Chapter 5 Flashcards
Physiological component
involves changes in the autonomic nervous system that result in respiratory, cardiovascular, and muscular changes in the body (e.g., changes in breathing rate, heart rate, and muscle tone).
Cognitive Component
includes alterations in consciousness (e.g., in attention levels) and specific thoughts a person may have while experiencing a particular emotion. For example, it is common for individuals experiencing a panic attack to think “I’m going to die,” or for someone with social anxiety to think “I’m going to embarrass myself in front of everyone.”
Behavioural Responses
tend to be consequences of certain emotions and thoughts. For example, if Greg experiences a panic attack during his exam, he may feel compelled to leave the situation.
Anxiety
Is an affective state where an individual feels threatened by the potential occurrence of a future negative event
Anxiety Concerns
Future oritented
Fear
more “primitive” emotion and occurs in response to a real or perceived current threat.
-Not an anxiety symptom
- fear is “present oriented” in the sense that this emotion involves a reaction to something that is believed to be threatening at the present moment.
Fight or flight response
-Fear prompts a person to either flee from a dangerous situation or stand and fight
Panic vs Fear
Fear is an emotional response to an objective, current, and identifiable threat
Panic is an extreme fear rejection that is triggered even though there is nothing objectively threatening to be afraid of
Historical: Neurosis
Anxiety disorder classified together with somatoform and dissociative disorders
-Implie that the cause was presumed to be a disturbance in the central nervous system
Freud and Anxiety
-Important difference between fears and neurotic anxiety
-Neurotic anxiety= signal to the ego that an unacceptable drive (mainly sexual in nature) is pressing for conscious representation
-Anxiety was viewed as a signal to ensure that the ego takes defesnive action against internal pressures
Freud said that anxiety occurred
Due to defence mechanisms failed to repress painful memories, impulses, or thoughts
Anxiety related disorders fall into three categories
Anxiety disorders, Obsessive-compulsive and related disorders and trauma and stressor related disorders
Genetics and Anxiety
Twin studies showcase the fact that there is evidence that anxiety can be hereditary
Neuroanatomy and Neurotrasnmitters
1) Registry of sensory info at the thalamus, sent to amygdala
2)Amygdala, then area in the hypothalamus, and midbrain area, and then to the brain stem and spinal cord
3) Brain stem and spinal cord connect with the various autonomic (heart rate, blood pressure, etc) and behavioural (freezing or flight)
Fear system
Involves a subcortical network that can be aroused without the influence of complex cortical input
No neurotransmitter system has been found to dedicate to solely the expression of
Fear, anxiety, and panic
Gamma-Aminobutyric Acid (GABA)
Is the most pervasive inhibitory neurotransmitter in the brain, and receptors for this neurotransmitter are well distributed along the neural fear circuit
Benzodiazephines
Class of anti-anxiety medications that operate primarily on GABA mediated inhibition of the fear system
Serotonin and norepinphrine systems
These systems serve general arousal regulatory functions in the central nervous system and many of the medications used in the management of anxiety disorders have serotonin and or norepinephrine based modes of action
Two factor theory= Mowrer
-Attempted to account for the acquisition of fears and maintenance of anxiety
Mowrer and fear
Fear develops through the process of classical conditioning and are maintained through operant conditioning
1) Neutral stimulus becomes paired with an inherently negative stimulus (frightening event
-Individual lessens this anxiety by avoiding the CS, a behaviour that is negatively reinforced through operant conditioning
Watson Little Albert
Fera of rat (CS) becam econtioned through pairing with a sudden loud noise (UCS)
-Avoid rats= less anxious
Avoidance
Effective through reducing a person’s anxiety in the short term but can serve to increase anxiety over the long haul
Flaw of Mowrer’s Two-factor theory
Does not explain phobias
-Not all fears develop through classical conditioning
-People can learn fears by observing the reactions of others (vicarious learning or modelling)
-Fears can develop by hearing fear-related information
Aaron Beck=main cognitive model for anxiety
-People are afraid. because of the biased perceptions that they have about the world, future, and themselves
-Anxious people see the world as dangerous, future as uncertain, and themselves as ill-equipped to cope with life’s theats
-They are helpless and vulnerable
Anxious people tend to focus on info that is relevent to their fears
-individuals who are phobic of spiders tend to orient toward words like crawl or hairy relative to positive or neutral words, whereas individuals with social anxiety show this effect for words such as boring or foolish
Interpersonal Factors of Anxiety
-Parents who are anxious themselves tend to interact with their children in ways that are less warm and positive, more critical and catastrophic, and less granting of autonomy when compared to non-anxious parents.
Parents with challenging parenting behaviour
children are encouraged to take risks or go outside their comfort zones, may reduce their children’s risk for anxiety by fostering self-efficacy in dealing with unfamiliar or frightening situations.
Children who develop anxious ambivalent
attachment style learn to fear being abandoned by loved ones. This attachment style may develop from interactions with parents who are inconsistent in their emotional caregiving toward the infant. Later in life, these individuals may be wary of the availability of significant others and become chronically worried about negative interpersonal events.
Panic Attacks
Involves a sudden rush of intense fear or discomfort during which an individual experiences a number of physiological and psychological symptoms
True Panic Attacks (4/13)
physiological in nature: specifically, disturbances in heart rate (i.e., palpitations, pounding heart, or increased heart rate)
-sweating, trembling or shaking, feelings of choking, chest pain, nausea or abdominal discomfort,
-paresthesias (numbness or tingling sensations), chills or heat sensations, dizziness or light-headedness, and sensations of shortness of breath or smothering
-psychological phenomena: derealization (feelings of unreality) or depersonalization (being detached from oneself), fear of losing control or “going crazy,” and fear of dying.
Other symptoms Culture Specific
tinnitus, neck soreness, headache, and uncontrollable screaming or crying, may also occur.
How long must a panic attack occur for
the panic attack must also develop suddenly, reaching a peak within minutes
-panic disorder usually experience numerous bouts of panic, but at least two unexpected attacks are required for this diagnosis.
-at least one of the panic attacks must be followed by persistent concerns (lasting at least one month) about having additional attacks or by worry about the ramifications of the attack (e.g., worry that the person will lose control, “go crazy,” have a heart attack, or die).
Panic disorder is diagnosed
When at least one panic attack results in a significant alteration in behaviour
Agoraphobia
“Fear of the marketplace”
is anxiety about being in places or situations where an individual might find it difficult to escape (e.g., being in crowds, standing in lines, going to a movie theatre, being on a bridge, travelling in a car) or in which help would not be readily available should a panic attack occur (e.g., being outside of home alone, travelling).
The similarity of panic disorder and agoraphobia
-highly comorbid, and the occurrence of panic attacks often instigates agoraphobia
Diagnosis of Agoraphobia
diagnosis is made only when feared situations are actively avoided, require the presence of a companion, or are endured only with extreme anxiety; and is made irrespective of whether panic disorder is present. If an individual meets the criteria for both panic disorder and agoraphobia, then both diagnoses are assigned
Panic Disorder Diagnosis
is that individuals initially experience unexpected panic attacks and have marked apprehension and worry over the possibility of having additional panic attacks.
Panic attack diagnosis
associated with other anxiety disorders are usually cued by specific situations or feared objects.
Anxiety disorder diagnosis
a multi-method assessment that includes a clinical interview, behavioural measurement, psychophysiological tests, and self-report indices is the ideal assessment strategy
Structural Clinical Interview for DSM-5
is a semi-structured interview that covers the main clinical disorders, including panic disorder and agoraphobia
Anxiety and Related Disorders Interview Schedule for DSM-5
used to establish differential diagnosis among the anxiety disorders.
Behavioural Avoidance Test (BAT)- Assess Agoraphobia avoidance
-patients are asked to enter situations that they would typically avoid
-They provide a rating of their degree of anticipatory anxiety and the actual level of anxiety that they experience
Symptom Induction-Panic Disorder
a patient may be asked to hyperventilate, to shake their head from side to side, or to spin in a chair in order to bring on symptoms of panic. Such exercises can be useful both as a way of assessing symptom severity and as a strategy for exposure treatment.
Psychophysiological assessment strategies
monitoring of heart rate, breathing, blood pressure, and galvanic skin response while a patient is approaching a feared situation or experiencing a panic attack
Panic Disorder and Agoraphobia: Biological
these disorders tend to run in families. The biological relatives of individuals with panic disorder, for instance, are about five times more likely to develop panic disorder than are individuals who do not have panic-prone relatives
- there is evidence that biological challenges induce panic attacks in individuals with panic disorder more frequently than they do in non-psychiatric controls
Biological Challenge
The presentation of a stimulus (hyperventilation) intended to induce physiological changes associated with anxiety
Nocturnal Pain- Panic Disorder
Attacks that occur while sleeping (most often during the lighter stages of sleep- 1-3 hours of falling asleep) and some experience panic when they attempt to relax
Nocturnal or relaxation Induced Panic Attacks
Fear of letting go
Catastrophic Misinterpretations- Panic Disorder
Misinterpret symptoms as a sign that something is wrong (I am going to have a heart attack)
Anxiety Sensitivity
With the belief that the somatic symptoms related to anxiety will have negative consequences that extend beyond the panic episode itself
Alarm Theory
True alarm occurs when there is a real threat- our bodies produce an adaptive physiological response that allows us to face the feared object or flee from the situation. Can be activated by emotional cues
Cognitive Model of Panic
1) Subjective Threat (increased heart rate, sweating, shortness of breath, etc)
2) Misinterpretation of bodily sensations (I’m going to have a heart attack; I’m going to die)
3) Intensification of bodily sensations
4) Increased anxiety and fear
People with panic disorders/attacks
Focus intensely on their bodily sensations (an on other environmental cues that may have been present during the attack) to prepare for and prevent future panic attacks
Specific phobias
A person’s fears are extreme
Fears
Adaptive reactions to threats in the environment, but phobias are excessive and unreasonable fear reactions
Diagnosis of a specific phobia
Marked and persistent fear of an object or situation
5 Specific phobias
1) Animal type the phobic object is an animal or insect
2)Natural Environmental Type= natural environment (height, water, thunderstorms)
3) Blood Injection Type= person fears seeing blood or an injury, or fears an injection or other types of invasive medical procedure
4) Situational Fear= person fears specific situations, such as bridges, public transportation, or enclosed spaces
5) Other types= not covered in categories
(extreme fears of choking, vomiting, clowns, illness phobia)
Illness Phobia
involves an intense fear of developing a disease that the person currently does not have
hypochondriasis
people believe that they currently have a disease or medical condition
Having a phobia from one of these subtypes
Increases the probability of developing another phobia within same category
Equipotentiality Premise
Assumes all neutral stimuli have an equal potential for becoming phobias
NonAssociative Model
Proposes that the process of evolution has endowed humans to respond fearfully to select a group of stimuli (water, heights, spiders) and no learning is necessary to develop these fears
-Ex: Babies are born with pre wired anxiety= stranger anxiety
Seligman=Biological Preparedness
process of natural selection has equipped humans with the predisposition to fear objects and situations that represented threats to our species over the course of our evolutionary heritage.
-Associative learning is still needed to develop a phobia
Disgust Sensitivity
refers to the degree to which people are susceptible to being disgusted by a variety of stimuli such as certain bugs, types of food, and small animals
-people develop some phobias because the phobic object is disgusting and possibly contaminated
Social Anxiety/Social Phobia
a marked and persistent (i.e., lasting six months or more) fear of social or performance-related situations. Individuals with social anxiety disorder fear interacting with others in most social settings
-Fear of being evaluated negatively and worry about what others might be thinking about them
Performance only Social Phobia
fear specific social situations or activities, which may include casual speaking, eating or writing in public, or giving formal speeches
Social Anxiety in Children
crying or tantrums, freezing or shrinking, clinging, or failing to speak in social situations
Symptoms of Social Anxiety
experience fear or anxiety in social situations that is out of proportion to the actual threat posed by these situations.
-The fear of scrutiny by others in these everyday situations, however, may be so overwhelming for individuals with social anxiety disorder that they go out of their way to avoid such situations. The ubiquity of social interactions means that these avoidance behaviours often cause significant problems for people.
Those with social anxiety will avoid
social situations; those situations they cannot avoid are otherwise endured with intense anxiety and distress
Those with social anxiety suffer with
often have low self-esteem and are at increased risk for mood problems such as depression
-Typical have another disorder
Diagnosis of social anxiety
-structured or semi-structured interview combined with completion of various self-report measures
Difference between social anxiety and Agoraphobia
The fear that characterizes social anxiety involves being negatively evaluated or embarrassed in social situations
Etiology of social Anxiety
1)Genetic factors
2) Behavioural inhibition is an early marker of risk for social anxiety disorder. Toddlers who are behaviourally inhibited are more than twice as likely to develop social anxiety by the end of adolescence when compared with non-inhibited toddlers
3)Bullied or teased in childhood
4)Parental criticism, overprotection, and control as a child
Cognitive Factors with Social Anxiety
involve both negative beliefs and judgments about self and others, as well as abnormal processing of social information
-Judge themselves, fear of making mistakes
-Judge themselves as inferior to others and engage in negative thinking about self
Dishonest Self disclosure
refers to a self-protective strategy wherein individuals assert inauthentic or dishonest opinions to try to “tell others what they want to hear” instead of expressing their own genuine opinion
Social Anxiety other:
-Abnormal social information processing (avoid looking directly at others faces)
-Increased brain activity in the amygdala when viewing others’ facial expressions
Self focussed attention
inked to increased activity in brain structures responsible for introspection and self-referential processes
Public self conscious- social
wareness of the self as an object of attention, or the tendency to see the self’s actions from the perspective of an outside observer rather than through the person’s own eyes
Interpersonal disorder- social anxiety
a condition that is commonly associated with marked disruption in the ability to relate with other people
Generalized Anxiety Disorder
central difficulty involves uncontrollable and excessive worry (also called pathological worry).
-Chronic, excessive, uncontrollable, and essentially takes the joy out of life
Diagnosis of GAD
GAD: Three of more other symptoms of anxiety must be present for more days than not over 6 months
include restlessness or feeling “keyed up,” tiring easily, difficulty concentrating, irritability, muscle tension, and sleep problems.
Those worry about everything
-GAD
-Worry about several things at once and have a history of worrying
Etiology of GAD
use worry primarily as an avoidance strategy. One thing that individuals with GAD appear to “avoid” by worrying is physiological arousal.
GAD use what to escape unpleasant feelings
They use worry as a strategy for escaping unpleasant feelings, since worry itself created unpleasant experiences in the form of negative emotions
Borkovec’s Cognitive Avoidance Theory
Worry faciltates avoidance for negative emotions
The Contrast Avoidance Theory of Anxiety
worry facilitates avoidance of significant changes in emotional states
GAD are:
articularly sensitive to emotional information in their environments. They are also especially sensitive to changes in emotional states, experiencing more distress than people without GAD when shifting from pleasant to negative emotional states.
Maintaining a state of emotional negativity through worrying
means that they are prepared for negative events when they occur. Worrying therefore reduces the distress caused by shifts in emotional states because the distress experienced from shifting from an unpleasant state to a more negative state is perceived as less unpleasant than a change from a pleasant to a negative state
Worrying decrease physiological arousal
orrying is primarily accompanied by verbal thought and very little imagery
-anxious images elicit arousal, whereas verbal thoughts decrease arousal. Hence, worrying is negatively reinforced because it can lead to a reduction in anxiety symptoms
Worry avoid Threat-GAD
worry is considered to be a very useful way of preparing for the future. worry is an effective way of preventing or preparing for future threat
-tend to worry so much that it significantly disrupts their life and causes more problems than benefits.
Reasons People believe worrying is helpful:
1) Improves motivation
2) facilitates problem solving
3) Protects against negative emotions
4) Prevents bad outcomes
5) Reflects a positive personality trait
Intolerance of Uncertainity (IU)
refers to an individual’s discomfort with ambiguity and uncertainty. refers to an individual’s discomfort with ambiguity and uncertainty.
IU creates
What if questions
-individuals with high levels of IU tend to pay more attention to threatening and uncertain information and to interpret ambiguous information as more threatening than do those with low IU
Obsessive-Compulsive Disorder (OCD)
recurrent obsessions and compulsions that cause marked distress for the individual.
Body dysmorphic disorder (BDD)
by a preoccupation with perceived defects in one’s own physical appearance, often accompanied by repetitive behaviours (e.g., mirror checking) in response to appearance concerns
Obsessions a
re defined as recurrent and uncontrollable thoughts, impulses, or ideas that the individual finds disturbing and anxiety-provoking. Common obsessions include thoughts related to uncertainty (e.g., doubting if one fhas locked the door or turned off the stove), sexuality (e.g., homosexual imagery), violence (e.g., harming a child), and contamination (e.g., believing one is dirty and covered with germs).
Compulsions
are repetitive behaviours or cognitive acts that are intended to reduce anxiety. Examples of repetitive behaviours include handwashing, checking, and rigidly maintaining order and organization (e.g., placing ornaments around the house in a particular order). Cognitive acts include things like counting numbers, praying, and repeating words or phrases over and over.
Compulsions reduce
Anxiety
Neutralizations
behavioural or mental acts that are used by individuals to try to prevent, cancel, or “undo” the feared consequences and distress caused by an obsession
OCD concerns with
excessive beliefs about personal responsibility and feelings of guilt
-concerned with making sure their behaviour will not lead to negative consequences, particularly to others.
- inflated sense of responsibility for their thoughts.
Thought-Action Fusion (TAF)
refers to two types of irrational thinking: (1) the belief that having a particular thought increases the probability that the thought will come true (e.g., “If I think about getting hit by a car, I’m more likely to get hit by a car”; referred to as Likelihood TAF); and (2) the belief that having a particular thought is the moral equivalent of a particular action (e.g., having a thought about harming someone is the moral equivalent of actually doing it; referred to as Moral TAF).
Diagnosis of OCD
-presence of either obsessions or compulsions
Obsessions vs worry
obsessions tend to be more bizarre and involve more imagery than do worries
Compulsions are
the behaviours or cognitive acts that the individual performs must serve the purpose of alleviating anxiety. They must also be considered excessive or have little connection with the thoughts or events they are intended to neutralize or prevent.
DSM-5 Diagnose
spending more than one hour per day engaged in obsessions and/or compulsions to be sufficiently time-consuming to warrant a diagnosis of OCD, though many people with OCD exceed this benchmark by several hours per day.
OCD have obsessions and compulsions specifically related to themes of contamination and washing or cleaning.
may experience discomfort or distress because they feel contaminated or “dirty,” or they may be concerned about germs harming themselves or others. Individuals with contamination concerns often engage in washing or cleaning behaviours to reduce the distress of feeling “dirty,” or reduce the perceived risk of spreading germs to others.
OCD symmetry
with a need for order or symmetry (because it “feels” right), and those with a strong tendency to engage in checking behaviours to relieve anxiety associated with thoughts of harm
OCD is related
genes and heritability
Neuropsychology models
basal ganglia and frontal cortex
One of the primary functions of the basal ganglia is to control motor behaviours, whereas the frontal cortex is responsible for a wide range of higher cognitive functions such as abstract reasoning, inhibition, planning, and decision making. These two areas of the brain are connected and form a looped system through which information travels back and forth. Structural and/or functional abnormalities in this brain system may be responsible for compulsions and obsessions.
-hyperactivation within the cingulo-opercular network, a collection of brain regions that detect error and subsequently signal to other areas of the brain the need for behavioural correction, but hypoactivation in brain regions responsible for responding to this signal and enacting inhibitory control.
Neureochemical theories of OCd
serotonin hypothesis, which is based on the notion that abnormalities in the serotonin system are responsible for OCD symptoms
Obsessions are caused by the person’s
reaction to intrusive thoughts. rgued that abnormal obsessions arise from catastrophic misinterpretations of these intrusive thoughts.
Individuals with OCD have high levels of personal responsibility and believe that their thoughts can influence the probability that others will be harmed.
they have thoughts of harming another, for example, people with OCD tend to conclude: “This must mean I’m actually a dangerous person” or “There’s a greater chance I might actually harm someone.”
Obsessions persist because
person’s maladaptive attempts to cope with them. Because misinterpretations often involve serious consequences (e.g., “I could contaminate or hurt another person”), the person feels compelled to take action. These actions include suppression of thoughts, avoidance behaviours, and neutralizations.
Rebound affect
trying to suppress obsessional thoughts can have the paradoxical effect of increasing their frequency
Compulsions persist because they tend to
lower the severity of anxiety, (2) lower the frequency of obsessions, and (3) “prevent” obsessions from coming true.
Body dysmorphic disorder (BDD)
excessive preoccupation with an imagined or exaggerated body disfigurement, sometimes to the point of a delusion. For example, individuals may become preoccupied with a perceived defect in their face, the shape or size of their nose, or other parts of their body.
Diagnosis of BDD
Similarities of BDD and OCD
Individuals with BDD have prominent obsessions and compulsive behaviours, similar to patients with OCD.
Trauma and Stressor Related Disorders
those in which exposure to a traumatic or stressful life event is listed explicitly as a diagnostic criterion. The diagnoses in this category include reactive attachment disorder, disinhibited social engagement disorder, post-traumatic stress disorder (PTSD), acute stress disorder, adjustment disorders, and prolonged grief disorder. In this section, we focus on PTSD
Criteria for Post Traumatic Disorder
Page 129
PTSD
is that the individual continues to re-experience intrusive, unwanted recollections of a past traumatic event. For example, individuals with PTSD may repeatedly have intrusive and distressing thoughts, images, and dreams about the traumatic event.
PTSD=emotional or physiological distress
include certain sights, sounds, or smells that resemble those around them when the trauma occurred.
PTSD and flashbacks
which are transient breaks from reality wherein an individual acts or feels as if the traumatic event is recurring in the present moment. The experience of a flashback is very different from simply remembering what happened to them because individuals actually feel as if they are reliving the event. During a flashback, individuals may experience visual and auditory hallucinations that “replay” the traumatic event
-“space out”= become numb, freeze, etc
PTSD and events
unable to remember aspects of the traumatic event, or have exaggerated feelings of guilt and self-blame.
Symptoms of OCD
Mood alterations may occur and include a markedly diminished interest or participation in pre-trauma daily-living activities, feeling detached or estranged from others, and being unable to experience certain feelings
-Concetration problems, irritability, anger and other arousal
Emotional Numbing
set of symptoms represents an inability to experience emotions
Diagnosis-PTSD
diagnosis and assessment of PTSD generally involves the combination of a semi-structured clinical interview and the results of psychometric scales. One of the most well-used and validated interview measures of PTSD is the Clinician Administered PTSD
Etiology- PTSD
- exposure of an individual to a traumatic life event plays a role in the development of PTSD.
-Women more likely
Pre event factors- PTSD
include being low in socio-economic status, education, and tested intelligence; having a previous psychiatric history; and experiencing childhood adversity, including being abused as a child.
Post event PTSD
are somewhat more powerful predictors of PTSD than are pre-event factors, and include the severity of the traumatic event, lack of social support, and whether or not additional stressful experiences occur after the traumatic event
Interpersonal traumas
(e.g., related to physical violence or sexual abuse) is generally more likely to provoke PTSD than exposure to non-interpersonal traumas (e.g., natural disaster, car accident).
Brain and PTSD
-brainstem, amygdala, and frontotemporal cortex, and have been collectively conceptualized as part of the innate alarm system
-greater activity and connectivity between IAS brain regions
-volume of the hippocampus is less in individuals with PTSD than in those without the disorder
Treatment of Anxirty and Anxiety Related Disorders- Phharmocoptherarpy: Benozodiazephines
-These drugs are appropriately referred to as minor tranquilizers; they provide rapid, short-term relief from physiological symptoms of acute anxiety such as heart palpitations, muscle tension, and gastrointestinal distress. Benzodiazepines bind to receptor sites for the neurotransmitter gamma-aminobutyric acid (GABA), which functions to temporally inhibit activity broadly across neural sites, including brain systems that are involved in generating fear and anxiety.
Benozodiapines Side affects
include psychomotor (e.g., dizziness and drowsiness) and cognitive (e.g., attention and memory) impairments, depending on the dosage and type of benzodiazepine used
-Not long term
Pharmacological treatments teach
patients that their anxiety symptoms themselves are “pathological” and can be controlled only by medication. This may focus patients’ attention even more on their anxiety symptoms rather than on finding solutions to the life problems that give rise to them
Antidepressant drugs
he monoamine oxidase inhibitors (MAOIs) are so called because they interfere with the action of monoamine oxidase, an enzyme that degrades certain neurotransmitters (including norepinephrine and serotonin) after being released by neurons, thus increasing the number of these transmitters in the brain generally
Cons of Antidepressant drugs
drugs can have significant adverse effects on the digestive and cardiovascular systems, especially when taken in combination with foods prepared by fermentation (e.g., alcohol), and their use has decreased accordingly.
tricyclic antidepressants (TCAs)
function to block the reuptake of the neurotransmitters norepinephrine and serotonin. These drugs (especially clomipramine) have been found to be particularly effective in the treatment of OCD,
Side effects of TCAs
ossible weight gain, blurred vision, dry mouth, and constipation.
Selective srotonin Reuptake Inhibitors (SSRIs)
are the most well-prescribed anxiolytic medications. As their name implies, these drugs have a particular affinity for serotonin receptors. Patients usually tolerate the side effects of SSRIs better
azapirones
appears to elicit its anxiolytic effects primarily through serotonergic effects, in addition to altering dopamine levels in the brain
serotonin-norepinephrine reuptake inhibitors (SNRIs)
act not only to increase serotonin but also both norepinephrine and dopamine levels in the brain, and are generally associated with fewer side effects than traditional SSRI medications
-SNRIs such as venlafaxine and duloxetine are particularly effective in the treatment of GAD
Cognitive Restructing
help patients develop healthier and more evidence-based thoughts—to help them adjust the imbalance between perceived risk and resource
Thought record
it is used to help patients understand the important relationship between what they are thinking and how they are feeling. Whenever their anxiety increases, patients learn to ask themselves, “What was I thinking just before I started to feel this way?” Patients also learn to monitor and “catch” their automatic thoughts and beliefs systematically so that they can examine the utility and validity of them.
Socratic Approach
involves asking a number of questions to query and evaluate the beliefs and behaviours that contribute to anxiety.
Cognitive Behavioural Therapy (CBT)
having completed at least one exposure exercise was the single strongest predictor of sustained reduction in symptoms post-treatment
Emotional Processing Theory
some fear structures are adaptive while others are maladaptive, giving rise to the problematic cognitions, sensations, and behaviours characteristic of anxiety disorders.
Habituation
exposure therapy works because repeated exposure to the feared stimulus eventually results in a diminished behavioural response (i.e., anxiety) to that stimulus
Inhibitory Learning
wherein anxiety is reduced because individuals learn, through repeated exposure, that the feared stimulus no longer predicts the feared consequence.
Systemic desensitization
A therapeutic technique whereby patients imagine the lowest feared stimuli and combine this image with a relaxation response. Patients gradually work their way up the fear hierarchy so that they can learn to handle increasingly disturbing stimuli.
Fear Hierarchy
is a list of feared situations or objects that are arranged in descending order according to how much they evoke anxiety
Vivo Exposure
(real life exposure) itself is more effective than imaginal exposure and that the inclusion of relaxation provides no better response than exposure alone
Worry Imagery Exposure
Identifying the patient’s main areas of worry, vividly imagining these unpleasant scenes, and concentrating on them while conjuring up images of the worst possible outcome. After holding these graphic images in their minds for a period of time, patients are then encouraged to generate as many alternatives as possible to the worst scenario.
Flooding or intense exposure
This involves starting at a very high level of intensity rather than working gradually through the fear hierarchy. Graduated and intense exposure are both effective; which approach is taken sometimes simply depends on what the patient is willing to tolerate.
Interoceptive exposure
Exposure to internal cues (i.e., bodily sensations) is called
- involves the induction of physical sensations (e.g., dizziness) by means of hyperventilating, spinning in a chair, exercising, and so on
Ritual Preventation/Response Prevention
Ritual prevention involves promoting abstinence from rituals that, while reducing anxiety in the short term, only serve to reinforce the obsessions in the long run
Subtle Avoidance
Engaging in safety behaviours that serve to maintain anxiety. For example, an individual may be able to go into a movie theatre only if they sit in the back near the exit or are accompanied by a significant other. These subtle behaviours need to end in order for anxiety to really diminish over the long term.
Problem Solving
based on the assumption that by generating and implementing effective solutions to problems, patients will experience less anxiety
Relaxation
strategies aim to reduce anxious arousal directly and can be classified into two general types: mental relaxation and physical relaxation
Treatment for Panic Disorder
Barlow’s panic control treatment, for example, involves psychoeducation (i.e., education about the nature and physiology of anxiety), cognitive restructuring, breathing retraining, applied relaxation, interoceptive exposure, and in vivo exposure
-CBT
Treatment for Phobias
vivo exposure
Treatment of Social Anxiety Disorder
-cognitive-behavioural group therapy (CBGT), integrates both cognitive restructuring and exposure
-D-Cycloserine (an antibiotic drug used to treat tuberculosis) can enhance the learning that takes place in exposure treatment for social anxiety
Treatment for GAD
-Benzodiazepines are commonly used to treat GAD
-antidepressants and azapirones
Treatment of OCD and BDD
OCD: Exposure and ritual preventation (ERP)
-ERP is a form of CBT in which individuals confront anxiety-provoking stimuli or situations while preventing themselves from engaging in avoidance or compulsive behaviours
-ERP alters the faulty appraisals and beliefs of individuals with OCD
-serotonin-based medications like clomipramine, fluvoxamine, and fluoxetine
BDD treatmnt
CBT for BDD includes components of cognitive restructuring and exposure and response prevention
-pharmacotherapy with SSRIs is regarded as the first-line treatment for BDD
Treatment for Post traumatic Stress Disorder
-involves facing the trauma and discussing it in detail. This can be done using imaginal exposure, in which the patient envisions or describes the trauma, or in vivo exposure, in which the patient confronts specific places, people, or situations associated with the trauma.
-Narrative exposure therapy (NET): individuals recount traumatic events with the goal of contextualizing the cognitions, emotions, and sensory information associated with these events and reducing the distress they cause.
-virtual reality technology
Common Treatments that Work
CBT is regarded as a highly effective treatment for anxiety and related disorders
