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Anxiety Disorders Flashcards

1
Q

Differences between anxiety and fear

A

Anxiety is a mood, whereas fear is an emotion
Fear is present-oriented, whereas anxiety is future-oriented
Fear is more intense than anxiety

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2
Q

Components of anxiety

A

Cognitions: apprehension, worry, dread
Behavior: avoidance
Physiology: stress response (cortisol)

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3
Q

Components of fear

A

Cognitions: danger
Behavior: escape
Physiology: fight or flight sympathetic arousal (adrenaline)

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4
Q

Anxiety disorders general characteristics

A

Pervasive and persistent anxiety or fear
Intense need for avoidance and escape
Clinically significant distress and/or impairment

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5
Q

Largest mental health problem in US

A

Anxiety disorders

20% lifetime prevalence

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6
Q

Panic attack

A

Abrupt period of intense fear that reaches its peak within minutes
Sympathetic response: pounding heart, sweating, shaking, shortness of breath, nausea/abdominal distress, paresthesias (numbing through various parts of body), chills or heat sensation, feeling dizzy or faint, chest pain/discomfort, feelings of choking, derealization or depersonalization, fear of losing control, fear of dying

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7
Q

Specific phobia description

A

Marked fear/anxiety about specific objects or situations
Exposure provokes a fear response
Object is avoided
Fear is out of proportion to danger

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8
Q

Types of specific phobia

A

Animal (spiders, mice, etc.)
Situational (small spaces, flying in airplane, etc.)
Natural environment (tornado, thunderstorm, etc.)
Blood injection injury (unique: person passes out)
Other (clowns, dolls, etc.)

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9
Q

Specific phobia epidemiology

A

Age of onset: teen years (11-17)
Chronic course
4:1 female to male
Relatively high lifetime prevalence (11%)

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10
Q

Specific phobia biological causes

A

Genetic vulnerability (moderate influence; don’t inherit phobia, but tendency)
BIS
HPA

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11
Q

BIS (Behavioral inhibition system)

A

Influence in all anxiety disorders
Drive to avoid danger
If high, then cautious

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12
Q

HPA (hypothalamus, pituitary, adrenal)

A

Influence in all anxiety disorders

Increased activity, then more likely to develop anxiety disorder

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13
Q

Specific phobia learning pathways

A

Classical/operant conditioning
Vicarious conditioning (observation)
Information transfer (someone tells you to fear something)
Prepared learning: people develop fears to some things more quickly than others (things that posed danger in human history)

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14
Q

Treatments for specific phobia

A

Cognitive behavioral therapy: exposure, flooding, graduated exposure
Medications rarely used

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15
Q

Exposure

A

Facing fear and discovering that nothing bad will happen

Used to treat phobias and panic attacks

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16
Q

Flooding

A

Put person in feared situation until fear response disappears
Not commonly used

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17
Q

Graduated exposure

A

Systematic desensitization using subjective units of discomfort
Used in treating phobias

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18
Q

Subjective units of discomfort

A

Patient rates levels of discomfort: 0 is not scary at all, 100 is extremely scary
Start out at low levels of discomfort and work up until patient is desensitized to feared stimulus

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19
Q

Panic disorder description

A

Recurrent, unexpected panic attacks

At least one month of worry about future attacks and behavioral change related to attacks

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20
Q

Panic disorder epidemiology

A

Age of onset: teens (11-17) and late 30’s
Course: chronic
33% of ER billing (similar symptoms to heart attack)
Gender: 2:1 female to male

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21
Q

Panic disorder learning pathways

A

Classical/operant conditioning
Fear response to interoceptive cues (learn to fear panicky feeling)
Cognitive: catastrophic misinterpretations of internal sensations

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22
Q

Panic disorder therapy treatments

A

CBT
Exposure, especially interoceptive exposure
Cognitive restructuring

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23
Q

Interoceptive exposure

A

Exposure to physical symptoms of panic attack without fear response
Ex- have patient breathe through straw

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24
Q

Cognitive restructuring

A

Changing the way people think

Challenging belief system

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25
Panic disorder medication treatments
Benzodiazepines (GABA): lower anxiety, but interfere with exposure therapy (take away fear) SSRIs and SNRIs: increase serotonin High relapse when discontinued (treats symptoms, not cause)
26
Agoraphobia
Anxiety about being in places/situations in which escape/help may be difficult in the event of a panic attack Can happen without panic disorder, but is most common with panic disorder Feared places/things: public transportation, open spaces, enclosed spaces, crowded place
27
Social anxiety disorder description
Marked fear/anxiety of social situations where there is possible scrutiny by others Fear of humiliation/embarrassment Situations are avoided Problem isn't with social skills
28
Social anxiety disorder epidemiology
Age of onset: around 15 Course: chronic Most common of anxiety disorders: 13% lifetime prevalence Slightly more common in females
29
Social anxiety disorder subtype
Performance only
30
Social anxiety disorder learning pathways
If someone laughs at you, you learn to fear being laughed at Cognitive: irrational beliefs ("Others are always judging me" or "I always mess up") Attentional biases: people read anger or judgment out of neutral faces
31
Social anxiety disorder therapy treatments
CBT, exposure, cognitive restructuring Gradually help people face fears: have them draw attention to themselves and force them to make social mistakes, helping them to realize that nothing bad will happen
32
Social anxiety disorder medication treatments
Antidepressants: SSRIs and SNRIs Beta-blockers (adrenaline antagonist) Relapse high when discontinued
33
Generalized anxiety disorder description
"What if" disorder Excessive and uncontrollable worry more days than not and across multiple domains Somatic symptoms of stress (restlessness, fatigue, difficulties concentrating, irritability, muscle tension, sleep issues)
34
Worry in GAD
Worry about low probability events (catching ebola, building collapsing, etc.) Positive beliefs about worry (worrying=problem solving) Emotion regulation strategy: verbal vs. imaginal (talking about things isn't as bad as visualizing things; worry keeps things in verbal)
35
GAD epidemiology
``` Age of onset: teens-early 20's Course: chronic 2:1 female to male Presents to primary care Highly comorbid with depression, other anxiety disorders, and substance abuse disorders ```
36
GAD genetic influence
Little evidence for genetic influence
37
GAD treatments
Most difficult of anxiety disorders to treat: medications aren't very effective and exposure doesn't work (nothing to be exposed to) Only treatment is restructuring, with relatively poor outcomes (worry is generalized and spreads)
38
Posttraumatic stress disorder description
Exposure to actual/threatened death, serious injury, or sexual violence Exposure can be through experiencing, witnessing, learning about trauma in close family member or friend, or repeated exposure to details of traumatic events Disturbance lasts more than 1 month
39
PTSD symptom clusters
1. Re-experiencing: nightmares, flashbacks ("1 foot in reality and 1 in situation"), vivid memories 2. Avoidance of events that cause remembrance of trauma 3. Alteration of mood/cognitions (depression, numbness of emotion, changes in relationships, stop planning for future) 4. Hyperarousal (hypervigilance, exaggerated startle response, difficulty concentrating, irritability, sleep difficulty)
40
Most common causes for PTSD by gender
Men: combat Women: sexual assault
41
Impacts to development of PTSD
``` Genetic vulnerability BIS & HPA Intensity of trauma Nature of trauma (grossed out and in fear: more likely to develop PTSD) Multiple traumas Feeling of helplessness ```
42
#1 protective factor against PTSD
Social support
43
PTSD learning pathways
Classical/operant conditioning Single trial learning: all it takes is 1 exposure to develop response Cognitions: belief that world is neither safe nor predictable
44
Impact of PTSD on neurological network
Associations between nodes in neural network that are related to trauma become strengthened
45
PTSD medication treatments
Medications don't target PTSD SSRIs and SNRIs as well as benzodiazepines can be used If stopped, symptoms come back
46
PTSD therapy treatments
Exposure (prolonged exposure) | Cognitive restructuring: challenging beliefs about safety and trust
47
Prolonged exposure
Very successful in treating PTSD 2 types: imaginal (think about trauma repeatedly, breaking connection between memory and emotions) and in vivo (exposure to avoided stimuli)
48
Obsessions
Recurrent thoughts, urges, or images that are intrusive and unwanted Individual attempts to ignore, suppress, or neutralize them "Not quite right" feeling
49
Compulsions
Generally occupy about 2 hours/day Repetitive behaviors or mental acts the individual feels driven to perform Attempts to neutralize obsessions or reduce anxiety Must be done until things "feel right"
50
Common obsessions
Contamination fears Violent impulses Sexual themes Religious transgressions ("I have to do this just right or God will be angry")
51
Common compulsions
Cleaning rituals | Checking rituals
52
Thought-action fusion
Symptom of OCD Having thought is the moral equivalent of performing action (thinking of hurting someone is the same as actually hurting the person)
53
OCD epidemiology
Age of onset: early adulthood Course: chronic Slightly more common in females Most disabling and most hospitalizations of the anxiety disorders
54
OCD learning pathways
Classical/operant conditioning: learn to fear outcomes Negative reinforcement: compulsions relieve stress of obsessions Cognitions: distorted beliefs about the world
55
OCD therapy treatments
Exposure and response prevention: expose to obsession and prevent compulsion Cognitive restructuring
56
OCD medication treatments
SSRIs are typically used | Relapse upon discontinuation
57
OCD last ditch effort treatments
Cingulotomy: surgery to remove part of brain | Deep brain stimulation: plant electrode in brain that is hooked up to pacemaker
58
Body dysmorphic disorder description
Classified in DSM IV as somatoform, but under OC spectrum in DSM V Preoccupation with a defect in physical appearance that is not observable or minor to others Repetitive behaviors in response to perceived defect Equally common in males and females
59
Associated behaviors with body dysmorphic disorder
``` Hide defect Correct defect (plastic surgery, etc.) Mirror behavior (monitoring defect) Comparing self to others either in mind or by asking others ("Is my chin as big as his?") ```
60
Hoarding
Persistant difficulty discarding or parting with possessions Obsession: "I may need this in the future" Distress associated with getting rid of items Results in accumulation of possessions that congest and clutter living areas Not necessarily useful items: can be trash
61
Trichotillomania
Habit/impulse control disorder in DSM IV, but under OC spectrum in DSM V Recurrent pulling out of one's hair resulting in hair loss In extreme cases, may eat hair Repeated attempts to stop
62
Excoriation
Habit/impulse control disorder in DSM IV, but under OC spectrum in DSM V Recurrent skin picking that results in lesions Repeated attempts to stop

Abnormal Psychology (15 decks)

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