Chapter 5 Flashcards
An unpleasant feeling of fear and apprehension accompanied by increased physiological arousal.
Anxiety
In learning theory, it is considered a drive that mediates between a threatening situation and avoidance behaviour.
Can be assessed by self-report, by measuring physiological arousal, and by observing overt behaviour.
Fear and avoidance of objects or situations that do not present any real danger.
An unwarranted fear and avoidance of a specific object or circumstance.
Specific phobia
Fear and avoidance of social situations due to possible negative evaluation from others.
Social anxiety disorder
A disorder in which a fear of being judged negatively is the core concern. Common anxiety-provoking situations include being observed by others (e.g., walking down the street, eating in front of others), social interactions (e.g., parties), and presentations.
Recurrent unexpected panic attacks involving a sudden onset of physiological symptoms, such as dizziness, rapid heart rate, and trembling, accompanied by terror and feelings of impending doom.
Panic disorder
Fear of being in public places.
Agoraphobia
Persistent, uncontrollable worry, often about minor things.
Generalized anxiety disorder
The anxious arousal and worry about losing contact with and proximity to other people, typically significant others.
Separation anxiety disorder
Results from not having contact or the possibility of losing contact with attachment figures.
A disorder in which the individual (often a child) feels intense fear and distress when away from someone on whom he or she is very dependent; said to be a significant cause of school phobia.
Failure to speak in one situation (usually school) when able to speak in other situations (usually home).
Selective mutism
Summary of Major Anxiety Disorders
SLIDES
- Phobia
- Panic Disorder
- Generalized Anxiety Disorder
- Separation Anxiety
Additional in textbook:
Social anxiety disorder
Agoraphobia
Selective mutism
Anxiety has two major components:
- Physiological
- heightened level of arousal and physiological activation - Cognitive
- Subjective perception of the anxious arousal and the associated cognitive processes: worry and rumination.
Anxiety tends to be:
- Future-focused
- The emphasis is on things that could happen. - Comorbid
- Anxiety disorders tend to be comorbid
Negative reinforcement problem
Anxiety and worry can be reinforced by the avoidance of feared outcomes and possible experiences that never happen.
When does anxiety become a problem?
When it is:
- chronic
- relatively intense
- associated with role impairment and causing significant distress for self OR others.
There is a subjective element to the diagnosis
What tends to distinguish chronically anxious people is their propensity to perceive threat and to be concerned/worried when there is no objective threat or the situation is ambiguous
Prevalance of Anxiety Disorders
- Anxiety disorders are the most common psychological disorders
- Early age of onset, typically during childhood
- Gender difference exists;
> Anxiety disorders were more common in women than in men across all age groups.
> The highest one-year prevalence rates (i.e., almost 1 in 5) were found in women 15 to 24 years of age. - A majority of Canadians report anxiety interfered with their home, school, work, and social life
Age of onset for Anxiety Disorders
- Early age of onset, typically during childhood.
Sex differences for Anxiety Disorders
More common in women
Is separation anxiety only in children?
No. It is seen generally as a type of anxiety that is prevalent among children of various ages but not relevant among older people. This is incorrect:
There is a growing focus on separation anxiety disorder in adults - Adults who cannot stand to be alone and are cognitively preoccupied with losing contact with loved ones
Study conducted with patients from an anxiety disorders clinic - almost 1 in 4 adult patients were diagnosed with an adult form of separation anxiety disorder.
These data suggest that the separation anxiety disorder diagnosis in adults deserves much more consideration than it currently receives.
Disrupting, fear-mediated avoidance that is out of proportion to the danger actually posed and is recognized by the sufferer as groundless
Phobia
Many specific fears do not cause enough hardship to compel an individual to seek treatment.
eg. an urban dweller with an intense fear of snakes will probably have little direct contact with the feared object and may therefore not believe that anything is seriously wrong.
The term “phobia” usually implies that the person suffers intense distress and social or occupational impairment because of the anxiety.
Specific phobia
An unwarranted fear and avoidance of a specific object or circumstance; for example, fear of nonpoisonous snakes or fear of heights.
Summary of Specific Phobia Subtypes
- Blood-injection-injury
e. g Seeing Blood, Going to Dentist - Situations
e. g Enclosed spaces, Planes, Elevators - Animals
e. g Insects, Dogs, Snakes - Natural environment
eg. Heights, Water, Storms - Other
eg. Choking, Vomiting, Clows
Fear of closed spaces
Claustrophobia
Fear of public places
Agoraphobia
Fear of heights
Acrophobia
Fear of working
Ergasiophobia
Fear of choking
Pnigophobia
Fear of being buried alive
Taphephobia
Fear of contamination and dirt
Mysophobia
Mean duration for specific phobias,
% of people who receive treatment
20 years
only 8% received treatment
Most common specific phobia subtypes in order:
(1) animal phobias (including insects, snakes, and birds);
(2) heights;
(3) being in closed spaces;
(4) flying;
(5) being in or on water;
(6) going to the dentist;
(7) seeing blood or getting an injection;
(8) storms, thunder, or lightning.
Pa-leng
China: Pa-leng (a fear of the cold) worries that loss of body heat may be life-threatening.
This fear appears to be related to the Chinese philosophy of yin and yang: yin refers to the cold, windy, energy-sapping, and passive aspects of life, while yang refers to hot, powerful, and active aspects.
Taijin kyofusho (TKS)
Japan: taijin kyofusho (TKS), fear of other people.
it is an extreme fear of embarrassing others—for example, by blushing in their presence, glancing at their genital areas, or making odd faces. It is believed that this phobia arises from elements of traditional Japanese culture, which encourages extreme concern for the feelings of others yet discourages direct communication of feelings.
Persistent, irrational fears linked generally to the presence of other people.
Social Phobia or Social Anxiety Disorder
People with a social phobias try to avoid situations in which they might be evaluated because they fear that they will reveal signs of anxiousness or behave in an embarrassing way.
Examples:
Speaking or performing in public
Eating in public
Using public lavatories
Two types of social phobia:
- Generalized Social Phobia
- Specific Social Phobia
Generalized Social Phobia
- involve MANY different interpersonal situations
an earlier age of onset
- often COMORBID with other disorders such as depression and alcohol use
- more severe impairment than specific phobia
Specific Social Phobia involve intense fear of ONE particular situation (e.g., public speaking).
Social Anxiety: self image
Socially anxious people are…
- more concerned about evaluation than are people who are not socially anxious
- highly aware of the image they present to others
- high in public self-consciousness
- preoccupied with a need to seem perfect and not make mistakes in front of other people
- tend to view themselves negatively even when they have actually performed well in a social interaction
- are less certain about their positive self-views
- relative to people without social phobia, they see their positive attributes as being less important
Social Phobia or Social Anxiety Disorder
Onset and Duration
- Onset generally during adolescence
(Average age onset: 13 years) - Average duration of symptoms: 20 years
Prevalence of social phobia:
Higher among people who have:
- never married or were divorced
- not completed secondary education
- lower income or were unemployed
- lacking adequate social support
- low quality of life
- or had a chronic physical condition
Aetiology of Phobias - Behavioural Theories
Phobias develope from… 5 Behavioural Factors:
Behavioural theories focus on learning as the way in which phobias are acquired.
Several types of learning may be involved:
1 - Avoidance Conditioning - reactions are learned avoidance responses (eg. little albert)
Phobias develop from two related sets of learning:
- Via classical conditioning
- Person learns to reduce conditioned fear by escaping from or avoiding the CS (operant conditioning)
- Modelling
- person can learn fear through imitating the reactions of others (vicarious learning). - Prepared Learning
- Some fears may reflect classical conditioning, but only to stimuli to which an organism is physiologically prepared to be sensitive
eg. People fear spiders, snakes, and heights but not lambs - The Role of Diathesis - Is a diathesis needed?
- Cognitive diathesis such as
> tendency to believe that similar traumatic experiences will occur in the future or
> not being able to control the environment may be important in developing a phobia. - Social Skills Deficits in Social Phobias
- Inappropriate behaviour or a lack of social skills the cause of social anxiety
- Individual has not learned how to behave so that he or she feels comfortable with others or the person repeatedly commits faux pas, is awkward and socially inept, and is often criticized by social companions.
- Socially anxious people are rated as being low in social skills (timing and placement of socially anxious responses in a social interaction, such as saying thank you at the right time and place, are impaired)
Aetiology of Phobia - Cognitive Theories
Focus on how people’s thought processes can serve as a diathesis and on how thoughts can maintain a phobia
Anxiety is related to being more likely to:
- Attend to negative stimuli
- Interpret ambiguous information as threatening
- Believe that negative events are more likely than positive ones to re-occur
Post-event Processing (PEP) of negative social experiences
- a form of rumination about previous experiences and responses to these situations, especially experiences involving other people that did not turn out well.
Post-event Processing (PEP) of negative social experiences
a form of rumination about previous experiences and responses to these situations, especially experiences involving other people that did not turn out well.
There is a link between social anxiety and PEP.
Aetiology of Phobia - Predisposing Biological Factors
Phobia Biological Factors
People with specific phobia, PTSD, and Specific Anxiety Disorder have greater activity in two areas associated with negative emotional responses:
Amygdala & Insula
- Autonomic Nervous System:
- Stability-lability
Labile, or jumpy, individuals are those whose autonomic systems are readily aroused by a wide range of stimuli. Because of the extent to which the autonomic nervous system is involved in fear and hence in phobic behaviour, a dimension such as autonomic lability assumes considerable importance. - Genetic Factors
Autonomic lability is to some degree genetically determined so heredity may have a significant role in development of phobias.
Aetiology of Phobias - Psychoanalytic Theory
- Phobias are a defence against the anxiety produced by repressed id impulses
- anxiety is displaced from the feared id impulse and moved to an object or situation that has some symbolic connection to it. - These objects or situations then become the phobic stimuli.
- By avoiding them the person is able to avoid dealing with repressed conflicts.
Disorder in which the individual has sudden and inexplicable jarring symptoms, such as difficulty breathing, heart palpitations, dizziness, trembling, terror, and feelings of impending doom.
Person suffers a sudden and often inexplicable alarming symptoms:
- Laboured breathing, heart palpitations,
- Nausea and chest pain;
- Feelings of
> Choking and smothering;
> Dizziness, sweating, and trembling;
> Intense apprehension, terror, and feelings of impending doom.
Panic Attack
May also experience;
- 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).
Other features of panic attacks:
- May occur frequently
- May be situationally predisposed
- May be uncued
Panic attacks can also occur in seemingly benign states, such as relaxation or sleep, and in unexpected situations.
*** Recurrent uncued attacks and worry about having attacks in the future are required for the diagnosis of panic disorder. **
The exclusive presence of cued attacks most likely reflects the presence of a phobia.
Feeling of being outside one ’s body
Depersonalization (experienced during panic attack)
Feeling of the world ’s not being real, as well as fears of losing control, of going crazy, or even of dying
Derealization (experienced during panic attack)
Types of Panic Attacks (4 types):
- Uncued/unexpected
- Out of the blue; the type required for a diagnosis of panic disorder - Cued/expected
- Strongly associated with trigger - Situationally predisposed
- Some association with trigger - Nocturnal
- Waking from sleep in a panic (unexpected)
Prevalence: Panic Disorder
6.4%
Panic attacks were related to numerous psychological and physical function variables, including;
- poor overall functioning
- suicidal ideation
- psychological distress
- activity restriction
- chronic physical conditions
- self-rated physical and mental health (Kinley et al., 2009).
Panic attacks may be a marker of severe psychopathology independent of a diagnosis of panic disorder.
Aetiology of Panic Disorder - Biological Theories
4 Biological Factors
Biological
- Noradrenergic Activity
hyper- function of the autonomic nervous system
- Mitral valve prolapse syndrome;
dizziness, numbness, chest pain or pressure, palpitations, anxiety, sleeplessness, gaseousness, bowel symptoms or actual diarrhea, and mood swings have beentermed Mitral Valve Prolapse Syndrome.
These symptoms are not due to the prolapse of the valve itself. Most often related to the excessive drive or hyper- function of the autonomic nervous system.
- Panic disorder runs in families, has greater concordance in identical-twin than fraternal
- Increased risk of 5–16% among relatives of those with panic disorder.
- Early onset of panic disorder associated with increased risk for family members.
- May be linked to a gene on chromosome 22 - Cholecystokinin (CCK)
- Hypersensitivity to CCK
Peptide that occurs in the cerebral cortex, amygdala, hippocampus, and brain stem, induces anxiety-like symptoms and effect can be blocked with benzodiazepines
Exposure to CCK-4 induces panic attacks and patients with panic disorder have a clear sensitivity to CCK-4.
There is genetic basis to CCK-4 and its role in panic disorder.
dizziness, numbness, chest pain or pressure, palpitations, anxiety, sleeplessness, gaseousness, bowel symptoms or actual diarrhea, and mood swings have beentermed…
Mitral Valve Prolapse Syndrome
Aetiology of Panic Disorder - Psychological Theories
2 Psychological Theories
- The fear-of-fear hypothesis
- Misinterpretation of physiological arousal symptoms
- ANS that is predisposed to be overly active coupled with a psychological tendency to become very upset by these sensations.
A Vicious Circle: Panic Attacks
- When high physiological arousal occurs, some people construe these unusual autonomic reactions (such as rapid heart rate) as a sign of great danger or even as a sign that they are dying.
- After repeated occurrences, the person comes to fear having these internal sensations and, by worrying excessively, makes them worse and panic attacks more likely.
- Psychology of the person takes over from where the biology began. The person becomes more vigilant about even subtle signs of an impending panic attack, and this, too, makes an attack more probable.
- Result is a vicious circle:
fearing another panic attack leads to increased autonomic activity; symptoms of this activity are interpreted in catastrophic ways; and these interpretations in turn raise the anxiety level, which eventually blossoms into a full-blown panic attack
