Anxiety disorders Flashcards
Characteristics
I
Generalised anxiety disorder
-pattern of frequent, persistent worry and apprehension about a perceived threat in the environment; the threat must be minor or non-existent
-panic attacks are common
-high level of anxiety can manifest itself in different ways: restlessness, muscle tension, constantly feeling on the edge, difficulty concentrating, tired, irritable, sleep disturbances
Phobias: Case study
-Kimya, f, 39
-fear of birds and related
Types: agoraphobia
-the fear of public places
-they will avoid agoraphobic situations or experience distress when experiencing them
Blood phobia
-irrational fear of blood, can extend to needles, injections or other evasive medical procedures
-may avoid hospitals or receiving injections
-increased heart rate when seeing blood, drop in blood pressure, may lead to fainting
Animal phobia
-may include: bird, dog, insect and spider phobias
-experience distress or even panic attacks when facing them
Measures
Blood injury Phobia Inventory (BIPI) measures blood phobia
-comprises 18 situations involving blood and injections
-the self report measure lists possible situations and asks to evaluate different reactions (cognitive, physiological, behavioral)
- 0-3 (never-always)
Generalised Anxiety Disorder 7 (GAD-7) is a screening test used to enable further referral to a psychiatrist
-has 7 items which measure the severity of anxiety
- 0-3 (not at all- nearly every day)
-useful for a further referral rather than a diagnosis
Evaluation of measures
+concurrent validity
-relies on self-report
Explanations of Phobias
II
Behavioural: classical conditioning
-Watson 1920
-may develop phobia if harmless stimulus is paired with frightening experience
Watson 1920: Little Albert
-11 month old
-shown white things prior to conditioning ->normal reaction
- white rat was chosen Neutral Stimuli (NS)
-metal bar struck with hammer behind head was unconditioned stimuli (US)
-US produced unconditioned response of fear (UCR)
-white rat produced response of fear in the boy
-the white rat became the conditioned stimuli (CS) and produced conditioned response of fear (CR)
-also learned to fear the white rabbit
Psychoanalytic
-Freud 1909
-anxiety and fear can result from the impulses of the id, usually when it is being denied or repressed
-phobias are one way this internal conflict can manifest
Freud 1909: Hans
-Hans, 5 yr old, phobia of horses
-developed interest in his penis, he often played with it
-mother was upset and threatened to cut it
-the boy was upset and developed a fear of castration
-young sister was born and mom was separated from him in hospital
-witnessed horse dying
-worried he would be bitten by a white horse
-conflict emerged between him and his father who had denied him coming into their bedroom in the morning to sit with his mother
-two fantasies: having children with mother, plumber replacing penis with larger one
-horse represented his father
-anxiety related to fear of castration and the banishment from parents’ bed
-Oedipus complex
Biomedical/Genetic
-Ost
-born prepared to fear certain objects
-threatening stimuli in environment we avoid with the help of genetics
-fear passed down through DNA
Ost 1992
-81 bloodphobic and 59 injection phobic also compared to a sample of other phobias
-underwent screening interview with clinician and also completed self-report questionnaire based on history and nature of phobia
-behavioural test: blood phobic shown 30 minute silent colour video of surgery; the injection phobic test was live and included 20 steps
-the measure included: percentage of maximal performance , rating of patient’s fainting (0-4), self rate of anxiety (0-10), questionnaire on thoughts, blood pressure, heart rate
-50% of b.p and 27% of i.p had 1 or more parents with same fear
-21% b.p at least one sibling with same
-70% b.p 56% i.p had a history of fainting
-more likely than any others to produce fainting
Cognitive
-Di Nardo
-bias in reasoning of what is harmful
-more likely to see ambiguous stimuli as harmful
-negative self beliefs, such as inability to cope with phobic stimuli
Di Nardo 1988
-origin of cynophobia
-14 dog-fearful and 21 non-fearful female college students
-individual structured interviews to gain info on origin of phobia
-whether unpleasant events known as conditioning events were more common in cynophobes or in non-cynophobes
-to compare expectations of harm and fear upon encountering a dog
-aged 18-21
-37 females
-57% of fearful had conditioning events
-66% in non-fearful group
-all of fearful group expected fear or harm upon encounter compared with a small minority in non-fearful
-concluded that factors other than conditioning are at play -> own interpretation and rationalisation
Evaluation Watson and Rayner, and Freud
-case studies no generalisability
+Watson &R conducted a number of trials using different stimuli -> greater relationship between cause and affect/ better levels of control over variables
-Freud’s lacked objectivity as he was friends with the father
-lacks validity as it may be biased to fit into his existing theories
Evaluation Ost, and Di Nardo
+standardised tests
+larger sample
+more generalisable
+better levels of control over variables
-cross-sectional (not longitudinal just in present) and did not consider different experiences in depth
Treatment and management
III
Systematic desensitisation
-Wolpe
-is a way of reducing undesirable responses to a particular situation
-holds the assumption that nearly all behaviour is a conditioned response to stimuli in the environment
-reciprocal inhibition: impossible 2 opposing emotions simultaneously
-to put fearful feelings associated with phobia directly in conflict with deep relaxation
-relaxation techniques, anxiety hierarchy, in vitro, in vivo,
Applied tension
-Ost
-applying tension to muscles, which increases blood pressure
-aim is to reduce instances of fainting in blood phobics
Ost et al 1989
-30 patients, same hospital, phobia of blood, wounds, injuries
-between 18-60, 19 w
-comparison between applied tension, applied relaxation, or a combination
-independent groups design
-self report and measures prior
-after treatment and 6 month follow up they were measured again
-73% across all groups showed improvements, but applied tension
behaviours are learned throug association
ok
CBT
-Ost & Westling
-the need to change the individual’s thoughts and beliefs about the source of their anxiety
-
Ost & Westling 1995
-compared effectiveness of CBT with applied relaxation (AR) in treatment of panic disorder
-38 patients, across 12 weekly sessions
-assessed using self report scale, before, after, and 1 yr follow up
-kept diary
-1st step: identifying the misinterpretation of bodily sensations
-2nd step: encouraged to generate alternative, non-catastrophic interpretations of their bodily sensations
-3rd step: therapist challenged the patient’s evidence for their beliefs
-both groups were successful and no relapse
Evaluation Ost et al
-sample from same hospital, limits generalisability
-independent groups design, participant variables
-shown videos of surgery which raises ethical issues
Evaluation Ost and Westling
+well controlled, better control over variables
+longitudinal
