Anxiety and fear related disorders Flashcards
What are the general characteristics of anxiety and fear related disorders
-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
What are the 3 types of anxiety
1)Generalised anxiety disorder
2)Agoraphobia
3)Specific phobia
Describe general anxiety
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
What is the ICD-11 criteria for general anxiety
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.
Describe agoraphobia
-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.
What is the ICD-11 criteria for agoraphobia
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.
Describe specific phobia
-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.
What is the ICD-11 criteria for specific phobia
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.
What two psychometrics are used to measure anxiety and fear related disorders
-GAD-7
-BIPI (Blood injection phobia inventory)
Describe GAD-7
-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.
What is the patient filling GAD-7 is asked to do
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.
What are the 7 symptoms in GAD-7
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
Evaluation of GAD-7
-Low validity
-Objective
-Useful application to everyday life
-Less valid data
What is BIPI (Blood injection phobia inventory)
-It contains 18 hypothetical situations involving blood and injection.
What is the person filling BIPI asked to do?
-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
Give examples of responses of BIPI
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
Evaluation of BIPI
- Useful application to everyday life
-Generates quantitative data
-holistic
-High concurrent validity with GAD-7
-It is a self report (weakness)
-Ethics ( weakness)
What are the aims of the example study Mas et al (2010)
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
what is the sample of the example study Mas et al (2010)
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
What are the results of Mas et al
-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
What is the conclusion of Mas et al
BIPI can accurately discriminate people and diagnose people with BII phobia from the non-clinical group.
what is the evaluation of Mas et al
-Holistic
-Control group
-Validity
-Sample
-Concurrent validity
-Supports the nomothetic side of the debate
What are the three psychological explanations of anxiety and fear related disorders
1) Behavioural (Classical conditioning)
2) Operant conditioning
3) Psychodynamic explanation
Explain Classical conditioning/Behavioural explanation as a psychological explanation for anxiety and fear
- 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)
Explain Operant conditioning as a psychological explanation for anxiety and fear
-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
Explain Psychodynamic explanation as a psychological explanation for anxiety and fear
-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
Describe the Example study , Watson and Rayner (1920)
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.
Describe the example study Freud (1909)
Sample;
-A 5 year old Austrian boy , named little Hans
-His father had referred the case to Freud and provided most of the detail.
Methodology;
-It is a case study
About;
-When Hans was 3 he developed an intense interest in his pp.
-He frequently played with it which angered his mother who threatened to cut it off.
-This upset the boy and he developed a fear of castration.
-Hans younger sister was born around that time, and his mother was separated from him at the hospital. He also witnessed an upsetting incident where a horse fell and died in the street.
-Quite soon after this his horse phobia emerged. He was particularly worried that he would be bitten by a white horse.
-Hans phobia lessened as he reached the age of 5 . His father noted that he experienced two notable fantasies at the time;
1)He had several children with his mum and imagined his father as the grandfather
2) He had fantasised that a plumber had come and removed his penis and replaced it with a new larger one
-Freud felt that the object of fear, the horse represented his father. The horse was white with a black nose band which represented his dads white skin and black moustache
Evaluate the psychological explanations of anxiety and fear related disorders
-Useful application to everyday life
-Determinism vs free will debate
-Reductionism vs holism
-
Explain the biological explanations of anxiety and fear related disorders
1) Genetic
-> this is the idea that we are born perapered to avoid/fear stimuli that pose a threat to our survival.
-BII phobia for instance is a unique type of phobia that is thought to have a biological basis.
-BII phobia is accompanied by strong physiological reactions such as the biphasic cardiac response and fainting.
Explain Biphasic cardiac response
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 .
What is the sample in the study by Ost
-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
Explain the procedure in the study by Ost
-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.
What are the measures in the study by Ost
- 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 .
Describe the results in the study by Ost
-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
What is the conclusion in the study by Ost
-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)
What are the 3 physiological treatments of anxiety and fear related disorders
Systematic desensitization
CBT fir anxiety
Applied muscle tension
Explain systematic desensitisation by Wolpe and how it is done
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 :The patient and the therapist work together to create an anxiety hierarchy. the hierarchy contains a list of feared stimuli. from least to most distressful.
All the stimuli must relate to the object/situation of fear
Step 3; The therapist exposes the patient to the stimuli systematically from least distressful to the most distressful. The exposure begins invitro and gradually becomes invivo.
Step 4; Lastly at each stage of exposure the patient is assisted to remain in a calm relaxed state. The patient does not move on to the next stage of the hierarchy unless they report no distress from the current stage.
CBT for anxiety disorder
-CBT begins by explaining the rational for cognitive and behaviour therapy.
-For example cognitive therapy is anchored on the idea that people with anxiety disorders e.g BII phobia experience specific thinking errors that lead to cognitive distortions such as catastrophising and jumping into conclusions.
-Behaviour therapy is used because phobias are thought to be learnt responses through classical conditioning. Exposure therapies help patients to unlearn the response.
-CBT techniques such as systematic desensitisation and imagery exposure therapy can be useful to help patients deal with their fears, self control is used to help patients immerse themselves into the imaginations.
what is applied muscle tension
-This is a biological treatment. it targets vasovagal syncope response in BII.
-Vasovagal syncope is a sudden sharp drop in heart rate and hypertension followed by a sharp rise in heart rate blood pressure causing reduced cerebral blood flow and fainting.
-Applied muscle tension aims to increase blood pressure in the target muscles hence delay in fainting behaviour.
What is the aim of the key study by De Lapp and Chapman
- To investigate whether BlI phobia could be successful in treated using CBT and applied muscle tension.
What is the sample of the key study by De Lapp and Chapman
- 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.
What were the events proceeding Ts phobia in the key study by De Lapp and Chapman
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.
Describe the procedure of the key study by De Lapp and Chapman
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)
- 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) . - 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.
Explain Beck anxiety inventory (psychometric used in Chapman)
- 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) .
Explain (psychometric used in Chapman)
Explain (psychometric used in Chapman)
Explain (psychometric used in Chapman)
Explain (psychometric used in Chapman)
