Anxiety Disorders Flashcards
What is the difference between fear, panic and anxiety?
Fear→ response to real or perceived current threat
- not a bad thing
- fight or flight response
- physiological answers→ increased heart rate, blood pressure, muscle tension…
Panic→ very similar to fear response physiologically
- BUT trigger even with absence of danger
- false alarm
Anxiety→ future oriented
- might be same symptoms as fear and panic
- absence of current threat
—>Anxiety disorders group anxiety and panic
—>need to have some high level of anxiety or panic that is preventing you from living your life
What is a phobia?
Phobias→ Marked, persistent, and excessive or unreasonable fear when in the presence of or anticipating encountering an object
- different from panic because cued fear
- situationally-bound panic attacks
Criteria
- exposure to stimulus almost invariably produces anxiety response
-phobic situation is avoided OR endured with intense distress
- avoidance counts as impairment
- ex: elevator phobia→ if only go places with stairs, would qualify
- interfere with a person’s normal functioning→ intense fear is not alone
What is the lifetime prevalence of specific phobias. gender differences and the age of onset?
- Specific→ 12.5%
- average onset of phobias is around 7-9yo
- 2F:1M
- Agoraphobia→ 1.5%
- agoraphobia→ 28yo
What are the different types of phobias?
Animal-Type→ rodents, reptiles, insects
- very common
Natural Environment-Type
- storms, heights
Blood/Injection/Injury type
Situational type
- tunnels, bridges, elevators, flying
Residual Other category
- choking, vomiting, illness, loud noises, falling down
Explain Operant conditioning
-Operant conditioning→ associating a response and its consequence
-Positive reinforcement-> supply a likeable stimulus in response to the behaviour
-Negative reinforcement-> remove an aversive stimulus in response to the behaviour
—>reinforcement increases behavior AND punishment decreases behavior
SEE TABLE
What is the learning theory developed by Orval Hobart Mowrer to explain phobias?
Orval Hobart Mowrer→ Learning Theory
- acquire through classical conditioning
- Dog fear because once bitten by a dog
- start to avoid the stimulus and then fear decrease→ negative reinforcement
—>would need some sort of traumatic experience
- BUT only 50% of people had a negative experience before the phobia
- might be due to forgetting?
- vicarious transmission→ don’t need to experience the stimulus ourselves to learn from experience/ can be a relative or something we’ve heard
—>not all traumatic experiences lead to phobias
What is the Evolutionary Preparedness theory?
Theory to explain phobias to certain things
- sensitivity to certain stimuli is adaptive and evolutionary
- ex: more easily to acquire fear to snake than daisies
How does familiarity with an object impact the likelihood of developing a phobia?
Lot of prior neutral or positive experience with objet might make it more difficult to develop phobias after negative experience
- novelty might have an impact
- familiarity as a buffer
What are the crtiteria for a diagnosis of panic disorder?
Panic must be uncued
- if respond reliably to stimulus→ phobias
Recurrent unexpected panic attacks
- at least one followed by a month or more of a persistent concern about having panic attacks
- not better accounted for by another disorder
- attacks develop abruptly and peak in 10minutes
- discrete period of fear or discomfort with 4 out of 13 symptoms
What are the common symptoms of a panic attack?
- palpitations, pounding heart, accelerated heart rate
- sweating
- trembling or shaking
- sensations of shortness of breath
- feeling of choking
- chest pain or discomfort
- nausea or abdominal distress
- feeling dizzy, unsteady, lightheaded, or faint
- chills or heat sensations
- paresthesias (numbness or tingling sensations)
- derealization (feelings of unreality) or depersonalization (being detached from oneself)
- fear of losing control or going crazy
- fear of dying
What are the different types of panic attacks?
Different types of panic attacks
- non-cognitive panic→ without fear of dying, losing control or going crazy
- nocturnal panic attacks→ waking from sleep with a feeling of panic
- 44-71% of people with panic disorder report at least one
What are the behavioural features used by people suffering from panic disorder?
Interoceptive avoidance→ avoidance of the internal bodily symptoms associated with anxiety
- ex: avoiding exercise, sex, caffeine…
Safety signals→ cues that signal safety
- ex: hospital near by, a close one…
- might help on short term
- BUT maintain panic disorder in the long term by preventing the disconfirmation of patient’s catastrophic predictions
Experimental avoidance
- ex: watching TV, eating…
- distraction often represent an unwillingness to experience anxiety-related thoughts
High on neuroticism
What is the epidemiology of panic disorder?
Lifetime prevalence→ 4-6%
- 2F:1M
- no significant associations with race/education
- median age of onset–>24
- very abrupt onset
- very high comorbidity→ 94% have at least one other mental disorder
- children with panic disorder more likely to apply external explanation than adults
-highly chronic
To what extend do genetics infleunce panic disorder?
Genetics→ 30-40%
- moderate loading for panic disorder and agoraphobia
- gene polymorphism 5‐HTTLPR→ a promoter region on the serotonin transporter gene could represent a genetic vulnerability
- adenosine receptor gene→ understand panic disorder dimensionally
What are the different proposed etiology for panic disorder?
Infant attachment
- insecure attachment might lead to development of anxiety disorders
- control during experimentation buffer effects of stressful experiences
Parenting
- bidirectional relationship between anxiety of mother and adolescent
- anxious mothers were observed to criticize and catastrophize more, and to display less warmth and autonomy granting toward their children
Child abuse→ more risk for panic disorder
Stress-diathesis perspective
- pre-existing vulnerability + life stressors can lead to panic disorder
Anxiety sensitivity→ risk factor for panic disorder
- primes reactivity to bodily reactions
What are the different psychological theories of panic proposed?
David Clark→ might be due to catastrophic misinterpretations of bodily sensations
- vicious cycles
- symptoms internally generated but sometimes come from caffeine, cocaine, anger
Reiss and McNally→ Anxiety Sensitivity Index
- Trait-like differences in how fearful one is about physiological sensations of anxiety
- sensitive people more likely to panic when they experience anxiety
- ex: study showed that people scoring high on the ASI were then more likely to develop panic disorder
Eysenck→ interoceptive fear conditioning
- low‐level somatic sensations of arousal or anxiety become conditioned stimuli due to their association with intense fear, pain, or distress
What could be the underlying neurocircuitry of panic?
Amygdala→ responsible for response system in panic disorder
- activate hypothalamus, locus coeruleus (heart rate), parabrachial nucleus (changes in respiration)
- under activation of the ventromedial prefrontal cortex (vmPCF)
- low baseline GABA levels→ not necessarily specific to panic disorder
What are the criteria for a diagnosis of generalized anxiety disorder?
DSM-IV→ Excessive anxiety and worry
- most of the days
- more days than not for at least 6months
- about multiple events and objects
- CANNOT occur exclusively during the mood episode
- no avoidance of object of anxiety
- anxiety about being anxious/ not about something external
Additional symptoms
- Restlessness, feeling on edge
- Easily fatigued
- Difficulty concentrating
- Irritability→ interfere with relationship with others
- Muscle tension
- Sleep disturbance
- Must cause significant distress or impairment
—>lot of overlap with depression
What are the rates of comorbidity for GAD?
Controversial→ almost always comorbid with other disorders
-90% meet criteria for another disorder
- Survey found that 80% of respondents with a principal diagnosis of GAD also had a comorbid mood disorder
- 41% with panic disorder
- 42% with SAD
- 29% with MDD
–>could just be a vulnerability marker for other disorders
What is the epidemiology of GAD?
Lifetime prevalence→ 5-6%
- 2F:1M→ bidirectional genetic vulnerability and gender socialization
- most commonly diagnoses disorder in primary care
Median age of onset→ 30s
- symptoms often already present in adolescence
- gradual onset
- earlier onset means higher levels of symptoms severity
Chronic course→ even after recovery, still higher level of worry
- personality disorder ?
- 12y follow up study, recovery 58%
- recurrence rate is high
What are the theories of worrying ?
Tom Borkovec→ worry=cognitive avoidance
- worry inhibits emotional processing
- engage in high functioning cognitive activity instead of feeling the emotion
- worry about low probability events
- worry to prevent something from happening
- negative reinforcement
- story with elephants
Try to control the worry
- vicious cycle
- increase intrusiveness of thoughts
- increase sense of lack of control
How does exposure therapy can infleunce GAD?
Treatment→ need imaginary to become emotionally aroused
- worry buffers GAD from high emotional arousal
- need patients to get aroused
What are the cognitive factors responsible of GAD?
Attentional biases
- information processing bias→ greater attention to threatening stimuli
- ex: emotional stroop or visual dot-probe task
- look more at threating material AND ambiguous stimulus
- ambiguous word stems more likely to be completed with negative words
- more negative available info
Poor problem solving or poor confidence in problem solving
Intolerance of uncertainty→ cognitive filter and vulnerability factor for mood and anxiety disorders
Overestimation and catastrophizing
What are the biological explanations of GAD?
- decreased GABA activity
- GABA receptors congregated in brain regions implicated in fear (amygdala, PFC
- serotonin
