anxiety I and II

Question 1

anxiety disorders reflect exaggerated responses to two emotions….

Answer 1

• fear

- anxiety

Question 2

characteristics of anxiety disorders

Answer 2

• Pervasive and persistent symptoms of anxiety and fear
• Involve excessive avoidance and escape
• Cause clinically significant distress and impairment

Question 3

3 systems model of anxiety and fear

Answer 3

• physiological (feelings)
• verbal/cognitive
• behavioral

Question 4

fear and anxiety from an evolutionary standpoint

Answer 4

• fear - immediate response to danger

- anxiety - preparatory fear in anticipation of danger

Question 5

three important differences between fear and anxiety

Answer 5

1) fear is acute - greater HR increase, more sweating, harder to control behavior, thoughts focused on danger
2) anxiety is a longer emotional response
3) fear is elicited by immediate threat whereas anxiety is elicited by unpredictability

Question 6

behaviors attached to anxiety vs fear

Answer 6

fear: defense, escape
anxiety: avoidance, preventiveness

Question 7

what all anxiety disorders have in common

Answer 7

Unpredictability and uncontrollability leads to exaggerated anxiety

Question 8

biological contributions to anxiety

Answer 8

• Genetic transmission
• Anxiety and brain circuits (Depleted levels of GABA)
• Limbic (amygdala) and septal-hippocampal systems
• Corticotropin releasing factor (CRF)

Question 9

Mowrer’s anxiety/fear interaction

Answer 9

1) aversive experience (dog bite)

2) avoidance of all dogs and inability to learn that some dogs don’t bite

Question 10

why do anxiety disorders persist?

Answer 10

the better you are at avoiding, the worse you are at improving

Question 11

list the anxiety disorders

Answer 11

Panic disorder with and without agoraphobia
Generalized anxiety disorder
Specific phobias
Social phobia

Question 12

definition, subtypes, symptoms of panic attack

Answer 12

• panic attack: abrupt episode of fear or discomfort in absence of real danger
• DSM-5 subtypes (cued vs uncued)
• breathlessness, HR rate up, chest pain

Question 13

panic disorder essential features

Answer 13

• Recurrent unexpected panic attacks
• At least 1 month of concern about having more panic attacks, or worry about consequences of having panic attacks, or behavioral changes because of panic attacks
• avoidance of situations where panic attack has occurred

Question 14

what is anxiety sensitivity

Answer 14

literally being anxious about anxious symptoms

Question 15

panic disorder WITHOUT agoraphobia

Answer 15

• Anxiety is about possibility of having more panic attacks

- Not necessarily whether escape is difficult, more so just about panic attacks

Question 16

panic disorder WITH agoraphobia

Answer 16

• Anxiety about having more panic attacks, and worry about having panic attack in situation where escape is difficult and/or embarrassing

Question 17

agoraphobia

Answer 17

• panic when escape is perceived as difficult

Question 18

meds for panic disorder

Answer 18

• 5-HT, NE, GABA targeted
• SSRIs the most effective (prozac and paxil)
• high rate of relapse when meds discontinued

Question 19

generalized anxiety disorder (GAD) symptoms

Answer 19

• Excessive worry and anxious apprehension
• Worry must be perceived as uncontrollable
• Coupled with strong, persistent anxiety
• Persists for 6 months or more
• Somatic symptoms differ from panic (e.g., muscle tension, “keyed up” or on edge)

Question 20

onset of GAD

Answer 20

• insidious
• begins in early adulthood and firmly in place by 30s
• highly prevalent in elderly

Question 21

GAD diagnosis

Answer 21

• Excessive anxiety and worry
• Difficult to control the worry
• Associated with 3 or more of:
  Restlessness/Keyed-up Fatigue
  Poor Concentration Irritability
  Muscle Tension Sleep Problems

Question 22

GAD often comorbid with….

Answer 22

social phobia, MDD, substance abuse

Question 23

how is GAD maintained?

Answer 23

• negative reinforcement by removal of negative imagery in the mind
• imagery relief has be be continuously amped up and repeated

Question 24

what is Barlow’s triple vulnerability theory?

Answer 24

1) biological vulnerability
2) general psychological vulnerability
- uncontrollable early learning environment
- constantly prepared for danger
3) specific psychological vulnerability
- specific learning event where specific cues for anxiety are learned, direct, vicarious, and instructional conditioning