Chapter 5 Flashcards
What is anxiety?
A common emotion characterized by physical symptoms, future-oriented thoughts, and escape or avoidance behaviors
Examples include dropping a class due to the anticipation of a presentation.
When does anxiety typically occur?
When people encounter a new situation or anticipate a life-changing event
Is anxiety usually time-limited?
Yes, it usually ends when the event is over
What are the 3 components of anxiety?
- Physiological - heightened level of arousal and physiological activation
EX. shortness of breath, dry mouth - Cognitive- subjective perception of anxious arousal and associated cognitive processes
EX. worry and ruminations - Behavioral - ‘safety’ behaviors; escape/avoidance
What is the difference between normal anxiety and abnormal anxiety?
Feeling anxious occasionally is normal; it becomes an issue when it impacts day-to-day life.
What factors can lead to normal anxiety?
Situational factors, such as truly upsetting situations or actual threats.
What characterizes chronically anxious people?
A tendency to perceive threat and worry when there is no objective threat or when the situation is ambiguous.
What are the criteria for anxiety to be considered disordered?
The anxiety must be chronic, relatively intense, and cause impairment and significant distress for self or others.
Define anxiety.
A negative mood state characterized by bodily symptoms of physical tension and apprehension about the future.
Define fear.
An immediate alarm reaction to dangerous or life-threatening situations.
What is a panic attack?
An abrupt experience of intense fear or acute discomfort accompanied by physical symptoms like heart palpitations, chest pain, shortness of breath, dizziness.
What is an expected (cued) panic attack?
A specific object causes lots of anxiety and can lead to avoidance behaviors.
What is an unexpected (uncued) panic attack?
A panic attack that occurs without a trigger; the cause cannot be pointed out.
What biological contributions are associated with anxiety?
People inherit the tendency to be anxious or highly emotional; there is no single gene.
Which neurotransmitter systems are associated with anxiety?
-> Low levels of GABA
-> Noradrenergic system
-> Corticotropin-releasing factor (CRF) system
->limbic system
-> amygdala
What is the role of the corticotropin-releasing factor (CRF) system in anxiety?
CRF activates the HPA axis and is directly related to GABA, serotonergic, and noradrenergic neurotransmitter systems.
What is the limbic system’s function in relation to anxiety?
Mediator between the brain stem and cortex
What is the behavioral inhibition system (BIS)?
A tendency to freeze, experience anxiety, and apprehensively evaluate the situation to confirm the presence of danger.
What happens in an overactive or hypersensitive BIS?
It leads to anxiety disorders.
What activates the behavioral inhibition system (BIS)?
-> Signals from the brain stem of unexpected events
-> Danger signals from the cortex to the septal-hippocampus area.
How is the BIS distinct from the fight/flight system?
The BIS is involved in apprehension and evaluation, while the fight/flight system is an immediate alarm and escape response and starts in the brain stem.
What psychological contributions can lead to anxiety?
-> Anxious behavior starts in childhood
-> influenced by overprotective and intrusive parents, and a feeling of no control over the environment.
These factors can set the stage for developing anxiety later in life.
Define anxiety sensitivity.
Tendency to fear the physiological symptoms of anxiety, such as rapid heartbeat or sweating.
Anxiety sensitivity can exacerbate anxiety disorders.
How do behaviorists view anxiety?
As a product of conditioning or modeling.
This perspective emphasizes learned responses to anxiety-provoking situations.
What are the social contributions to anxiety?
Stressful life events that trigger biological and psychological vulnerabilities, including social, interpersonal (marriage, work life), physical events (illness, injury)
Examples include marriage, work life, illness, and injury.
What is the triple vulnerability model?
Three vulnerabilities that contribute to the development of anxiety disorders: biological, specific psychological, and generalized psychological vulnerabilities.
Having all three significantly increases the risk of developing an anxiety disorder after a stressful event.
List the three vulnerabilities in the triple vulnerability model.
- biological vulnerability (heritable contribution to negative affect)
→”glass is half empty”
→irritable
→driven - specific psychological vulnerability (ex physical sensations are potentially dangerous)
→hypochondriac?
→nonclinical panic? - generalized psychological vulnerability (sense that events are uncontrollable/unpredictable)
→tendency toward lack of self- confidence
→low self esteem
→inability to cope
What is comorbidity? What are commonly comorbid?
Occurrence of two or more disorders in a single person.
-> Major depression and anxiety disorders most commonly comorbid
—>additional diagnosis of depression, alcohol, drug abuse makes recovering from anxiety difficult
Major depression and anxiety disorders are the most commonly comorbid.
What percentage of people with one anxiety disorder also have another anxiety disorder or depression?
57%.
This high rate of comorbidity complicates recovery.
What is the suicide risk associated with panic disorder?
20% of panic disorder patients attempt suicide
->suicide attempts common and more likely by those who self harm
This rate is comparable to individuals with depression.
How are anxiety disorders characterized?
By heightened physical arousal, cognitive distress, and behavioral avoidance of feared objects/situations/events.
They are the most common psychological disorders.
Which gender is more likely to be diagnosed with anxiety disorders?
Women.
This trend is consistent across all age groups.
Define Panic Disorder.
Recurrent panic attacks involving sudden onset of physiological symptoms, accompanied by terror and feelings of impending doom.
Symptoms include dizziness, rapid heart rate, and trembling.
What is Agoraphobia?
Fear of being in public places.
What defines Specific Phobia?
Fear and avoidance of objects or situations that don’t present any real danger.
What is Social Anxiety Disorder?
Fear and avoidance of social situations due to possible negative evaluation from others.
Describe Separation Anxiety.
Anxious arousal and worry about losing contact with significant others.
What is Selective Mutism?
Failure to speak in one situation (usually school) when able to speak in other situations (usually home).
What are the general features of Generalized Anxiety Disorder (GAD)?
-> Uncontrollable, unproductive worrying about everyday events
->feeling impending doom,
->inability to stop the worry
These features often lead to significant distress.
What are the characteristics of GAD?
- Muscle tension
- Mental agitation
- Susceptibility to fatigue
- Irritability
- Difficulty sleeping
- Difficulty concentrating
→ 6 month duration before diagnosed
What is the 12-month prevalence rate of GAD for individuals aged 15 and older in 2022?
5.2%.
This reflects an increase from 2.6% in 2012.
Which age group is most commonly affected by GAD?
People over 45 years.
->more so women then men
This statistic is based on a US study.
What are the possible causes of GAD?
- Genetic predisposition
- Anxiety sensitivity
- Learning theories
->Anxiety regarded as having been classically conditioned to external stimuli, but with a broader range of conditioned stimuli - Cognitive theories
Each of these factors contributes to the onset and maintenance of GAD.
What do cognitive theories focus on regarding anxiety?
Control and helplessness, emphasizing the perception of not being in control as a central characteristic of all forms of anxiety.
What is attentional bias in GAD?
The attention of people with GAD is easily drawn to stimuli suggesting possible physical harm or social misfortune.
This can lead to misinterpretation of ambiguous situations as threatening.
What are the cognitive characteristics of GAD?
- intolerance of uncertainty
- positive beliefs about worry
→worrying helps solve a problem - poor problem orientation (threats to be avoided)
- cognitive avoidance (avoiding negative affect associated with the threat - worry as an avoidance behavior-no images in their mind when worrying)
What are some ways to treat GAD?
→drugs: benzodiazepines - increase availability of GABA = decreased anxiety (prescription for only a week or two), antidepressants (Paxil)
→psychological: Cognitive-Behavioral Treatment
—>focus on worry process and avoidance of feelings of anxiety and negative affect, and seem to work about as well as drugs
—>effective with kids and older adults
→Mindfulness-based approaches
—>helps people stay in the present and stop worrying by letting the bad thoughts pass without judgement
What’s Panic Disorder (PD)?
→ Sensation of dying or of losing control, unexpected panic attacks
→In many cases, PD accompanied by Agoraphobia
In PD a person suffers a sudden and often inexplicable attack of alarming symptoms:
◦ Rapid or labored breathing, heart palpitations,
◦ Nausea and chest pain;
◦ Feelings of Choking;
◦ Dizziness and trembling;
◦ Intense apprehension and Feeling that disaster is imminent
→ Person may also experience (less common):
◦ Depersonalization - a feeling of being outside one’s body
◦ Derealization - a feeling of the world’s not being real, as well as fears of losing control, of going crazy, or even of dying
EX. reading a book
What’s Agoraphobia?
→ Greek word- fear of the marketplace (public place) - fear and avoidance of situations: they feel unsafe and inescapable
→ A cluster of fears centering on public places and being unable to escape or find help should one become incapacitated
→ Become so scared because of uncertainty
→ People develop agoraphobia as they never know when the panic like or other embarrassing symptoms may occur
→ Avoidant behaviors are displayed
→ Could lead to drug and alcohol abuse/dependence
What is required for a diagnosis of agoraphobia?
Anxiety in at least 2 of 5 specific situations
What makes agoraphobia different from specific phobias?
Agoraphobia involves anxiety in multiple situations, not just one specific thing.
What are the 5 situations where anxiety must occur for an agoraphobia diagnosis?
- Public transportation
- Open spaces
- Enclosed spaces
- Lines/crowds
- Being out of the house alone
How is agoraphobia related to panic disorder?
Many people with panic disorder develop agoraphobia, but not everyone with panic disorder has agoraphobia.
How does agoraphobia impact daily life for many people?
Many people with agoraphobia are unable to leave the house or only do so with great distress.
What’s Interoceptive Avoidance?
->avoidance of internal physical sensations
->removing self from situations/activities leading to arousal
EX. different breath pattern = panic attack, watching scary movie changes physical sensations = panic attack
What percentage of Canadians will experience panic disorder in their lifetime?
4% (according to the Canadian Mental Health Association).
Is panic disorder more common in men or women?
more common in women than men.
What is the mean age of onset for panic disorder?
25–29 years old
->Most initial attacks begin at or after puberty
How do cultural norms explain gender differences in panic disorder?
Women: Socially accepted to report fear and anxiety, leading to higher reported rates.
Men: Socially expected to appear strong and brave, leading to underreporting.
Why might women be more affected by panic disorder?
Women are generally more fearful of anxiety and its symptoms.
Does panic disorder (PD) exist worldwide?
yes
In which regions are the lowest rates of panic disorder reported?
Asian and African countries
How does the expression of panic disorder vary across cultures?
Cultural factors influence how panic symptoms are experienced and described.
EX. Latin America- Susto – a fright disorder specific to Latin American culture, soul frightened by some sort of event, separation of soul from their body
When do panic attacks most frequently occur during sleep?
Between 1:30 a.m. and 3:30 a.m.
During which stage of sleep do nocturnal panic attacks typically happen?
During deep sleep or Delta (slow wave) sleep.
What is isolated sleep paralysis?
A phenomenon where a person is consciously awake but unable to move their body
Caused when REM cycle overlaps with waking cycle
What do biological theories suggest about the causes of panic disorder?
->Panic disorder runs in families, with a 5–16% increased risk among relatives of those with the disorder
->noradrenergic activity theory
What does research on identical twins and fraternal twins reveal about panic disorder?
Identical twins have a higher concordance rate for panic disorder than fraternal twins, supporting a genetic basis.
What is the noradrenergic activity theory of panic disorder?
Panic is caused by overactivity in the noradrenergic system
Stimulation of the locus coeruleus (a nucleus in the Pons - largest collection of neurons that uses noradrenaline) causes monkeys to have “panic attack”.
What role does GABA play in panic disorder?
→GABA generally inhibit noradrenergic activity
→Positron emission tomography (PET) study found fewer GABA-receptor binding sites in people with Panic Disorder
What psychological theory explains panic disorder?
Misinterpretation of physiological arousal symptoms leads to fear, creating a vicious cycle of panic attacks.
->Overly active ANS + psychological tendency to become very upset by these sensations = danger signal
What is the “vicious cycle” in panic disorder?
panic attack = fear = fearing another panic attack = increased autonomic activity = catastrophic ways of interpreting these symptoms = raise the anxiety level = a full-blown panic attack
What are the most widely used medications for panic disorder?
Benzodiazepines, SSRIs, and SNRIs.
What are some drawbacks of medications for panic disorder?
->SSRIs: Sexual dysfunction in 75% or more of patients.
->Benzodiazepines: Adverse effects on cognitive and motor functions.
—>High relapse rates (~90%) if medication is stopped.
What’s psychological interventions can be done?
→Exposure based therapies concentrated on reducing agoraphobic avoidance
→Exposure to feared situation
→Gradual exposure exercises combined with relaxation or breathing retraining
What psychological interventions are effective for panic disorder?
->Exposure-based therapies: Gradual exposure to feared situations combined with relaxation or breathing retraining.
->Cognitive Behavioral Therapy (CBT): Modifies attitudes and perceptions about feared situations.
What is Panic Control Treatment (PCT)?
A therapy where therapists induce “mini” panic attacks to help patients confront and reframe their fears about panic symptoms.
Is combining drugs and CBT more effective for treating panic disorder?
Research shows no initial advantage to combining drugs and CBT, but psychological treatments tend to perform better in the long term.
->”stepped care approach”
—>Adding additional treatments (e.g., CBT, medication) to an existing treatment plan to enhance outcomes.
What is the clinical description of a Specific Phobia?
An irrational fear of a specific object or situation that markedly interferes with an individual’s ability to function.
What are the key features of a Specific Phobia?
- Unwarranted fears caused by the presence or anticipation of a specific object or situation.
- Fear and avoidance are out of proportion to the actual danger posed.
- The fear is recognized by the sufferer as groundless.
EX. see snake on height and get scared = normal but if start avoiding that trail or scream running away = problem/out of proportion
What is the origin of the word “phobia”?
The suffix “phobia” is derived from the Greek god Phobos, who frightened his enemies. The prefix is often a Greek word for the feared object or situation.
Give examples of phobias and their meanings:
Claustrophobia:
Acrophobia:
Ergasiophobia
Taphephobia:
Fear of closed spaces.
Fear of heights.
Fear of working
Fear of being buried alive
How do new phobias emerge?
New phobias tend to develop in response to societal changes, such as advances in technology or cultural shifts.
What is Nomophobia?
A pathological fear of remaining out of touch with technology, commonly experienced by people who are overly dependent on their mobile phones or personal computers. It is more prevalent in younger individuals
What is Coronaphobia, and what are its effects?
Coronaphobia is an excessive fear of contracting the COVID-19 virus, leading to:
- Excessive concern over physiological symptoms.
- Significant stress about personal and occupational loss.
- Increased reassurance-seeking behaviors.
- Avoidance of public places and situations.
- Marked impairment in daily life functioning.
What are the major subtypes of specific phobias?
- Blood-injury-injection phobia (fainting at the sight of needles or blood).
- Situational phobias (e.g., fear of enclosed spaces).
- Natural environment phobias (e.g., heights, storms).
- Animal phobias.
- Other phobias (e.g., illness phobia—irrational fear of contracting a disease).
Can phobias be culturally specific? Provide an example.
Yes, phobias can be culturally specific.
EX. Pediophobia – fear of dolls or humanoid figures, common in Japan.
What is the global lifetime prevalence of specific phobias?
The lifetime prevalence ranges from 3% to 15%.
Which types of phobias are the most common?
Phobias concerning heights and animals are the most common
Why do most people with phobias remain untreated?
->Phobias are common and treatable, but most people work around them.
->Only the most severe cases seek treatment.
How can classical conditioning lead to a phobia?
Example: Fear of honey bees
->Bees = Neutral Stimulus.
->Bee sting (Unconditioned Stimulus) → Fear (Unconditioned Response).
->Pairing of bee stings with bees → Bees become a source of intense fear.
How does negative reinforcement maintain phobias?
Avoiding the feared stimulus reduces anxiety, which reinforces the avoidance behavior, making it more likely to continue.
What are the causes of specific phobias?
- Traumatic experiences/traumatic conditioning
- Prepared learning - biologically more likely to get fears of certain things then others
- Vicarious experience - see someone go thru a trauma = you get phobia
- Information transmission - you hear about something and develop phobia
- Panic attack (false alarm)- phobia of that situation, have one in elevator = scared of elevators
- Anxiety over the possibility of another traumatic event or false alarm
- Social and cultural factors
—>Most reported specific phobias occur in women
What is the most effective treatment for specific phobias?
Exposure-based exercises are the most effective treatment as they help modify neural circuitry in the amygdala, insula, and cingulate cortex, which are overactive in people with phobias.
What is Separation Anxiety Disorder?
A child’s unrealistic and persistent worry that something will happen to their parents or important people in their life. It can cause school avoidance, nightmares, and significant distress.
Can Separation Anxiety Disorder continue into adulthood?
Yes, 35% of cases extend into adulthood if not treated during childhood. In some cases, the disorder can also begin in adulthood.
What are the causes of Separation Anxiety Disorder?
- Biological vulnerability.
- Parent-child attachment (e.g., inconsistent caregiving or overprotectiveness).
- Traumatic events and major life changes (e.g., separation, divorce, death of a loved one).
What are common treatments for Separation Anxiety Disorder?
- Gradual Exposure: Controlled exposure to separation situations.
- Cognitive Restructuring: Challenging irrational thoughts about separation.
- Relaxation Training: Coping strategies to manage anxiety.
- Parent-Child Interaction Therapy (PCIT): Improving parent-child interactions, teaching positive responses, and setting consistent rules.
What does Parent-Child Interaction Therapy (PCIT) include for treating Separation Anxiety Disorder?
-> Parent training.
->Modeling appropriate responses.
->Setting consistent rules and expectations.
What is Social Anxiety Disorder (SAD)?
Persistent, irrational fears of being judged by others, leading to avoidance of situations where evaluation might occur. Concerns include blushing, shaking, or sweating being observed by others.
What are common social situations that trigger Social Anxiety Disorder?
- Speaking or performing in public (e.g., public speaking).
- Social interactions.
- Being observed in public.
What is the 12-month prevalence rate of Social Anxiety Disorder (SAD) in Canada?
7.1% of Canadians experience SAD, according to the 2022 Mental Health and Access to Care Survey (MHACS).
When does Social Anxiety Disorder typically begin, and who is most affected?
-> SAD usually begins during adolescence, with a peak age of 15 years.
-> More common in young, less educated, single, and economically disadvantaged individuals.
-> Slightly more prevalent in females, though males more frequently seek help.
What are some cultural variations of Social Anxiety Disorder?
-> Japan: Taijin Kyofusho (TKS) – fear of offending or embarrassing others.
->North America: Olfactory Reference Syndrome – fear of offending others with a foul body odor.
What are the biological causes of Social Anxiety Disorder?
- Prepared learning: Reacting strongly to angry faces due to heightened amygdala activation and less cortical control.
- Biological vulnerability: Tendency to develop anxiety or social inhibition.
- Panic attacks in social settings: Anxiety linked to social cues after a panic attack.
- True alarms: Real social trauma causes anxiety in similar situations.
How can childhood experiences contribute to Social Anxiety Disorder?
Difficult periods during ages 12-15 years (e.g., bullying or taunts) can lead to social anxiety.
What are the cognitive characteristics of Social Anxiety Disorder?
-> Attentional bias toward negative social information.
->Perfectionistic standards for social performances.
->High public self-consciousness.
->Post-event processing (PEP): Rumination on negative social experiences.
What is Alden’s Interpersonal Transaction Cycle?
->Biased social perceptions → maladaptive behavior in social situations → negative reactions from others.
->Social comparisons (upward or downward) can also contribute.
What are upward and downward social comparisons in SAD?
Comparing yourself to someone better/worse than you.
