Anxiety Disorders Flashcards
Immediate emotional alarm reaction to present danger or life-threatening emergencies
Fear
A mood state that follows from apprehension about (potential) negative future outcomes
Anxiety
Sudden overwhelming fear or terror
Panic
Fast onset of panic that includes intense physical symptoms
Panic attack
Describe why anxiety is important for life
A moderate level of anxiety is helpful by motivating action and increasing concentration
Anxiety can help us avoid potential threats through problem-solving
Describe what the optimal arousal graph suggests
Medium arousal (optimal) produces the highest performance
What are the four categories of anxiety-related disorders?
Anxiety Disorders
Obsessive-Compulsive Disorder
Post-Traumatic Stress Disorder
Illness Anxiety Disorder
What are the five types of anxiety disorders?
Generalized Anxiety Disorder
Social Anxiety Disorder
Separation Anxiety Disorder
Specific Phobia
Panic Disorder
What is the evolutionary perspective as it relates to anxiety?
Evolution has favored humans who are threat sensitive (increased survival)
What are the two major neural circuits that control anxiety?
Fight-or-flight
Behavioural inhibition system
Describe the process of the fight or flight response after encountering a perceived threat
Panic response to a perceived threat
Corticotropin-releasing factor (CRF) stimulates the hypothalamic– pituitary–adrenocortical (HPA) axis
Leads to specific physiological change (e.g. increased heart rate)
The behavioural inhibition system control the —
Freeze response
Signals our bodies to stop and evaluate the situation to determine the threat
Freeze response (BIS)
What four developmental factors can contribute to developing an anxiety disorder?
Childhood environment
Parental strategies
Social learning (that worry is useful)
Possible gene-environment correlations
Describe the possible gene-environment correlations related to developing an anxiety disorder
Anxious parents create environments that might enhance anxiety while also passing on genetic vulnerability
What two psychological factors may contribute to developing an anxiety disorder?
A need for control
Avoidance (perpetuates anxiety)
What social factor can contribute to developing an anxiety disorder?
Stressful life events can trigger anxiety
Early negative experiences
An integrated model of three key factors that contribute to anxiety
Triple Vulnerability Theory
Describe the three vulnerabilities outlined by triple vulnerability theory
The first vulnerability (diathesis) = generalized biological vulnerability
The second vulnerability = generalized psychological vulnerability
The third vulnerability = specific psychological vulnerability
— is the most common mental health concern globally
Anxiety
— of Canadians aged 12 and over have a diagnosed anxiety disorder
8.6%
How much comorbidity exists between anxiety disorders and mood disorders?
1/3 Canadians diagnosed with a mood disorder have been diagnosed with an anxiety disorder
Up to 50% comorbidity between anxiety and depressive disorders over a lifetime
Describe the logic behind exposure therapy
Most anxiety disorders are characterized by avoidance, which worsens the anxiety
Exposure is about facing the fear directly
Name four examples of types of exposure therapy for anxiety disorders
Imaginal exposure
In-vivo (real-life) exposure
Interoceptive (physical sensations) exposure
Virtual reality exposure
Why does exposure therapy work?
Habituation and inhibitory learning
Name two types of relaxation techniques
Meditation and/or relaxation breathing
Grounding exercises
What are the four common treatment options for anxiety disorders?
Exposure therapy
Relaxation techniques
Existential techniques
Cognitive-behavioural strategies
Focus on finding meaning in life despite
unfortunate truths
Existential techniques
Achieving happiness through cultivating virtues (not
material success) and accepting the present moment as it is,
regardless of the pleasure or pain it brings
Stoicism
What are the two major categories of medications for anxiety?
Benzodiazepines
SSRIs
Fast-acting central nervous depressant that affects the GABA system
Benzodiazepines
Why are benzodiazepines not recommended for managing anxiety in the long-term?
Can lead to dependence and many negative health
effects
The recommended first line medication treatment for anxiety
SSRIs
What are the DSM-5 criteria (A-F) for generalized anxiety disorder?
Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months,
about a number of events or activities
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) the list of six symptoms
D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
E. The disturbance is not due to the direct physiological effects of a substance
or another medical condition.
F. The disturbance is not better explained by another mental disorder
What are the six symptoms associated with generalized anxiety disorder under criterion C?
- Restlessness or feeling keyed up or on edge.
- Being easily fatigued.
- Difficulty concentrating or mind going blank.
- Irritability.
- Muscle tension.
- Sleep disturbance
GAD tends to be — severe and debilitating than other disorders, which may prevent people from
seeking treatment
Less
Are there gender and age-related differences concerning GAD?
Yes: Experienced more by women and those over 45 years old
4 notable features that distinguish people with GAD?
- Intolerance of uncertainty
- Positive beliefs about worry
- Poor problem orientation
- Cognitive avoidance
How is intolerance of uncertainty treated for those with GAD?
Behavioural experiments
Exposure to uncertain situations (habituation and tolerance)
How are positive beliefs about worry treated for those with GAD?
Discussing the pros/cons of worrying and challenging
these positive beliefs
How are low problem orientations treated for those with GAD?
A component of CBT for GAD is teaching effective problem-
solving skills
Reframing problems as inevitable aspects of life/opportunities to learn
How is cognitive avoidance treated for those with GAD?
Imaginal exposure, worry scripts
What are the two types of cognitive avoidance strategies typically used by people with GAD?
Invisible strategies (suppressing thoughts)
Overt strategies (avoiding certain situations)
Describe why avoidance makes anxiety worse
The more we try to
repress our thoughts, the more they come back
Fear of leaving a safe space (e.g. home), belief the outside is dangerous
Agoraphobia
What is the relationship between agoraphobia and panic disorders
Someone with panic attacks might develop agoraphobia
Prevalence rates for panic disorders and agoraphobia are —
About 5% and under
What is the difference between an expected and an unexpected panic attack?
Expected panic attacks have a clear trigger.
Unexpected panic attacks do not have a clear trigger and happen “out of the blue”
What are the DSM-5 criteria (A-D) for panic disorders?
A. Recurrent unexpected panic attacks: An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the listed symptoms occur
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the listed conditions
C. The disturbance is not attributable to the physiological effects of a substance
D. The disturbance is not better explained by another mental disorder
A subtype of panic attacks that present in many South American countries; characterized by screaming and crying
Ataque de nervios
A phenomenon described in Inuit and Western Greenland hunters where panic symptoms emerge while hunting at sea; can lead to avoidance
Kayak angst
What are the criteria (A-E) for agoraphobia?
A. Marked fear or anxiety about two (or more) of the five listed situations…
B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms
C. The agoraphobic situations almost always provoke fear or anxiety.
D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.
True or False: Panic disorder is highly treatable
True
Describe panic symptoms as a “vicious cycle”
People with panic disorder catastrophically misattribute normal bodily sensations (e.g. elevated heart rate = heart attack, arousal misinterpreted as anxiety)
People then avoid these sensations and the situations that might trigger them (e.g. agoraphobia)
Overt actions or thoughts that people do to cope with anxiety in the short-term, but perpetuate anxiety in the long-term
Safety behaviours
What are five common safety behaviours?
Avoidance of physical activities or situations where a panic attack may occur
Relaxation strategies, distraction, and prescription medication
Excessive checking of one’s body and of medical information
Seeking reasurance from family, friends, and physicians
Carrying safety aids such as a cellphone, water bottle, medications
People are systematically exposed to bodily sensations associated with panic (like elevated heart rate)
Interoceptive (Bodily Sensation) Exposure for Panic Disorders
What are the four common categories for phobias/
Situational
Animals (those with more immediate adverse effects seem to more readily become phobias)
Blood-injection-injury
Other (e.g vomiting)
What is the DSM-5 criteria (A-G) for specific phobias?
A. Marked fear or anxiety about a specific object or situation
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
G. The disturbance is not better explained by the symptoms of another mental disorder
What are the top three most common phobias?
Illness/injury, storms, animals
What does treatment for specific phobias entail?
Gradual exposure is the frontline intervention for specific phobia
What is the DSM-5 criteria (A-F) for social anxiety disorder?
A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.
B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated
C. The social situations almost always provoke fear or anxiety.
D. Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.
E. The social situations are avoided or endured with intense fear or anxiety.
F. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context
What is the lifetime prevalence of SAD?
13.3% of the population
What are features of treatment for SAD using CBT?
Tracking fear-based beliefs
Considering safety behaviour
What are three treatments for social anxiety?
Exposure-based methods including behavioural experiments
Social skills training (if there is a skills deficit)
Performance-only subtype: practicing while experiencing physical sensations of anxiety
Not speaking in one or more settings where speaking is expected (e.g. school)
Selective mutism (caused by social anxiety)
