim, helper)
  • Meaning (e.g., uncontrollability)
37
Q

Post-trauma factors

Risk for later problems in PTSD

A
  • Social support
  • Coping style
  • Ongoing stressors
38
Q

Biological Treatments for PTSD

A
  • Benzodiazephines
  • Antidepressants
39
Q

Cognitive Behavioural Therapies for PTSD

A
  • Core treatment components
    • Assess suitability
    • Psychoeducation
    • Anxiety management techniques
    • Cognitive restructuring
    • Prolonged exposure
  • CBT is more effective than medication or supportive psychotherapy
40
Q

Eye Movement Desensitization and Reprocessing (EMDR)

PTSD

A
  • Now used to treat a variety of anxiety disorders
    • Eye movements are the crucial components of the procedure and essential for its effectiveness
    • Training has to be provided by EMDR Institute
  • Research evidence:
    • EMDR is best seen as an exposure technique
    • Eye movements are not necessary for effectiveness

PSYC3018 (15 decks)

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