Chapter 5: Anxiety Disorders Flashcards
Elements of Fear: Cognitive
discernment of an immediate threat to life or limb.
Specific, identifiable threat
Appraisals provoke the bodily reaction of fear
E.g. a noise coming from behind you in the dark.
Elements of Fear: Somatic Elements
body’s emergency reaction to danger
External: Physical manifestations of fear
Internal: Thoughts and brain processes in reaction to fear
Elements of Fear: Emergency Reaction
- Wherein the sympathetic branch of the autonomic nervous system is activated.
- Causes our heart rate to increase, spleen to contract and release scores of red blood cells to carry more oxygen, adrenaline to secrete, liver to release glucose, loss of bladder and sphincter control
Elements of Fear: Emotional Elements
- Feelings of dread, panic, terror
- We are typically more conscious of these elements fear than the physiological elements.
Elements of Fear: Behavioral
- Fleeing, freezing or fighting
- Involuntary: Result of classical conditioning
3 Responses to Fear
1) Freeze
2) Fight
3) Flight
Define “Escape Responding”
Subject leaves the scene when fearful event occurs
Define “Avoidance Responding”
Subject will leave before harmful event occurs.
Define “phobia”
When the fear response is out of proportion to the amount of danger
Difference between a fear and an anxiety
-Fear is based in reality, anxiety is based on intangible danger
Define “Social Phobia”
Afraid they will act in a way that is humiliating or unacceptable and that they will end up having a panic attack
Who is most prone to a social phobia?
- Most social phobias begin in adolescence, occasionally in childhood and rarely after 25.
- More prevalent among women and poor people.
What is the prevalence rate of social phobia?
13.1% of Americans
Name three factors that cause phobia:
1) Biological
2) Neurophysiological
3) Behavioral (Pavlovian)
4) Vicarious Conditioning: Watching other people react to phobic objects
Therapies for Phobias
1) Exposure
2) Sensitization
3) Applied tension: tensing and relaxation of body
4) Biofeedback
5) Drugs: benzodiazapines (Valium), alprazolam (Xanax), monoamine oxidase inhibitors, serotonin reuptake inhibitors
DSM-IV Description of PTSD
- Confrontation with threat of death or injury responded to with horror or helplessness.
- Wide range of emotional, behavioral and somatic symptoms; reliving trauma repeatedly in dreams, flashbacks, in reverie
- Pervasive numbness and anxiety that reminds sufferer of trauma
- Person experiences symptoms of anxiety and arousal that were not present before the trauma, including sleeplessness, over-alertness, trouble concentrating, exaggerated startle and outbursts of anger
- Forgetting of important details of the event
- Less interest or participation in activities and feels detached from others, significantly impairing function
- Symptoms persist for months to decades
- Drugs are largely ineffective
- During first month, it is referred to as acute stress disorder.
Vulnerability to PTSD
- Those prior with history free of mental problems do better after a traumatic event than those with.
- High score of neuroticism and family history of mental disorders.
- Those with family members with a history of traumatic events
- Those with other past traumatic events
- The younger one is exposed to trauma
- Those trained to resist trauma experience less PTSD
- Even if good psychological health is present before a trauma, if an event is devastating enough, it can ruin one with perfect mental health.
- Lower socioeconomic and educational levels
- Physical abuse associated with a smaller corpus collosum, a tract that allows R and L brain to communicate
- Extreme stress experienced during event may lead to long-term even lifelong increase in activity of the hypothalamic-pituitary gland (HPA), which governs response to prolonged stress.
Who will not heal from PTSD?
-Those with a defeatist attitude
What are some treatments for PTSD?
Psychotherapeutic
- Exposure
- Desensitization
- Applied tension
- Disclosure
Drugs
-Antidepressants/anxiety
What is panic disorder?
An anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral changes lasting at least a month and of ongoing worry about the implications or concern about having other attacks, the latter being “anticipatory attacks.” Attacks must happen at least once a week to be diagnosed as such.
Describe the Symptoms of Panic Disorder
- Physical: Shortness of breath, dizziness, racing heart, trembling, chills, chest pain
- Cognitive: Individual thinks they are going to have a heart attack and die, go crazy or lose control
Treatments of Panic Disorder
- Drugs: Benzodiazapines and antidepressants.
- Cognitive and Behavioral Therapy.
Biological causes of Panic Disorder
- Sodium lactate production
- This is produced in the the locus coeruleus, a part of the brain’s arousal system
- Related to alcoholism.
What is the difference between Panic Disorder and Agoraphobia?
- Anxiety (Phobias) is preceded by chronic stressors which build to reactions of moderate intensity that can last for days, weeks or months.
- Panic attacks are acute events triggered by a sudden, out-of-the-blue cause: duration is short and symptoms are more intense.
- As such, anxieties can trigger panic attacks.
- Therefore, the comorbidity is high.
Treatment of Agoraphobia
- Imapramine
- Exposure therapy
DSM-IV Description of Generalized Anxiety Disorder
- Chronic, not acute, unlike PD.
- Trouble controlling the worry and anxiety
- Distress and problems at work and in relationships
- Restless, jittery and tense, vigilant, constantly on edge
- Expectations of something awful yet vague
- Chronic muscle tension, lethargia, difficulty concentrating, irritable, tense, trouble sleeping
- Flails around looking for something to ease the worrying
- Reduced flexibility in cardiac system
Among what demographics is GAD most prevalent?
-Highest incidence is among young black Americans.
-Anxiety about violence, jobs or health care.
Common in…
-Urbanized countries in which people must cope with stresses of social change.
-War-torn countries, politically-oppressed countries
What kind of brain abnormalities are associated with the presence of GAD (etiology)?
- Locus coeruleus, parts of the limbic system and prefrontal cortex
- GABA is the main neurotransmitter implicated in GAD, with GABA deficiencies associated with the disorder.
Treatment of GAD
-Benzodiazepines, abecarnil, buspirone, anti-depressants
-Cognitive Behavioral Techniques
-Prevention
-Cognitive behavioral skills and practicing
graduated exposure to fear-provoking situations
Define “Obsessive” in the context of OCD
OBSESSIONS: Repetitive thoughts, images or impulses that invade consciousness, are often abhorrent and very difficult to control or dismiss.
Define “Compulsion” in the context of OCD
COMPULSIONS: are the responses to the obsessive thoughts
- Rigid rituals or mental acts
- The compulsions are aimed at preventing or reducing distress or averting some dreaded event or situation.
- Actions, however, are not connected in a realistic way with what they are designed to prevent and they are clearly excessive.
- Distress and anxiety if ritual is prevented by outside forces
Psychodynamic Theory of OCD
-Obsessive thought is seen as a defense against the anxiety produced by an even more unwelcome and unconscious thought.
-This thought involves displacement and substitution
The thoughts that substitute the underlying thought are not arbitrary
How does the psychodynamic approach cure OCD?
-Unconscious conflict is recognized and worked through
Psychodynamic Theory: Who develops OCD ?
- People with specific unconscious conflicts
- E.g., thoughts of injuring or murdering one’s child or family member
- Obsessions and compulsion are maintained because they successfully defend against anxiety
According to CBT, who develops OCD?
People who cannot distract themselves easily from troubling thoughts, often combined with depression
According to CBT, how does depression exacerbate OCD?
Obsessive thoughts become frequent and persistent, while depression simultaneously weakens ability to distract oneself.
According to CBT, how is OCD sustained?
- Patient discovers a ritual that temporarily relieves anxiety, which is then reinforced through repetition.
- Ritual = relief, relief from obsessions is desired, therefore a compulsion is created.
- Relief, however, is temporary
What kind of brain scan abnormalities are present in the instance of OCD, according to neuroscience?
- People with overactive cortical-striatial thalamic circuit
- Involves the caudate nucleus in the basal ganglia, the orbital region of the frontal cortex, the thalamus.
- Repetitive behavior may be poorly inhibited by the cortical-striatial thalamic circuit, anxiety may be inadequately dampened, filtering of irrelevant information may be inadequate.
What is the Biological (Evolutionary) explanation of how OCD is sustained?
- Obsessive thoughts and compulsive behaviors are directed toward objects and situations evolution has prepared to us to see as threatening
- Germs and cleaning kept us alive
- Violence, sexuality, excretion also had a hand in our survival
What does neuroscience say is comorbid with OCD?
-Comorbid with epilepsy
-Tourette’s syndrome
Compulsive-like disorder of motor tics and uncontrollable verbal outbursts, apparently of neurological origin
Many patients with Tourette’s also have OCD
How does Exposure Therapy treat OCD?
- Showing the patient that the dreaded event does not occur in the feared situation
- By showing the patient that no dreaded event occurs even though the compulsive ritual is not performed
What kind of drugs are used to treat OCD?
- Clomipramine.
- Antidepressant, serotonin reuptake inhibitor
- Fluoxetine, fluvoxamine, sertraline, paroxetine
What are the side effects to drug therapy to treat OCD?
- Large number of patients do not get better
- Side-effects: drowsiness, constipation, loss of sexual interest
- Once treatment stops, symptoms return
What are treatments for everyday anxiety?
- Relaxation techniques
- Meditation
Neurophysiological Explanation for Phobias
- Abnormalities in serotonin and dopamine pathways in their limbic system.
- Low levels of gamma aminobutyric acid (GABA), which typically helps inhibit physiological arousal.
- Formation of phobias heavily involves the actions of the amygdala, an area of the limbic system associated with the development of emotional associations
Behavioral Explanation for Phobias
Pavlovian conditioning
Vicarious Conditioning of Phobias
Watching others be afraid of certain stimulus
