Anxiety and fear related disorders

Question 1

What are the general characteristics of anxiety and fear related disorders

Answer 1

-Excessive worries and apprehension when one interacts with the object/situation of fear

-The worries are disproportionate to the threat caused by the situation/object of fear hence irrational.

-Abnormal avoidance of the object or situation of fear

-Worrying about worrying - disease state- worrying about apprehensive expectations

Question 2

What are the 3 types of anxiety

Answer 2

1)Generalised anxiety disorder
2)Agoraphobia
3)Specific phobia

Question 3

Describe general anxiety

Answer 3

General anxiety is characterised by general apprehensiveness that is not restricted to any particular environmental circumstance.

and excessive worry about re-events occur in several different aspects of everyday life e.g worry about finances , school etc

Question 4

What is the ICD-11 criteria for general anxiety

Answer 4

1) The symptoms are not transient and persist for several months for more days than not.

2) The symptoms are not better accounted for by another medical disorder e.g depressive disorder.

3)Symptoms are not a manifestation of another medical condition e.h hyperthyroidism or not due to the effect of substance/medication on the CNS.

4)Symptoms result in significant distress about experiencing persistent anxiety symptoms (worrying about apprehensive expectation)

5) Symptoms cause significant impairment in the core areas of functioning.

Question 5

Describe agoraphobia

Answer 5

-Agoraphobia is characterised by marked and excessive fear or anxiety that occurs in or in anticipation of multiple situations when escape might be difficult or help might not be available.

-Examples , using public transport , being in crowds , leaving the house alone.

Question 6

What is the ICD-11 criteria for agoraphobia

Answer 6

1) Symptoms are not transient they are persistent for an extended period of time e.g for at least several months.

2)Symptoms are not better accounted for by another mental disorder.

3)Symptoms result in significant distress about experiencing persistent anxiety symptoms.

4) Symptoms cause significant impairment in the core areas of functioning.

Question 7

Describe specific phobia

Answer 7

-Specific phobia are characterised by excessive fear that consistently occurs when one is exposed to an object or situation
the fear could also occur when one anticipates exposure to an object/situation of phobia
-The object or situation is actively avoided or else endured with intense fear or anxiety.

Question 8

What is the ICD-11 criteria for specific phobia

Answer 8

1)The fear , anxiety , phobia is not transient i.e it persists for an extended period of time.
2)symptoms are not better accounted for by another disorder e.g social anxiety
3) Symptoms result in significant distress about experiencing persistent anxiety symptoms.
4) Symptoms cause significant impairment in the core areas of functioning.

Question 9

What two psychometrics are used to measure anxiety and fear related disorders

Answer 9

-GAD-7
-BIPI (Blood injection phobia inventory)

Question 10

Describe GAD-7

Answer 10

-It is a 7 item questionnaire that is used to measure the severity of anxiety.
-It is used as a screening tool by general practitioners to enable further referral to specialists such as clinical psychologists and psychiatrists.

Question 11

What is the patient filling GAD-7 is asked to do

Answer 11

The patient filling the questionnaire is asked to indicate on a 4-point scale from 0=not at all , to , 3=nearly everyday , how often they’ve been bothered by the 7 symptoms over the last 2 weeks.

Question 12

What are the 7 symptoms in GAD-7

Answer 12

1) Feeling nervous , anxious or on edge
0=not at all
1= more than half the day
2= several days
3= nearly everyday

2)Not being able to stop or control worrying.
3)Worrying too much about different things
4)You have trouble relaxing
5)Being so restless that it is hard to sit still
6)Becoming easily annoyed or irratible
7)Feeling afraid as if something off might happen

Question 13

Evaluation of GAD-7

Answer 13

-Low validity
-Objective
-Useful application to everyday life
-Less valid data

Question 14

What is BIPI (Blood injection phobia inventory)

Answer 14

-It contains 18 hypothetical situations involving blood and injection.

Question 15

What is the person filling BIPI asked to do?

Answer 15

-The person filling the questionnaire is asked to indicate on a scale from 0-3 , the physiological , behavioral and cognitive reaction to those situations.
examples of situations ;
-> when i think about having to get a blood test
->if i’m in the kitchen and i see a knife with blood on it , after cutting meat
->When i see an injured person after an accident , bleeding on the road or on tv

Question 16

Give examples of responses of BIPI

Answer 16

Physiological :
- My heart beat speeds up ( 0=never , 3 = always)
-My palms or armpits swaet (0= never , 3 = always)

cognitive response :
-I dont thinbk ill be able to bare the situation (0-3)
-My mind goes blank (0-3)
-i think im going to faint

Behavioural responses :
- i avoid going , i avoid it
-i am paralysed and i cannot move
-i keep quiet , speechless

Question 17

Evaluation of BIPI

Answer 17

• Useful application to everyday life
  -Generates quantitative data
  -holistic
  -High concurrent validity with GAD-7
  -It is a self report (weakness)
  -Ethics ( weakness)

Question 18

What are the aims of the example study Mas et al (2010)

Answer 18

1) To see whether BIPI could discriminate between those diagnosed with BII phobia and those who were not.

2) To investigate whether blood phobia was a one - dimensional construct or whether it was influenced by a range of stimuli

3)To identify whether BIPI could identify a change in people with the phobia due to therapy

Question 19

what is the sample of the example study Mas et al (2010)

Answer 19

clinical sample ;
-39 ss diagnosed with BII phobia
-Aged between 15-30
-Completed the BIPI and FQ

control sample ;
-135 ss selected rom the population
-67 male , 68 female
-Matched with the clinical sample on age and gender

-All ss completed the BIPI and FQ
-The FQ (fear questionnaire) was designed to measure agoraphobic fear , social anxiety and blood injection injury phobia

Question 20

What are the results of Mas et al

Answer 20

-BIPI had excellent reliability and internal consistency as well as good concurrent validity with subscales of blood phobia of the FQ
-The BIPI could differentiate between those diagnosed with BII phobia and those who were not

-BIPI was found to be a sensitive tool in therapeutic improvement

Question 21

What is the conclusion of Mas et al

Answer 21

BIPI can accurately discriminate people and diagnose people with BII phobia from the non-clinical group.

Question 22

what is the evaluation of Mas et al

Answer 22

-Holistic
-Control group
-Validity
-Sample
-Concurrent validity
-Supports the nomothetic side of the debate

Question 23

What are the three psychological explanations of anxiety and fear related disorders

Answer 23

1) Classical conditioning
2) Operant conditioning
3) Psychodynamic explanation

Question 24

Explain Classical conditioning as a psychological explanation for anxiety and fear

Answer 24

• This is the idea that we learn by associating two events.
  When this association happens ,the presence of one event signals the presence of the other.

-In the context of anxiety and fear related disorders , a previously neutral stimulus becomes associated with a potentially threatening event.
for example a person may develop a fear of darkness as a consequence of being mugged in the dark

example/explanation study (Watson and Rayner)

Question 25

Explain Operant conditioning as a psychological explanation for anxiety and fear

Answer 25

-This is the idea that we learn from the consequences of our actions.
-When the consequence of a behaviour is rewarded , the response increases in frequency.When the consequence of a behaviour is punishing the response is weakened.

-An explanation of phobias is operant conditioning . The avoidance behaviour negatively reinforces the phobia and maintains it.

-This means the distress caused by the phobia is relieved through abnormal avoidance. this is a form of negative reinforcement

Question 26

Explain Psychodynamic explanation as a psychological explanation for anxiety and fear

Answer 26

-This is the idea that a phobia is a form of ego-defense mechanism , called displacement of castration anxiety.

• An ego defense mechanism is an unconscious strategy used by the ego/self to protect itself from being consumed by anxiety.

-example of ego defense ;
displacement = channeling fears to less threatening targets.
Rationalisation = logically explaining away our failures/frustrations e.g “after all…”

-Example/explanation study Freud

Question 27

Describe the Example study , Watson and Rayner (1920)

Answer 27

Sample ;
- A normal healthy , 9 month old infant
- A boy named little Albert

What is it about ?
- Watson and Rayner used the principles of classical conditioning to create a fear in little Albert

Procedure ;
- Before conditioning Albert was shown a range of different stimuli : - a white rat , a rabbit , cotton wool , a dog , a monkey , masks with and without hair.

• it reacted normally and neutrally throughout with no outward signs of fear . The white rat was chosen as the neutral stimulus (NS)
• They also placed a metal bar above and behind Alberts head , and struck it loudly with a hammer. This was the unconditioned stimulus as it produced an unconditioned response of fear in the boy.
• The next step was the conditioning, when Albert was shown the rat , he began to reach for it but just as he touched the animal the researchers made a loud noise by striking a hammer against a metal bar just behind his head
• Watson and Rayner repeatedly paired the Loud noise with presentation of the white rat over several trails one week after the initial trial.
• Eventually Albert only had to see the rat and he began to show a fearful response.

Results :
- The white rat had become a CS , producing a CR of fear . When presented with other similar looking animals Albert also had a distressed reaction. These results suggest that fear can be learnt through classical conditioning.

Question 28

Describe the example study Freud (1909)

Question 29

Evaluate the psychological explanations of anxiety and fear related disorders

Answer 29

-Useful application to everyday life
-Determinism vs free will debate
-Reductionism vs holism
-

Question 30

Explain the biological explanations of anxiety and fear related disorders

Question 31

Explain Biphasic cardiac response

Answer 31

When an Individual is exposed to the object or situation of blood or injury , they experience an increase in heart rate and hypertension, followed by a sharp drop in heart rate and blood pressure. This lowers the cerebral blood flow resulting in fainting .

Question 32

What is the sample in the study by Ost

Answer 32

-81 individuals with blood phobia
- 59 individuals with you injection phobia
- they were compared with a sample of other participants who had been diagnosed with different specific phobias e.g animal , dental

Question 33

Explain the procedure in the study by Ost

Answer 33

-Participants underwent a screening interview with a clinician and completed a self - report questionnaire on the history and nature of their phobia.

• this included them discussing the impact the phobia had on their normal lives , as well as giving ratings to particular situations that might trigger a fearful response.

-Participants underwent a behavioral test. Those with blood phobia were shown a 30 minute silent colour video of surgery being performed. They were told not to close their eyes but to try watch for as long as they felt they could.

• The experimenter tracked gaze direction and if participants looked away or stopped the video using a remote control , the test would be terminated.
• The injection phobia test was ‘live’/in vivo and involved 20 steps , from individuals fingertip being cleaned to having a fingertip prick performed on them.
• the tests were described to the ss who had to say whether or not it was okay to perform if they said no the test ended.

Question 34

What are the measures in the study by Ost

Answer 34

• The measures included a score relating to the percentage of maximal performance (e.g how long they watched the video)
• The experimenters rating of the patients fainting behavior (0= no fainting, 4= fainting)
• A self - rating of anxiety (0= not at all anxious , 10= extremely anxious)
• Patients also completed a questionnaire on their thoughts during the test and had their blood pressure and heart monitored .

Question 35

Describe the results in the study by Ost

Answer 35

-The family history of ss revealed that around 50% of those with blood phobia had one or more parents who also had blood phobia.

• 27% of those with injection phobia had at least one parent with injection phobia.

-21% of those with blood phobia also reported having at least one sibling who shared the disorder.

• A a high proportion of subjects with blood phobia and injection phobia had a history of fainting when exposed to the respective phobic stimuli (70% of those with blood phobia and 56 of those with injection phobia

These results are much higher than those spots spends with the other specific phobia or anxiety

Question 36

What is the conclusion in the study by Ost

Answer 36

-There is a strong genetic link for blood and injection phobias , which are more likely than other phobias to produce a strong physiological response (fainting)

Question 37

What are the 3 physiological treatments of anxiety and fear related disorders

Answer 37

Systematic desensitization
CBT fir anxiety
Applied muscle tension

Question 38

Explain systematic desensitisation , Wolpe 1958

Question 39

Explain how systematic desensitization is done

Answer 39

This is a counter conditioning technique of therapy. It’s based on the idea that If all behavior is learned through conditioning then it can be unlearned through counter conditioning , ( a type of exposure therapy).

Step 1 ;
- it begins by relaxation training. This can be done through visualization exercises , PMR or through medication.

Step 2 :

Question 40

What is the aim of the key study by De Lapp and Chapman

Answer 40

• To investigate whether BlI phobia could be successful in treated using CBT and applied muscle tension.

Question 41

What is the sample of the key study by De Lapp and Chapman

Answer 41

• A single individual referred to as “T”|
• T is a 42 year old non Hispanic white male.
  He was self referred (after hearing about CBT on the internet) for his intense fear of medical procedures , e.g blood pressure cuffs , waiting rooms etc and vasovagal syncope on exposure to routine phlebotomy.

-T has presented for treatment due to significant distress and impairment. One of T’s children has ACD (autism spectrum disorder) which requires frequent hospital visits, but T is distressed about being unable to observe medical procedures received by his children.

Question 42

What were the events proceeding Ts phobia in the key study by De Lapp and Chapman

Answer 42

1) Ts mother jokingly suggested on a number of occasions that he was vulnerable to heart problems.
2. family deaths; T reported frequent exposure to incidents that surrounded death. For example T reported that at the age of ten he was the only individual physically present when his grandfather died of cancer. Also , he witnessed his uncle die of cancer and his aunt of Lupus on separate occasions.
3. Also T lived with a highly anxious grandmother, who continuously listened to an ambulance dispatch scanner that reported local emergencies throughout the day.
4. T reported that he had a routine medical evaluation after graduation, and that the physician exaggerated the importance of health , his physical examination and eating habits. This report caused an instance of high blood pressure in T. Although it did not give any negative results, it made T highly anxious.

Question 43

Describe the procedure of the key study by De Lapp and Chapman

Answer 43

The procedure involved 9 separate sessions of treatment , inter-grating CBT and applied muscle tension. several psychometrics were used as outcome measures (to measure the progress of treatment)

1. psychometric 1 ; Beck anxiety inventory (BAI)
   - This is a self report questionnaire designed to measure symptoms associated with anxiety . When given at baseline Ts responses scored a total score of 41 (severe anxiety) .
2. Beck depression inventory 2 (this is a shorter version of BDI) (BDI 2)
   - BDI measures depression symposium over the past two weeks. Ts total score was 9 (minimal depression symptoms) , minimal depression symptoms

3 . Quality of life satisfaction questionnaire
Q - LES - Q
- Q - LES - Q asses general satisfaction with life across a number of domains in the clients life. The questionnaire indicated that he genuinely believes that he has good health in most domains.

• Fear survey schedule 2 (FFS2)
  FFS-2 asses fear of a number of objects and situations on a scale form 0-6 . 0= none , 6= terror. T endorsed a 6 (terror) for blood and a 5 (very much fear) for death of loved one illness and untimely early death and hypodermic needles.
• Blood injection symptoms scale (BISS)
  Used to measure blood phobia . This a 17 item self report questionnaire that asses sensations experienced during situations involving blood or injections.
  T endorsed ‘yes’ for all the 17 items of BISS , which suggested that experienced of negative sensations in situations involving blood or injections.

Question 44

Explain Beck anxiety inventory (psychometric used in Chapman)

Answer 44

• This is a self report questionnaire designed to measure symptoms associated with anxiety . When given at baseline Ts responses scored a total score of 41 (severe anxiety) .

Question 45

Explain (psychometric used in Chapman)

Question 46

Explain (psychometric used in Chapman)

Question 47

Explain (psychometric used in Chapman)

Question 48

Explain (psychometric used in Chapman)