Anxiety

Question 1

What is anxiety?

Answer 1

An emotional and physiological response that occurs when we perceive threat

Question 2

Full body response of anxiety

Answer 2

• Phsyical
• Cognitive
• Emotional
• Behavioural

Question 3

Characteristics of clinically significant anxiety

Answer 3

o Anxiety: future-oriented, marked negative affect, bodily tension, and chronic apprehension (e.g., Generalised Anxiety Disorder) and
o Fear: immediate alarm reaction to present danger, strong escape- action tendencies (e.g., specific phobia), sometimes in the absence of stimuli (e.g., panic).

Question 4

Triple vulnerability theory (Barolow)

Answer 4

there are likely several factors that synergistically interact to result in a person developing separation anxiety disorder.

• biological vulnerability (e.g., genetic predisposition
• a general psychological vulnerability (e.g., early experiences of lack of control over one’s environment perhaps as a function of overly controlling or critical parenting),
• specific psychological vulnerability (e.g., early experiences, perhaps related to attachment processes, )

Question 5

Separation Anxiety Disorder Etiology

Answer 5

• Triple vulnerability theory
• Role of temperament (Behavioural inhibition might indicate anxiety proneness, placing children at greater risk for the development of anxiety disorders)
• Attachment (consistency, responsiveness and warmth = essential for healthy development) (often insecure attachment making SAD an interpersonal disorder)
• parenting style and family factors (high control, overinvolvement and low warmth. maternal rejection, anxious parenting, family members with SAD)
• Learned behaviour (parental reinforcement of dependency associates with sAD).

Question 6

OCD Etiology

Answer 6

• Behavioural factors: Mowrer’s (1939) two-stage theory for the acquisition and maintenance of fear and avoidance behavior has often been used to explain the development of compulsions in OCD. (First stage: intrusive thought, Second stage: escape and avoidance (through negative reinforcement of compulsions))
• Cognitive factors (Extreme beliefs about the responsibility to protect oneself or others from harm have also been cited as a key factor in the maintenance of OCD symptoms. o Thought–action fusion is believed to arise out of an excessive sense of personal responsibility and guilt over intentions and seems to develop from childhood experiences or learning focused on the salience of any type of thought)
• Biological factors: (abnormal serotonin metabolism, possible Abnormal functioning in the cortico-striatal-thalamo-cortical circuit and its component structures, particularly within the basal ganglia, has been found to be related to OCD symptoms, reduced activation in the orbitofrontal cortex )

Question 7

Specific phobias Etiology

Answer 7

• While traumatic conditioning experiences can certainly result in phobias, vicarious learning and simple information trans- mission (e.g., telling your child to be very careful around dogs) may contribute as does the accidental pairing of uncued, unexpected panic attacks with objects or situations

Question 8

Social Phobia (social anxiety disorder) etiology

Answer 8

• biological: fear of angry faces (overreaction), possible dopamine depletion.
• behavioural: conditioning, ethological considerations (evolution of vulnerability to social threat)
• Cognitive contributions: individuals with social phobia share typical negative beliefs about themselves in social situations

Question 9

Panic Disorder (PD) with and without Agoraphobia

Answer 9

• the initial panic attack is conceptualized as a misfiring of the fear system under stressful life circumstances in physiologically vulnerable individuals
• PD is immediate survival threat where anxiety is future threats
• An overly reactive autonomic nervous system (flight or fight)
• anxiety sensitivity: A persistent tendency to misinterpret certain bodily sensations as catastrophic or imminently dangerous (is a trait)

Question 10

Generalised Anxiety Disorder (GAD)

Answer 10

• appears to result in part from a generalized biological vulnerability in the form of a genetic predisposition, in com- bination with a generalized psychological vulnerability resulting from early learning about the uncontrollability of life events

Question 11

How does GAD differ from other anxiety disorders?

Answer 11

o GAD = less responsive on physiological measures of anxiety (e.g., heart rate, blood pressure, skin conductance, and respiration)
o GAD = autonomic restrictors
o Muscle tension is characteristic of GAD
o GAD = more attentive to threat than are those who do not have an anxiety disorder
o EEG activity in individuals with GAD is increased in the left frontal lobe, indicating intense cognitive processing but no creation of mental images, thus causing those with GAD to avoid images of potential threat and leading to automatic restricting… This means that the images and negative emotions that accompany anxiety are never processed, and chronic worrying and the physical symptoms of GAD result

Question 12

Avoidance and safety behaviour in Anxeity

Answer 12

o While short-term relief from anxiety and distress is usually experienced, the anxiety problem can be perpetuated in a number of ways, including by
 (i) reinforcing the idea that the fear or anxiety is real
 (ii) reducing self-efficacy of being able to cope
 (iii) perpetuating false beliefs that can interfere with treatment, such as make it difficult to implement exposure therapy
 (iv) perpetuating false beliefs that can interfere with life in general.

Question 13

Anxiety assessment

Answer 13

Psychologists need to assess and understand avoidance behaviour to facilitate intervention, including asking:
- what is avoided, how often, and under what circumstances.
The thoughts and beliefs about the safety behaviours also need to be assessed.
In undertaking this assessment it is important to elicit concrete examples.

Question 14

Anxiety assessment tools

Answer 14

• Beck anxiety inventory (21 items)
• GAD-7 (7 items)
• State-trait anxiety inventory (40 items)
• hospital anxiety depression scale (14 items)

Question 15

Cross cutting symptom measure in DSM5

Answer 15

 developed to be administered at the initial patient interview and to monitor treatment progress, thus serving to advance the use of initial symptomatic status and patient reported outcome (PRO) information, as well as the use of “anchored” severity assessment instruments.
 Instructions, scoring information, and interpretation guidelines are included.
 Clinicians and researchers may provide APA with feedback on the instruments’ usefulness in characterizing patient status and improving patient care
Level 1: symptom detecting for further enquiry (symptoms over past 2 weeks)
Level 2: cross-cutting symptom measure

Question 16

• Tripartite Model (Clark and Watson)

Answer 16

o way to help conceptualise the similarities and differences between anxiety and depression.
o 3 domains:
- negative affect (emotions that are negative and distressing, like anger, sad and worried).
- Positive affect (positive emotions).
- Physiological hyperarousal (all the anxiety and arousal symptoms)
o depression is characterised as low positive affect, so the lack of joy. But anxiety is characterised by high hyperarousal, high physiological arousal.