Anxiety Disorders Flashcards
Define anxiety
A state of intense apprehension, uncertainty, and fear resulting from the anticipation of a threatening event or situation, often to a degree that normal physical and psychological functioning is disrupted
- Anxiety is an adaptive emotion that readies children both physically and psychologically to cope with danger
- anticipation of future threat: feeling
Define fear
the emotional response to the real of perceived threat
3 interrelated systems
- Cognitive: anxious thoughts develop in response to cognitive distortions in the attention, interpretation and memory components of information processing
- Physical: brain sends messages to the sympathetic nervous system: fight or flight
- symptoms are excessive in intensity or duration - Behavioural
- Action/ inaction taken to prevent exposure to feared stimuli or reduce the anxoety associated with the exposure to the feared stimuli
(the behaviour is always functional)
Separation anxiety disorder
3+ symptoms in DSM criteria
- Excessive distress when separation from attachment figure is anticipated
- Excessive worry about losing or possible harm to figure
- Excessive worry that an event will lead to separation
- Reluctance or refusal to go to school because of separation fear
- Excessive fear or reluctance to be alone
- Reluctance or refusal to go to sleep without being near attachment figure
- Nightmares involving theme of separation
- Complaints of physical symptoms when separation occurs/is anticipated
Selective mutism
- voluntary refusal to speak
- typically occurs outside of home/ immediate family
Social phobia
- Marked and persistent fear of one or more social or performance situations in which child is exposed to unfamiliar people or possible scrutiny by others
- The child fears he/she will act in a way that will be humiliating or embarrassing
- Exposure to situation provokes considerable anxiety
Feared situations are avoided or else endured with intense anxiety and distress
General Anxiety Disorder
- Excessive anxiety, unrealistic worries, and fearfulness, not related to a specific object or situation
- “what if” statements
- children tend to be perfectionistic
- engage in excessive approval and frequent solicitations of reassurance
- anxiety level contributes to physical symptoms
- some children may develop nervous habits
Childhood fears and phobias
• Childhood fears range from those related to very specific and concrete objects (e.g.,animals and strangers) to those which are more abstract (e.g., monsters, war, death).
- DSM: ○ Marked and persistent fear that is excessive and unreasonable, cued by the presence or anticipation of a specific object or situation
(duration at least 6 months)
Post-traumatic stress disorder
A. Exposure
- exposed to an event that involved threat of harm/ death to self/ other
- person’s response involved intense fear, helplesness or horror
B. Traumatic event is re-experienced
- recurrent and intrusive recollections (play) or dreams
- acting as if event was re-occurring
- intense distress at exposure to internl or external cues that resemble an aspect of the event
- physiological reactivity on exposure to cues
C. Persistent avoidance of stimuli associated with trauma & numbing of general responsiveness
D. Persistent symptoms of increased arousal
E. Duration of symptoms more than 1 month
Panic Disorder
- Persistent fear or concern of inappropriate fear responses with recurrent unexpected panic attacks incl physiological changes such as accelerated heart rate, sweating, dizziness, trembling and chest pain
- Panic disorder has physical and cognitive symptoms and involves numerous unexpected panic attacks
Assessment
- Diagnostic interviews
- Anxiety disorders interview schedule for DSM-5 - Rating scales
- screen for child anxiety related emotional disorders (SCARED)
- multidimensional anxiety scale for children
- fear survey schedule for children - Observation
- Social-evaluative tasks
- Behavioural avoidance to phobic stimulus
- Parent-child interaction - Self-monitoring procedures
- Quantify and describe symptoms (diary)
Treatment
- Behavioural & Cognitive-behavioural treatments
- SSRI’s
Treatment should target the 3 interrelated symptoms
1. Physical symptoms
(rapid heartbeat, muscle tension, insomnia)
2. Cognitive symptoms (distorted perceptions of threat)
3. Behavioural symptoms (escape & avoidance)
Behavioural therapy
- Exposure therapy
- Systemic Desensitization
- Relaxation Exercises
- Contingency Management strategies
- Modeling
- Exposure
- create fear hierarchy (list of fearful events and rating from least to most anxiety provoking)
- gradual exposure
Exposure with response prevention
- OCD: child asked to refrain from engaging in compulsive rituals
e. g. of response prevention: does not engage in hand washing - this breaks the conditioned fear response and consequently acquires new, less threatening (and more adaptive) fear representations
- Systemic Desensitization
- Teach child to relax
- construct fear hierarchy
- present anxiety-provoking stimulus sequentially as child remains relaxed
- this breaks the conditioned fear response
