Anxiety Disorders Flashcards
What are the 3 main elements of anxiety?
- Behavioral response
- A physiological reaction
- An internal psychological feeling
What is the difference between fear and anxiety?
Fear: - Response to an immediate threat - "I am in danger!" - Increased heart rate - Desire to escape or run Anxiety: - More general - "I am worried about what might happen" - Tension - General avoidance
What are the nine different anxiety disorders in the DSM 5?
- Panic disorder
- Panic attack disorder
- Agoraphobia
- Specific phobia
- Social anxiety disorder
- Generalized anxiety disorder
- Separation anxiety disorder
- Substance induced anxiety disorder
- Anxiety disorder due to another medical condition
What percentage of people with mental illnesses report having anxiety?
20%
What is the main feature of generalized anxiety disorder?
Chronic state of uncontrollable or excessive worry
What are some of the issues of generalized anxiety disorder in terms of diagnosis?
- There can be nonspecific risk factors versus disorders in their own right
- Hard to diagnose
What is the psychodynamic explanation of generalized anxiety disorder?
Anxiety due to unconscious conflicts between the id and ego
What is the systems model for generalized anxiety disorder?
Affected individuals have the physiological inability to fully resolve the problem so the anxiety persists
What are medications for generalized anxiety disorder?
Anti anxiety medications e.g. benzodiazepines
What are psychological treatments for generalized anxiety disorder?
Exposure based treatment that challenges the client to confront the situations/objects that are causing them worry
- Systematic desensitization
What are examples of this psychological techniques for generalized anxiety disorder?
- Relaxation training
- Cognitive behavioral methods
- Challenge and modify negative thoughts
- Increase ability to tolerate uncertainty
- Worry only during scheduled times
- Focus on present moment
What are essential features of panic disorders?
- Occurrence of recurrent panic attacks
- Must have 4 or more panic attacks in a 4 week period to meet diagnostic criteria
- Can be with or without agoraphobia
What are uncued attacks?
- Occur unexpectedly or without warning
- Panic disorder diagnosis requires recurrent uncued attacks
- Causes worry about future attacks
What are cued attacks?
- Triggered by specific situations
- Phobia based
What is the role of norepinephrine in panic attacks?
- Increased levels of norepinephrine increase the likelihood of panic attacks
- SNRIs inhibit this reuptake of norepinephrine and serotonin
What are genetic factors of panic attacks?
It is 10x more likely in families with panic disorder
Where are panic attacks triggered in the brain?
Locus coeruleus
Where is secondary anxiety generated?
Limbic system
Where is avoidance mediated?
Frontal lobes
What is the biological theory of panic, anxiety, and agoraphobia?
- Panic attacks arise in the amygdala in the locus coeruleus
- Anticipatory anxiety people experience about having another panic attack is generated in the hippocampus of the limbic system
- Avoidance from social situations is generated in the frontal lobes
What medication treat panic disorder?
- SSRIs (antidepressants)
What are psychological treatments to treat panic disorder?
Cognitive behavioral therapy
A. teaching patient about panic
B. training anxiety reduction techniques (breathing)
C. cognitive techniques (distraction)
What percentage of people who take SSRIs and stop have relapse symptoms?
40%
What is panic control therapy (PCT)?
- Exposure to somatic sensations associated with a panic attack in a safe setting
- ## Coping strategies (breathing, relaxation)
What is agoraphobia?
- Fear of being in places in which escape would be difficult
- Fear of open spaces
What fraction of people with agoraphobia are women?
2/3
What do symptoms of agoraphobia look like?
- Examined with panic attacks but some do not experience panic like symptoms
- Can be mild at first
- Symptoms are less when with a trusted friend
Agoraphobia is marked about having fear of one of the following
- Using public transportation
- Being in open spaces
- Being in enclosed spaces
- Standing in line or being in a crowd
- Being outside the home
What are 7 common fears?
- Injections
- Flying
- Cats
- Clowns
- Bridges
- Blood
- Spiders
What are phobias?
Persistent and irrational fear associated with specific objects or situations leading to avoidance
What is the psychodynamic explanation of phobias?
Unconscious conflict that is strictly clinical
What is the biological model for phobias?
Preparedness hypothesis and evolutionary significance (bears and snakes)
What is the cognitive behavioral model for phobias?
- Learned through association through classical conditioning
- Concept of self-efficacy
How are specific phobias treated?
Systematic desensitization
- imaginal versus in vivo exposure
- flooding
What treatments are not recommended for phobias?
Medication
What is social anxiety disorder?
A persistent fear of one or more social situations in which the person is exposed to unfamiliar people or possible scrutiny by others. The individual fears that they will act in a way that is humiliating or embarrassing.
Is social anxiety disorder more common in females or males and what do they have a hard time receiving/doing?
Males: have a hard time receiving social criticism and eating or drinking in front of others
When does social anxiety disorder usually start?
Adolescence
What is the difference between social anxiety disorder and agoraphobia?
Social anxiety disorder: fear of being introduced
Agoraphobia: being alone, public spaces, stores
What are cognitive factors of social anxiety disorder?
- Unrealistic negative beliefs about about consequences of behaviors
- Excessive attention to internal cues
- Fear of negative evaluation by others (expect people to dislike them)
- Negative self evaluation (harsh on themselves)
How is social anxiety disorder treated via psychological treatments?
- Exposure and social skills training
- Exposure and cognitive-behavioral therapy involving cognitive reconstruction
- Important for self-efficacy and confidence that a person can cope successfully
How is social anxiety disorder treated via medication?
- Antidepressants
- Anti-anxiety medications (can be addictive)
What is separation anxiety disorder?
- Excessive fear or anxiety concerning separation from the home or the attachment figure
- MUST be excessive
- Decreases prevalence with age
What is selective mutism?
- Inability or failure to speak in social situations where the expectation is to speak such as school
- Not just related to autism spectrum disorder
- Very rare
- Mostly seen in children
What does social anxiety disorder increase with?
Increases with substance use disorder
What percent of people with anxiety disorder meet the criteria for another anxiety disorder?
80%
What are the causes of comorbidity?
- Symptoms used to diagnose the various anxiety disorders overlap: social anxiety disorder and agoraphobia both involve fear of large crowds
- Etiological factors may increase risk for more than one anxiety disorder
What percent of those with an anxiety have another psychological disorder?
75%
What are disorders typically comorbid with anxiety?
- 60% of those with anxiety also have depression
- Substance use disorder
- Personality disorders
- Medical disorders
What are six factors that might increase the risk for more than one anxiety disorder?
- Genetic vulnerability
- Decreased functioning of GABA and serotonin and increased norepinephrine activity
- Behavioral inhibition
- Neuroticism
- Cognitive factors such as sustained negative beliefs
- Increased activity in the fear circuit of the brain
Why are women twice as likely as men to have anxiety disorders?
- Women are more likely to report symptoms
- Men are more likely to face fears
- Women are more likely to experience childhood sexual abuse
- Women show more biological stress reactivity –> active sweat glands, muscle contractions
What are genetic risk factors for anxiety disorders?
- Twin studies suggest heritability of about 20-40% for phobias, generalized anxiety disorder, and PTSD and about 50% with panic disorder
What are neural characteristics for people with anxiety disorders?
- Fear circuit overactivity (amygdalda)
- Nuerotransmitters (Poor functioning of serotonin and GABA/ higher levels of norepinephrine)
What are risk factors of social anxiety?
- Behavioral inhibition
- Tendency to be agitated, distressed, and cry in unfamiliar situations
- Observed in infants - Predicts anxiety in childhood and social anxiety in adolescence
- Neuroticism
- React with negative affect
- Linked with anxiety and depression
- Higher levels linked to double the likelihood of developing anxiety disorders
What are cognitive risk factors of anxiety disorders?
- Sustained negative beliefs about the future
- Bad things will happen
- Act cautiously - Belief that one lacks control over environment
- More vulnerable to developing anxiety disorder
- Childhood trauma can foster those beliefs
- Serious life events can threaten sense of control - Attention to threat
- Tendency to notice negative environmental cues
- Selective attention to signs of threat
What are medications used in general to treat anxiety disorders?
- Anti-anxiety medications (benzodiazepenes: valium and xanax)
- Antidepressants (SSRIs, and SNRIs)
