Anxiety Disorders

Question 1

Neurotic behaviour

Answer 1

• Maladaptive behaviour pattern that does not involve gross distortions in reality or marked personality disorganization
• DSM avoids this term, but it’s still common
• Central component of anxiety-based disorders

Question 2

Neurotic Anxiety

Answer 2

• No obvious danger or threat

- Event or stimulus is, objectively, minor or insignificant (ie. Mouse, thunder, shopping mall, etc.)

Question 3

Neurotic Paradox

Answer 3

• Pattern of persistent self-defeating behaviours a neurotic person does, even if they realize it’s maladaptive
• Reduces anxiety in the short-term, but has negative long-term consequences
• Ex. Person with agoraphobia staying at home to reduce anxiety, but this prevents them from going to
  school/work, seeing friends, etc
• Assumption: we maximize pleasure and minimize pain

Question 4

Outcomes of neurotic paradox

Answer 4

• Blocks personal growth
• Relationship issues
• Anxiety becomes all-encompassing
• Lack energy and enthusiasm
• Egocentric concerns (excessively focused on self)

Question 5

3 characteristics of neurotic styles

Answer 5

• Deficit in behavioural repertoire (inhibition of behaviours we see as healthy because they cause anxiety)
• Behaves in an inflexible and exaggerated manner opposite to the deficient behaviour
• Behaviour does not fully contain the anxiety (ie. behaviour doesn’t fully eliminate anxiety)

Question 6

4 Neurotic Styles

Answer 6

• Aggressive/assertion inhibition:
• • Avoiding hostility/aggression
• • Can result in ulcers, migraines, etc.
• Responsibility/independence inhibition:
• • Being overly dependent on others
• • Can result in helplessness, depression, etc.
• Compliance/submission inhibition:
• • Being defensive and non-compliant
• • Can result in various health issues (ie. by not complying with doctor’s orders)
• Intimacy/trust inhibition:
• • Extremely sensitive to other’s opinions, intimacy causes anxiety
• • Can result in many short-term, superficial friendships/relationships

Question 7

Kornberg’s Model: neurotic

Answer 7

• Least severe
• Have sense of reality -> can distinguish what is real and what is not
• No large personality distortions
• Good sense of own strengths and weaknesses – can recognize a problem

Question 8

Kornberg’s Model: borderline

Answer 8

• Middle ground
• Reality-testing generally intact
• Fragmented sense of self and others – inconsistent -> leads to interpersonal difficulties
• • Lots of polarization -> makes treatment difficult

Question 9

Kornberg’s Model: psychotic

Answer 9

• Most severe
• Gross distortions in reality (ie. Perception)
• Some personality disorganization
• Does not recognize problem

Question 10

Anxiety

Answer 10

• Unpleasant feeling of fear/apprehension
• • Adaptive in appropriate situations
• • Problematic when chronic, intense, associated with impairment, and causes significant distress to self and others

Question 11

Anxiety Disorders - DSM Symptoms

Answer 11

• Mood symptoms: anxiety, tension, panic, apprehension
• Cognitive symptoms: reflect apprehension/concern about impending doom (ex. Rumination)
• Somatic symptoms
• • Immediate symptoms: sympathetic nervous system activation (ex. Sweating, muscle tension, etc.)
• • Delayed symptoms: due to constant activation of sympathetic nervous system (ex. Ulcers, migraines,
    etc. )
• Motor Symptoms: pacing, fidgeting, increased reactivity

Question 12

Anxiety Disorders - PDM Symptoms

Answer 12

• Affective states: can feel anxiety due to various situations (ie. loss of significant other, loss of love, loss of
  bodily integrity, loss of affirmation, fear of loss of self-regulation)
• Cognitive patterns: distractedness, confusion, difficulty thinking, etc.
• Somatic states: tension, sweaty palms, etc.
• Relationship patterns: expressions of fear of rejection, of guilt, or of conflicts of dependency

Question 13

Types of Anxiety Disorders - PDM

Answer 13

• Separation anxiety (losing something/someone you love)
• Moral anxiety (fear of consequences of transgressing your values)
• Castration anxiety (damage to one’s body)
• Annihilation anxiety (catastrophically overwhelmed – afraid of death, end of the world, etc.)

Question 14

Types of Anxiety Disorders - DSM

Answer 14

• Generalized anxiety disorder: persistent, uncontrollable anxiety over various areas of life
• Social anxiety disorder: fear/avoidance of social situations due to possible negative evaluation of others
• Panic Disorder: recurrent panic attacks involving sudden physical symptoms such as dizziness, rapid heart
  rate, trembling, etc.
• Agoraphobia: fear of being in public places
• Specific Phobia: fear/avoidance of objects/situations that don’t present any real danger
• Separation anxiety: fear of losing someone they’re close to, or harm coming to major attachment figure
• Selective mutism: when someone is afraid to speak in certain situations (ie. at school) but can speak in other
  situations (ie. at home)

Question 15

Phobias

Answer 15

fear/avoidance of objects/situations that do not present any real danger

Question 16

Specific Phobias

Answer 16

• Unwarranted fears caused by presence or anticipation of a specific object/situation
• Typically long-lasting
• Common ones blood-injection-injury, situations (ie. planes), animals, natural environment (ie. water), choking, clowns, etc. -> animal phobias most common
• 3 defining features of specific phobias
• • Unwarranted fears of specific object or situation
• • Fear and avoidance out of proportion
• • Fear is recognized by the person as irrational

Question 17

Etiology of Specific Phobias

Answer 17

• Behavioural theories (ie. Learning fear through conditioning, modelling, etc.)
• Cognitive theories (ie. Believing that negative situations are more likely to occur than positive ones)
• Biological theories (ie. Those with autonomic nervous systems that are easily aroused)
• Psychoanalytic theories (ie. People develop phobias as a defense mechanism against anxiety produced by repressed impulses)

Question 18

Exposure Therapy

Answer 18

• Treatment for specific phobias
• creating a safe environment in which to expose individuals to things they fear -> eventually decreases avoidance
• Variations:
• • Imaginal exposure: vividly imagining feared object/situation
• • In vivo exposure: being in the presence of the feared object/situation
• • Virtual reality exposure: using VR equipment to experience feared object/situation (just as effective as in vivo exposure)
• • Augmented reality (AR): combines VR and real world, less expensive to develop

Question 19

anxiety (T)

Answer 19

• unpleasant feeling of fear and apprehension
• more common amongst women
• future-focused (worrying about things that COULD happen in the future)
• 2 main components: physiological (ie. blood pressure, sweat) and cognitive (ie. worry, rumination)
• 3rd component: behavioural (ie. avoidance, drinking, etc.)

Question 20

test anxiety

Answer 20

• includes all facets of anxiety (ie. physiological - tension and cognitive - test-irreverant thinking/mind-wandering)

Question 21

nomophobia

Answer 21

• a specific phobia of not having a cell phone/being out of touch
• consists of inability to communicate, being disconnected, inability to access information, and inconvenience

Question 22

social anxiety

Answer 22

• 3 types of situations to be feared/avoided: public speaking/performing, social interactions, being observed in public
• highly comorbid with drug/alcohol dependence in adults, and selective mutism in kids
• new subcomponent: social media anxiety
• cultural variants - TKS in Japan (embarrassing others)

Question 23

etiology of phobias and SAD

Answer 23

• behavioural theories (avoidance conditioning, modelling/vicarious learning, prepared learning - some things lend themselves more to fear than others, diathesis)
• cognitive theories (more likely to attend to negative stimuli, interpreting ambiguous info as threatening, believing negative events are likely; concern with evaluation and self-criticism in case of SAD)
• biological theories: diathesis (ex. amygdala differences, reactive autonomic nervous system, genetics/heritability)
• psychoanalytic (phobias defence against anxiety produced by repressed id impulses)

Question 24

3 main cognitive characteristics of SAD

Answer 24

• focusing on negative info/interpreting ambiguous info as negative
• perfectionistic standards
• high degree of self-consciousness
• AND they also engage in post-event processing (rumination) of negative social experiences

Question 25

2 characteristics of panic disorder

Answer 25

• depersonalization: feeling outside your body

- derealization: feeling that the world is not real

Question 26

4 types of panic attacks

Answer 26

• uncued/unexpected (no apparant trigger)
• cued/expected (strongly associated with trigger)
• situationally predisposed (some association with trigger)
• nocturnal (waking from sleep in panic - unexpected)

Question 27

etiology of panic disorder

Answer 27

• biological: runs in families; overactivity in noradenergic system; hypersensitivity to CKK (cholecystokinin)
• psychological: fear of fear (anxiety sensitivity); overly-active ANS

Question 28

etiology of GAD

Answer 28

• cognitive-behavioural: tied to environment (conditioning), not being in control, unpredictability (intolerance of uncertainty) and fear of anxiety
• biological: genetic component
• psychoanalytic: conflict between ego and id

Question 29

treatment

Answer 29

• most people with anxiety don’t seek treatment
• behavioural approaches (ex. systematic desensitization, learning social skills, modelling, flooding - source of phobia at full intensity)
• cognitive (reappraisal, changing beliefs, introceptive exposure - going through conditions that induce panic in a safe way, mindfulness)
• biological (drugs that reduce anxiety - axiolytics, SSRIs, etc.)
• psychoanalytic (uncovering repressed conflicts