Anxiety and Phobias Flashcards
Anxiety and fear background
People cope behaviourally with stressors/threats in their environment
•Basic responses: running/avoiding potential stressors
Anxiety and fear are noxious (they feel bad)
•But they aren’t bad (crucial to survival)
Both can be adaptive or maladaptive
•Adaptive when they warn you of real danger and promote helpful response (F/F)
•Maladaptive (disorder) when F/F activates with no real danger and promote unhelpful responses
Fear
Feeling of SAM system/fight or flight Basic components:
1) Cognitive: belief that there’s danger to well being of self or integrity
2) Emotional: fear (strong and immediate)
3) Physiological: increased HR and breathing, sweaty palms
4) Behavioural: reaction to fear (running away, screaming, etc.)
Panic attacks: an intense version with no immediate threat to well being/morality (often themes of dying, going crazy, losing control)
Anxiety
Anxiety: complex mixture of unpleasant emotions and thoughts to normal things (more diffused and future oriented)
•Constantly on edge (like a background noise) but it can be more intense if something is activating fear
•Focus on potential threats or danger, overestimating risk and underestimating ability to cope with outcome
Basic components:
1) Cognitive: worry, preoccupation
2) Emotional: dread, agitation
3) Physiological: tension, over arousal
•Ready to engage in F/F with no immediate threat
•Hat-band effect: pressure/tingly feeling on part of your head
4) Behavioural: avoidance of things were afraid of
•Can be a debilitating behaviour
Highly related to neuroticism/neurosis
•Tendency towards negative emotions
•Distress with good reality testing: experience difficulties/get anxious but know what’s real and what isn’t
Anxiety statistics
Prevalence of any anxiety disorder:
•Lifetime: 29% // One year: 18%
•Gender: most common disorder in women, second most common in men
High comorbidity: if you have one type of anxiety, likely you’ll have other types
•Substance use, depression, other anxieties (very common mental disorders)
Many disorders will involve anxiety and fear •Some disorders primarily focus on excessive/unrealistic anxiety responses
Shared etiological factors
•Psychological: neuroticism
•Biological: limbic system (especially amygdala - fear and GABA - calming down brain - people with anxiety don’t do as well
•Social: unstable/unpredictable environment
Specific phobia
Persistent fear and avoidance of an object/situation that presents no danger
•Common themes: animals, nature, blood-injection-injury, situation, others (chocking)
•Approaching phobia causes anxiety/fear
•Usually isn’t a problem (knowledge that fears are unrealistic)
•Becomes a problem with significant impairment (too scared to leave the house because you’re scared of dogs)
Diagnostic criteria
1) Fear and anxiety about an object/situation
2) Immediate fear or anxiety
3) Active avoidance, or endurance with fear or anxiety
4) Out of proportion
5) Persistant for 6 months
Prevalence and Heritability
Prevalence •Lifetime: 12% •More common in women, but varies •Animal phobia (95% women, 5% men) •Blood-injection-injury (same for M/F) •Onset in childhood is common (animals, childhood fears like dentist) which sometimes go away but sometimes don't •Adolescence/early adulthood (driving) Heritability •Moderate •Children: related to behavioural inhibition temperament •Adults: high neuroticism •Genes: serotonin transmitter COMT
Learning phobias
Possibilities (not all phobias can be traced to a clear learning experience)
•Classical conditioning
•Conditioned avoidance response for persistence of fear (relief of anxiety with avoidance reinforces avoidance)
•Awareness for feared object increases attention paid to it and exacerbates fear overtime
•Vicarious learning (seeing other people’s fears to it)
Exposure to non fearful interactions decreases chance of developing phobia (exposure to harmless dogs)
Evolutionary preparedness
More relevant concerns in evolutionary ancestral environment are common phobias
•Not born with phobias, but some are easier to learn than others
•Ex: fear of spiders even though they don’t kill as many people as cars, but there is less fear of cars
Blood-Injection-Injury phobia
Different physiological response from SAM:
•Brief increased HR/BP, followed by rapid drop causing nausea, dizziness, or fainting
•Along with anxiety, also a strong disgust
Reasons for differences:
•Different evolutionary etiology
•Protection from harms when injured in battle (fainting-thinking their dead)
Treatment of specific phobias
1) Graduated exposure: step by step, controlled, safe (can use virtual reality)
2)Flooding: all at once, terrifying, but effective if you wait for F/F to decrease
Complicated by comorbidity with other anxiety disorders, but generally quite treatable
Social anxiety disorder (social phobia)
Intense/debilitating fear or anxiety about social situations out of proportion with risk
•Anticipatory anxiety: before social situation, there is a buildup that peaks right before
•Person usually is interested in social activities, but has a crippling fear of:
•Being scrutinized/perceived negatively, acting embarrassing or offensively, unable to handle conflict/rejection, revealing physical signs of anxiety (shaking,blushing)
•Significant distress: leads to low social support, poor relationships, loneliness, difficulties with school/work/life activities
•There is a common fear of public speaking which can be considered a SAD
Social interaction anxiety vs SAD
•SIA: scared of what could happen (more common)
•SAD: being seen and observed in public (more severe)
Possible to have both
Prevalence of SAD
Lifetime: 12% // One year: 7% (culturally dependent)
Gender: more common in women (1.5-2.2x higher)
Onset: 8-15 years old
Persistant
Social learning
50-90% of adults with SAD report experience of direct distressing social experiences growing up
•Singular traumatic event or persistent environment can both be equally impactful
•Traumatic: getting locked in a locker
•Persistent: getting bullied for years
•Observational learning can also contribute
Lack of control
Often subject to uncontrollable social stress during development, resulting in submissive behaviour (shyness or trusting few people in stressful environment as protective function)
•Ex: family conflict (hostile or overprotective dynamics), divorce, abuse
