Ch #9 anxiety disorder lecture notes Flashcards
Stress defintion
body response associated with environmental pressure or demands (positive or negative). Can lead to physical and psychological symptoms.
anxiety
an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure
stress characteristics
-generally a response to an external cause, such as taking a big test or arguing with a friend.
-goes away once the situation is resolved
-can be positive or negative. for example, it may inspire you to meet a deadline, or it may cause you to lose sleep
anxiety characteristics
-generally is internal, meaning its your reaction to stress
-usually involves a persistent feeling of apprehension or dread that doesn’t go away, and that interferes with how you live your life.
-is constant, even if there is no immediate threat.
anxiety and stress commonalities
both stress and anxiety can affect your mind and body. you may experience symptoms such as:
-excessive worry
-uneasiness
-tension
-headaches or body pain
-high blood pressure
-loss of sleep
anxiety vs. fear
fear: fear is a response to threats here and now
anxiety: anxiety is a future-focused fear
prevalence of separation anxiety disorder, specific phobia, social phobia and GAD.
around 5 %
prevalence of OCD, agoraphobia/panic and selective mutism
around 1-2%
Separation anxiety disorder (SAD)
Separation anxiety is important for a young childs survival:
-it is normal from about age 7 months through preschool years
-lack of separation anxiety at this age may suggest insecure attachment
SAD is distinguished by:
-age-appropriate, excessive, and disabling anxiety about being apart from parents are away from home
Separation anxiety disorder prevalence, comorbidity and course
-SAD is one of the two most common childhood anxiety disorders
-occurs in 4-10% of children and is more prevalent in girls than boys
-more than 60% of children with SAD have another anxiety disorder
-about 50% develop a depressive disorder
-associated with major stress
-persists into adulthood for more than 1/3 of affected children and adolescents–> associated with relationship difficulties and impairment in personal life
separation anxiety disorder in regards to school reluctance and refusal
One of the biggest problems associated with SAD in school refusal behaviour–>refusal to attend classes or difficulty remaining in school for an entire day
-occurs most often in ages 5-11
-fear of school be fear of leaving parents (separation anxiety), but can occur for many other reasons
describe the specific phobia disorder
Age-inappropriate persistent, irrational, or exaggerated fear that leads to avoidance of the feared or event and causes impairment in normal routine
-lasts at least 6 months
-extreme and disabling fear of objects or situations that in reality pose little or no danger or threat
-can lead to avoidance of the object/situation
specific phobia prevalence, comorbidity and course
prevalence and comorbidity–> about 20% of children are affected at some point in their lives, although few are referred for treatment, more common in girls
onset, course and outcome–> onset at 7-9 yrs especially for phobias involving animals, darkness, insects, blood and injury, clinical phobias are more likely to persist over time compared to normal fears
Social anxiety disorder/social phobia
- a marked, persistent fear of social situation or performing in front of people that expose the child to scrutiny and possible embarrassment
characterized by:
-anxiety over mundane activities
-most common fear is doing something in front of others
-more likely than other children to be highly emotional, socially fearful, and inhibited, sad and lonely
-great degree of overlap with selective mutism
what are the two main fears with social anxiety disorder
fear of performance situations: speaking in front of others
fear of interaction situations: talking to people at a party
social anxiety disorder prevalence, comorbidity, and course
-lifetime prevalence of 6-12% of children
-twice as common in girls
-more than 60% also have another anxiety disorder
-20% suffer from major depression and may self-medicate with alcohol and other drugs
-most common age of onset is early to mid-adolesence and is rare under age 10
generalized anxiety disorder
-excessive, uncontrollable anxiety and worry
-worrying can be episodic or continuous
-worry excessively about minor everyday occurrences
accompanied by at least one somatic symptom such as:
-headaches
-stomach aches
-muscle tension
-trembling
generalized anxiety disorder prevalence, comorbidity, onset, course and outcome
-lifetime prevalence rate is 2.2%
-equally common in boys and girls
-accompanied by high rates of other anxiety disorder and depression
-average age of onset is early adolescence
-older children have more symptoms
-symptoms persist over time
associated characteristics: cognitive disturbances
-cognitive errors and biases
The following cognitive bias are common in children and adolescents with anxiety:
-selective attention to threatening or dangerous information (anxious vigilance)
-catastrophizing
-rumination
-less positive reappraisal
-feelings of lack of control over the environment
together these biases can affect a childs ability to concentrate and their academic performance
associated characteristics: physical symptoms
-somatic complaints, such as stomachaches, headaches, are more common in children with GAD, PD, and SAD than in those with a specific phobia
-90% with anxiety disorders have sleep-related (nocturnal panic)
-high rates of anxiety in adolescence are related to reduced accidents and accidental deaths in early adulthood (short-term benefit of anxiety–> reduced risky behaviour)
associated characteristics: anxiety and depression
-up to 90% of individuals with anxiety experience symptoms of depression
-social and externalizing problem —->anxiety
-internalizing problems–> depression
-Threatening life events–> anxiety
-loss and stress–> depression
anxiety: trembling, rapid heart rate, palpitations, increased breathing, sweating, muscle tension, feeling nervous, hypervigilence, agoraphobia, panic, sense of impending danger
anxiety and depression: excessive worry, somatic complaints, difficulty with thinking concentration, or decision making, restlessness, agitation, appetite or sleep disturbance, social withdrawal
depression: fatigue, irritability, loss of interest in activities, guilt, low self-esteem, worthlessness, helplessness, hopelessness, prolonged grief, persistent sadness, suicidal thoughts
causes: family and genetic risk of anxiety
family and twin studies suggest:
-about one-third of the variance in childhood anxiety symptoms is genetic
-genes are linked to broad anxiety-related traits (behavioural inhibition)
-in general, multiple genes seem linked to anxiety in interaction in environmental influences (gene x environments interaction)
causes: neurobiological factors of anxiety
behavioural approach system (BAS): stimulates behaviours in situations of reward or to avoid punishment
behavioural inhibition system (BIS): explains our tendency to freeze, feel anxiety when we perceive danger
overactive behavioural inhibition system (BIS)–> anxiety
the entire anxiety response system is controlled by several interrelated systems to produce anxiety:
-hypothalamic-pituitary-adrenal (HPA) axis= increased cortisol
-Limbic system=hyperactive amygdala
-ventrolateral prefrontal cortex=works with the amygdala for the perception of threat
-other cortical and subcortical structure and primitive brain stem
causes: family factors
-parenting practices–>parents of anxious children tend to be over involved, intrusive, or limiting Childs independence
-prolonged exposire to high doses of family dysfunction associated with extreme trajectories of anxious behaviour
-low SES
-insecure early attachments
treatments for anxiety are mostly directed at modifying:
-distorted information processing
-physiological reactions to perceived threat
-sense of lack of control
-excessive escape and avoidance behaviours
-(reducing) the anxiety and negative affect
cognitive behavioural therapy
Cognitive restructuring:
-identify thought
-challenge thought
-propose an alternative
Use of Imagery:
Help the child imagine the anxiety producing thought become more and more distant
Emotion:
Humor, use of anger (maybe towards a doll)
Physiology:
Relaxation techniques to stimulate our vagus response
Behaviour:
Main technique is exposure to feared stimulus while providing children with ways of coping other than escape and avoidance (graded exposure, systematic desensitization)
treatment: family interventions
-addressing children’s anxiety disorders in a family context may result in more dramatic and lasting effects
-parental involvement in modeling and reinforcing coping techniques
-parental anxiety-management strategies
-parent skills training
