Chapter 5: Anxiety Disorders Flashcards
Define fear.
The CNS’s physiological and emotional response to a serious threat to one’s well-being
Define anxiety.
The CNS’s physiological and emotional response to a vague sense of threat or danger
What is the DSM-V definition of GAD?
- Excessive anxiety and apprehension that isn’t limited to particular situations
- Worry is difficult to control
- Symptoms (at least 3) = muscle tension, restlessness, difficulty concentrating, feeling on edge
- Symptoms must have been present for at least 6 months
- Symptoms cause significant distress or dysfunction
When is the onset of GAD?
0-20 years
What course does GAD take?
- Often onset in childhood/adolescence
- Often a chronic course
- Worsened by increase in life stressors
What is the one year prevalence of GAD?
3.1%
What is the lifetime prevalence of GAD?
5%
What is the only anxiety disorder that is found at a higher rate in the elderly than the overall population?
GAD
What is the gender ratio of GAD?
2:1 (female:male)
How does GAD tend to run in families?
- Modeling of anxious behavior by overprotective, anxious parents
- Genetic factors (serotonin, GABA)
What is the prevalence of GAD among low income people compared to total pop? African American? Hispanic American? Elderly?
- Low income = higher
- African American = higher
- Hispanic American = same
- Elderly = Higher
Which type of psychotherapy works best for GAD?
Drug therapy
What medication is used to treat GAD?
- Antidepressants
- Benzodiazepines
- Buspar
- Neurotonin
What is the prevalence of specific phobias among low income people compared to total pop? African American? Hispanic American? Elderly?
- Low income = higher
- African American = higher
- Hispanic American = higher
- Elderly = lower
What is the prevalence of social phobias among low income people compared to total pop? African American? Hispanic American? Elderly?
- Low income = higher
- African American = higher
- Hispanic American = same
- Elderly = lower
What is the prevalence of panic disorder among low income people compared to total pop? African American? Hispanic American? Elderly?
- Low income = higher
- African American = same
- Hispanic American = same
- Elderly = lower
What is the prevalence of OCD among low income people compared to total pop? African American? Hispanic American? Elderly?
- Low income = higher
- African American = same
- Hispanic American = same
- Elderly = lower
What is client-centered therapy? Who developed it?
- Carl Rogers
- Humanistic therapy in which clinicians try to help clients by being accepting, empathizing, accurately, and conveying genuineness
What are basic irrational assumptions? What disorder are they associated with?
- Inaccurate and inappropriate beliefs held by people w/ various psychological probs
- Albert Ellis suggested that these are the primary cause of GAD
What is rational-emotive therapy? Who developed it?
- Albert Ellis
- Cognitive therapy of GAD that helps clients identify and change the irrational assumptions and thinking causing their psychological disorder
What are family pedigree studies?
Research design in which investigators determine how many and which relatives of a person w/ a disorder have the same disorder
What is the most common group of antianxiety drugs?
Benzodiazepines
What is GABA? Significance of low activity?
- Inhibitory neurotransmitter in the brain
- Low activity linked to GAD
What is the role of GABA in GAD?
- Continuous firing of neurons (anxiety, fear) triggers a feedback system –> brain and body reduce levels of excitability by releasing GABA –> GABA binds to receptors and instructs neurons to stop firing –> anxiety, fear subsides
- Peeps w/ GAD might have probs in their anxiety feedback system (too few GABA receptors, GABA receptors that don’t readily capture the neurotransmitter)
What comprises the brain circuit that produces anxiety reactions?
- Prefrontal cortex
- Anterior cingulate cortex
- Amygdala
How do benzodiazepines and GABA play a role in GAD?
Benzodiazepines bind to GABA-A receptors –> increase ability of GABA to bind to them –> improve GABA’s ability to stop neuron firing and reduce anxiety
What are sedative-hypnotic drugs?
Drugs that calm people at lower doses and help them fall asleep at higher doses
What is relaxation training? Main idea?
- A treatment procedure that teaches clients to relax at will so they can calm themselves in stressful situations
- Physical relaxation –> psychological relaxation
What is biofeedback?
A technique in which a client is given info about physiological reactions as they occur (HR, muscle tension) and learns to control the reactions voluntarily
What is an electromyograph (EMG)? What treatment and disorder is this associated with?
- A device that provides feedback about the level of muscular tension in the body
- Biofeedback for GAD
What is the DSM-V definition of phobias?
- Persistent, unrealistic fears of specific objects or situations
- Exposure to feared stimulus produces intense fear or panic attacks
- Avoidance responses are almost always present
- Anxiety dissipates when phobic situation is not being confronted
- Symptoms present for at least 6 months
- Symptoms cause significant distress or dysfunction
What are the 3 subcategories of phobias?
- Agoraphobia
- Specific phobia
- Social phobia
What is the DSM-V definition of specific phobias
- Excessive fears of particular objects or situations
- Immediate anxiety usually produced by exposure
- Avoidance of feared object/situation
- Symptoms present for at least 6 months
- Symptoms cause significant distress, impairment
What are the types of specific phobias?
- Animal
- Natural environment
- Situational
- Blood-injection/injury
What is the one year prevalence of specific phobias?
8.7%
What is the lifetime prevalence of specific phobias?
11%
What is the gender ratio of specific phobias?
2:1 (female:male)
When is the onset of specific phobias?
Usually in childhood, but can start any age
What is the course specific phobias take?
- Young children often have phobias, but many of them are outgrown without therapy
- Phobias later in life may be life-long if not confronted
Define the ways through which fears are learned?
- Classical conditioning
- Modeling = observing & imitating others’ reactions
- Stimulus generalization = response to one stimulus also elicited by similar stimuli (Little Albert)
Define preparedness.
A predisposition to develop certain fears
What is exposure therapy? Describe some examples.
Behavioral treatments of specific phobias in which persons are exposed to the objects/situations they fear
- flooding = repeated, intense exposure
- systematic desensitization = relaxation training, fear hierarchy
- participant modeling
- virtual exposure
What is the DSM-V definition for social phobia?
- Fear of social or performance situations (especially involving exposure to unfamiliar people)
- Concern about rejection, humiliation, or embarrassment
- Symptoms present for at least 6 months
- Symptoms cause significant distress or dysfunction
What factors can predispose a person to social phobia?
Shyness, cautiousness, introverted temperament, sensitive NS
When is the onset and peak of social phobia?
- Onset @ 10-20 years
- Peak around age 13
What is the one year prevalence of social phobia?
6.8%
What is the lifetime prevalence of social phobia?
9%
What is the gender ratio of social phobias?
3:2 (female:male)
What types of medications help treat social phobias?
- Antidepressants (especially SSRI’s)
- Beta blockers
What are some psychological forms of treatment for social phobias?
- Social skills training
- Assertiveness training
- Group therapy
- Cognitive therapy
What is the DSM-V definition of agoraphobia?
- Excessive fear of being in public places or situations from which escape might be difficult or embarrassing or help unavailable if panic-like symptoms were to occur
- Fear tends to be worse when alone
- Extensive avoidance behavior which can become very generalized (house-bound)
- Symptoms present for at least 6 months
- Symptoms cause significant distress or impairment
What is the etymology of agoraphobia?
- “Agora” = center of public life in ancient Athens
- “fear of the marketplace”
What is the one year prevalence of agoraphobia?
0.8%
What is the lifetime prevalence of agoraphobia?
5%
What is the gender ratio of agoraphobia?
5:2 (female:male)
When is the onset of agoraphobia?
Ages 20-35
What are the treatment options of agoraphobia?
- Exposure therapy (behavior)
- Cognitive therapy
- Antidepressants (especially SSRI’s)
What is the DSM-V criteria for a panic attack?
A discrete period of intense fear or discomfort in which 4 or more of the following symptoms develop abruptly and reach a peak w/in a few mins:
-pounding heart/palpitations, sweating, trembling, shortness of breath, choking feeling, chest pain, nausea, feeling dizzy, depersonalization, fear of going crazy, fear of dying, numbness, chills or hot flashes
What is the etymology of panic?
Pan = Greek & Roman god of nature, the wild, often associated with sexuality and fertility
What is the DSM-V definition of panic disorder?
- Repeated and unexpected panic attacks
- Fear of recurring panic attacks or losing control
- Avoidance of situations associated w/ prior attacks
- Symptoms present for at least 6 months
- Symptoms cause significant distress or dysfunction
What is the one year prevalence of panic disorder?
2.7%
What is the lifetime prevalence of panic disorder?
5%
What is the gender ratio of panic disorder?
2:1 (female:male)
When is the onset of panic disorder?
Ages 15-35 (rarely before puberty)
What is the etiology of panic disorder?
- Often biological predisposition (genetic, hypersensitive NS, oversensitive locus ceruleus)
- First panic attack may be triggered by street drugs, meds, medical condition, trauma
- Conditioning process
What is norepinephrine?
A neurotransmitter whose abnormal activity is linked to panic disorder and depression
What is the locus ceruleus? Significance in panic attacks?
- A small area of the brain that seems to be active in the regulation of emotions
- Many of its neurons use norepinephrine
What comprises the brain circuit that produces panic attacks?
- Amygdala
- Ventromedial nucleus of the hypothalamus
- Central gray matter,
- Locus ceruleus
What are biological challenge tests?
A procedure used to produce panic in participants by having them exercise vigorously or perform some other potentially panic-inducing task in the presence of a researcher or therapist
What is anxiety sensitivity?
A tendency to focus on one’s bodily sensations, assess them illogically, and interpret them as harmful
What are the educational treatments of panic disorder?
- Breathing exercises to prevent hyperventilating
- Relaxation training to reduce overall stress
- Reducing caffein intake
- Regular eating
- Encourage moderate aerobic exercise
- Conditioning process
- Knowing that panic is a normal fight/flight process
What are the cognitive exercises that help restructure thinking about panic?
- Identify negative thoughts and learn how to combat them
- Devise coping statements
- Distraction techniques
- Humor, distanciation
What are behavioral exercises to eliminate avoidance behavior related to panic disorder?
Exposure therapy and desensitization
What medications are used to treat panic attacks? When does each start working?
- Antidepressants = start working after weeks of daily intake
- Benzodiazepines = start working after 30-60 mins
Define obsession.
Intrusive, repetitive, anxiety-arousing thought or image
What are common themes of obsession?
- Contamination
- Harming somebody
- Driving off bridges
- Sexual ideas
- Order
- Symmetry
Define compulsion.
Need to perform acts to reduce anxiety
What are common behaviors/rituals of compulsion?
- Cleaning, washing
- Checking
- Counting
- Ordering
- Touching
- Licking
- Praying
- Seeking verbal reassurances from others
What is the DSM-V definition of OCD?
- Recurrent intrusive thoughts/images and/or compulsions
- Attempts made to suppress the thoughts or behaviors
- Symptoms present for at least 6 months
- Symptoms cause significant distress or dysfunction
When is the onset of OCD? When is it rare?
- Ages 4-25
- Rare after age 40, unless comorbid depression or pregnancy
What course does OCD take?
“Waxing and waning” = chronic course if not treated
What is the lifetime prevalence of OCD?
2.5%
What is the gender ratio of OCD?
1:1
What things are comorbid with OCD?
- Depression
- Other anxiety disorders
- Alcohol and cannabis abuse
What is the etiology of OCD?
- Biological (genetic predisposition, etc,)
- Conditioning process
Define isolation.
An ego defense mechanism in which people unconsciously isolate and disown undesirable and unwanted thoughts, experiencing them as foreign intrusions
Define undoing.
An ego defense mechanism whereby a person unconsciously cancels out an unacceptable desire or act by performing another act
What is reaction formation?
An ego defense mechanism whereby a person suppresses an unacceptable desire by taking on a lifestyle that expresses that opposite desire
What is exposure and response prevention?
A behavioral treatment for OCD that exposes a client to anxiety-arousing thoughts or situations and then prevents the client from performing his compulsive acts
Define neutralizing.
A person’s attempt to eliminate unwanted thoughts by thinking or behaving in ways that put matters right internally, making up for the unacceptable thoughts
What is serotonin?
A neurotransmitter whose abnormal activity is linked to depression, OCD, and eating disorders
What comprises the brain circuit that produces OCD?
- Orbitofrontal cortex
- Caudate nuclei
- Thalamus
- Cingulate cortex
- Amygdala
What is the behavioral treatment of OCD?
Exposure with Response Prevention
What is the cognitive treatment of OCD?
Habituation training
What medications help treat OCD?
Medications that increase serotonin levels (Clomipramine, SSRI’s)
What is the DSM-V definition of hoarding disorder?
- Strong need to accumulate possession regardless of value
- Persistent difficulty or distress associated w/ discarding them
- Leads to cluttering of the home and associated physical safety and relationships probs
- May feel a sense of emotional security from being surrounded by stuff
- Person may fail to recognize that the hoarding behavior is a problem
What is the DSM-V definition for excoriation disorder?
- Compulsive or repetitive picking of skin, resulting in sores
- May involve scratching, picking, rubbing, or digging into the skin
- May be attempt to remove slight skin imperfections or as a coping response to stress or anxiety
What is the DSM-V definition of trichotillomania?
- Compulsive or repetitive hair pulling resulting in hair loss
- Hair pulling may involve the scalp, eyebrows, or other parts of the body
- Hair pulling has soothing effects and is used as coping response to stress or anxiety
What is the DSM-V definition of body dysmorphic disorder?
- Preoccupation with an imagined or grossly exaggerated bodily defect
- Person believes others think less of him because of this “defect”
- Compulsive checking in mirror, excessive grooming
When is the onset of body dysmorphic disorder?
Usually begins during adolescence
What is the prevalence of body dysmorphic disorder in the U.S. general and college population?
- General = 2%
- College = 4%
What is the gender ratio of body dysmorphic disorder?
1:1
What is the etiology of body dysmorphic disorder?
- Family history of anxiety disorders, especially OCD
- Shyness and social phobias
- Cultural emphasis on perfection and beauty
What is the treatment for body dysmorphic disorder? What doesn’t work
- SSRI meds
- Exposure and response prevention
- Cognitive therapy
- Cosmetic surgery doesn’t work
