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