Chapter 5 Flashcards
Define Anxiety
Is a future- oriented state of mood characterized by marked negative affect and bodily
symptoms of tension in which a person apprehensive anticipates future danger or misfortune. Anxiety may involve feelings, behaviors, and physiological responses.
Define fear
immediate alarm reaction (ANS arousal) to dangerous situations
Define Panic
intense fear (ANS arousal) in absence of “real” threat
Define Panic Attack
Abrupt experience of intense fear or discomfort accompanied by physical
symptoms such as dizziness or heart palpitations.
2 Types of Panic Attack
Expected Panic Attack = Cued: something you know you have fear around starts the panic
Unexpected Panic Attack = Uncued: you do not have a clue where and when the next attack
will occur
Biological Causes of Anxiety
-Inherited tendency to be anxious or highly emotional
-Neurotransmitter systems
-GABA, noradrenergic system
-Corticotropin-releasing factor (CRF) system
-Limbic system (amygdala, hippocampus)
-Behavioural inhibition system (BIS)
Signalling of danger
Psychological Causes of Anxiety
Anxious behaviour starts in childhood
-Feeling of no control over environment
-Overprotective and over intrusive parents
Personality traits
-Anxiety sensitivity
Conditioning develops
Social Causes of Anxiety
Stressful life events
-Social, interpersonal, physical
-Lead to physical reactions
Triple Vulnerability Model
An Integrated Model
-Generalized biological vulnerability
-Generalized psychological vulnerability
-Specific psychological vulnerability (learned experience of yourself or others)
Comorbidity
occurrence of two or more disorders in a single person
Relationship Between Anxiety and Depression
-Major depression and anxiety disorders most commonly comorbid
-Additional diagnoses of depression, alcohol, drug abuse make recovering from anxiety difficult
Comorbidity With Anxiety and Physical Disorders
-Anxiety disorders co-occur with several physical conditions
-People with physical disorders fit criteria for anxiety disorder
-Anxiety precedes physical disorder
-Both together lead to poor quality of life
Relationship Between Suicide and Anxiety
-20% of panic disorder patients attempt suicide
-Comparable to people with depression
-Having any anxiety disorder
-Increases suicidal ideation
-Increases chances of suicide attempts
-More likely by those who inflict self-harm
Kinds of Anxiety Disorders
Generalized anxiety disorder, panic disorder, agoraphobia,
specific phobia, social anxiety, separation anxiety, and selective mutism.
Generalized Anxiety Disorder (GAD)
Anxiety disorder characterized by intense, uncontrollable,
unfocused, chronic, and continuous worry that is distressing and unproductive accompanied by physical symptoms of tenseness, irritability, and restlessness (occurring more days than not for six months)
Generalized Anxiety Disorder (GAD) Clinical Description
-Uncontrollable, unproductive worrying about everyday events
-Feeling impending catastrophe even after successes
-Inability to stop the worry-anxiety cycle
-Muscle tension, mental agitation, susceptibility to fatigue, irritability, difficulty sleeping
Who is Most Likely to Have GAD
- More women than men over age 15
-Two-thirds female
-Most common in people over 45 years
Is GAD Chronic
yes - 92% of the time
Anxiety Sensitivity
Tendency to become distressed in response to arousal-related sensations,
arising from beliefs that these anxiety-related sensations may have harmful consequences
4 Characteristics of People With GAD (Cognitive Causes)
- Intolerance of uncertainty
- Positive beliefs about worry
- Poor problem orientation
- Cognitive avoidance
Biological Causes of GAD
-Possibility of a genetic cause
-GAD runs in families
-Greater risk for monozygotic twins
-Heritability for anxiety sensitivity
Drug Treatment for GAD
-Benzodiazepines: effectiveness is not empirically supported long term
-Antidepressants
Psychological Treatment for GAD
-Cognitive-behavioural treatment (CBT)
-Evoke worry process and confront threatening images and thoughts
-The patient learns to use cognitive skills and other coping techniques to counteract and control the worry process.
-Effective with children and older adults
Panic Disorder
-Recurrent unexpected panic attacks accompanied by concern about future attacks and/or a lifestyle change to avoid future attacks
-Sensation of dying or of losing control, panic attacks
-Racing heartbeat, rapid breathing, dizziness, nausea, or sensation of heart attack or imminent death
Agoraphobia
Anxiety about being in places or situations from which escape might be difficult (you need this to happen in more than two places)
Is Panic Disorder (PD) Often Accompanied by Agoraphobia
yes
Development of Agoraphobia
-Could lead to drug and alcohol abuse/ dependence
-Avoidant behaviours displayed: removing self from situations/activities leading to arousal
-Interoceptive avoidance
Interoceptive Avoidance
Avoidance of internal physical sensations
Mean Onset Age For PD and Agoraphobia
Mean age of onset: 25–29 years
Initial attacks begin at or after puberty
Nocturnal Panic
panic attacks that occur more frequently between 1:30 a.m. to 3:30 a.m.
Causes of PD and Agoraphobia
-Genetic vulnerability to stress
-Learned alarms
-People with PD develop anxiety over possibility of another panic attack
-Agoraphobia often develops after a person has unexpected panic attacks
Medication Treatment For PD and Agoraphobia
-Most widely used drugs: benzodiazepines, SSRIs, SNRIs
-Relapse closer to 90% if medication stopped
-Benzodiazepines adversely affect cognitive and motor functions to some degree
SSRI
selective serotonin reuptake inhibitor
SNRI
serotonin and noepenepherine reuptake inhibitor
SSRI and SNRI Side Effects
sexual dysfunction, dependence
Psychological Treatment For PD and Agoraphobia
- Panic Control Treatment PCT
- Combined psychological and drug treatment
- stepped care approach
Stepped Care Approach
tart with one treatment and continue to add (independently from one another to see what treatments are working)
Panic Control Treatment (PCT)
Cognitive behavioral treatment for panic attacks, involving
gradual exposure to feared somatic sensations and modification of perceptions and attitudes about them
Specific Phobia
Unreasonable fear of a specific object or situation that markedly interferes with daily life functioning
Types of Phobias
- Situational phobia
- natural environment phobia
- animal phobia
- blood-injury-injection phobia
Situational Phobia
Anxieties involving enclosed places (ie claustrophobia) or public transport (ie flying)
Natural Environment Phobias
Extreme fear of situations or events in nature, especially heights, storms, and water
Animal Phobia
Unreasonable, enduring fear of animals or insects that usually develops early in life
Blood-Injury-Injection Phobia
Unreasonable fear and avoidance of exposure to blood, injury,
or the possibility of an injection. People experience fainting and a drop in blood pressure
Specific Phobia Causes
-Traumatic experiences/traumatic conditioning
-Vicarious experience
-Panic attack
-Social and cultural factors
-Most reported specific phobias occur in women
Treatment for Phobias
-Structured and consistent exposure-based exercises in supervised therapeutic context
-Imaginal exposure
-Virtual reality exposure therapy, a newer approach, is effective
Separation Anxiety Disorder
Excessive enduring fear in some children that harm will come to
them or their parents when they are apart (mostly in children)
Social Anxiety Disorder (SAD) (Social Phobia)
Extreme, enduring, irrational fear and avoidance of social or
performance situations
Causes of SAD
-Biological vulnerability to develop anxiety
-Biological tendency to social inhibition
-Conditioned panic attack in a social situation
-Experience of a real social trauma
Treatment for SAD
-Cognitive-behavioural group therapy (CBGT)
-Rehearsal or role-play
-Virtual reality therapy
-Interpersonal psychotherapy (IPT)
-SSRIs
Selective Mutism
Rare childhood disorder characterized by a lack of speech in one or more settings in which speaking is socially expected
