Anxiety & Related Disorders Flashcards
What is anxiety?
- Often labelled ‘fear’ ‘panic’
- The experience of anxiety is the same in normal and abnormal anxiety, however normal anxiety is needed for survival
- Activated in response to perceived threat
Interrelated anxiety systems
o Physical system
• Fight/flight: sympathetic nervous system
• Mobilises resources to deal with threat
• Symptoms: sweating, heart rate, trembling etc
o Cognitive system
• Perception of threat
• Attentional shift of focus and hyper vigilance
• Difficulty concentrating on other information
o Behavioural system
• Escape/avoidance tendencies
• Aggression → safer to run away, most animals only fight when cornered and have no other choice
Eliciting conditions
Threat appraisal → Expectancy of harm →Automatically Elicits Anxiety
o Realistic/objective threat to self
• Physical vs. social threat (Lovibond & Rapee, 1995)
• Stored in 2 different systems
o Specific ‘prepared’ stimuli (Seligman, 1971)
• Insects, animals, heights, enclosed places, anger
• Can be due to evolutionary instincts → more fear of spiders and snakes than cars even though cars present more danger in modern day society
o Novel stimuli
• If we don’t know what is going on, presented into a new, unknown situation e.g. first day somewhere, job interviews
Threat Appraisal
- Determine difference between situation and outcome, different individuals can be afraid of different outcomes if put in the same situation
- Generates expectancy of harm (situation & outcome)
- Product of:
o Perceived probability → likelihood
o Perceived cost, how bad it will be → intensity - Often based on past:
o Experience
• Conditioning, reinforcement (e.g. traumatic childhood events)
o Observational learning (e.g. witnessed an accident)
o Instruction (e.g. taught by parents)
Abnormal Anxiety/Anxiety Disorders
- Individual differences in:
o Trait anxiety: Tendency to perceive threat in ambiguous situations & Extent to which anxiety response is activated (different intensities)
o Specific fears - → ‘Abnormal’ anxiety, is not qualitatively different from normal anxiety
o Same 3 aspects (physical, cognitive & behavioural) - BUT: Excessive or inappropriate occurrence:
o Characterised by overestimation of threat:
• Cost or probability of harmful outcome
• Physical fears: mainly probability overestimation
• Social fears: mainly cost overestimation
Anxiety Disorders
- Involve experience of anxiety/ fear/ panic
o Physical
o Cognitive
o Behavioural - Reflect an internal dysfunction
o Anxiety in response to situations that are not objectively dangerous
o Activated without presence of harm/danger - Socially inappropriate/harmful/unexpected
o Interfere with everyday social or occupational activities - Categorised according to focus of anxiety
DSM-4 Anxiety Disorders
- Separation Anxiety Disorder (childhood onset) –> Being away from primary caregiver (age inappropriate)
- Specific Phobia –> Animals, natural environment, blood-injections-injury, situational, other (evolutionary, excessive and inappropriate)
- Social Phobia (Social Anxiety Disorder) –> Fear of negative social evaluation
- Generalized Anxiety Disorder –> Excessive and uncontrollable worry about a range of outcomes. Different from other disorders as it does not have a main focus
- Panic Disorder –> Unexpected/spontaneous panic attacks, Followed by anxiety about having another attack. With or without Agoraphobia → environmental, if panic attack occurred on a bus, they will not then go on a bus again
- Posttraumatic Stress Disorder & Acute Stress Disorder –> Thoughts/memories of traumatic experience
- Obsessive-Compulsive Disorder –> Obsessions: Intrusive thoughts or impulses, thoughts deemed as unacceptable, Compulsions: Ritualised behaviours to relieve the anxiety caused by obsessions
DSM-4 Anxiety Disorders Comorbidity
- Anxiety disorders are highly comorbid with each other, depression, substance use
o Generalised biological vulnerabilities → common causal factors (Genetics, Neuroticism)
o Generalised psychological vulnerabilities (Trait anxiety, low perceived control → Any anxiety disorder, depression)
o Specific psychological vulnerabilities (Focus of threat-related beliefs, Direct experience, observation, instruction, Specific Anxiety Disorders, Barlow (2000))
Treatment of anxiety disorders
Use highly similar treatments for most anxiety disorders due to their commonalities
Biological/Pharmacological treatments of Anxiety
o Barbiturates (Amobarbital, Phenobarbital)
• Quick acting, but relapse very common (80-90%)
• Highly addictive, can lead to OD, interact with alcohol
• Have NOT been used very commonly since 1970s
o Benzodiazepines (Valium, Xanax, Rohypnol)
• Quick acting, but relapse very common
• Less addictive, but interact with alcohol
• Acts of CNS, doesn’t treat anxiety, merely the symptoms and physiological responses of anxiety
o SSRIs (antidepressants, e.g., Prozac, Zoloft)
• Slower acting
• Fewer side effects
• Relapse common (20-60%)
Cognitive Behavioural Therapy (CBT) for Anxiety
o Treat the underling dysfunction
o Aim to reduce (biased) threat appraisal –> How likely is it that the event will happen? How bad would it be if it did happen?
o Increase (biased) coping appraisal
o Cognitive Techniques:
• Thought-diaries to identify automatic thoughts → write down what is going through your mind when feel anxious
• Thought challenging
• Socratic questioning
• What’s the evidence (for/against) the thought/belief?
• Pros and Cons of having the thought/belief
Other Behavioural Techniques
Exposure techniques
o Exposure to feared stimuli (public transport).
o Exposure to feared outcomes (negative evaluation)
• In vivo vs. imaginary exposure
• Flooding vs. Systematic desensitisation
- Reduce (biased) threat appraisal:
o Exposure to feared stimuli –> Reduces judgments of likelihood of harm
o Exposure to feared outcomes –> Reduces judgments of cost
o Exposure is essential in anxiety treatment → avoidance of not objectively dangerous situations, exposure teaches that these preconceptions of situations are untrue
o Flooding, mainly used in 50’s and 60’s, pushing individual into highest possible exposure situation of their fear
o Nowadays Systematic desensitisation is used (gradual exposure)
Changes from DSM-4 to DSM-5
- Panic Disorder and Agoraphobia become 2 separate disorders instead of Panic with Agoraphobia
- Posttraumatic Stress Disorder & Acute Stress Disorder moved into DSM-5 Trauma and Stressor-Related Disorders
- Obsessive-Compulsive Disorder moved into DSM-5 Obsessive-Compulsive and Related Disorders
DSM-5 Anxiety Disorders
- Separation Anxiety Disorder
- Selective Mutism
- Specific Phobia
- Social Phobia
- Generalised Anxiety Disorder
- Panic Disorder
- Agoraphobia
DSM-5 Trauma and Stressor-Related Disorders
- Posttraumatic Stress Disorder
- Acute Stress Disorder
- Adjustment Disorder
- Reactive Attachment Disorder
- Disinhibited Social Engagement Disorder
