Anxiety Flashcards
Panic is
very severe anxiety, just qual diff
abnormal anxiety is
same as normal anxiety just dimensionally higher, and to a level where is causes harm
What it is in the body
physical, behavioural and cognitive activation from threat
Physical activation
resources redirected to deal with a threat
sweating, pupils dilate, major muscle blood, digestion and memory deficits
heart rate increase etc
Cognitive activation
cognitive resources redirected eg
hypervigilance
memory loss (but hyper memory of threat details)
attentional shift, cannot top down realign
Behavioural activation
escape and aviod tendancies, safest/most adaptive, so most prevelant
if you cannot escape you turn to fight mode (animal in a corner)
Why social anxiety, whats the threat?
Social animals, we survived and thrived in groups, social threats are hugely important for survival therefore
Specific Prepared Stimuli
Heights, small spaces, spiders, snakes, ostracism, novel stimuli
The cognitive process of anxiety;
threat perception and apraisal - expectancy of harm (seperate from threat itself, based on beleifs/biases/phobias etc, once activated then, a combination of PERCIVED RISK % AND PERCEIVED HARM QUANTITY…) - results in automatically elicited anxiety
High anxiety due to
oversetimation of risk of harm of extent of harm,
(behaviourism) this is due to past experiences/learning or observing or instruction ie from parents
genetic loading also
they percieve threat in ambiguity (which is everywhere)
AND have a heightened and lengthened reaction to threats
qual the same as normal anxiety, but occur when there is no objective threat, or to a greater extent than is reasonable
Physical vs Social anxieties, the differences
(in normal adaptive worry;)
Young people = more likely social
old people = more likely physical
physical tend to be overestimated likelihood of occurance (severity is known pretty well)
social tends to be oversestimation of cost/harm, bad evaluation in social setting = death
Maintaing factor
AVOIDANCE, natural and extremely reinforcing response to anxious making stimuli, it maintains and EXACERBATES anxiety! - hence EXPOSURE THERAPY is essential
why does depression follow often from anxiety?
Because of the effects on the persons normal functinoing from their anxiety.
All anxiety disorders are;
comorbid highly with each other
why so much comorbidity?
trait/ genetic (fcorse interrealted factors, one causes the other) lodaing underlying general neuroticism
Belifs and thoughts and memories experiences - interact with genetic/bio underpinning
which form a loop with anxiety disorders (feeds back to the beleifs etc)D
difference b/w dsm 4 and 5 anxiety disorders
DSM 4 social seperation panic GAD phobias PTSD OCD
DSM 5
added selective mutism and agoraphobia
took out PTSD and OCD (there own catagories)
seperation anxiety can now occur in adults
SOCIAL ANXIETY
fear of (one or many) social situations where the individua may be exposed to possible scrutiny/observation/judgement of others
Fear that showing the anxiety itself will cause judgement intensifies the disorder
generalised to all social interactions, not just ones where its normal to be anxious for adaptive reasons, ie meeting new people
out of proportion to actual threat liklihood and cost especially cost
persistant (6 months or more)
causes distress/dysfunciton
not better explained by another disease
isnt reflective of actual judgement going on, ie because you have a stutter, is abnormal fear/maladaptive
Demographic data about social anxiety
12 month prev 8% in aus
2:1 women (although equal in treatment)
less prevelant in collectivist cultures
onset mostly adolescants early adulthood
often after some traumatic event
30% remitance within a year
50% seek help (usually after 10 or more years)
without treatment is chronic
in treatment 2/3rds substaintially improve
COGNITIVE MODEL OF SOCIAL PHOBIA
social situation
-
activates assumptions (if, then assumptions, if i do this, then that, if they do this, then that, another thing is that they have super high standards of self to begin with, plus negative beleifs about self (low self esteem)
-
perceived threats (feedback loop with processing of self as social person and evaluation)
That perceived threat then intensifies by the feedback loop, then causes behavioural symptoms (which feeds back into evaluation of self as social object) and cognitive and somatic symptoms which feed back into assumptions and beleifs about self
avoidance of social situations is a reinforcer
attentional shift to the source of the anxiety ie the self, extreme inward looking causes worse self beleifs, and hyper aware of self as social actor bit
safety behaviours in social phobia
- extreme inward looking
- talk quietyl/not at all
both increase fanxiety as in the cog model
also they actually do interfere with your social performance hence more reinforcment of that system
Pre and Post event processing
consent, pervasive overwhelming thoughts, often mis acuratley represent the actual events, reinforce assumptions and beleifs about self and cause lots of SHAME and GUILT and suffering
Treatment for social anxiety
first line (best) = CBT
which involves
STEP 1 - psychoeducation
STEP 2 - Cognitive challenging of negative thoughts
STEP 3 - Behavioural expiriments
STEP 4 - Reduce safety behaviours, slowely one by one eliminate
STEP 5 - Attentional Training, ie turning attention outwards
STEP 6 - video feedback
Exposure works best WHEn
you have explained rationale to client, and done psychoeducation
Social phobia therapy often done…
in groups! to practise skills
GAD is…
generalised, execisve, uncontrollable, without nervous system exitation WORRY
DSM 4 new definition of GAD
from ‘free floating anxiety’ to better definition
lasts greater than 6 months
atleast 3/6 somatic symptoms, restlessness sleeplessness, irritabiltiy, fatigue, difficulty concentrating muscle tension
target of worries is many and varied
not better explained by other disorders/diseases that also involve worry (distinguishing feature is the generalised nature of the worry)
epidemiology of GAD
2:1 women
4% of population meet diagnostic criteria
NORMAL WORRY
- occurs in response to perceived future threat (present threat = fear/anxiety)
- more verbal than visual
- percieved positive aspects/protective factor
- problem solving function, percieve threat, generate solutions, keep evaluating till you find one, solution selection, carry out solution
PATHOLOGICAL WORRY
no solution selection
worry in ambiguous situations (everything is a perceived threat)
more activation due to finding threat in ambiguity
plus never ending decision tree, never solution select
Theories of GAD
Avoidance theory
Intolerance of Uncertainty theory
Metacognitive theory
Avoidance theory
Borkover 94
distress intolerance
worry is mainly image based, those images are highly aversive causing anxiety (which they are intolerant of)
worry itself as a cognitive avoidance strategy, switching to verbal thoughts worry so you dont have to have the visual worry, reinforcing worry altogether
never properly emotionally process normal worry as you always deflect and go into a worry cycle (worry as a maintaining factor)
avoidance of many internal experiences in the extreme, good or bad, general low level worry is safer
Intolerance of Uncertainty
Life is full of uncertainty
big worriers are intolerant of this
they beleive uncertainty reflects badly on them
this causes stress, frustationadn prevents action
worry itself reduces uncertainty
desire to reduce uncertainty to zero, which is impossible, hence worry continues
Metacognitive theory
type 1 worry, normal worry worry to cope with threat, threat goes away, worry goes away
type 2 worry, worry about worry, use of ineffective thought control strategies, increased anxiety and worry
Therapy for GAD
all theories involved biased threat percepetion = cognitive restructuring to perceive threat more acurately
closing the loop, and solution selection also through cognitive therapy, training them in solution selection
avoidance theroy - solution is to make them go through worry and deal with it and see that its ok (exposure to the avoided stimuli) ie mindfullness, a safe exposure technique
metaworry can be dealt with by metacognitive theapy, challenge pos and neg beleifs about worry
treatment effects are moderate, only about 30% effectiveness
