anxiety disorder Flashcards
1
Q
What are the different types of anxiety disorders according to the the DSM?
A
- specific phobia > fear of objects or situations that is out of proportion to an real danger
- social anxiety disorder > fear of unfamiliar ppl or social scrutiny
- panic disorder > anxiety abt recurrent panic attacks
- agoraphobia > anxiety abt being in places where escaping or getting help would be difficult
- generalised anxiety disorder > uncontrollable worry about future threats
2
Q
what is fear?
A
- response to immediate threat
- basic emotion associated with reaction to threat useful for mobilising quick & adaptive reactions in response to threatening situations
- adaptive response > may trigger flight or fight response
3
Q
what is anxiety?
A
- apprehension abt future threat
- future focused cognitive association that connects basic emotions e.g. fear to events, meanings and responses
- adaptive response > increases preparedness
- can be maladavptive > distress & impairment in daily functioning
4
Q
what is fear conditioning?
A
- Mowrer’s two factor model > classical conditioning : person learns to fear NS paired with UCS, > operant conditioning: person gains relief by avoiding CS = avoidance maintained through neg reinforcement
5
Q
what is the DSM criteria for generalised anxiety disorder (GAD)?
A
- Excessive worry about multiple domains for at least 3m
- anxiety associated w/ one + of following: restlessness & muscle tension
- associated w/ > marked avoidance of behaviours w/ possible neg outcomes
- disturbance causes clinically significant distress & impairment affecting daily functioning
6
Q
what are biological the causes for GAD?
A
- Genes > twin studies> heritability 30%
- Brain areas > amygdala & prefrontal brain regions = abnormalities in emotional regulation
- Neurotransmitters > serotonin, norepinephrine & GABA imbalances
7
Q
what are the cognitive models for worry?
A
- metacognitive model: normal worry (type1; normal) & meta worry (type2: pathological) - worry about worry
- cognitive avoidance model: worry to suppress emotional processing of fear/ control neg emotions
- contrast avoidance model: engaging in worry to be distressed & ready for worst case scenario
- intolerant of uncertainty model > individuals who find it hard to tolerate ambiguity
8
Q
what are the cognitive mechanisms of GAD?
A
- attention to threatening stimuli > heightened focus on potential threats= increase anxiety
- difficulty to disengage from threat >struggle to shift attention away from perceived threat
- attentional avoidance > actively avoiding stimuli perceived as threatening
- reasoning & interpretation biases > interpret situation as more dangerous
9
Q
what is the integrated cognitive model of worry?
A
- interaction between involuntary (bottom up) processes and voluntary (top down) processes
- automatic selective biases >lvl of awareness> neg thought feeling
- GAD sufferer make conscious attempt to overcome this situation by thinking of solution to avoid worrying
- automatic cognitive bias and attentional control make difficult to break off this cycle of worrying
10
Q
what are treatments for GAD?
A
- psychological therapy > CBT >stimulus control & exposure + cognitive reconstructing
- exposure CBT > exposing individual to anxiety, triggers in controlled manner
- scheduled worrying > located time for worrying = sense of control
11
Q
what are panic attacks
A
- abrupt surge of intense fear/intense discomfort that reaches a peak within minutes
- out of the blue or associated with specific situations
12
Q
what are panic attack symptoms?
A
- physical: chills or heat sensations> heart palpitations, dizziness, hyperventilating, nausea, trembling, numbness or tingling
- cognitive: severe apprehension > fear of losing control, fear or dying, derealisation > feeling of unreality or depersonalisation > feeling detached from oneself
13
Q
what is the DMS-5 panic disorder critera?
A
- recurrent, unexpected panic attacks followed by 1m + either persistent worry abt additional panic attacks
- significant maladaptive change in behaviour related to the attacks > e.g. avoidance behaviour
- disturbance is not attributable to direct physiological effects of a substance
14
Q
what is agoraphobia?
A
- a fear or avoidance of situations or places where escape might be difficult or help might not be available in event of a panic attack
- ppl with agoraphobia may avoid crowded places, open spaces, public transportation, or situations where they perceive it might be challenging to leave
15
Q
what is the DSM-5 criteria for agoraphobia?
A
- marked fear or anxiety from two or more of the following situations:
- public transport
- open spaces
- being in shops
- standing in Line/crowd
- being outside of the home alone in other situations
- fears these situations due to thoughts that escape might be difficult or help might not be available in event of panic like symptoms
16
Q
what are psychological theories of panic disorder?
A
- classical conditioning > associating NS with panic attack = fear response
- anxiety sensitivity
- catastrophic misinterpretation of bodily sensations > (e.g. increased heart rate) as sign of severe medical problem < cognitive factors > interpret as impending doom
- role of safety behaviours
17
Q
what are biological theories of panic disorder?
A
- hyperventilation > rapid breathing = ventilation exceeding metabolic demand = carbon dioxide too low = raising blood ph lvl
- noradrenergic overactivity > ppl with PD deficient in GABA neurons
18
Q
what are behavioural factors of Panic Disorder?
A
- interoceptive conditioning > classical conditioning of panic in response to internal bodily sensations > person experiences somatic signs of anxiety - followed by panic attack = panic attack become conditioned response to somatic changes
19
Q
what is the panic cycle?
A
- triggering stimulus = perceived as threat> apprehension
- monitoring of body increases adrenaline
- beliefs increase anxiety
- further adrenergic effect on autonomic system
- safety behaviours e.g. rituals or actions to prove prevent anxiety or avoidant strategies = maintain by reinforcing belief
20
Q
what are treatments of Panic Disorder?
A
- medication > tricyclic antidepressants & SSRIs recommended as long term treatment, benzodiazepines & sedatives not recommended by NICE
- CBT> relaxation, breathing retraining, cognitive restructuring
21
Q
What are key facts about anxiety disorder?
A
- prevalence > 28% ppl affected
- 2015 AD 10th leading cause of disability worldwide
- Generalised Anxiety disorder (GAD) > 5% in UK
- more common in females > age range 35-59
- affects around 40% of ppl in their lifetime
- high comorbidity > i.e. depressive disorder
22
Q
what are environmental causes of GAD?
A
- unpredictable & stressful events
- parenting style on development> attachment style
- high stress environments > inc: socioeconomic factors
23
Q
what are psychological theories of GAD?
A
- info processing biases, beliefs & the function of worrying > (necessary to prevent future catastrophe)
- dispositional characteristics of worriers
24
Q
How has medication for anxiety changed overtime?
A
- in the 50s and 60s > benzodiazepine (benzos) were commonly prescribed > no longer due to guidelines from nice
-current medication > anxiolytics or anti depressants (SSRI) > higher intensity approach
25
what are treatment guidlines for GAD?
- follows step care approach
> 1: assessment, education, and monitoring
> 2: low intensity, psychotherapy, intervention > self-help
> 3: high intensity, psychotherapy, interventions > drug treatment
> 4: specialist care for complex cases
- depending on severity and response to initial treatments > may use combination of medical and therapy
