Ch #9 anxiety disorder lecture notes

Question 1

Stress defintion

Answer 1

body response associated with environmental pressure or demands (positive or negative). Can lead to physical and psychological symptoms.

Question 2

anxiety

Answer 2

an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure

Question 3

stress characteristics

Answer 3

-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

Question 4

anxiety characteristics

Answer 4

-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.

Question 5

anxiety and stress commonalities

Answer 5

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

Question 6

anxiety vs. fear

Answer 6

fear: fear is a response to threats here and now

anxiety: anxiety is a future-focused fear

Question 7

prevalence of separation anxiety disorder, specific phobia, social phobia and GAD.

Answer 7

around 5 %

Question 8

prevalence of OCD, agoraphobia/panic and selective mutism

Answer 8

around 1-2%

Question 9

Separation anxiety disorder (SAD)

Answer 9

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

Question 10

Separation anxiety disorder prevalence, comorbidity and course

Answer 10

-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

Question 11

separation anxiety disorder in regards to school reluctance and refusal

Answer 11

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

Question 12

describe the specific phobia disorder

Answer 12

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

Question 13

specific phobia prevalence, comorbidity and course

Answer 13

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

Question 14

Social anxiety disorder/social phobia

Answer 14

• 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

Question 15

what are the two main fears with social anxiety disorder

Answer 15

fear of performance situations: speaking in front of others

fear of interaction situations: talking to people at a party

Question 16

social anxiety disorder prevalence, comorbidity, and course

Answer 16

-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

Question 17

generalized anxiety disorder

Answer 17

-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

Question 18

generalized anxiety disorder prevalence, comorbidity, onset, course and outcome

Answer 18

-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

Question 19

associated characteristics: cognitive disturbances

Answer 19

-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

Question 20

associated characteristics: physical symptoms

Answer 20

-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)

Question 21

associated characteristics: anxiety and depression

Answer 21

-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

Question 22

causes: family and genetic risk of anxiety

Answer 22

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)

Question 23

causes: neurobiological factors of anxiety

Answer 23

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

Question 24

causes: family factors

Answer 24

-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

Question 25

treatments for anxiety are mostly directed at modifying:

Answer 25

-distorted information processing
-physiological reactions to perceived threat
-sense of lack of control
-excessive escape and avoidance behaviours
-(reducing) the anxiety and negative affect

Question 26

cognitive behavioural therapy

Answer 26

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)

Question 27

treatment: family interventions

Answer 27

-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