Chapter 5 - Anxiety and Related Disorders Flashcards
anxiety
affective state whereby an individual feels threatened by the occurrence of a possible future negative event
fear
Occurs in response to a real or perceived current threat
what kind of an emotion is fear
“present oriented”
“fight or flight” response
fear prompts a person or organism to either flee from a dangerous situation or stand and fight
panic
similar to fear, making these two emotional states difficult to distinguish in terms of their physiological and behavioural components
until 1980 what were anxiety disorders classified with
somatoform and dissociative disorders
what did Freud theorize about the difference in anxiety
difference between objective fears and neurotic anxiety
what did Freud theorize about anxiety
proposed that neurotic anxiety is a signal to the ego that an unacceptable drive (mainly sexual in nature) is pressing for conscious representation
how much more likely is an individual who’s family member is diagnosed with anxiety disorder to have on as well
4-6x more likely
where is the information from the amygdala sent to
areas in the hypothalamus and then through a midbrain area to the brain stem and spinal cord
what kinds of autonomic and behavioural components do the brain stem and spinal cord connect with in expression of fear
autonomic: increased heart rate, blood pressure, body temperature
behavioural: freezing, fight/flight
what areas are not directly involved in the fear circuit?
higher cortical areas
two-factor theory
suggests that fears develop through the process of classical conditioning and are maintained of anxiety
what does the two-factor theory not do a good job of explaining
the development of all phobias
vicarious learning
develop fears by observing the reactions of other people
what relationship may be important in the development of anxiety
early attachment relationship
what do anxiety disorders tend to be without treatment
chronic and recurrent and are associated with significant distress and suffering
panic attacks
involves recurrent attacks of overwhelming anxiety that occur unexpectedly - have the physical symptoms of anxiety
symptoms of panic attacks
1) sweating
2) trembling or shaking
3) feelings of choking
4) nausea or abdominal distress
5) chills or heat sensations
6) fear of dying
7) pounding heart
how many symptoms must be present for panic attacks
at least 4 symptoms with at least two unexpected attacks are required for this diagnosis
agoraphobia
anxiety about being in places or situations where an individual might find it difficult to escape
what two disorders are highly comorbid?
panic disorder and agoraphobia
gender differences in panic disorder
women are twice as likely
behavioural avoidance test (BAT)
patients are asked to enter situations that they would typically avoid - provide a rating of their anticipated anxiety and actual anxiety
symptom induction test
patient may be asked to do something to bring on symptoms of panic (ex. hyperventilate) - this will let them assess symptom severity and be a strategy for exposure treatment
how much more likely is an individual who’s family member is diagnosed with panic disorder to have on as well
5x more likely
nocturnal panic
attacks that occur while sleeping (most often during lighter stages of sleep)
catastrophically misinterpret
one misinterprets normal bodily sensations as signals that one is going to have a heart attack, go crazy etc.
anxiety sensitivity
with the belief that the somatic symptoms related to anxiety will have negative consequences that extend beyond the panic episode itself
alarm theory
theory proposes that a “true alarm” occurs when there is a real threat - bodies produce an adaptive physiological response
what kinds of phobias do women report more often
animal and situational
5 types of phobias
animal, natural environment, blood injection-injury, situational, other/illness
animal type
phobic object is an animal or insect
natural environment type
phobic object is part of the natural environment (ex. thunderstorms, height)
blood injection-injury type
person fear seeing blood or an injury, or fears an injection or other type of invasive medical procedure
situational type
person fears specific situations ex. public transportation
other type
phobias not covered in the other categories, ex choking, clowns, also contains illness phobia
illness phobia
intense fear of developing disease that the person currently does not have
Equipotentiality premise
all neutral stimuli have an equal potential for becoming phobias
nonassociative model
proposes that the process of evolution has endowed humans to respond fearfully to a select group of stimuli (ex. water) and thus no learning is necessary to develop these fears
biological preparedness
process of natural selection has equipped humans with the predisposition to fear objects and situations that represented threats to our species over the course of our evolutionary heritage
disgust sensitivity
the degree to which people are susceptible to being disgusted by a variety of stimuli ex. bugs, food
social anxiety disorder
fear of interacting with others in most social settings
performance only social phobia
fear specific social situations or activities, which may include casual speaking, eating or writing in public, or giving formal speeches
what does the onset of social anxiety predict regarding comorbid disorders
predicts the onset of comorbid disorder
what kind of form does social anxiety assessment take
structured or semi-structured
what do individuals with social anxiety exhibit
abnormal social information processing
what do individuals with social anxiety show increased brain activity in?
amygdala when viewing others’ facial expressions which suggests increased threat monitoring
public self-consciousness
awareness of oneself as an object of attention
interpersonal disorder
a condition that is commonly associated with marked disruption in the ability to relate with other people
generalized anxiety disorder
uncontrollable and excessive worry
gender differences in GAD
more common in women
how many symptoms are needed for GAD
3 or more for adults, and one for children
symptoms for GAD
1) restlessness or feeling keyed up or on edge
2) being easily fatigued
3) difficulty concentrating or mind going blank
4) irritability
5) muscle tension
6) sleep disturbance
primary criterion for GAD
presence of excessive worry which must be present for more days than not for a period of at least 6 months
intolerance of uncertainty
individual’s discomfort with ambiguity and uncertainty
obsessions
recurrent and uncontrollable thoughts, impulses, or ideas that the individual finds disturbing and anxiety-provoking ex. doubting if someone locked the door and checking it
compulsions
repetitive behaviours or cognitive acts that are intended to reduce anxiety ex. counting numbers
neutralizations
behavioral or mental acts that are used by individuals to try to prevent the feared consequences and distress caused by an obsession
thought-action fusion
refers to two types of irrational thinking:
1) the belief that having a particular thought increases the probability that the thought will come true
2) belief that having a particular thought is the moral equivalent of a particular action
subtypes of OCD
contamination and washing/cleaning, checking, hoarding, ordering/symmetry
serotonin hypothesis for OCD
abnormalities in the serotonin system are responsible for OCD symptoms
cognitive-behavioral conceptualization for OCD
problematic obsessions are caused by the person’s reaction to intrusive thoughts
why are obsessions believed to persist
person’s maladaptive attempts to cope with them
why are compulsions believed to persist
1) the lower the severity of anxiety
2) lower the frequency of obsessions
3) “prevent” obsessions from coming true
PTSD
experienced, witnessed or learned about the traumatic event of a loved one, or have experienced repeated exposure to the aftermath of traumas
4 domains symptoms of PTSD are categorized into
1) intrusion symptoms
2) avoidance symptoms
3) cognition and mood symptoms
4) hyperarousal and reactivity symptoms
intrusion symptoms
memories, nightmares etc.
avoidance symptoms
avoiding memories, avoiding places or people that are associated with the trauma etc.
cognition and mood symptoms
amnesia, negative cognitions etc.
hyperarousal and reactivity symptoms
hypervigilance, self-destructive behaviour etc.
emotional numbing
inability to experience emotions
what do individuals with PTSD also experience
sleep difficulties, concentration problems, irritability, significant anger problems etc.
what kind of trauma is more likely to provoke PTSD
interpersonal traumas
volume of hippcampus in individuals with PTSD is lower or higher
lower
what kind of medications are the best for treatment of anxiety disorders
antidepressants drugs
what do individuals with anxiety disorders usually overestimate
probability and severity of various threats
what do individuals with anxiety disorders usually underestimate
ability to cope with threats
goal of cognitive restructuring
to help patients develop healthier and more evidence-based thoughts
systematic desensitization
patients imagine the lowest feared stimuli and combine it with relaxation response - work their way up
fear hierarchy
list of feared situations or objects that are arranged in descending order according to how much they provoke anxiety
worry imagery exposure
identify the patient’s main areas of worry, vividly imagining these unpleasant scenes and concentrating on them
intense exposure
starting at a very high level of intensity rather than working gradually through the fear hierarchy
interoceptive exposure
exposure to internal cues - effective for panic disorders
ritual prevention for OCD
involves promoting abstinence from rituals that reduce anxiety in the short term and reinforce obsessions in the long run
3 components of anxiety
physiological, cognitive, behavioral
symptoms of phobic disorders
1) persistent and irrational fear of an object or situation that presents no realistic saner
2) fears interfere with everyday life
3) physical symptoms
4) often aware that fears are irrational
classical conditioning regarding anxiety
anxiety response can be acquired through pairing of an initially neutral stimuli with a frightening event
operant conditioning regarding anxeity
once fear is acquired, the stimulus is avoided, and the avoidance is negatively reinforced due to the anxiety reduction
symptoms for OCD
1) obsessions: persistent, uncontrollable intrusive thoughts
2) compulsions: urges to engage in rituals to alleviate such thoughts
hoarding
difficulty discarding possessions, regardless of actual value
ASD
experienced, witnessed, or learned about the traumatic event of a loved one, or have experienced repeated exposure to the aftermath of traumas
5 domains for symptoms of ASD
1) intrusion symptoms
2) negative mood
3) dissociative symptom
4) arousal symptoms
5) avoidance symptoms
how long must the symptoms for ASD be present
must have started or worsened after traumatic event and must be present for 3 days to 1 month prior to diagnosis
