Chapter 5

Question 1

What is anxiety?

Answer 1

A future-oriented negative mood state characterized by physical tension and apprehension.

Question 2

What is fear?

Answer 2

An immediate emotional reaction to current danger characterized by strong escape action tendencies and, often, a surge in the sympathetic branch of the autonomic nervous system.

Question 3

What is panic?

Answer 3

Sudden overwhelming fear or terror.

Question 4

What is a panic attack?

Answer 4

An abrupt experience of intense fear or acute discomfort, accompanied by physical symptoms that usually include heart palpitations, chest pain, shortness of breath, and, possibly, dizziness.

Question 5

What are the 2 types of panic attacks?

Answer 5

1. Expected (crossing a bridge when you have a fear of that)
2. Unexpected (random occurrence)

Question 6

Panic attack recorded in a lab showed?

Answer 6

• Increased heart rate
• Increased muscle tension
• Increased finger temperature
  Autonomic NS surge

Question 7

True or false: Panic tendencies run in families.

Answer 7

True

Question 8

What biological systems are central to the expression of anxiety and depression?

Answer 8

Corticotropin-releasing factor (CRF) system, behavioural inhibition system, and fight or flight system.

Question 9

What area of the brain is most often associated with anxiety?

Answer 9

The limbic system.

Question 10

What is the behavioural inhibition system (BIS)?

Answer 10

Brain circuit in the limbic system that responds to threat signals by inhibiting activity and causing anxiety.

Question 11

What is the fight/flight system (FFS)?

Answer 11

The circuit involved in panic.

Question 12

True or false: It is likely that factors in your environment can change the sensitivity of these brain circuits, making you more or less susceptible to developing anxiety and its disorders.

Answer 12

True

For example, one important study suggested that cigarette smoking as a teenager is associated with greatly increased risk for developing anxiety disorders as an adult, particularly panic disorder and generalized anxiety disorder.

Question 13

When do anxious behaviours often start?

Answer 13

In childhood.

Question 14

What are psychological contributions to the development of anxiety?

Answer 14

Having little sense of control and having anxiety sensitivity.

Question 15

What is anxiety sensitivity?

Answer 15

Fear of anxiety-related sensations/symptoms.

Question 16

Panic attacks may be triggered due to what two types of cues?

Answer 16

External cues: places or situations similar to the one where the initial panic attack occurred.
Internal cues: increases in heart rate or respiration that were associated with the initial panic attack, even if they are now the result of normal circumstances, such as exercise.

Question 17

What are the social contributions to developing anxiety?

Answer 17

Life stressors and genetic factors.

Question 18

What are the three vulnerabilities people have that can lead to anxiety?

Answer 18

1) Biological (tendency to be uptight)
2) Generalized Psychological (Sense that things are uncontrollable)
3) Specific Psychological (Dogs are dangerous)

Question 19

True or false? If individuals possess all three vulnerabilities, the odds are greatly increased that they will develop an anxiety disorder after experiencing a stressful situation.

Answer 19

True

Question 20

Anxiety increases or decreases the likelihood of panic?

Answer 20

Increases.

Question 21

How many Canadians age 12+ have an anxiety disorder?

Answer 21

8.6%.

Question 22

What is comorbidity?

Answer 22

The co-occurrence of two or more disorders in a single individual.

Question 23

Is comorbidity common with anxiety disorders?

Answer 23

Yes, the different anxiety disorders often co-occur.

Question 24

What is most commonly comorbid with anxiety disorders?

Answer 24

Depression.

Question 25

Anxiety disorder was found to be uniquely and significantly associated with what diseases?

Answer 25

Thyroid disease, respiratory disease, gastrointestinal disease, arthritis, migraine headaches, and allergic conditions.

Question 26

Anxiety disorders often occur before or after physical disorders?

Answer 26

Before.

Question 27

Panic attacks often co-occur with certain medical conditions such as...

Answer 27

Cardiovascular, respiratory, gastrointestinal, and vestibular (inner ear) disorders.

Question 28

What percentage of patients with panic disorder attempt suicide?

Answer 28

20% (comparable to that for individuals with major depression).

Question 29

Having any anxiety or related disorder, not just panic disorder, uniquely increases the chances of having...

Answer 29

- Thoughts about suicide (suicidal ideation) - Making suicidal attempts.

Question 30

Complete the following statements about anxiety with the following terms: (a) comorbidity, (b) panic attack, (c) expected, (d) neurotransmitter, (e) brain circuits, and (f) stressful.

Answer 30

1) A(n) ---- is an abrupt experience of intense fear or acute discomfort accompanied by physical symptoms, such as chest pain and shortness of breath. 2) A(n) ---- panic attack often occurs in certain situations but not anywhere else. 3) Anxiety is associated with specific ---- (e.g., behavioural inhibition system or fight/flight system) and ----- systems (e.g., noradrenergic). 4) The rates of ---- among anxiety disorders are high because they share the common features of anxiety and panic. 5) ---- life events can trigger biological and psychological vulnerabilities to anxiety.

Question 31

What features characterize GAD?

Answer 31

Characterized by intense, uncontrollable, unfocused, chronic, and continuous worry that is distressing and unproductive accompanied by physical symptoms of tenseness, irritability, and restlessness.

Question 32

What distinguishes pathological worrying from the normal kind we all experience occasionally as we prepare for an upcoming event or challenge?

Answer 32

Difficult to turn off or control the worry process.

Question 33

What are the physical symptoms of GAD?

Answer 33

Muscle tension, mental agitation, susceptibility to fatigue (probably the result of chronic excessive muscle tension), some irritability, and difficulty sleeping.

Question 34

GAD is most common in what populations?

Answer 34

- Females - Over 45.

Question 35

People with GAD tend to have less or more responsiveness on most physiological measures, such as heart rate, blood pressure, skin conductance, and respiration rate than individuals with other anxiety disorders?

Answer 35

Less.

Question 36

What are the 4 cognitive characteristics of GAD?

Answer 36

(1) intolerance of uncertainty (2) positive beliefs about worry (its effective to worry) (3) poor problem orientation (Threat= problem to avoid rather than challenge to be met) (4) cognitive avoidance (worry but have no mental imagery of worry, cannot work through problems).

Question 37

Note:

Answer 37

In summary, some people inherit a tendency to be tense, and they develop a sense early on that important events in their lives may be uncontrollable and potentially dangerous. Significant stress makes them apprehensive and vigilant. These emotions set off intense worry, which helps the individual avoid anxious images and physiological arousal in the short term but eventually leads to the disorder of GAD.

Question 38

What are some of the drug treatments for GAD?

Answer 38

Benzos and antidepressants.

Question 39

What are some of the psychological treatments for GAD?

Answer 39

CBT.

Question 40

Psychological treatments seem to confer ------ benefit as drugs in the treatment of GAD, but psychological treatments are --- effective in the long term.

Answer 40

The same More.

Question 41

What is panic disorder?

Answer 41

Recurrent unexpected panic attacks accompanied by concern about future attacks and/or a lifestyle change to avoid future attacks.

Question 42

Panic disorder is often accompanied by?

Answer 42

Agoraphobia.

Question 43

What is agoraphobia?

Answer 43

Anxiety about being in places or situations from which escape might be difficult.

Question 44

What criteria must be met to be diagnosed with panic disorder?

Answer 44

A person must experience an unexpected panic attack and develop substantial anxiety over the possibility of having another attack or about the implications of the attack or its consequences.

Question 45

High comorbidity exists between panic disorder and what disorder?

Answer 45

Alcohol use.

Question 46

Could someone still be agoraphobic even if they endure the situations they fear?

Answer 46

Yes, if they endure them with great fear and dread.

Question 47

What is interoceptive avoidance?

Answer 47

Avoidance of situations or activities that produce sensations of physical arousal similar to those occurring during a panic attack or intense fear response. Ex. Exercise.

Question 48

What is the mean age of onset for panic disorder?

Answer 48

25-29 yrs.

Question 49

When do panic attacks for someone with PD typically begin?

Answer 49

At or after puberty.

Question 50

What is nocturnal panic?

Answer 50

Panic attacks that occur at night (occur during slow wave sleep) - People are afraid to sleep.

Question 51

What may cause nocturnal panic?

Answer 51

The change in stages of sleep to slow-wave sleep produces physical sensations of 'letting go' that are very frightening to an individual with panic disorder.

Question 52

Agoraphobia often develops after what?

Answer 52

A person has unexpected panic attacks.

Question 53

What are learned alarms?

Answer 53

Harmless exercise is an example of an internal cue or a conditioned stimulus for a panic attack. Being in a movie theatre when panic first occurred would be an external cue that might become a conditioned stimulus for future panics. Because these cues become associated with several different internal and external stimuli through a learning process, we call them learned alarms.

Question 54

What are the most widely used drugs to treat panic disorder and agoraphobia?

Answer 54

High-potency benzodiazepines, the newer selective-serotonin reuptake inhibitors (SSRIs), such as Prozac and Paxil, and the closely related serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine.

Question 55

Relapse rate is --- for those who stop taking benzos with PD

Answer 55

High/90%.

Question 56

What is a common psychological intervention for panic disorder?

Answer 56

Panic control treatment, exposing patients with panic disorder to the cluster of interoceptive sensations that remind them of their panic attacks.

Question 57

True or false: Some studies show that drugs, particularly benzodiazepines, may interfere with the effects of psychological treatments.

Answer 57

True.

Question 58

Is there an advantage in combining drugs and CBT for panic disorder?

Answer 58

No, this suggests the psychological treatment should be offered initially, followed by drug treatment for those patients who do not respond adequately or for whom psychological treatment is not available.

Question 59

What is a specific phobia?

Answer 59

Unreasonable fear of a specific object or situation that markedly interferes with daily life functioning.

Question 60

What are the 4 types of phobias?

Answer 60

- Animal (e.g., spiders, insects, dogs). - Natural environment (e.g., heights, storms, water). - Blood-injection-injury (e.g., needles, invasive medical procedures). - Situational (e.g., airplanes, elevators, enclosed places).

Question 61

How do many people with phobias cope with them?

Answer 61

By working around or avoiding them.

Question 62

How much of the Canadian population have phobias?

Answer 62

6.4%.

Question 63

What are the common causes of phobias?

Answer 63

Traumatic experiences, vicarious experiences (TV), stressors, genetic vulnerability, social and cultural factors.

Question 64

Why may most reported phobias be from women?

Answer 64

In most societies around the world, it is almost unacceptable for men to express fears and phobias.

Question 65

What are treatment options for phobias?

Answer 65

Exposure based exercises - Gradual exposure - VR exposure.

Question 66

What is separation anxiety disorder?

Answer 66

Excessive enduring fear in some children that harm will come to them or their parents while they are apart.

Question 67

What are common symptoms of separation anxiety disorder?

Answer 67

Refuse to go to school or to leave home.

Question 68

Note:

Answer 68

Of course, all young children experience separation anxiety to some extent; this fear usually decreases as the child grows older. Therefore, a clinician must judge whether the separation anxiety is greater than would be expected at that age.

Question 69

What is social anxiety disorder?

Answer 69

Extreme, enduring, irrational fear and avoidance of social or performance situations.

Question 70

Do people with SAD struggle with social interactions?

Answer 70

No they usually have no difficulty with social interaction, but when they must do something specific in front of people, anxiety takes over and they focus on the possibility that they will embarrass themselves.

Question 71

How common is SAD?

Answer 71

8.1% of Canadians.

Question 72

When does SAD begin normally?

Answer 72

Childhood.

Question 73

What are the 3 paths to developing SAD?

Answer 73

1) Someone could inherit a generalized biological vulnerability to develop anxiety 2) when under stress, someone might have an unexpected panic attack in a social situation that would become associated (conditioned) to social cues. 3) someone might experience a real social trauma resulting in a true alarm.

Question 74

What are treatments for SAD?

Answer 74

- CBT group therapy - VR therapy - Interpersonal psychotherapy - SSRIs.

Question 75

What is selective mutism?

Answer 75

Rare childhood disorder characterized by a lack of speech in one or more settings in which speaking is socially expected.

Question 76

How may parents enable selective mutism?

Answer 76

By readily intervening and 'do their talking for them.'

Question 77

Identify the following specific phobias: (a) blood-injury-injection, (b) acrophobia, (c) animal, (d) social, (e) natural environment, and (f) other.

Answer 77

1) Mark had no friends at school and hid in the boys' bathroom during both lunch and recess. 2) Dennis fears and strenuously avoids storms. Not surprisingly, on his first ocean-going cruise, he found that deep water terrified him, too. 3) Rita was comfortable at the zoo until the old terror gripped her at the insect display. 4) Armando would love to eat fish with his fishing buddies, but he experiences an inordinate fear of choking on a bone.