Anxiety Flashcards
What are the three interrelated anxiety systems activated in response to a perceived threat?
Physical, behavioural and cognitive
How does the physical system respond to anxiety?
Fight/flight response activated by sympathetic nervous system. Mobilises resources to deal with threat. Physical symptoms.
How does the cognitive system respond to anxiety?
Attentional shift and hypervigilance (can’t think about anything else)
How does the behavioural system respond to anxiety?
Safest response is to avoid/escape threat.
If you cannot escape, then respond with aggression.
Why are the three systems set up like this?
To keep us alive. Normal anxiety is necessary for survival.
What are specific ‘prepared’ stimuli?
Things in the environment that we are genetically predisposed to fear because they once posed a threat to us eg insects, animals, heights, enclosed spaces, anger
Threat appraisal –> ______ –> automatically elicits anxiety
Expectancy of harm
It is important to distinguish between the stimulus and the expected harm/outcome. Eg if public transport is the stimulus, what are different possible outcomes?
- Embarrassment (social anxiety)
- accident/death (PTSD)
- germs/illness (OCD)
Expectancy of harm is the product of….
Perceived probability (how likely ppl will stare at me on the bus) and perceived cost (how bad will it be if people stare at me on the bus)
Estimations of harm are often based on…
Past experience (conditioning, reinforcement) Observational learning Instruction (parents telling you that water is dangerous)
People who are high in trait anxiety…
More tendency to perceive threat in ambiguous situations, and a greater anxiety response to the perceived threat
What is the difference between normal and abnormal anxiety?
In abnormal anxiety the anxiety occurs excessively or inappropriately in the absence of objective danger (or is excessive compared to the level of danger)
In abnormal anxiety
Physical fears: mainly _____ overestimation
Social fears: mainly _____ overestimation
Probability, cost
Explain internal dysfunction in regards to anxiety
The function of anxiety is to keep you alive. But in anxiety disorders, this function is no longer functioning as it is meant to, as the anxiety response is triggered in the absence of objective danger
What causes your anxiety disorder to maintain and get worse?
Avoidance
Why are anxiety disorders highly comorbid with one another and with substance abuse and depression?
Generalised biological vulnerabilities
- genetic loading towards neuroticism
Generalised psychological vulnerabilities
- trait anxiety, low perceived control
Specific psychological vulnerabilities
- role of experience, observation, instruction towards developing more specific threat-related beliefs
- —> leads to specific anxiety disorders
Around 75% of people report that the age of onset for their SAD was between…
8 and 15 years
About _____% of people with SAD get better within a year
30
Clark and Wells (1995) offered the ….
cognitive model of social phobia
Cognitive Model of Social Phobia:
when faced with a social situation, it triggers a number of assumptions. What are the three different types of assumptions?
- Excessively high standards (eg I must not screw up; I must please everyone)
- Conditional beliefs about consequences (eg if I get anxious, they will think I’m an idiot)
- Unconditional beliefs about the self (eg I am different, I can’t cope)
Cognitive Model of Social Phobia
Once socially anxious person enters the situation, there is …
an attention shift towards the self and how others perceive you
- do I look anxious?
What is a safety behaviour?
Something people do to avoid or stop the danger
- eg talking quietly, not talking, avoiding eye contact
Unfortunately safety behaviours only…
Increase self-focused attention
Increase anxiety symptoms
Interferes with social performance (comes across as aloof, unfriendly) –> confirms social fears
Cognitive Model of Social Phobia:
What happens once the event is over?
Post-event processing - replaying situation in head, finding more and more evidence of how bad it was, interpret innocuous events as negative
- –> Increase/maintain anxiety
- –> carry guilt/shame
What is first-line treatment of SAD?
CBT
What are the components of CBT for SAD?
- psychoeducation
- cognitive challenging
- behavioural experiments (exposure)
- stop safety behaviours
- attention training
- video feedback (reduce their negative bias of their performance)
Exposure tasks work better with…
a cognitive rationale
About ____ of SAD people get better with CBT
2/3
GAD is characterised by…
excessive and uncontrollable worry about a variety of events/outcomes
GAD first introduced in
DSM-III-R
In addition to the uncontrollable worry, people with GAD also experience
3 of 6 somatic symptoms:
restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
GAD does not include…
the hallmark symptoms of anxiety - autonomic arousal eg increased heartrate, trembling etc
Worrying contains more ________ than _________
verbal thought, imagery
One of the earliest theories on Worrying was in terms of its ____________ function
problem solving
People who worry at the pathological level don’t achieve _________ to their problem solving attempts
closure
Last two steps of Social Problem Solving are problematic in high worriers. What are they and why?
Solution evaluation (positive/negative) Solution selection High worriers have an excessive negative evaluation of all potential solutions - snowballs
Avoidance Theory of GAD (Borkovec, 1994) are not only trying to avoid future negative events but also
something internal - a cognitive avoidance. High worriers aim to reduce imagery of possible negative event as that will reduce arousal/anxiety. So they switch to verbal thinking - worrying is a coping mechanism to make you feel better (reduce physiological arousal and negative affect)
Cognitive avoidance interferes with _________ _________ which…
emotional processing, maintains fear structures. It is a cyclical process
Worry is associated with which three things.
Fear of Anxiety - anxiety sensitivity
Distress intolerance - want to avoid being upset in general
Experiential avoidance - avoid internal experiences
- don’t want to feel very happy bc when it goes away they’ll feel worse
People who worry a lot have difficulty in….
emotion regulation
- identifying the emotion
- tolerating the emotion
- modulating the emotion (once you feel one way, it’s difficult to feel another way)
Intolerance of Uncertainty Theory (Ladouceur et al, 2000) states that high worriers think that uncertainty …
reflects badly on a person, causes frustration and stress, and prevents action
Intolerance of Uncertainty Theory:
people worry to reduce ________ which leads to….
uncertainty
preoccupation with details and interferes with problem solving
Intolerance of Uncertainty Theory:
The worrier keeps worrying because…
it’s impossible to reduce the uncertainty to zero
Metacognitive Theory of worry differentiates between…
Worry (Type 1) and Metaworry (Type 2)
Type 1 worry is..
normal worry - worry to cope with threat
Type 2 Metaworry occurs because
Pathological worriers have a large number of negative beliefs about worry (eg worrying is dangerous, I can’t control it), and then start worrying about worrying
Metaworry will…
increase your anxiety. will lead to other methods of ineffective thought-control
What are the components of treating GAD?
Targeting biased threat perception
- probability and cost judgments
Problem solving –> Structured problem solving training
Avoidance –> Exposure to vivid images of feared event
- – exposure to anxiety/emotional experience/distress (mindfulness helps with this)
- – exposure to uncertainty (just live with the anxiety)
Meta-cognitive —> Challenging positive and negative beliefs about worry
Treatment effects of GAD have been…
Modest. 50-60% improve at follow-up
To be diagnosed with GAD, the anxiety and worry must have been present on most days for at least ___ months
6
Individuals with GAD tend to overestimate the likelihood of _______ events happening while underestimating their ability to _____ with the negative events should they occur.
Catastrophic, cope
Well’s Metacognitive Model of worry also argues that people with GAD hold positive beliefs about worry such as ..
‘worry helps me prepare for danger’
‘worry stops bad things from happening’
‘worrying about others means I am a caring person’
Avoidance Theory of Worry:
The everyday content of worry is hypothesised to also as a means of avoiding…
more distressing and emotional topics or core underlying fears that developed as a consequence of traumatic events, early negative experiences or poor current interpersonal relationships.
The Intolerance of Uncertainty Model argues that people with GAD possess a ‘poor problem orientation’: what does this mean?
they selectively focus on the uncertain aspects of problems and have low levels of confidence regarding their capacity to solve problems
What are some new approaches for treating GAD?
Interpersonal psychotherapy (IPT) - addressing interpersonal problems believed to be maintaining the symptoms Mindfulness approaches - learn to be more present-focused (rather than future-focused) and to observe (rather than react) to worries
What treatment has been specifically developed for compulsive washers (OCD)?
Danger Ideation Reduction Therapy
