Anxiety & Trauma related disorders Flashcards
What is considered normal worry?
- Occurs in response to perceived threat: mainly social threat in adults, more about physical threat in older adults
- Contains verbal thought vs. imagery
- Perceived positive aspects: Motivates action, helps to problem solve, avoid negative outcomes, distract from more distressing topics
What is the Problem Solving Theory of worry?
Worrying involves problem solving attempts, but problem solving attempts of pathological worriers
are ‘thwarted’ (often due to biased threat perception)
Social Problem Solving Stages:
1. Problem definition
2. Generation of alternative solutions
3. Solution evaluation (positive / negative)
4. Solution selection
Last two stages are problematic in high worriers
Treatment: change biased threat perception, probability and cost judgements, problem solving training
What is the Metacognitive Theory of worry?
Two types of worry:
Type 1 Worry:
- Perception of threat + positive beliefs about worry, worry to cope with threat
- possible exit by problem solving or reassurance
Type 2 Metaworry:
- Worry + negative beliefs about worry
- ineffective thought-control strategies increase anxiety and worry
- -> Excessive and uncontrollable worry
treatment: challenge beliefs about worry (positive and negative)
What is the Avoidance Theory of Worry?
Worry: more verbal thought than imagery; Images of possible negative event are highly aversive & cause anxiety symptoms (= sympathetic arousal)
- Reduced imagery => reduced arousal/anxiety (GAD is associated with tension symptoms)
Worry = cognitive avoidance
- Cognitive avoidance interferes with emotional
processing
- Fear structures are maintained => keep worrying
Experiential Avoidance
- worry is associated with difficulties in emotional regulation, stress intolerance, fear of anxiety, and avoidance of stimuli
Treatment: Exposure to vivid images of feared event, exposure to emotional experience / distress, exposure to uncertainty
What is Intolerance of Uncertainty theory?
- Uncertainty reflects badly on a person, causes
frustration and stress, and prevents action - Worry to reduce uncertainty –> Leads to preoccupation with details
- Interferes with problem solving
◦ Worriers aim to reduce uncertainly to zero (not possible)
treatment: Exposure to uncertainty, challenge cognitions about uncertainty
What is Generalised Anxiety Disorder (GAD)?
First introduced in DSM-III-R (1980) DSM-IV (1994) and DSM-5 (2013) definition:
- Excessive, uncontrollable worry about a variety of
events / outcomes
- Occurs more days than not for at least 6 months
- At least 3 of 6 somatic symptoms: Restlessness, fatigue, difficulty concentrating, irritability, muscle
tension, sleep disturbance
- Does not include autonomic arousal
What is Post-Traumatic Stress Disorder (PTSD)?
A. Exposure to actual or threatened death, serious
injury, or sexual violence in one (or more) of the
following ways:
- Directly experiencing the traumatic event(s).
- Witnessing, in person, the event(s)
- Learning that the traumatic event(s) occurred to a close family member or close friend.
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)
B. Intrusion symptoms (1 or more needed); Memories, dreams, flashbacks
C. Persistent avoidance of stimuli (1+); memories etc, or external reminders of the event
D. Negative changes in cognition, mood (2+); Fear, negative beliefs about self, others, the world
E. Changes in arousal, reactivity (2 +); Anger, recklessness, self-destructive acts, sleep
disturbance
D. Duration of symptoms is 1 month or more
What is the prevalence and aetiology of PTSD?
50-60% of people experience traumatic event, about 25% of those develop post-traumatic problems (PTSD prevalence: 5-11%), distress drops substantially within 3 months in about 75% of people
Risk Factors:
- Pre-trauma factors; childhood trauma, prior psychiatric history, family instability, substance abuse, social/economic disadvantage
- Trauma factors; Degree of life threat or loss, severity of exposure, location of trauma (safe place vs elsewhere), Individual’s role in the trauma, Meaning (e.g., uncontrollability)
- Post-trauma factors; Social support, coping style, ongoing stressors
What are the current treatments for PTSD?
Biological treatments; benzodiazephines, antidepressants
CBT; Assess suitability, psychoeducation, anxiety management techniques, cognitive restructuring, prolonged exposure
EMDR: Eye Movement Desensitization and
Reprocessing (EMDR) Now used to treat a variety of anxiety disorders, training has to be provided by EMDR Institute
What are the major features of anxiety?
Physical system: fight/flight: sympathetic nervous system, Symptoms: sweating, heart rate, trembling etc
Cognitive system: perception of threat, attentional shift and hypervigilance, difficulty concentrating on other information.
Behavioural system: escape/avoidance tendencies, aggression
Eliciting conditions: Realistic/objective threat to self, physical vs social threat, specific ‘prepared’ stimuli
Threat appraisal –> Expectancy of harm –> automatically Elicits Anxiety
What differs anxiety and abnormal anxiety?
Abnormal anxiety is not qualitatively different from normal anxiety (how it is experienced)
Anxiety becomes abnormal when it is excessive or inappropriate occurrence (usually characterised by overestimation of threat)
Anxiety disorders:
- Reflect an internal dysfunction (reactions to non-dangerous things)
- Are socially inappropriate/harmful/unexpected (Interfere with everyday social or occupational activities)
- Categorised according to focus of anxiety
What are the commorbidities of anxiety disorders?
Anxiety disorders are highly comorbid with
- each other,
- depression,
- substance use
What are the common treatments for anxiety disorders?
Medication: SSRIs (slow acting, few side effects, common rate of relapse 20-60%) Benzodiazepines (fast-acting, addictive, high rate of relapse, react with alcohol)
CBT: aim to reduce biased threat appraisal, increase biased coping appraisal (thought diaries, thought challenging)
Behavioural techniques; exposure therapy (desensitization, reduction of threat appraisal)
What were the changes from the DSM-IV to V for anxiety related disorders?
PTSD; is now under stressor related disorders
OCD: is now under obsessive compulsive related disorders
Phobias: can be diagnosed under 18
addition: selective mutism and separation anxiety (moved from early childhood onset disorders)
What is a panic attack?
An abrupt surge of intense fear or discomfort, peaks within minutes, includes 4 (or more) symptoms
Can occur in the context of any anxiety disorder
Expected (cued) panic attack
- Usually occur in context of other anxiety disorders (Specific phobia,Social phobia, PTSD)
Unexpected (uncued/spontaneous) panic attack
- Person can not identify the source of fear
- Occur in context of Panic Disorder
