Chapter 4 - Anxiety Disorders Flashcards
1
Q
Fear
A
Activated quickly and to specific threats
Activation of fight/flight response
Strong urge to escape
There are lots of different responses possible
2
Q
Anxiety
A
Activated diffusively, can be continuous, ongoing
Future oriented
Tension, chronic over-arousal, prepared for fight-or-flight response
Avoidance = negative reinforcement
3
Q
What are the 2 major components of anxiety (and a third?)
A
Physiological (heightened level of arousal and physiological activation)
Cognitive (subjective perception of the anxious arousal and the associated cognitive processes; worry and rumination)
*Behavioural: avoidance and safety behaviours
4
Q
Difference between worry and rumination
A
Rumination = thinking about the same thing over and over again
Worry = thoughts passing
Both can keep the anxiety alive
5
Q
Describe the Yerkes-Dodson Law
A
A medium level of arousal is best for the best performance
Not enough arousal is detrimental, and so is too much
(arousal being the anxiety level)
6
Q
Neuroticism
A
People who are stressed, low emotional stability, control freaks, irritable, anxious (linked with anxiety disorders)
7
Q
Which is the + common psychological disorder?
A
Anxiety disorders
8
Q
Gender gap in anxiety disorder
A
9% of men vs 16% women
9
Q
Lifetime and one-year prevalence of anxiety disorders
A
Lifetime = 16.6% One-year = 10.6%
10
Q
Changes in the DSM-5 concerning anxiety disorders
A
PTSD now a stress disorder
OCD now under “OC and related disorders”
11
Q
Separation anxiety
A
the anxiety that results from having contact or the possibility of losing contact with attachment figures
(usually prevalent among children, but also in adults)
12
Q
Adult separation anxiety
A
Adults who cannot stand to be alone and preoccupied with losing contact with loved ones (can be more prevalent than we think)
13
Q
Phobic disorders
A
Persistent and disproportionate fear of some specific object or situation that presents little to no danger
14
Q
Meaning of the term phobia
A
Implies that the person suffers intense distress and social and occupational impairment because of the anxiety - people with phobias are insightful about it
15
Q
5 phobia subtypes
A
Agoraphobia Fears of heights or water Threat fears (blood/needles, storms/thunder, etc) Fears of being observed Speaking fears
16
Q
Specific phobias duration
A
Long-lasting (mean of 20yrs)
only 8% receive treatment
17
Q
Algophobia
A
Pain
18
Q
Monophobia
A
Being alone
19
Q
Mysophobia
A
Contamination
20
Q
Nyctophobia
A
Darkness
21
Q
Pyrophobia
A
Fire
22
Q
Dextrophobia
A
Objects on right side of the body
23
Q
Lininophobia
A
String
24
Q
Eophobia
A
Dawn
25
Hellenologophobia
Scientific or greek terms
26
Nomophobia
Remaining out of touch with technology
27
Pa-leng (China)
Fear of the cold; fear that the loss of body heat may be life-threatening
28
Age of onset of phobias
Vary widely
29
Causal theories for specific phobias
```
Deep-seated psychodynamic conflicts (anxiety = defense mechanism)
Fear conditioning
Cognitive diathesis (predisposed to looking out for negative stimuli)
Evolutionary origins (biological perparedness)
```
30
Phobias according to psychoanalytic theory
Are a defense mechanism against the anxiety produced by repressed Id impulses
Anxiety is displaced from the feared Id impulse and moved to an object or situation that has some symbolic connection to it
The objects/situations become the phobic stimuli
Avoiding them = avoiding dealing with internal conflicts
31
What is psychoanalytic theory focusing on when treating phobias
The content of it; supposed to be symbolic
32
Phobias in behavioural model
result from fear conditioning (US + NS = CS)
33
Vicarious conditioning
Seeing someone's phobia - getting that phobia
34
Factors influencing fear conditioning before, during and after
Before: genetic/temperamental factors, prior experiences (can immunize or weaken)
During: controllability - perceived
After: inflation effect
35
Prepared stimuli
Some fears can be innate (ex: being afraid of snakes when you live in the country where you will be exposed to some)
36
2 brain areas associated with negative emotional responses activated in phobias, PTSD, and SAD
Amygdala and insula
37
Labile ANS
Labile ANS: peolpe who are labile, jumpy, readily aroused, importance in development of anxiety disorders
MAY be geneticall inherited
38
Negative reinforcement in phobias
Behaviours followed by the termination of negative consequences will increase - avoidance behaviour is negatively reinforced and prevents extinction (increases phobia)
39
Attentional bias in phobias
Scanning for the object/situation at all times, focused on the possible negative experience (increases phobia)
40
Treatment for phobia - 3 types of exposure therapy
Exposure therapy (60-90% success)
- in vivo (irl - high dropout rate and low acceptance)
- systematic desnsitization (list + relax)
- VR
- Augmented Reality (VR+ real life)
41
Psychoanalytic treatment of phobias
Improvement is not sign that the internal conflict has been resolved
42
Treatment for blood-injection phobias
Tense, rather than relax, to avoid fainting
43
Social Phobia (Social Anxiety Disorder)
Disabling fear of 1 or + discrete social situations in which a person fears that they may be exposed to the scrutiny and potential negative evaluation of others
44
Symptoms of SAD
- More concerned about evaluations
- Highly aware of the image they present to others
- High in public self-consciousness
- Preoccupied with a need to seem perfect in front of others
- Tend to view themselves negatively even when they perform well in social situations
- Less certain about their positive self-views
- See their positive attributes as being less important
45
2 specifiers of SAD
Generalized (many situations) or non-generalized (specific)
46
Generalized SAD
involve many situations
earlier age of onset
more severe impairment than specific phobia
47
Prevalence - comorbidity of SAD
```
12% lifetime prevalence
More females than males
Comorbid with MD, substance abuse, other AD, APD
Average age of onset is 13yo
Average duration is 20yrs
```
48
People + at risk for SAD
Never married/divorced
Low SES
Lack social support
Report low quality of life, chronic physical condition
49
Behavioural theory for SAD
Lack of social skills is the cause of the phobia
The person repeteadly commits faux pas since they never learned how to behave
Timing/placement of social responses are impaired
50
Cognitive theories for SAD
How people's thought processes can serve as a diathesis - how thoughts can maintain a phobia
Are + likely to: attend - stimuli, interpret ambiguous situations as threatening, believe that negative events are + likely than positive to occur
51
Post-Event Processing (PEP) of negative social experiences
Form of rumination about previous experiences and responses to these situations, especially experiences involving other people that did not turn out well
52
Taijin Kyofusho (TKS)
fear of doing something that will embarrass, offend, or bring shame to others
symptoms: fear of eye contact and blushing
53
Treatment for SAD
Antidepressants
Understanding underlying causes
CBT (exposure to situations, cognitive techniques, video feedback, social skills training) - about 60% success, reduced relapse compared with meds
54
Panic disorder definition
characterized by unexpected panic attacks that seem to come out of the blue
55
Panic disorder criteria (3)
1. Recurrent, unexpected panic attacks
2. At least 1 attack followed by: persistent concern about other attacks, worry about consequences of the attack, significant behavioural change related to the attack
3. Absence or presence of agoraphobia
56
Agoraphobia
EITHER:
1. anxiety about being in places/situations from which escape might be difficult or embarrassing, or where help may not be available
2. situations are avoided, restricted or endured with distress or anxiety about having a panic attack, require the presence of a companion
57
Agoraphobia
EITHER:
1. anxiety about being in places/situations from which escape might be difficult or embarrassing, or where help may not be available
2. situations are avoided, restricted or endured with distress or anxiety about having a panic attack, require the presence of a companion
58
Typical agoraphobic fears
being outside the home alone, being in a crowd or standing in line, traveling by car, bus, or train, being on a bridge
59
Prevalence of panic disorder
4.7% lifetime
50% have other diagnosis
80-90% report that 1st attack happened after a major negative life event
2x+ prevalent in women
60
Panic Disorder among the Inuit of Northern Canada or West Greenland
Kayak-angst: Occurs among seal hunters that are alone at sea - involved intense fear, disorientation, and concerns about drowning
61
Which region of the brain may be involved in phobic avoidance and anticipation
Hippocampus
62
Which brain region with abnormal activity may start panic attacks
Amygdala
63
Noradrenergic activity theory for panic disorder
Panic is caused by overactivity in the noradrenergic system
Stimulation of the locus ceruleus causes monkeys to have panic attacks - but drugs that block firing in this area are not effective to stop panic attacks
Yohimbine (drug stimulating the area) can cause panic attacks in humans
64
Problem in GABA theory for Panic Disorder
GABA usually inhibits noradrenergic activity
| People with PD have less GABA receptor binding sites
65
Cognitive behavioural theories for Panic Disorder
Interoceptive conditioning (fearing fear)
Anxiety sensitivity and perceived control
Safety behaviours and maintenance of panic
Cognitive biases and maintenance of panic
Cognitive theory of panic
66
Cognitive theory of panic
(see slide) something triggering is a perceived threat, apprehension about having a panic attack occurs, body sensations arrive, interpretation of sensations of catastrophy - is a perceived threat, circle goes on
67
Anxiety sensitivity
being very sensitive/connected to your anxiety, constantly monitoring
risk factor for anxiety psychopathology
predicts the development of panic attacks
68
Treatments for panic disorder
Medications (minor tranquilizers or antidepressants)
CBT: breathing techniques, progressive relaxation, cognitive techniques (target catastrophizing), exposure - 75-95% efficacy
69
Generalized Anxiety Disorder
Chronic, excessive or unreasonable anxiety and worry about a number of events and daily activities
free-floating anxiety
difficult to control the worry
anxious apprehension
70
Physical symptoms of GAD
```
restelessness, being on edge
being easily fatigued
difficulty concentrating, mind going blank
irritability
muscle tension
sleep disturbance
```
71
Prevalence of GAD
```
5.7% lifetime
gradual onset
2x+ common in women
don't typically seek treatment
begins in mid-teens
high comorbidity with anxiety/mood disorders
difficult to treat
```
72
Psychosocial factors influencing GAD
```
Psychodynamic: defense mechanisms are not workin
uncontrollable events (hypervigilance)
Cognitive biases (attentional bias, negative interpretation)
vicious circle
```
73
Benefits of worry according to GAD patients
```
Superstitious avoidance of catastrophe
actual avoidance of catastrophe
avoidance of deeper emotional topics
coping and preparation
motivating device
```
74
Worry and aversive images
Worry reduced the reaction to aversive images
75
Biological factors for GAD
Mild-modest heritability (neuroticism trait)
GABA deficiency - based on the fact that benzos are effective for treating it - increase the release of GABA
GABA inhibitors increase anxiety
76
Treatments of GAD
Anxiolytics (benzos, buspirone)
Antidepressants
CBT: worry outcome monitoring, identifying/targeting core fears, response prevention (avoidance), mindfulness
Psychodynamic: understand underlying conflicts, work through the origins of the defense
77
Selective mutism
Failure to speak in one situation (usually school) when able to speak in other situations (usually home)
78
SAD specifier in DSM-5
Now a "performance only" specifier can be added, but the generalized vs specific is not there anymore
79
What is the "widening the bandwidth" technique to get rid of SAD?
doing acts that people with SAD deem inappropriate, and notice the lack of reaction in others - goal is to come to the conclusion that they can widen the scope of their actions without negative feedback
80
Depersonalization and derealization in panic disorder/agoraphobia
Depersonalization: feeling of being outside one's body
| Derealization: feeling of the world's not being real, fears of losing control, going crazy, dying, etc
81
CBGT Cognitive-Behavioural Group Therapy
combination of cognitive restructuring and situational exposure typically delivered in a group of 6-8 clients
82
Panic-control therapy
3 components
Relaxation training
Combination of Ellis and Beck type interventions (CBT)
Exposure to internal cues that trigger panic (interoceptive exposure)
Practicing behaviours that elicit panic in a safe setting to learn how to respond to them - reduces unpredictability
83
Types of Mindfulness used in treatment
Decentering: being able to view thoughts and emotions objectively, without engaging with them (central to GAD therapy)
Lovingkindness: type of mindful meditation useful in the treatment of SAD, where people focus on being kind towards themselves and extending that kindness onto others
84
DCS: d-cycloserine
medication that could enhance exposure-based treatment by facilitating extinction of fear
Administered close to an exposure (1-2hrs)
Caveat: if the exposure does not go well the drug could enhance the fear memory - making the phobia worse
