anxiety-based disorders Flashcards
what is anxiety
- A basic emotion
- Cognitive, behavioural, physiological subsystems
- A personality dimension (trait anxiety or neuroticism)
- A psychological disorder (e.g., panic disorder, OCD)
what is the nature of anxiety
- Cognitive and physiological preparation for future threats
- Distinguishable from mood (content specificity)
- Anxiety is associated with danger
- Depression is associated with hopelessness
content specificity
different emotions have different content of thoughts
content specificity is a variable central to cognitive models of emotion and disorder
anxiety is distinguishable from mood
what behaviour is anxiety associated with
anxiety is associated with danger
anxiety is associtated with avoidance or wanting to fight
what behaviour is depressions associated with
depression is associated with hopelessness
conservation of emotion
resting more
withdrawal
what are the two components anxiety is divided into
cognitive and emotionality components
what research highlights that cognitive and emotionality components of anxiety are different
test-anxiety research
what is factor analysis
Factor analysis - took their data with a large number of different factors and wanted to see if all these items could come together be reduced and related to one or two overarching factors - found two dimensions of state anxiety
what is cognitive anxiety relating to?
worry
the cognitive component worry - worry is the chain of negative thoughts and autonomic
Cognitive dimension is more disruptive than the emotional component
what is autonomic anxiety relating to?
emotional/somatic/emotionality
what is trait anxiety
“relatively stable individual difference in anxiety proneness”
trait anxiety inventory scale
Some people are more prone to experiencing anxiety than others
On this scale increased scores on trait anxiety indicate increased vulnerability or anxiety proneness
what are the causal factors of anxiety
only 1/4 of varience is inherited rest is learned behaviours or related to other factors
reliable cognitive differences - at the level of content of thoughts and the control of attention
differences in the way individuals process information differences in attention and memory
cause or consequence of anxiety?
what is there no differences in high and low anxious trait individuals relating to anxiety
no differences between high and low anxious trait individuals in physiology
brain wave activity- heart rate - galvanic skin response - EEG,HR,GSR
no differences at the physiological or genetic level
what is the % of variance in neuroticism due to genetic factors
25% of variance in neuroticism due to genetic factors
what is trait anxiety
a personality dimension
cognitive - what is trait anxiety positively correlated with?
Trait anxiety positively correlated with selective attention to threat stimuli
High in trait anxiety are more likely to show an attention bias to threatening stimuli
Pay more attention to threat
Tend to show more negative thoughts content focusing on danger
Worry more
what is trait anxiety a strong predictor of?
Trait anxiety stronger predictor of attention than state anxiety
what is the worry component in anxiety linked to in text anxiety
Test -anxiety: worry component linked to performance decrement more than somatic component
worry might be more important than physiological arousal in explaining psychological disorder and explaining decrease in performance
what pattern is seen in anxiety and performance
State anxiety more detrimental than trait anxiety (Eysenck, 1982).
• Worry more damaging than emotionality (Morris et al, 1981).
• State anxiety most detrimental in certain tasks (difficult, short-term memory tasks, dual tasks; (Eysenck, 1997).
what is state anxiety and what does it do
Anxiety can interfere with functioning and negatively impact performance on tasks
State anxiety - how anxious your feeling in the moment impacts performance more than trait anxiety especially for tasks that require effort and attention
why is state anxiety detrimental in certain tasks
State anxiety is more detrimental in certain tasks since worry is using up our attentional resources so its taking our attention away from engaging in other tasks like memory
what is the emotional stroop task
State anxiety impacts performance
Trait anxiety and anxiety disorders do appear to show a reliable effect on attention
This has been demonstrated by emotional strop task
Word naming automatic response - hard to suppress - original
Emotional stroop task - test cognitive theories of emotional disorders
Threat related words are printed in different colours participants are asked to name the colour of the words
Compared to neutral words trait anxious and anxierty disorder patients show greater interference with threat related words
what does the emotional stroop task show
trait anxiety and anxiety disorder show robust effects on attention
greater interference with threat related words
example of anxiety and attention bias in the emotional stroop task
Watts et al ( 1 9 8 6 ) : Spider phobic’s presented 3 word lists– general emotional words; neutral words, and spider related: WEB; TARANTULA ; CRAWL; phobic’s as fast as controls on first two lists but slower colour naming spider words
what is the dot probe task
Gaze on a cross
Word pair shown
Words will include a threatening and non threatening word
E.g. table and death
Then a dot will appear in either the threat related word box or the neutral word box
what are the results of the dot probe task
Dot Probe Task
• Word pairs (threat and non-threat), follow by a dot probe in
the same position as one of them. Trait- anxious and anxious patient’s focus on threat word (e.g., MacLeod & Mathews, 1988).
Anxious individuals move their attention to the threat word and are faster to name the threatening word than the non threatening word as their attention is already focused on identifying threat
what is homophone spelling
- Homophone Spelling
- Listen to words with 2 alternative meanings
- (e.g. die; dye, tease; teas, slay; sleigh).
- Trait -anxious write threatening word (Eysenck, MacLeod & Mathews, 1987).
what is the processing stage theory of anxiety to explain bias
Williams et al (1988). Processing stage theory: anxiety affects automatic processing leading to bias
Unclear whether bottom up or top down - isn’t clear on if anxiety is automatic or strategic
Bottom-up process anxiety is seen as low level out of conscious awareness and is hardwired or highly learned
attention may be a consequence - top down - part of coping
what is the hypervigilance theory of anxiety to explain bias
Eysenck (1992). Hypervigilance theory:Trait anxious scan environment for threat excessively and lock onto it
what is the S-REF theory of anxiety to explain bias
Wells & Matthews (1994). S-REF theory: Anxiety associated with activation of Cognitive Attentional Syndrome (CAS) involving self-focus, worry, monitoring for threat and ironic
coping responses (bias is a consequence of coping strategy)
bias is a consequence of threat monitoring
when is anxiety classed as a disorder
- Anxiety interferes with functioning
- Anxiety is prolonged/excessive
- Anxiety impairs quality of life
gets in the way of social and occupational functioning
how many chapters does the DSM 5 have for anxiety disorders
3
what are the chapters of anxiety disorders in the DSM5
- Anxiety disorders
- OCD and related disorders
- Trauma and Stress related
what is classed as anxiety disorders
- Separation anxiety
- Selective mutism
- Specific phobia
- Social anxiety disorder
- Panic attack
- Agoraphobia
- Generalized anxiety disorder
- Substance induced
- Anxiety due to medical condition
- Unspecified anxiety disorder
phobias within anxiety disorders
cluster around animals and objects
preparedness theory states phobias are biological predisposition that was an advantage in the past
what is agoraphobia
a fear of places or situation that may make you feel trapped
what is a panic attack
Panic attacks are a sudden increase in anxiety where at least 4 symptoms are present e.g. increased heartrate, sweating becoming dizzy, nausea , shortness of breath
Occur suddenly
Reach peaks in 10 mins
Are a disorder in their own right
A sense of immediate catastrophe
May think they’re going to have a heart attack or lose mind or going crazy
Can occur in any psychological disorder e.g. depression with panic attacks or hypochondriasis with panic attacks
Exist across any psychological problem areas or on their own
what is generalised anxiety disorder
GAD is characterised by excessive worry
The content of the individual worry varies
Worry about anything
Generalised form of anxiety
what is substance induced anxiety
Caffeine - anxious
Too much caffeine can lead to a dependency and anxiety attacks
what is anxiety due to medical conditions
Medical conditions
E.g. mitral valve prolapse where heart and blood flow can lead to panic like symptoms
what is unspecified anxiety disorder
Anxiety without diagnostic criteria or anxiety NOS
Don’t fully meet criteria of one disorder
Not quite meeting diagnostic criteria
what is categorised as OCD and related disorders
- OCD
- BDD
- Hoarding
- Trichotillomania (hair pulling)
- Excoriation (skinpicking)
- Substance induced OCD
- OCD related medical condition
- Other specified OCD
- Unspecified OCD
what is an obsession?
- Intrusive thoughts
- Image or urge
- Ego-dystonic (disgusting/abhorrent)
80% of people have ego-dystonic thoughts which are also called normal obsessions
Normal obsessions aren’t much different to pathological obsessions what is different is how people interpret and deal with these thoughts
Experienced by the individual as disgusting or abhorrent
what are compulsions?
• Overt or covert action
• Aim is to decrease distress
ex. Washing checking
Compulsions can lead to significant interference with life as often very time consuming
what is BDD
Body dysmorphia - anxiety in ones appearance - may thing head or ears are too big even when in a normal range
what is trichotillomania
hair pulling
what is excoriation
skin picking
what are the trauma and stress disorders in the DSM 5
- Reactive attachment disorder
- Disinhibited social engagement disorder
- PTSD
- ASD
- Adjustment disorders
- Other specified trauma and stressor disorder
- Unspecified trauma and stressor disorder
what is PTSD
PTSD - occur after trauma
Complex ptsd - multiple traumas and abuse
Delayed onset ptsd - develop months or even years after trauma exposure e.g. 9/11 individuals experienced acute stress which then decreased after a number of years when they were reminded of the trauma then then went on to develop post-traumatic stress disorder
what is acute stress disorder
Acute stress disorder
Often occurs within 4 weeks of being exposed to a trauma
Can have memory difficulties, increased arousal, sleepiness
Normal response which usually decreases within 4 weeks
When these difficulties tend to persist a diagnosis of ptsd may be warranted
It’s this persistence that marks a normal vs maladaptive response
what is social anxiety disorder (SAD)
Fear of performance or social situations in which person is subject to scrutiny
• Exposure almost invariably causes anxiety
• The situation is avoided or endured with intense anxiety/distress
• Common symptoms: sweating, shaking, blushing, blank mind, fear of humiliation
Bias in cognitive processes can be formulated
SAD -common anxiety disorder associated with other issues such as substance abuse, mood disturbance and difficulty in social interaction
Stop from getting on with life, relationships and it’s also associated with depression, suicidality and substance misuse
what are the clinical models of SAD
- Social Skill deficit (little support)
* Cognitive-behavioural factors (Clark & Wells, 1995):
the clinical model of Social Skill deficit has little evidence
Individuals with social anxiety are deemed to have a lack of social skills like conversation skills or assertiveness
Little evidence - doesn’t explain the way social anxiety presented e.g. specific forms of social anxiety involve fear of using a telephone or eating while being observed but the individual doesn’t lack a skill to do this
Early treatment trained people in social skills and while this did work it was due to exposure not increasing skills , instead the psychological data directs us towards looking at cognitive factors such as bias and attention and behavioural factors
cognitive-behavioural factors as a model of SAD
• Coping responses and cognitive processes not deficits are central to anxiety maintenance
Model draws on becks schemas theory and the cognitive model
Social anxiety is maintained by individual coping strategies and cognitive processes
clark and wells model - why doesnt social anxiety self correct
what are the 5 factors responsible for maintaining social anxiety disorder and resulting in disorder?
- Self-focused attention
- Processing of inner image
- Safety behaviours & avoidance
- Anticipatory processing
- The post mortem
what is one of the recommended models for treating testing social anxiety disored in NICE guidelines
the Clark and Wells model
what are the stages in the clark and wells model
look at slide 12 for placement
social situation activates assumption percieved social danger - negative automatic thoughts processing self as a social object safety behaviours somatic & cognitive symptoms
what does the clark and wells model assume
assume person with social anxiety has underlying beliefs or assumptions about the social world
distinguishes between situation and vulnerability factors
what happen in anticipatory processing and post mortem
Varying maintenance mechanisms that are keeping the patient experiencing anxiety
Anticipatory processing - social anxiety patients will worry and anticipate danger for hours or days before entering the social situation
Failure and anxiety starts before situation therefore the bias processing has already started which leads to difficulty in having an experience that challenges the negativity
Post mortem - when the anxious person leaves the social situation the anxiety continues and they go over the situation again and again and ruminate and overanalyse the performance - too busy for using on threat and themselves that they only remember their inner image e..g how did I look , what did i say reinforces the negative image even if it went well from an observer perspective the positive experience can be neutralised due to the post mortem and the cognitive rumination that bias and cognition that maintains anxiety
what are presence and effect of mechanisms
safety behaviours and inner image
conclusions from lecture
Anxiety is multi faceted we can usefully distinguish normal and pathological norms of anxiety
Anxiety itself can be broken down into sub components with the word component being particularly relevant in understanding behaviour and performance
High anxiety is associated with cognitive biases and such biases have been explored and used to develop an understanding and more effective treatments of anxiety such as social anxiety disorder
what is worry
a cognitive avoidance response to percieved threat
what is rumination in depression
difficult to control repetitive thoughts concerning personal problems
focusing on fact one is depresed
worry and rumination are linked to
increased blood pressure and cortisol levels
lower heart rate variability
