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Psyc 241 - Midterm 2 > Chapter 5 - Anxiety and Related Disorders > Flashcards

Chapter 5 - Anxiety and Related Disorders Flashcards

1
Q

Characteristics of anxiety

A

Physiological - changes in autonomic nervous system
Cognitive - alterations in consciousness and specific thoughts
Specific behavioural responses - to certain emotions, thoughts, situations

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2
Q

Anxiety

A

Individual feels threatened by the potential occurrence of a future negative event - future oriented

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3
Q

Fear

A

Occurs in response to a real or perceived current threat
Fight or flight
Present oriented

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4
Q

Panic

A

Extreme fear reaction triggered even though there is nothing objectively threatening happening

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5
Q

Historical perspective of anxiety disorders

A

Traced back to hippocrates
Until 1980 - classified under somatoform and dissociative disorders - neurosis
Labelled as neurotic - disturbance in the central nervous system
Freud - theorized there is a difference between objective fears and neurotic anxiety

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6
Q

Genetic factors of anxiety

A

4-6x higher risk of family member diagnosed
Heritability ranges from 30-50%
There is a non specific genetic risk - passed on in terms of broader temperamental traits

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7
Q

Neural fear circuit

A

Thalamus, amygdala, hypothalamus, midbrain, brain stem, spinal cord - Neural fear circuit - acts on heart rate, blood pressure, body temperature

Direct electrical stimulation of the circuit leads to differing levels of anxiety-terror based on stimulation level

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8
Q

Behavioural factors of anxiety

A

Two factor theory - classical conditioning teaches fears, operant conditioning maintains them

Fear of rat (CS) was conditioned through pairing with loud noises (UCS) - avoiding rats leads to less feelings of anxiety - increase probability that the avoidance behaviour continues

Some phobias develop through vicarious learning or modeling

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9
Q

Cognitive factors for anxiety

A

People are afraid due to biased perceptions about the world, the future, and themselves
see world as dangerous
Selectively attend and recall information consistent with their views of themselves as helpless

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10
Q

Interpersonal factors for anxiety

A

Parenting can impact childs risk of anxiety
Challenging parenting behaviour - encourage children to take risks or go outside comfort zones, may reduce childrens anxiety risk
Anxious parents may foster anxiety
Anxious ambivalent attachment style - inconsistent emotional parenting

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11
Q

Anxiety disorders

A

Most common - 31%
Phobias develop in childhood, BDD in adolescence, GAD in adulthood
Cost 17.3 billion in Canada

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12
Q

Panic disorder

A

Recurrent and unexpected panic attacks
Panic attack must develop suddenly and peak in minutes
At least 1 attack must be followed by consistent concerns about having more attacks, or worries about the ramifications of the attack
1.5% meet criteria, women 2x more likely, develop in late teen years or early adulthood
Comorbid w/ depression

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13
Q

Panic attacks

A

Sudden rush of fear or discomfort
4/13 following symptoms - disturbances in heart rate, sweating, trembling 0r shaking, feelings of choking, chest pain, nausea, abdominal discomfort, paresthesia, chills or heat sensations, dizziness or light headed, sensations of shortness of breath, derealization or depersonalization, fear of losing control, fear of dying

21% Canadians age 15 up will experience a panic attack in their life

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14
Q

Agoraphobia

A

Anxiety about being in places that are hard to escape from - crowds, lines
Highly comorbid with panic disorder
Diagnosis only made when feared situations are actively avoided, require the presence of a companion, or are endured with extreme anxiety

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15
Q

Diagnosis and assessment of panic disorder and agoraphobia

A

Cardinal feature - unexpected panic attacks, apprehension over possibility of having more panic attacks

Structured clinical interview for DSM5, Anxiety and related disorders schedule for DSM5, Behavioural avoidance test, symptom induction test, psychophysiological assessment, anxiety severity index

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16
Q

Etiology of panic disorders

A

5x more likely to develop with a relative with it
Cognitive - catastrophic misinterpretation of bodily senses - interpret that something is wrong - anxiety sensitivity - belief that anxiety symptoms will have negative consequences
Alarm theory of panic - system activated by false alarms - focus on bodily sensations to prepare for and prevent future attacks

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17
Q

Specific phobias

A

Excessive and unreasonable fear reactions - marked distress significantly disrupt daily lives
12.1% in a given year, 18.4% lifetime, 15.7% in females, 6.7% in males
Women - more animal and situation fears, more degree of fear overall, women and men - injection and dental procedure fears

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18
Q

Diagnosis and assessment of phobias

A

Marked and persistent fear, unreasonable anxiety reaction, symptoms interfere with everyday functioning

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19
Q

Types of phobias

A

Animal type, natural environment type, blood-injection injury type, situational type, other type - choking, vomiting, illness phobia

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20
Q

Etiology of phobias

A

Classical conditioning theory of fear - assumes all stimuli have an equal chance of being a fear
Nonassociative model - process of evolution is why we respond fearfully to some stimuli - too dangerous to learn the fear through experience
Genetic contributions - 35-51% heritability
Biological preparedness - Natural selection, we fear things that threatened us in the past
Disgust sensitivity - people develop some phobias because the phobic object is disgusting

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21
Q

Social anxiety disorder

A

Marked and persistent fear of social or performance related situations
Performance only - public speaking, eating in public..
Underlying fear of being negatively evaluated, hates being center of attention, debilitating fear in benign situations
Avoidance behaviour can cause significant problems, often aware of their excessive fears
3% one year prevalence, 63% comorbid w/ anxiety, mood, substance disorders

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22
Q

Assessment of social anxiety disorder

A

Structured or semi structured interview combined with completion of various self report measures

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23
Q

Etiology of social anxiety disorder - genetic and biological

A

Genetic - 40% heritability
Biological - Interactions of structures involved in fear recognition and conditioning, arousal, stress

Regulation of areas that monitor negative affect

Dysregulation of serotonin, norepinephrine

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24
Q

Etiology of social anxiety disorder - psychosocial and cognitive

A

Psychosocial experiences - 92% socially anxious adults experienced bullying or teasing as a child, exposed to parental criticism - lowers self confidence

Cognitive factors - negative beliefs and judgements about self and others - views self as inferior, negative, abnormal social information processing (self focused attention, high in public self consciousness), repeated self honest disclosure (telling ppl what they wanna hear)

25
Generalized anxiety disorder
Uncontrollable and excessive worry - experiences lots of worry to a normal amount of life stress 2% in any given 12 month period, 4% will develop at some point - highest prevalence in high income countries, 2x common in women
26
Diagnosis and assessment of generalized anxiety disorder
Excessive worry for more days than not over 6 months, difficulty controlling worrying Three or more of - restlessness, tiring easily, difficulty concentrating, irritability, muscle tension, sleep problems Impairment in function, distress
27
Etiology of generalized anxiety disorder
Cognitive - use worry as an avoidance strategy to escape unpleasant feelings Contrast avoidance model of GAD - worry facilitates avoidances of significant changes in emotional states Worrying comes with verbal thought - images increase arousal and verbal thought decreases it Worrying can avoid future threat - worry because of work, study hard, get good grade, reinforce worry
28
GAD - IU
Intolerance of uncertainty Lower thresholds for uncertainties - what if questions - uncertainty of the future - individuals with high IU levels pay more attention to uncertainties and interpret ambiguos information as more threatening
29
Obsessive compulsive disorder
Obsessions - recurrent and uncontrollable thoughts, impulses, ideas - invoke anxiety - uncertainty, sexual, violent, contamination Compulsions - attempt to cope with discomfort, repetitive behaviour intended to reduce anxiety - handwashing, checking, maintaining order, counting, praying Neutralizations - behaviours or mental acts used to prevent, cancel, undo feared consequences of an obsession
30
Thought action infusion
Likelihood TAF - belief that having a thought increases the likelihood of it happening Moral TAF - belief that having a thought is the moral equivalent to the action
31
Diagnosis and assessment of OCD
Presence of either obsessions or compulsions or both Symptoms cause significant distress - more than 1 hour a day engaged in obsessions or compulsions Cleaning, need for order, thoughts of harm
32
Etiology of OCD - Genetics and biology
Genetics - 32-40% Biology - Less frontal cortex volume and more basal ganglia volume - hyperactivation in areas that detect error and signal for behavioural correction, hypoactivation in areas responsible for inhibitory control - Serotonin, SSRIs can treat OCD symptoms
33
Body dysmorphic disorder
Excessive preoccupation with an imagined perceptions or exaggerated body, disfigurement, sometime to the point of delusion Significant distress or impairment in functioning 25% attempt suicide Men - genitals, body build, thinning hair Women - skin, stomach, weight, breasts, butt
33
Etiology of OCD - cognitive behavioural
Problematic obsessions' caused by that persons reaction to intrusive thoughts Rebound effect - trying to suppress thoughts may increase their frequency Consequences reward and maintain use of compulsions - lower severity of anxiety, lower frequency of obsessions', prevent obsessions from coming true
34
Diagnosis and assessment of BDD
More disturbed than those with OCD - higher rates of suicidal ideation, delusions, major depression, substance abuse, social phobia
35
Post traumatic stress disorder
Re-experience intrusive, unwanted recollections of a past traumatic event Experience flashbacks - transient breaks from reality - may have auditory and visual hallucinations Cognitive and behaviour avoidance of the event, may be unable to remember some aspects Emotional numbing - diminished interests, feeling detached, estranged 6% exposed to traumatic events, women 2x more likely - more likely to be exposed to PTSD inducing events
36
PTSD diagnosis and assessment
Combination of semi structured clinical interview and results of psychometric scales Clinician administered PTSD scale Determine whether other disorders are present
37
PTSD etiology - biology
Dysfunctions in innate alarm system - brain stem, amygdala, frontotemporo cortex - decreased cortisol/enhanced negative feedback of adrenal function, lower hippocampus volume
38
PTSD etiology - cognitive
Interpersonal traumas more likely to provoke PTSD than non interpersonal Pre event factors: low SES, education , intelligence, bad childhood Post event factors - trauma severity, lack of social support, additional stress dual representation theory: Traumatic memories stores and retrieved in sensory not verbal form Those who have experienced trauma are forced to integrate conflicting previous beliefs
39
Pharmacotherapy
Benzodaiazeines - act on GABA - for infrequent anxiety Monoamine oxidase inhibitors - effective in treatment of social anxiety disorder Tricyclic antidepressants - effective in OCD treatment SSRIs are most well prescribed
40
New pharmacotherapy
Azapirones - alter dopamine in brain Serotonin-norepinephrine reuptake inhibitors - associated with fewer side effects than SSRIs - GAD treatment Anticonvulsant pregabalin - first line option for GAD and SAD
41
Cognitive restructuring
Goal to help patients develop more evidence based thoughts - help adjust balance between perceived risk and resource Thought record - when anxiety increases, patients record what they were thinking about before the anxiety
42
Exposure
Completing an exposure exercise predicted sustained reduction in symptoms By facing anxiety provoking stimuli, ones fears become extinguished, new coping skills developed, cognitive change occurs
43
Habituation
Repeated exposure to feared stimulus eventually results in a diminished behavioural response
44
Systemic desensitization
Patient develops a fear hierarchy - subjective units of distress 0-100 - pair relaxation response with feared stimuli - counter conditioning
45
In vivo
In real life exposure More effective
46
Imagery in GAD treatment
Worry imagery exposure - systematic exposure to feared images that are related to an individuals worries
47
Flooding or intense exposure
Starting at high intensity levels rather than working through fear hierarchy
48
Interoceptive exposure
Exposure to internal clues - induction go physical sensations
49
Ritual prevention
Main treatment for OCD Promotes abstinence from rituals that while reduce anxiety in the short term, reinforce obsessions in the long run
50
Problem solving
Generating and implementing effective solutions to problems - patients will experience less anxiety Problem oriented phase - Individuals encouraged to approach and deal with their problems constructively
51
Relaxation
Mental relaxation - guided imagery - develop personalized description of positive thoughts and images Muscle relaxation - Tense and relax muscle groups, learn to reduce anxiety by relaxing muscle tension Breathing restraining - Breathe using diaphragm not chest
52
Other techniques
Mindfulness - Meditation with principles intended to promote psychological well being Virtual reality - Expose people to things they fear Eye movement desensitization and reprocessing - Remember an actual or imagined negative life event while focusing attention on an oscillating stimulus Internet based CBTi
53
Treatment of panic disorder
CBT - 50-80% panic free by end
54
Treatment of specific phobias
In vivo exposure - 80-90% success Virtual reality exposure
55
Treatment of social anxiety disorder
CBT group therapy D-cycloserine and exposure treatment
56
Treatment of generalized anxiety disorder
Benzodiazepines - 65-70% short term success Anti-depressants, azapirones CBT
57
Treatment of OCD and BDD
OCD - exposure and ritual prevention, CBT BDD - CBT
58
Treatment of PTSD
Facing trauma and discussing Imaginational exposure In vivo exposure Cognitive processing therapy Narrative exposure therapy Virtual reality

Psyc 241 - Midterm 2 (4 decks)

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