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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
Q

Generalized anxiety disorder

A

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
Q

Diagnosis and assessment of generalized anxiety disorder

A

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
Q

Etiology of generalized anxiety disorder

A

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
Q

GAD - IU

A

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
Q

Obsessive compulsive disorder

A

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
Q

Thought action infusion

A

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
Q

Diagnosis and assessment of OCD

A

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
Q

Etiology of OCD - Genetics and biology

A

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
Q

Body dysmorphic disorder

A

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
Q

Etiology of OCD - cognitive behavioural

A

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
Q

Diagnosis and assessment of BDD

A

More disturbed than those with OCD - higher rates of suicidal ideation, delusions, major depression, substance abuse, social phobia

35
Q

Post traumatic stress disorder

A

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
Q

PTSD diagnosis and assessment

A

Combination of semi structured clinical interview and results of psychometric scales

Clinician administered PTSD scale

Determine whether other disorders are present

37
Q

PTSD etiology - biology

A

Dysfunctions in innate alarm system - brain stem, amygdala, frontotemporo cortex - decreased cortisol/enhanced negative feedback of adrenal function, lower hippocampus volume

38
Q

PTSD etiology - cognitive

A

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
Q

Pharmacotherapy

A

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
Q

New pharmacotherapy

A

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
Q

Cognitive restructuring

A

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
Q

Exposure

A

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
Q

Habituation

A

Repeated exposure to feared stimulus eventually results in a diminished behavioural response

44
Q

Systemic desensitization

A

Patient develops a fear hierarchy - subjective units of distress 0-100 - pair relaxation response with feared stimuli - counter conditioning

45
Q

In vivo

A

In real life exposure
More effective

46
Q

Imagery in GAD treatment

A

Worry imagery exposure - systematic exposure to feared images that are related to an individuals worries

47
Q

Flooding or intense exposure

A

Starting at high intensity levels rather than working through fear hierarchy

48
Q

Interoceptive exposure

A

Exposure to internal clues - induction go physical sensations

49
Q

Ritual prevention

A

Main treatment for OCD

Promotes abstinence from rituals that while reduce anxiety in the short term, reinforce obsessions in the long run

50
Q

Problem solving

A

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
Q

Relaxation

A

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
Q

Other techniques

A

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
Q

Treatment of panic disorder

A

CBT - 50-80% panic free by end

54
Q

Treatment of specific phobias

A

In vivo exposure - 80-90% success
Virtual reality exposure

55
Q

Treatment of social anxiety disorder

A

CBT group therapy
D-cycloserine and exposure treatment

56
Q

Treatment of generalized anxiety disorder

A

Benzodiazepines - 65-70% short term success

Anti-depressants, azapirones

CBT

57
Q

Treatment of OCD and BDD

A

OCD - exposure and ritual prevention, CBT

BDD - CBT

58
Q

Treatment of PTSD

A

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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