Anxiety (COMPLETE) Flashcards
What is anxiety?
An intense fear of events/ situations that are avoided or endured with dread
What’s the difference between fear and anxiety?
Fear:
Motivated by imminent threats
Arousal via sympathetic nervous system
Brief emotional reaction
Adaptive
Specific triggers
Anxiety:
Usually motivated by future threats
arousal via sympathetic nervous system
sustained affective state
adaptive
diffuse
What’s the sympathetic nervous system
Directs the body rapid involuntary response to dangerous or stressful situations
What’s the prevalence/epidemiology of anxiety?
Lifetime prevalence in US is 28.8%
Highly co-morbid
Woman experience higher rates of anxiety; 2:1 ratio
Comment on anxiety’s co-morbidity
50% of ppl with one anxiety disorder have the criteria for another anxiety disorder
66 meet criteria for another- 60% high comorbidity with depression
What’s the genetic aetiology of anxiety
20-40 percent heritability
even higher in panic disorder-50%
What’s the environmental aetiology of anxiety
Childhood trauma exposure increases risk
Cultural context influences prevalence
GAD much less prevalent in easter compared to western countries
What’s a cultural specific anxiety disorder
kayak angst
disorientation and fear of drowning among Inuit seal hunters
What’s the common criteria for anxiety disorders
Impairment in functioning
not better explained by a medical condition/drugs
Symptoms persist for 6 months (except panic which is 1)
Symptoms cannot be explained by another disorder
What are the anxiety disorders
Agoraphobia
Generalised anxiety disorder
specific phobia
social anxiety disorder
panic disorder
What are some examples of specific phobias?
Arachnophobia- fear of spiders
Trypanophobia- fear of needles
Cynophobia - fear of dogs
Acrophobia- fear of dogs
Claustrophobia- fear of small spaces
What’s the DSM 5 criteria for specific phobias
- Marked and disproportionate fear consistently triggers by specific objects/situations
- object is avoided or endured with intense anxiety
What’s the prevalence specific phobia
7-13% lifetime prevalece
Median age of onset is 8 years old and may be linked to specific experiences, ie. a dog bite
What’s the DSM 5 criteria for social anxiety disorder?
- Marked and disproportionate fear consistently triggered by exposure to potential social scrutiny
- Exposure to trigger leads
to intense anxiety about being evaluated negatively - Triggering situations are
avoided or else endured with intense anxiety
What’s the difference between specific phobia and social anxiety disorder
Social anxiety is much ore serious because social situations are present in all daily life
Avoidance is the worst issue cut ruins their life
They’re always thinking of ways in which social situations will go wrong
They often begin in adolescence unlike SP which begins at usually 8
What’s a panic attack
Unexpected and uncontrollable episodes of terror, apprehension, sense of dread that are accompanied by physical changes, ie. breathlessness, palpitations, nausea and dizziness
What are panic disorder attacks often accompanied with?
Derealisations
depersonalisation
What’s the prevalence of panic attacks
Relatively common -25% of ppl have experienced a panic attack
What’s the DSM 5 criteria for panic disorder?
Recurrent unexpected panic attacks- if its triggered by something then specific phobia is more of an accurate diagnosis
At least one month of concern/worry about experiencing more attacks/fearing of the consequences of an attack or maladaptive behaviour changes
Panic disorders are a mis-firing of our fear system
Shortness of breath, sweating and faintness might cause someone to believe that they’re going through a medical emergence, ie. having a heart attack
What’s agoraphobia
Fear/anxiety act being in a large crowd and it would be embarrassing/difficult to escape if anxiety symptoms occurred,ie. public transport/shopping centres
These situations are either avoided/ require a companion or are suffered through with intense anxiety
Used to be a special case pf panic disorder but made its own cuz less than half had panic attacks
What’s the DSM 5 criteria for generalised anxiety disorder
Excessive anxiety/ worry at least 50% of days about a number of events
finds it hard to control the worry
Associated with at least 3 of the following:
Restlessness
Easily fatigued
difficulty concentrating/mind going black
Irritability
Muscle tension
sleep disturbance
NO SPECIFIC TARGET- MUCH MORE DIFFUSED
What’s the overview of GAD
Tends to eb chronic
50% reported perseverance
GAD highly comorbid with other anxiety and psychiatric disorders
80% meet the criteria for other anxiety disorders
What are the causes of anxiety disorder?
Learning
Emotional responses
Fear conditioning
Instrumental conditioning
Mowrers 2 factor model
Fear generalisation
Learning and anxiety disorders
Learning involves a change in behaviour that result from regularities in the environment
Associative learning- pavlovian theory
Emotional responses and anxiety
Emotional responses are learned too
Example: Little Albert
What was the little Albert experiment
Baby had no problem with animals
Then the neutral stimulus was paired with noise
The animal was now a conditioned stimulus that motivates a conditioned response, ie fear
What did the Little Albert experiment teach us
Fear conditioning is an extremely important and adaptive fiction
Kids must acquire lots of fears as this is key to survival in a world that changes much faster than we evolve.
Do all fear associations need to be learned through direct experience?
No they can be learnt though:
1. Modelling
2. Verbal instruction.
What is extinction
A process where an association between a conditioned stimulus and noise diminishes
Why does an irrational fear stay alive if the bad thing never actually happens?
Mowrer two- factor model
- Pavlovian conditioning: gets the fear started
- Instrumental conditioning: keeps the fear alive
Whats instrumental conditioning?
Behaviours are strengthened by consequences ,ie. reinforcement
What is positive reinforcement?
parents buy you a holiday if you get a 1:1 degree
What’s negative reinforcement??
Parents kick you out if you fail
Avoidance is a special case of negative reinforcement
,ie. if you do it ‘right’ nothing happens
Application of Mowrers Two factor Model
Pavlovian conditioning: Dog snaps at a child and being near the dog makes a big fear reaction
Instrumental conditioning
The individual avoids coming near dogs/ crosses the street when they see a dog
and they never get to learn that most dogs don’t bite
Qualificiations to Mowrers two factor model
Its simplistic
Why do some ppl have the same experiences, ie a dog bite but never develop specific phobia
How s fear measured in a lab setting
Self report- how afraid are u from a scale of 1-10
Physiology
Heart rate/Skin conductance response
Behaviour:
Avoidance responses
Brain:
Amygdala reactibity
This is used to study individual differences in how ppl
1. Acquire and
2. Extinguish fears
What was the finding in fear conditioning and extinction in anxious patients
Anxious patients tend to be more fearful of the neutral stimulus- generalise fears
Anxious patients are slower to extinguish fears
Studying fear conditioning allows us to study how treatments work and how to develop new ones
What is fear generalisation
Fear-avoidance reaction is rarely isolated to the events that featured in a learning experience.
Example: Because the mouse was associated with loud noise, he generalised that fear to the rabbit and the dog
What is stimulus generalisation?
The process whew neutral stimuli is distinct from but still similar to the original conditioned stimulus and then it can partially elicit a conditioned reposes
How can fear generalisation be shown on a scale
Curvilinear gradient
The amygdala’s role in anxiety
Fear acquisition
fear storage
Fear expression
the medial prefrontal cortex and anxiety
extinguishes fear
Regulates emotions on demand
Regulates the amygdala
The brain and generalised anxiety disorder
Neuroimaging looks more similar to depression
What are other general risk factors of anxiety disorders?
Behaviour inhibition- becoming distressed or withdraw when faced with novel situations
Neuroticsm- tendency to experience frequent and intense negative affect
Attention to threat- paying more attention to negative cues in the environemnt
Negative bias- interpreting neutral stimuli as negative
What are specific risk factors for social anxiety disorder?
Two factor theory
Catastrophising
Negative self- evaluation
Monitoring performance, ie. was that a fake laugh
What are specific risk factors for panic disorder?
Stress triggers noripinephrine release
It increases activity of the sympathetic nervous system
NE and panic disorders
Locus coeruleus produces it
Drugs that increase noripenephrine cause panic attacks
Drugs that decrease it decrease the risk of panic attacks
Other specific risk factors for panic disorder
Physiological Factors = predisposition for panic attacks
Two-Factor Theory = learned catastrophic interpretation of the attacks + engaging in avoidance behaviours
How do panic attacks arise?
from a catastrophic interpretation of physiological symptoms
Can be induced in a lab through inhalation of air enriched with CO2
In healthy ppl, if an explanation is given that theyll feel breathless, then panic is lessened
What are the specific risk factors for agoraphobia
triggers are exteroceptive- places
rather than introceptive- bodily states
What are the specific risk factors for generalised anxiety disorder?
Generalised distress and worry
Strong association with major depression
high intolerance of uncertainty- causes sufferers to worry mote
reinforcing properties of worry- distracts from real and intense emotions
What’s the psychological treatment for anxiety disorders?
CBT
Behavioural:
Exposure to threats, ie. social situations
prevent safety behaviours,ie trying to not use eye contact
Cognitive
Challenging beliefs
Develop confidence in coping abilities
What about CBT and generalised anxiety disorder
Its kind of an exception aux there’s no triggering stimulus to expose
Relaxation training
Cognitive restructuring
Reduces negative bias
reduces catastrophising
Mindfulness- being in the present
Efficacy of CBT for anxiety
Effective for all anxiety disorders, but best for PTSD and OCD
What are the pharmacological treatments for anxiety disorders
Anxiolytics
Benzodiazepines
Antidepressants
What are anxiolytics?
Any drug that reduces anxiety
What are benzodiazepines
VAlium/xanax
effective over placebo but are addictive and have sedative side effects, ie. drowsiness/memory loss
What are antidepressants
SSRis, SNRIs Tricyclics
Effective over placebo and are not additive
but side effects can be very bad but less dangerous, ie. weight gain/insominia
Finding of pharmacological treatments and anxiety disorder.
Relapse can happen if you stop taking it
Combined CBT and medication is the best
