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PSYC3018 Abnormal Psychology > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

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1
Q

What is Anxiety?

A

Fear/Panic

Response to threat

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2
Q

Three systems of Anxiety

A

Physical: Fight/Flight, SNS activation –> mobilising response
Cog
Behavioural

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3
Q

Eliciting conditions for Anxiety

A

Realistic/objective threat to self
Specific “prepared” stimuli
Novel Stimuli

Threat appraisal –> Expectancy of harm –> Anxiety

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4
Q

Threat appraisal

A

Generates expectancy of harm (e.g. public transport)
Product of perceived probability and perceived cost
Often based on past experience (cond, rft), obs learning, and instruction

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5
Q

Separation Anxiety

A

Anxious about being away from primary caregiver

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6
Q

Specific phobias

A

Excessive and Inappropriate fear about specific targets

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7
Q

Social phobia

A

Fear of negative social evaluation

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8
Q

General Anxiety Disorder (GAD)

A

Excessive & Uncontrollable worry about a range of outcomes

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9
Q

Panic disorder

A

Unexpected/spontaneous panic attacks
Anxiety about having more panic attacks
Agoraphobia (fear of public/open places) - can result from excessive avoidance of places where panic attacks have previously occurred. Complication of Panic Disorder

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10
Q

OCD

A

Obsession: Intrusive Thoughts/impulses
- Hard to avoid thought
- Belief: Think thought –> bad event will happen
Compulsion: Ritualistic behaviour that relieves anxiety caused by obsession

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11
Q

PTSD

A

Intrusive thoughts/memories about past traumatic event

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12
Q

Anxiety: Comorbid conditions

A

Anxieties comorbid with each other, depression & substance abuse
General bio vulnerabilities: Genetics, Neuroticism
General psych vulnerabilities: Trait anxiety, low perceived control
Specific psych vulnerabilities: Focus of threat-related beliefs

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13
Q

Biological treatment for Anxiety Disorders?

A

Barbituates - quick, common relapse, but addictive & interacts with alcohol
Benzodiazepines - quick, common relapse, interacts with alcohol
SSRIs/antidepressants - slower, common relapse, less side effects

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14
Q

Psychological treatment for Anxiety Disorders/CBT? (Cog + behavioural techniques)

A

CBT:
Aim: To reduce (biased) threat appraisal by reducing perceived probability and cost of event while increasing (biased) coping appraisal.

Cognitive techniques:

  • Thought diaries –> increased awareness of anxious thoughts
  • Thought challenging - leading questions –> self-realisation of irrationality of thoughts

Behavioural techniques: EXPOSURE
- Exposure: in vivo or imaginary exposure
- Either flooding (highest fear level) or systematic desensitisation
-

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15
Q

Anxiety Disorders: Changes from DSM-IV to DSM-V

A

Selective mutism added

PTSD, OCD and Acute Stress Disorder have their own chapters now

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16
Q

DSM-V: Which disorders are in the chapter of Obsessive Compulsive and Related Disorders?

A 
OCD
Hoarding Disorder
Trichotillomania 
Excoriation Disorder
Body Dysmorphic Disorder
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17
Q

Hoarding Disorder

A

Excessive hoarding - unwilling to discard items, regardless of value

18
Q

Trichotillomania

A

Excessive hair-pulling, to relieve anxiety caused by intrusive thoughts/images

19
Q

Excoriation Disorder

A

Excessive skin-picking, to relieve anxiety caused by intrusive thoughts/images

20
Q

Body Dysmorphic disorder

A

Preoccupation with perceived defects/flaws in physical appearance. Extreme manifestation of vanity

21
Q

Panic Attack (mention >4 symptoms)

A

Influx of fear/discomfort within minutes, reflective of >4 symptoms:

  • increased HR/palpitations
  • sweating
  • Trembling
  • Choking sensation
  • shortness of breath
  • dizziness
  • nausea
  • Chill/heat sensation
  • Fear of losing control
  • Fear of dying
22
Q

Panic Attack: two types of attack

A 
Expected (cued) attack: 
 - Trigger: specific or social phobias
 - Context: most anxiety disorders
Unexpected (uncued) attack:
 - Unidentifiable trigger
 - Context: Panic Disorder
 - >2 unexpected attacks --> Panic Disorder
23
Q

Panic Disorder

A

> 2 unexpected attacks
Persistent concern/worry about having another attack
Significant maladaptive change in behaviour related to attacks
Symptoms for >1 mth

24
Q

Panic Disorder: Other information (e.g. comorbidity, etc.)

A

One-year incidence: 2-3%
Median age onset: 20-29
Course: Chronic, but waxing/waning
Comorbid: Other anxieties, Depression, alcohol use (10-65%)

25
Q

Cognitive Theory of Panic (Clark, 1988)

A

Panic comes from fear of bodily sensations –> misinterpret their consequences (e.g. heart palpitations –> impending heart attack) - positive feedback between increased anxiety and increased symptoms
Misinterpretations are maintained by safety behaviours: protective actions to prevent harmful events
- prevents learning that bodily sensations are safe
Risk factors: neuroticism, anxiety sensitivity

26
Q

Agoraphobia - DSM edition changes, Symptoms

A

DSM edition changes:

  • DSM-IV: Always accompanied Panic Disorder
  • DSM-V: Separate entity, as often occurs without panic

Symptoms:

  • Avoidance of public transport, open/enclosed public places, being part of a crowd/line, and being outside alone
  • Anxiety that they would not be able to escape when panic-like symptoms will occur
  • Not like normal phobias: added fear of embarrassment/incontinence, etc, on top of panic symptoms
27
Q

Why does Agoraphobia develop?

A

(Social fears)

  • heightened childhood dependence
  • lowered perception of self-coping ability
  • History of separation anxiety & social phobia
  • physical concerns that weakness –> Panic –> embarrassment/incontinence
  • has increased social evaluative concerns
28
Q

Treatment of Panic/Agoraphobia

A

Biological: Anxiolytics (Barbiturates, Benzos) and Antidepressants
Psych/Cog-behav:
- Cog restructuring
- Exposure to: Interoceptive stim (Panic) or Avoided situations (Agoraphobia)
- decrease safety behaviours
- CBT: Effective in 80-85% of Panic Disorder Patients

29
Q

GAD Diagnostic criteria

A

Excessive, uncontrollable worry about a variety of events/outcomes
occurs more days than not, for >6mths
>3-6 somatic symptoms: Restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance - NO SNS AROUSAL

30
Q

What is normal worry?

A

Response to perceived threat
Focus: Adults: Social threat, Older adults: Physical threat
Contains verbal thought (vs imagery)
Perceived positive aspects: e.g. motivates actions, etc.
Worry control: Problem solving, distraction, social support
Normal Worry –> problem solving attempts
Pathological worry –> No solution, due to thwarted problem solving - biased threat perception

31
Q

What are some Problem Solving Theories? Social Problem Solving

A
  1. Define problem
  2. Generate alternative solutions
  3. Solution evaluation (pos/negative)
  4. Solution selection
    - Pathological worriers: Steps 3-4 do not occur
    - Step 3: only generate negative solutions –> don’t want to select a solution –> No chosen solution
32
Q

What are some Problem Solving Theories? Metacognitive Worry

A

Type 1 Worry: Perception of threat + Positive beliefs about worry –> Worry to cope with threat
- Possible exit: Problem solving or reassurance
Type 2 Metaworry: Worry + negative beliefs about worrying –> Metaworry –> Ineffective thought-control strategies –> Increased anxiety and worry
- Excessive and uncontrollable worry

33
Q

What are some Problem Solving Theories? Avoidance Theory

A

Worry: More verbal thought than imagery, because

  • Images of possible negative event are highly aversive, and cause anxiety symptoms (= sympathetic arousal)
  • Anxiety symptoms are highly aversive
  • Reduced imagery –> Reduced arousal/anxiety
  • – GAD associated with tension symptoms
  • Worry = cognitive avoidance: Interferes with emotional processing
  • Fear structures are maintained –> Keep worrying
34
Q

What are some Problem Solving Theories? Experiential Avoidance

A 
Worry is associated with: 
 - Fear of anxiety/anxiety sensitivity
 - Distress intolerance
 - Experiential avoidance: Worriers avoid internal experiences
Difficulties in emotional regulation: Worriers have difficulties with
 - Clearly identifying emotion
 - Tolerating emotion
 - Modulating emotion
35
Q

What are some Problem Solving Theories? Intolerance of Uncertainty Theory

A

Uncertainty reflects badly on a person –> frustration and stress, and prevents action

  • Worry to reduce uncertainty
  • Leads to preoccupation with details
  • Interferes with problem solving
  • Worries aim to reduce uncertainty to 0 - not possible
36
Q

Treatment of GAD: 4 approaches

A
  1. Biased threat perception: Prob/cost judgements
  2. Problem solving: Structured problem solving training
  3. Metacog: Challenge beliefs about worry (pos/neg)
  4. Avoidance: Exposure to:
    - Vivid images of feared event
    - Emotional experience/distress
    - Uncertainty
    Treatment effects have been modest: 50-60% improvement at follow-up (not very good)
37
Q

PTSD: Diagnostic Criteria

A

A. Exposure to actual/threatened death, serious injury, or sexual violence in >1 of the following ways
- Direct experience
- Witnessing event as it occurs
- Learning about traumatic event to close family/friend
- Experience repeated/extreme exposure to aversive details of traumatic event
B. Intrusion symptoms (1+: memories, dreams, flashback)
C. Persistent Avoidance of stimuli (1+)
D. Negative changes in cog/mood (2+): Fear, negative beliefs about self, others, world
E. Changes in arousal, reactivity (2+): Anger, recklessness, self-destructive acts, sleep-disturbance
Duration of symptoms >1 month

38
Q

What normally happens in immediate post-trauma phase?

A

50-60% of people experience traumatic event
25% develop post-traumatic problems: PTSD, depression, anxiety, substance abuse.
- PTSD prevalence: 5-11% Western countries
Normative response to trauma: Get over it.
- Distress immediately after traumatic event is normal
- Distress drops substantially within 3 months in about 75% of people

39
Q

Risk factors Pre-trauma:

A

Childhood trauma, Prior psychiatric history, family instability, substance abuse, social-economic disadvantage (limited resources to deal with trauma)

40
Q

Risk factors During trauma:

A

Degree of life threat/loss, Severity of exposure to traumatic elements, Location of trauma (safe place/elsewhere), Individual role in trauma (victim, helper), Meaning

41
Q

Risk factors post-trauma:

A

Social support, coping style, ongoing stressors

42
Q

Treatments For PTSD

A

Biological: Benzo’s, antidepressants
CBT: Core treatment components include
- Assess suitability for treatment
- Psychoeducation
- Anxiety management techniques (prep for exposure)
- Cog restructuring of biased thoughts
- Prolonged exposure - great detail of reporting of event, being willing to be exposed to associated objects/symbols
CBT more effective than medication or supportive psychotherapy
EMDR (Eye-Movement Desensitisation and Reprocessing)
- Eye movements as critical components of procedure and essential for its effectiveness
- EMDR as exposure technique
- Eye mvt not necessary for effectiveness

PSYC3018 Abnormal Psychology (20 decks)

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