Anxiety

Question 1

Panic is

Answer 1

very severe anxiety, just qual diff

Question 2

abnormal anxiety is

Answer 2

same as normal anxiety just dimensionally higher, and to a level where is causes harm

Question 3

What it is in the body

Answer 3

physical, behavioural and cognitive activation from threat

Question 4

Physical activation

Answer 4

resources redirected to deal with a threat
sweating, pupils dilate, major muscle blood, digestion and memory deficits
heart rate increase etc

Question 5

Cognitive activation

Answer 5

cognitive resources redirected eg
hypervigilance
memory loss (but hyper memory of threat details)
attentional shift, cannot top down realign

Question 6

Behavioural activation

Answer 6

escape and aviod tendancies, safest/most adaptive, so most prevelant
if you cannot escape you turn to fight mode (animal in a corner)

Question 7

Why social anxiety, whats the threat?

Answer 7

Social animals, we survived and thrived in groups, social threats are hugely important for survival therefore

Question 8

Specific Prepared Stimuli

Answer 8

Heights, small spaces, spiders, snakes, ostracism, novel stimuli

Question 9

The cognitive process of anxiety;

Answer 9

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

Question 10

High anxiety due to

Answer 10

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

Question 11

Physical vs Social anxieties, the differences

Answer 11

(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

Question 12

Maintaing factor

Answer 12

AVOIDANCE, natural and extremely reinforcing response to anxious making stimuli, it maintains and EXACERBATES anxiety! - hence EXPOSURE THERAPY is essential

Question 13

why does depression follow often from anxiety?

Answer 13

Because of the effects on the persons normal functinoing from their anxiety.

Question 14

All anxiety disorders are;

Answer 14

comorbid highly with each other

Question 15

why so much comorbidity?

Answer 15

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

Question 16

difference b/w dsm 4 and 5 anxiety disorders

Answer 16

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

Question 17

SOCIAL ANXIETY

Answer 17

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

Question 18

Demographic data about social anxiety

Answer 18

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

Question 19

COGNITIVE MODEL OF SOCIAL PHOBIA

Answer 19

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

Question 20

safety behaviours in social phobia

Answer 20

• 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

Question 21

Pre and Post event processing

Answer 21

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

Question 22

Treatment for social anxiety

Answer 22

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

Question 23

Exposure works best WHEn

Answer 23

you have explained rationale to client, and done psychoeducation

Question 24

Social phobia therapy often done…

Answer 24

in groups! to practise skills

Question 25

GAD is…

Answer 25

generalised, execisve, uncontrollable, without nervous system exitation WORRY

Question 26

DSM 4 new definition of GAD

Answer 26

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)

Question 27

epidemiology of GAD

Answer 27

2:1 women

4% of population meet diagnostic criteria

Question 28

NORMAL WORRY

Answer 28

• 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

Question 29

PATHOLOGICAL WORRY

Answer 29

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

Question 30

Theories of GAD

Answer 30

Avoidance theory
Intolerance of Uncertainty theory
Metacognitive theory

Question 31

Avoidance theory

Answer 31

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

Question 32

Intolerance of Uncertainty

Answer 32

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

Question 33

Metacognitive theory

Answer 33

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

Question 34

Therapy for GAD

Answer 34

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