Chapter 5

Question 1

What is fear

Answer 1

• Emotional response attributed to something negative
• Usually about a perception of danger or harm
• Very adaptive
• Immediate physiological response
• Actual threat, true alarm

Question 2

Fear vs anxiety

Answer 2

• Fear happening now

- Anxiety is about something that will happen in the future

Question 3

What is anxiety

Answer 3

• Anticipation of future threat with a dread
• Think about seeing a bear @ keji → don’t go to keji
• Leads to being unable to do things

Question 4

Panic

Answer 4

• Particular type of fear response, intense
• Abrupt, not anticipated
• Alarm response
• Quickly reaches a peak of intensity
• Lasts several minutes
• Physiological symptoms
  o Palpitations, shortness of breath, abdominal distress, dizziness, sweating, numbness
• May include psychological symptoms like
  o Fear of losing control, going crazy or dying, feeling of unreality or of being detached from oneself
• May or may not be related to panic attack
• Related to anxiety disorder if → feel panic attack, is it going to happen again? (angst around panic)
• Panic and fear can become associated with specific situations

Question 5

Panic attacks

Answer 5

• May be cued (tied to anxiety) or uncued
• Commonly accompany anxiety disorders
• May occur in the absence of a psychological disorder
• High level of fight or flight for a long period of time
• Peak at 10 min

Question 6

What is an anxiety disorder

Answer 6

• Persistent and pervasive symptoms of anxiety and fear
• Characterized by extreme avoidance
• Characterized by extreme levels of impairment → many things people limit themselves on
• Specific phobias: specifically aimed so you can often aboud and not be impaired
• Situation can be endured but with extreme distress

Question 7

Biological vulnerabilities

Answer 7

• Genetics → diathesis stress model
• General tendency for anxiety inherited
• Neurotransmitters
  o Low levels of GABA related to increased anxiety
  o One of medication treatments = SSRIs
• Brain circuit
  o Neural fear → limbic an cerebral cortex
  o Panic circuit → fight or flight, originates from brain stem, travels to limbic system structures
  o Amygdala overly sensitive to info in environment and cortex doesn’t buffer HPA axis
  o Implicated with neurotransmitters being related to anxiety

Question 8

Psychological vulnerabilities

Answer 8

• Personality traits and behavioral tendencies
• Temperament
  o How are we typically: shy, angry etc.
• Anxiety sensitivity
  o Fear of arousal related somatic sensations
  o Feel one of panic attack symptoms →> have anxiety disorder take more seriously, freak out
  o Overly sensitive to these things have genetic links
  o More likely to experience fear, tendency to respond more to anxiously
• Negative affect
  o Tendency to experience things as negative (situations, people etc.)
• Life stressors
  o Unique familial and interpersonal stressors
  o Stressful life events
  o Vicarious learning
  o Events may trigger existing or create new biological/psychological vulnerabilities
  o Magnify existing or create new sensitivities

Question 9

• General complexity

Answer 9

o Existence of concurrent psychological disorders
o Common across anxiety disorders
o ~50% have 2+ secondary diagnoses
o Major depression is the most common

Question 10

Specific phobia

Answer 10

• 11% of general population
• 9% of women 4% of men
• Extreme and irrational fear in presence of a phobic stimulus
• Extreme avoidance
• Triggers:
  o Confronting in person, reading about it, hearing about it
  o Common to have more than 1
  o Unexpected panic attack in presence of phobic stimulis
  o Informational transmission
• If kid you express distress as crying, tantrum
• Typical onset btwn 7-11y
• Must have fear and be struggling for at least 6mo
• Make sure that nothing else is going on
• Clinically significant distress of cause impairment
• Onset is young, anywhere from childhood to adolescence

Question 11

• Blood injection injury

Answer 11

o Fear of needles, invasive medical procedures, blood, injury
o May or may not be about seeing blood/injury
o Inherited vasovagal response
o More about being frightened
o Most inherited phobia

Question 12

• Natural environment

Answer 12

o Heights, storms, water etc.

Question 13

situational

Answer 13

o Particular places and situations

o Airplanes elevators, enclosed spaces

Question 14

animal

Answer 14

o Fear of specific animals

o Spiders, dogs, insects, snakes etc.

Question 15

other

Answer 15

o Fear of situations that may lead to choking, vomiting

o In kids: costumed characters, loud noises

Question 16

treatment -SP

Answer 16

• Cognitive behavior therapies
• Systematic desensitization
  o Discovered that responses can exist at the same time
  o If you can get people into a physical and mental state of relaxation
  o You cant also experience panic
  o Person can tolerate higher and higher levels on higharchy
• Exposure based therapy
  o Similar, use imagination
  o Graduated
  o Consistent
  o Structures
  o Relaxation
• Virtual reality

Question 17

social anxiety disorders

Answer 17

• Fear in social situations
• On a stage, using a urinal, at a party
• Fear of humiliation or being judged
• Avoid social situations or endure with great distress
• Associate experience wit emotion and get anxiety so avoid
• Peak around age 13, can develop in 20s
• People aren’t usually evaluating us to the degree that we think they are
• Rate higher in Canada than US

Question 18

biological -SAD

Answer 18

• Prepared learning: prepped to feel anxious and avoid angry and threatening people, evolution
• Inherited
  o Behavioral inhibition: extreme shyness
  o Genetic predisposition for anxiety
• Neurobiological
  o Multiple neurotransmitters implicated

Question 19

psychological -SAD

Answer 19

• Generalized vulnerability
• Anxiety sensitivity
• Negative beliefs including anxious apprehension
  o Looks → anxiety that your sensitive to depends on you, but get anxious about it and it can get worse
  o Reading catastrophic meaning into cues
  o Focusing on negative self talk
  o All anxiety disorders have uncontrollability aspect
  • If have high need for control when out can feel more anxious
• Vicarious experience
  o Way we socialize can be learned from parents (way they act affects)
  o People with SAD don’t have a lot of the same social cues as others
  • Selectively attend to negative cues, lots of comparisons with others
• Specific vulnerability
  o Traumatic exposure : something we’re involved in that becomes traumatic, most obvious way for disorder to start
  o True alarm or false: something you judge as bad and assume others are but people pay less attention than thought
  o Uncued or unexpected panic attack or intense fear

Question 20

treatment -SAD

Answer 20

• Medications
  o SSRIs
  o Only does so much, once you stop disorder may come back
• Psychological
  o Cognitive behavior treatment
  • Exposure
  • Rehearsal
  • Role play
  • Group therapy → hard for SAD but important, reality testing
  • Doesn’t let you avoid
  o Highly effective, good with long term results

Question 21

panic disorder

Answer 21

• Experience of recurrent, unexpected panic attacks
• Develop persistent anxiety worry or fear about having another panic attack or its implications
• Engage in behaviors designed to prevent or avoid future panic attacks
• Seems to happen in all kinds of situations
• Associated features
  o Agoraphobia
  o Interoceptive/exteroceptive
  • Intro: symptoms and associate with panic attack symptoms feel like panic so avoid
  • Extero: actual avoidance
  o Nocturnal panic attacks – when asleep
  o High rates of suicide and attempts

Question 22

agoraphobia

Answer 22

• Variation of panic disorder
• In places where person feels like they cant escape becomes part of disorder
• Avoid any situation where panic disorder occurs and escape is an issue
• Ex. public transit, enclosed place
• Begin to limit life and don’t go where you cant escape
• Severe: may become homebound
• High rates of comorbidity and impairment
• Without treatment remission = 10%
• Some people endure with intense dread

Question 23

biological -PD

Answer 23

• Inherited, strong genetic predisposition → have gene and 5x more likely
  o Inherit anxiety and over reactiveness
  o Stress vulnerability

Question 24

psychological -PD

Answer 24

• Anxiety and sensitivity
• Negative beliefs, self evaluation more aware of every change
• Worry about it → make more likely to have PA – anxious apprehension
• Hyper vigilance → sensitivity to threatening things
• Negative attributions
• Conditioning resulting in a learned alarm reaction

Question 25

treatment -PD

Answer 25

Medications
-	Target serotonergenic, noradrenergetic, benzodiazepine GABA systems 
-	SSRIs: currently preferred 
-	High relapse when discontinue 
-	Benzos are highly addictive 
Psychological 
-	Cog behave therapy effective 
-	Learn to manage anxiety
-	Gradual exposure – based exericeses 
-	Relaxation and breathing 
-	Psych treatment should be offered initially and then meds offered for those who the meds don’t work for
Panic control 
-	Exposure to interoceptive cues 
-	Cog therapy 
-	Therapist creates mini panic attack

Question 26

gad

Answer 26

• Excessive, uncontrollable apprehension and worry about numerous life events
  o Cant stop worry anxiety
• Strong pronounced persistant anxiety
• Somatic symptoms
• Sleeping problems
• Chronic course
• No panic attacks, just constant worry
• Muscle tensions → chronic aches and pains
• Feel restless, overwhelmed bc of worries

Question 27

biological -GAD

Answer 27

• High genetic predisposition
• Anxiety sensitivity → think the worst is going to happen and get stressed
  o Become distressed in response to arousal related sensations
  o Anxiety related sensations have harmful consequences
• Unique physiological patterns
  o Chronic muscle tension
  o Reduces responsiveness to most anxiety measures
• Risk higher for identical twins when one already had GAD
• Inherit tendency to be anxious, not disorder itself

Question 28

psychological -GAD

Answer 28

• Unique cog characterisitcs
  o Intolerance of uncertainty → cant calm themselves, less tolerant of uncertainty situations
  o Erroneous beliefs → think worrying will help them
  • Effective in avoiding negative outcomes
  o Poor problem orientation → don’t focus on problem solving
  o Cog avoidance → avoid, never able to work through problems

Question 29

treatments -GAD

Answer 29

• meds
  o Benzodiazepines – short term relief but high risk
  • Impair cognitive and motor functioning
  • Produce dependence, hard to stop taking
  • Best for short term relief of a temporary crisis
  o Antidepressants
  o SSRIs promising
• Psychological
  o Cog behave treat
  • Exposure to worry process
  • Confronting anxiety provoking images
  o Coping strategies
  o Mindful based treatments

Question 30

Trauma and stressor related disorders

Answer 30

• DSM5 created a new diagnostic category
• Includes
  o Reactive attachment disorder
  o Disinhibited social engagement disorder
  o Adjustment disorders
  • With: depressed mood, anxiety, conduct disturbance, mixed emotion/conduct disturbance
  o Acute stress disorder
  o Post traumatic stress disorder

Question 31

ptsd

Answer 31

• Trauma exposure: actual or threatened death, serious injury or sexual violence
• May be thought direct experience, witnessing or learning that a traumatic even has occurred to significant other
• Experiencing repeated or extreme exposure to aversive details of the trauma (ex. first responders, child service workers)
• Typically experience extreme fear, helplessness or horror, although not required
• Most common: sexual assault, domestic violence, accidents, natural disasters, combat
• Symptoms:
  o Avoidance
  o Intrusive symptoms
  o Negative cognitions and mood states
  o Emotional numbing
  o Altered physiological arousal and reactivity
• 3 core features
  o Persistent re-experiencing of event
  o Avoidance of associated stimuli and numbing of general responsiveness
  o Symptoms of extreme arousal

Question 32

causes -ptsd

Answer 32

• Biological and psychological vulnerabilities
  o Genetics
  o Neurobiological impact of traumatic event
  o Emotional and cognitive reactions (pre and post trauma)
  o Social support (pre and post)
  o Psychiatric history (includes previous trauma)
• Event related factors
  o Dosage related
  o Natural vs man made trauma
  o Nature of threat

Question 33

treatment -ptsd

Answer 33

-	Medications 
o	SSRIs
-	Cognitive behavioral therapy 
o	Exposure
o	Imaginal 
-	Increasing positive coping skill s
-	Increase social support 
-	Highly effective

Question 34

ocd and related disorders

Answer 34

• Obsessive compulsive disorder
• Body dysmorphic disorder
• Hoarding disorder
• Trichotillomania
• Excoriation
• Substance-induced obsessive-compulsive and related disorders
• Obsessive-compulsive and related disorder due to another medical condition

Question 35

ocd

Answer 35

• Presence of obsessions, compulsions, or both
• Obsessions
  o Repetitive and persistent thoughts
  • Intrusive and unwanted thoughts, images, urges
  o Attempts to resist or eliminate
• Compulsions
  o Repetitive behaviors or mental acts
  • Driven to perform in response to an obsession, r according to rules which must be rigidly followed
  o Temporarily suppresses obsessions
  o 4 major categories
  • Checking, ordering, arranging, washing/clearning

Question 36

biological -ocd

Answer 36

o Genetics
• A moderate genetic risk identified for OCD related dysfunctional beliefs and symptoms
o Neurobiological
• Research implicated the basal ganglia and frontal cortex
• Hypothesized: structureal and/or functional abnormalities in the basal ganglia and frontal cortex may be responsible for obsessions and compulsions
• Neurochemical hypotheses: abnormalities in serotonin system have been implicated

Question 37

psychological -ocd

Answer 37

o Early life experiences may result developing maladaptive beliefs about oneself, one’s thoughts (dangerous), leading to dysfunctional behaviors
• Catastrophic misinterpretations of thoughts including anxious apprehension
• Thought/action fusion
• Thought suppression and rebound effect
• Compulsions (thoughts or behaviors) may develop as maladaptive coping mechanism

Question 38

treatment -ocd

Answer 38

-	Medications 
o	Clomipramine and SSRIs 
•	50-50% benefit 
•	High relapse when discontinued 
-	Cognitive-behavioral therapy 
o	Exposure and ritual prevention (ERP)
o	Reality testing 
o	Highly effective 
•	85% benefit from ERP
-	Psychosurgery (cingulotomy)
o	Extreme cases: 30% benefit

Question 39

body dismorphic disorder

Answer 39

• Preoccupation with perceived defects or flaws in physical appearance
• Typical unobservable or slight flaws
• Strong beleifs regarding unattractiveness or physical abnormalities
• Characterized by intrusive thoughts (pops up all the time), time consuming activities related to appearance
  o Checking mirrors, comparison to others
  o Efforts to improve appearance (grooming, exercise, cosmetic surgery, skin picking)
• Usually no one else is able to tell what they’re obsessing about
• May be ore focused on appearance than others
• Don’t want to confuse with eating disorders – diff = that people with anorexia have a fear of becoming obese and have a disturbed body image
• Can confuse with excoriation – in this case skin picking is about trying to improve appearance
• Causes largely unknown
  o Similarities with ocd: symptomology, etiology, treatment

Question 40

treatment -bdd

Answer 40

o Ssris

o Exposure and response prevention therapy