Anxiety Dxs

Question 1

All anxiety Dxs are loosely modeled off of which anxiety Dx?

Answer 1

Specific phobia Dx

Question 2

Specific Phobia
Criteria:
A. Marked ____ or _____ about a ______ object or situation

Answer 2

fear; anxiety; specific

Question 3

Specific Phobia
Criteria: 
B. The phobic object is...
1. Actively \_\_\_\_\_\_
2. Endured with intense \_\_\_\_\_ or \_\_\_\_\_

Answer 3

avoided;

fear or anxiety

Question 4

Specific Phobia
Criteria:
C. Anxiety and avoidance lasts at least ____ months

Answer 4

6

Question 5

Specific Phobia
Criteria:
D. Causes marked _____ or _______

Answer 5

distress or impairment

Question 6

Specific Phobia
Criteria:
E. Not better explained by ________

Answer 6

another Dx

Question 7

Specific Phobia
Specifiers:
An\_\_\_\_
Nat\_\_\_\_\_\_ \_\_\_\_\_
Bl\_\_\_\_\_/In\_\_\_\_\_/In\_\_\_\_\_
Sit\_\_\_\_\_\_\_
Ot\_\_\_\_

Note: If more than one applies, code _____.

Average person fears ___ different objects or situations

Answer 7

Animals
Natural environment
Blood/Infection/Injury
Situational
Other

Code all

3 different objects

Question 8

Specific Phobia
Basic info:

Most common phobia?
Prevalence: ___% - ___ %
Sex ratio: 2:1
Course: If extended into adulthood ______

Answer 8

Heights

7-9%

Female to Male

unlikely to remit.

Question 9

Specific Phobia
Etiology:

Phobias can develop three different ways. What are they?

Answer 9

1. Direct conditioning - I was pinched by a lobster.
2. Modeling - I saw someone pinched by a lobster.
3. Informational - I was told you can lose a finger if you get pinched by a lobster.

Question 10

Specific Phobia
Tx:

Behavioral Therapy for a specific phobia is also known as…

Answer 10

systematic desensitization

Question 11

Specific Phobia
Tx: Systematic Desensitization

1. Establish a _____ hierarchy
   - Has many _____
   - Begins with items likely for ______
2. Practice ______ and ______
3. Slowly pair each item with ______ versus ______
   - Want to break _____-____ pairing
   - Want to create a new pairing of ______/______ when faced with stimulus

Answer 11

1. fear/exposure;
   - many levels;
   - success;
2. relaxation and coping
3. relaxation versus fear response
   - stimulus-fear pairing
   - mastery/efficacy

Question 12

Social Anxiety Dx
Criteria:

A. Marked fear about at least 1 _______ where they will be _____ by others.

Note: For children - anxiety needs to occur in _____ settings; not just with _______

Answer 12

social situation; judged

Note: peer; adults

Question 13

Social Anxiety Dx
Criteria:

B. Person ______ _____ ___ ___ in a way that leads to ______, _______, _______

Answer 13

fears they will act;

embarrassment; humiliation; rejection

Question 14

Social Anxiety Dx
Criteria:

C. Social situations almost always _______ _____ ______.

Note: Children - fear/anxiety may be expressed by ______, _______, ________. _______, ________, or ________

Answer 14

provoke fear or anxiety

crying; tantrums; freezing; clinging; shrinking; failing to speak in social situations

Question 15

Social Anxiety Dx
Criteria:

D. The person either _____ the situation or _______ it with _________

Answer 15

avoids; endures; intense fear

Question 16

Social Anxiety Dx
Criteria:

E. Fear is _____ ________ to the threat

Answer 16

out of proportion

Question 17

Social Anxiety Dx
Criteria:

F. Lasts at least ___ months

Answer 17

6

Question 18

Social Anxiety Dx
Specifier:

There is only one specifier for SAD. What is it?

Answer 18

Performance only

Question 19

SAD - Basic Info

Prevalence 
Sex ratio: ~ 2:1
Onset: 
Comorbidity: 
Course:

Answer 19

• 8%
• Female to male
• age 13
• Alcohol Use Dx (11% of those with Alcohol Dependence have SAD)
• About 1/2 will spontaneously recover

Question 20

Social Anxiety Dx
Etiology:

Which two neurotransmitters play a part?

Answer 20

Serotonin (mixed support)

Dopamine

Question 21

Social Anxiety Dx
Etiology:

What was Kagan’s temperament research showing?

Answer 21

White middle class 4 month old children displayed two types of behavior in response to unfamiliar stimuli: Inhibited and Disinhibited:
Inhibited children are shy, timid, and fearful.
Disinhibited children display bold, sociable, and outgoing behaviors.

Variations in behavior accord to motor behavior and crying in response to unfamiliar visual, auditory, and olfactory stimuli. High reactive children are likely to grow to become inhibited and low-reactive children are likely to grow to become uninhibited.

Question 22

Social Anxiety Dx
Etiology:
Parent Modeling:

1. Anxious parent models fearing _______ _____ & ______
2. Parent creates fewer chances for child to learn and practice ______ so the child then actually does get _______ more from others

Answer 22

1. negative evaluation & judgment

2. social skills; rejected

Question 23

Social Anxiety Dx
Tx:

SSRI’s and MAO inhibitors are roughly equal to what other kind of treatment?

IPT and Mindfulness are less effective than what other kind of treatment?

45% of clients don’t respond to which kind of treatment?

Combined psychotherapy + meds provide….

Answer 23

CBT;

CBT;

CBT;

inconsistent results - it’s unclear if combined treatment is better than either treatment alone.

Question 24

Selective Mutism
Criteria:

A. Consistent failure to _____ in specific ________ where there is an expectations to _______, despite ______ in other situations.

B. Disturbance interferes with ______ or ______ achievement or with _______ communication.

C. Duration is at least ___ (not limited to ____ of school)

D. Not attributable to a ______ ______ of, or comfort with, the _________

E. The disturbance is not better explained by a _________ Dx and does not occur exclusively during _____ or a _______ Dx

Answer 24

A. speak; social situations; speak; speaking
B. educational; occupational; social
C. 1 month; 1st month
D. lack of knowledge; spoken language 
E. communication; ASD; psychotic

Question 25

Selective Mutism Basic Info: Prevalence Sex Ratio Onset Comorbidity

Answer 25

- Less than 1% - About equal in sex ratio - Less than 5 years - Social Anxiety Dx

Question 26

Selective Mutism will often morph into ________ later on in a child's life.

Answer 26

Social Anxiety Disorder

Question 27

How is selective mutism reinforced for a child in social situations?

Answer 27

Adults will jump in to protect their own feelings for the child not speaking. The child recognizes this behavior and learns that they don't have to speak if they just wait. Child is prompted to engage verbally or behaviorally ===> child experiences distress and inhibits ===> environment observes distress ===> adults rescue ===> everyone feels relief ===> negative reinforcement cycle restarts

Question 28

How is selective mutism treated?

Answer 28

Exactly the same way as specific phobia treatment: exposure therapy. Gradual increase in exposure; build positive experiences; generate a success framework. SSRI's can also be used. Integrated Behavioral Tx = psychoeducation, inclusion of family, and gradual exposure to talking.

Question 29

Separation Anxiety Dx Criteria: A. Developmentally inappropriate & excessive ______ or ________ re: separation from _________ figure, shown by at least 3 of the following: 1. They experience recurrent and excessive distress when they anticipate or are actually what? 2. They excessively and persistently worry about losing who because of what? 3. They persistently and excessively worry about themselves experiencing what that will cause a separation from who? 4. They experience a persistent reluctance or refusal to go where because of what? 5. They persistently and excessively fear a reluctance to be what or without whom and where? 6. They have a persistent reluctance or refusal to do what without being close to who. 7. They experience repeated what involving what? 8. They make repeated what when separated from major attachment figures or when separation is what? 9. The fear, anxiety, or avoidance lass for how long for children and adolescents? How long for adults? 10. What does the disturbance have to cause? 11. The disturbance cannot be better explained by what? Note: For adults, who can the attachment figure be?

Answer 29

A. fear; anxiety; attachment 1. Separated from an attachment figure 2. major attachment figures because of harm in the form of illness, injury, disasters, or death. 3. experiencing an untoward event (getting lost or kidnapped) that will cause them to be separated from their major attachment figure. 4. to go anywhere because of a fear of separation. 5. to be alone or without major attachment figure at home or other settings. 6. sleep away from home or going to sleep without being near a major attachment figure. 7. nightmares involving fear of separation. 8. complaints of physical Sxs (headaches, stomachaches, nausea, vomiting) when separated or separation is anticipated. 9. ≥ 4 weeks for children/adolescents and ≥ 6 months for adults. 10. It has to cause distress or impairment in functioning. 11. Another mental disorder. Note: It can be spouse or offspring.

Question 30

Agoraphobia Criteria: A. They experience a marked what or what about ≥ 2 of the following situations: 1. Using what? 2. Being in what kind of spaces? 3. Being in another kind of space, but the opposite to the kinds of spaces in criteria 2. 4. Standing in or being in a what? 5. Being outside of what alone? B. Individual fears or avoids these situations because of: 6. They have thoughts that what might be difficult OR 7. What might not be available if what happens? OR 8. They fear what kind of event happening? 9. Agoraphobic situations almost always provoke what? 10. Agoraphobic situations are actively what, require the presence of who, or are endured with what? 11. The fear or anxiety is out of proportion relative to what? 12. How long does the fear, anxiety, or avoidance last? 13. There is distress or impairment in what? 14. If there is another medical condition, the fear, anxiety, or avoidance is clearly what? 15. It cannot be better explained by what?

Answer 30

A. fear or anxiety 1. public transportation 2. open spaces 3. enclosed spaces 4. line or a crowd 5. outside of their home 6. escape might be difficult 7. help won't be available if they develop panic-like symptoms 8. incapacitating or embarrassing symptoms (fear of falling in elderly; fear of incontinence) 9. fear or anxiety 10. actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. 11. relative to the danger posed and sociocultural context 12. It lasts ≥ 6 months. 13. distress or impairment in functioning 14. the fear, anxiety, or avoidance is clearly excessive 15. another mental Dx.

Question 31

Agoraphobia: Agoraphobia does not occur merely as a fear of leaving the home. Rather it's a fear of what happening outside of the home that is the reason for their marked fear or anxiety?

Answer 31

Some embarrassing event that's out of their control.

Question 32

Agoraphobia Basic info: Coding note: Agoraphobia is Dx'ed irrespective of the presence of ______, so if the person meets criteria for both, the therapist should what? Prevalence: Percentages Sex Ratio: 2:1 Onset: Most cases are before the age of...? Course: duration is...?

Answer 32

Coding note: panic Dx; diagnose both Prevalence 1.3% to 1.7% Sex ratio: Female to male Onset: 35 Course: chronic

Question 33

Agoraphobia Basic Info: 1. There is significant overlap with what other disorder? 2. What are the treatments?

Answer 33

1. Panic Disorder - 1/3 to 2/3 have agoraphobia Agoraphobia - 1/2 have panic attacks 2. SSRIs and exposure therapy.

Question 34

Panic Attacks: Panic attacks occur in many different anxiety Dxs. Do we diagnose Panic Dx as a comorbidity when the person has a separate anxiety Dx?

Answer 34

Only if they meet all the criteria as a separate Dx. If not, add a panic attack specifier to the original Dx.

Question 35

Panic Attack Symptoms: A: Panic attack: An abrupt surge of what that peaks within what amount of time? -How many symptoms does the person need to have? 1. Palpitations, pounding, or _________ 2. Swe______ 3. Trembling or ______ 4. Shortness of ______ or sensation of being _______ 5. Feelings of ch______ 6. Chest _______ or _______ 7. Nausea or _______ distress 8. Feeling ______, unsteady, _______ _____, faint 9. Chills or _______ sensations 10. Parathesias ( ______ or _______ sensations) 11. Derealization or __________ 12. Fear of losing _______ or "going _______" 13. Fear of dy____

Answer 35

A: fear and discomfort that peaks within minutes - At least 4 1. accelerated HR 2. Sweating 3. shaking 4. breath or smothered 5. choking 6. pain or discomfort 7. abdominal 8. dizzy; lightheaded 9. heat 10. numbing or tingling 11. depersonalization 12. control; "going crazy" 13. dying

Question 36

Panic Dx Criteria: 1. There are recurrent and unexpected what? 2. ≥ 1 of the attacks have been followed by ≥ 1 months of 1 or both of the following: a. persistent ______ or ______ about additional ______ or their consequences b. a significant ________ change in behavior related to the attacks (behavior designed to avoid having panic attacks) 3. Not attributable to what? 4. Not better explained by what? (Panic attacks don't occur only in response a. A specific social situation (which disorder?) b. Circumscribed phobic objects or situations (which disorder?) c. Obsessions (which disorder?) d. Reminders of trauma (which disorder?) e. Separation from attachment figure (which disorder?)

Answer 36

1. Panic attacks 2a. concern or worry about additional panic attacks 2b. maladaptive 3. substance or medical condition 4. Another Dx a. social anxiety dx b. specific phobia c. OCD d. PTSD e. separation anxiety dx

Question 37

Panic Dx: True or false: Panic attacks can be predicted before they occur?

Answer 37

False. They're unexpected, the onset cannot be predicted, and there's no way to discern the reason for the panic.

Question 38

Panic Dx Basic Info: ``` Prevalence: percentages Sex Ratio: 2:1 Onset: what age range? Course: Comorbidity: Note: Approximately 1/3 are ______ panic attacks where the individual _______ in a panic ```

Answer 38

Prevalence: 2-3% Sex ratio: F:M Onset: 20-24 years at onset Course: Waxing and waning Comorbidity: Highly comorbid and often seen with other anxiety Dxs, depression, and substance Dxs Note: nocturnal panic attacks; wakes up in a panic

Question 39

Panic Dx: Describe the Sanderson, Rapee, and Barlow Panic Dx experiment: Hints: Light bulbs, dials, and CO2 levels

Answer 39

1. An increase in CO2 is associated with panic attack onset 2. Patients were placed in a room with elevated CO2 3. Patients were told they could control CO2 levels with a dial when a light bulb came on 4. For half the subjects, the light bulb never came on. For the other half, the light bulb was always on. 5. The dials were not actually connected to anything and patients had no control over CO2 levels. 6. Results: 80% who felt they had no control (the half where the light bulb never illuminated) had a panic attack. 20% of those who felt like they had control (other half where the light bulbs did come on) had panic attacks. Both groups were exposed to same amount of CO2. So, perception of control is affects panic attacks.

Question 40

Panic Dx Etiology: Genetic: How heritable is it? Cognitive Distortions: 1. Hypersensitivity and hyperactivity to what? 2. Catastrophic misappraisals of what? 3. Lack of perceived control over what?

Answer 40

Genetic: Moderate heritability (.3 to .4) 1. Hypersensitivity and hyperactivity to bodily/physical sensations 2. Catastrophic misappraisals of those bodily sensations 3. Lack of perceived control, particularly over their thoughts and Sxs

Question 41

Panic Dx Tx: Meds: Which class of drugs are effective in reducing panic? What often occurs when meds are stopped? CBT: How effective is it compared to meds? Combined (Meds + CBT): Is combined therapy more, equally, or less effective?

Answer 41

Meds: SSRIs. Relapse often occurs when stopped CBT is about as effective compared to meds. Equal in efficacy Combined therapy > meds alone

Question 42

Generalized Anxiety Disorder Criteria: A. Excessive anxiety and worry that occurs _____ than not and about a number of _______ and _______ B. Difficult to control the ______ C. ≥ ____ months D. Plus at least __ other Sxs more days than not (note: only need ___ if a child) 1. Restless, ______, on edge 2. Easily fa_____ 3. Difficulty _____ 4. Irr_____ 5. Muscle ______ 6. Sleep ______

Answer 42

``` A. more days than not; events and activities B. Difficult to control the worry C. ≥ 6 months D. 3 other Sxs (note: 1 if a child) 1. keyed up 2. fatigued 3. concentrating 4. irritable 5. muscle tension 6. sleep problems ```

Question 43

GAD Basic Info: ``` Prevalence: percentages Sex Ratio: 2:1 Onset: Mean = ___ years (wide standard deviation) Course: Comorbidity: 1. > 40% have ___ 2. ~ 30-40% have ____ 2a. Lots of symptom overlap with _____ ```

Answer 43

``` Prevalence: 2.9% adults; .9% adolescents Sex Ratio: F:M Onset: 30 years (GAD is likely to occur in every age group but 30 years is slightly younger than middle of life span - that's why mean onset is named at this age) Course: Chronic; waxing and waning Comorbidity: High 1. Social Anxiety Dx and Panic Dx 2. MDD 2a. MDD ```

Question 44

GAD Etiology: A. Dysregulation in _____. It takes longer to recover from a stressor B. Difficulty with _____ regulation. More intense_____ and more difficulty managing _______ ______ C. Cognitive _____: 1. Catas______ 2. Bias to attend/remember _________ stimuli 3. Encode neutral stimuli as _______ D. Intolerance of ________. Better to anticipate the _____ vs. dealing with _______

Answer 44

``` A. CNS B. affect; emotions; negative affect C. biases 1. Catastrophizing 2. threatening 3. threatening D. uncertainty; anticipate the bad vs. dealing with unknown/uncertainties ```

Question 45

GAD Tx: CBT - _____ to _____ effect 12 months post Tx Meds (SSRIs mostly) had _____ effect than psychotherapies CBT is ____ effective in Tx of GAD because the anxieties can be so generalized and unspecific that the treatment of worry A, B, C _______ for the person's worry about D, E, and F.

Answer 45

CBT - small to medium effect Meds had larger effect than psychotherapies CBT is less effective. Worries about A, B, C do not account for the person's worries about D, E, and F. CBT for GAD is kind of like whack-a-mole.