anxiety disorder Flashcards

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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
Q

what are treatment guidlines for GAD?

A
  • 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