chapter 5: anxiety, OCD, stress-related disorders Flashcards
1
Q
define anxiety
A
future oriented emotion (feeling tension, dread, or apprehension) for something to come
2
Q
define fear
A
present emotion from a response to danger or perceived threat
3
Q
what are our physiological changes experienced in the body due to “fight or flight”
A
two systems controlled by the hypothalamus
1. ANS (SANS specifically)
2. adrenal-cortical system
4
Q
what does the stimulation from the hypothalamus on the SANS cause this system to do ?
A
acts on smooth muscle and internal organs to produce bodily changes (inhibit digestion, accelerate heart beat, etc)
5
Q
from the stimulation of the hypothalamus how does the adrenal- cortical system respond?
A
releasing hormones like CRF -> pituitary (which releases ACTH) -> andrenal glands and causes many hormones to be released like epinephrine and norepinephrine
6
Q
what is the body’s major stress hormone
A
adrenocorticotropic hormone (ACTH)
7
Q
what brain structure turns off the “fight or flight” cascade
A
hippocampus (also responsible for regulating emotions)
8
Q
what happens to the “fight or flight” response in those we discuss during this chapter?
A
typically becomes dysregulated
9
Q
what are some of the feelings of anxiety associated with the disorders discussed in this chapter?
A
- some disorders involve anxiety that is more specific and acute to certain objects, thoughts, or situations
- or just a more generalized level of anxiety
10
Q
Define a panic attack
A
Short and intense period of physical experiences like heart palpitations, shortness of breath, dizziness, intense dread, etc. but is a psychological event
11
Q
Do panic attacks always have
a specific trigger
A
No
12
Q
What percentage of adults experience occasional panic attacks
A
28%
13
Q
What is the definition of panic disorder?
A
When panic attacks become problematic - common occurrence , not usually provoked by any particular situation ( are unexpected) and begin to change behavior because of them
14
Q
what are some biological factors of Panic disorder?
A
- along with generalized anxiety disorder, has a high lifetime prevalence
- family component - 43-48% of family history and twin studies suggest heritability (we dont know a specific gene for cause)
- dysfunction of flight or flight response - poor regulation of several neurotransmitters (norepinephrine, serotonin, GABA, and CCK
15
Q
what are some biological factors for how panic attacks can be triggered?
A
hyperventilating, inhaling carbon dioxide, caffeine, breathe in paper bad, or taking sodium lactate - these initiate physiological responses of fight-or-flight
16
Q
what are some brain structure differences between individuals with panic disorder, and those who do not?
A
- difference in limbic system (stress response) like amygdala, hypothalamus, and hippocampus
17
Q
differences in what in the brain help explain development of symptoms associated with panic disorder
A
somatosensory cortex and thalamus - these areas relate to how people interpret sensations within body
18
Q
what is the locus ceruleus
A
area of the brain stem and associated dysfunction of norepinephrine has been linked with panic disorder. it has well define pathways with limbic system. this can cause a panic attack which notify’s limbic system of stress and just continues cycle
19
Q
why can women experience more severe anxiety symptoms
A
progesterone (usually PMS and postpartum) can affect both serotonin and GABA neurotransmitter systems. increased progesterone can induce mild chronic hyperventilation and in some women this is enough for a panic attack.
20
Q
what are some psychological factors associated with cognitive theories around panic disorder
A
pay very close attention to bodily sensations, misinterpret body sensations in negative way, engage in snowball catastrophic thinking making symptoms worse
21
Q
define anxiety sensitivity
A
unfounded belief bodily symptoms have harmful consequences - makes people with this more likely to have panic disorder, and have more frequent panic attacks
22
Q
define interoceptive awareness
A
heightened awareness of bodily cues - these have usually occurred at the beginning of previous panic attack
23
Q
interoceptive conditioning
A
bodily cues from interoceptive awareness become conditioned stimuli of new attacks
24
Q
what are some of the most known cognitive factors that contribute to panic disorder
A
biased thoughts, anxiety sensitivity, high interoceptive awareness, interoceptive conditioning (learning), and beliefs about controllability
25
what is the viscous cycle of integrated model of panic disorder?
bio and psych factors of mild stimulus make individuals hypervigilant for signs of panic attacks making them have a constant stake of anxiety which increases probability of panicking again
26
conditioned avoidance reponse
associated panic with location or situation so you begin avoiding these things to reduce symptoms and stays in comforting places reinforcing this behavior
27
what are some biological treatments for panic disorder
usually work to affect serotonin and norepinephrine systems (SSRIS - paxil, prozac, and zoloft) and SNRIs - effexor), tricyclic antidepressenants
28
what do benzodiaepines do?
surpress central nervous system and GABA, norepinephrine, and serotonin transmitter systems to reduce panic attacks and general symptoms
29
what are the negatives of biological treatments like antidepressants and SSRIs
highly addictive and usually experience significant withdrawal symptoms. If someone discontinued their meds without therapy usually experience relapse of symptoms
30
how does cognitive-behavioral therapy benefit those with panic disorder
1. challenge and change irrational thoughts about situations
2. help lessen/stop anxious behaviors
31
what are some components of cognitive-behavioral interventions for panic disorder?
1. teach breathing and relaxation techniques
2. identify spiraling emotions when having bodily sensation changes (either from client documents when it happens throughout day or therapist will induce during a session)
3. practice breathing and relaxation techniques when panicked
4. taught to challenge spiraling thoughts
5. systematic exposure (desensitization therapy) of client exposed to most feared situations and maintaining control over symptoms
32
what is the percentage of success of cognitive-behavioral therapy for panic disorder
85-90% of patients experience complete relief from panic attacks within 12 weeks - nearly 90% were panic-free after 2 years. better odds and preventing relapse compared to antidepressants
33
characteristics of separation anxiety
usually associated with childhood onset - emotional distress caused by possibility of being separated from caregiver. can usually happen after trauma, significant life event, getting lost, parent hospitalization - usually impacts 4-10% of children and is equally common among boys and girls
34
what is the diagnosing timeline for how long symptoms have to persist for separation anxiety
at least 4 weeks and significantly impair child's functioning
35
characteristics of adult separation anxiety
usually impacting 7.7% (13-17) and 6.6% (18-64%)
maintain attachment with frequent calls, rigid routine, fear of being alone. usual onset in early twenties
very comorbid with other mental disorders
36
biological factors around separation anxiety
genetic component of general anxiety - none so far on specific to separation anxiety
37
define behavioral inhabitation
children are shy, fearful, and irritable as toddlers and become cautious, quiet, and introverted during school age. can become clingy towards care giver.
this is a risk factor
38
psychological and sociocultural factors of separation anxiety
-children usually are modeling behavior of anxious parent
-children who feel they have little control may develop anxiety symptoms
-mothers that use overprotective, less assertive, and punitive parenting style are more likely linked with higher rates of separation anxiety
39
treatment of separation anxiety
-for children CBT seen to do the best, could also try mindfulness-based, acceptance and commitment therapy
- possible drugs include antidepressants, anti-anxiety drugs,
40
what is selective mutism?
failure to speak in specific social situations - now we have identified a strong relationship between SM and anxiety, usually social phobias
41
what are some characteristics of selective mutism?
usually presents during childhood and can last into adulthood - individuals are capable of holding conversations but when in situations that invoke anxiety they have a failure to speak. more rare with 0.03-0.79 % prevalence in school-aged.
-thought to be result of genetic, temperamental, environmental, and developmental factors
42
generalized anxiety disorder
no specific situation or trigger, feel anxious in all parts of life. worry about own life and those around them
43
describe some key features of general anxiety disorder
usually excessive worry during everyday situations, described as intrusive, distressful, causes functioning impairment. tend to worry about many things not just one issue
44
some physical symptoms of general anxiety disorder
sleep disturbance, restlessness, muscle tension, gastrointestinal symptoms and impacts 2.9 percent of adults 18-64 each year
45
some characteristics of generalized anxiety disorder across the world
80% comorbidity with other lifetime disorders
-positive correlation with high income counties and GAD impairment
-sever impairment with small percentage in China, Mexico, Netherlands, and Romania
46
explain some emotional and cognitive factors of GAD
emotions:
-highly reactive to negative events, uncontrollable or manageable
cognitive: maladaptive assumptions (from concerns of uncertainty or losing control) with focus on detecting possible threats in the environment. GAD individuals usually maintain a constant level of anxiety so they dont have to feel a sudden increase from a bad experience
47
what is the stroop-coloring naming task
words are flashed on a computer in different colors. person is asked to identify the color - individuals with GAD are slower at naming the color of a word with threatening content
48
biological factors associated with GAD
heightened activity of sympathetic NS and amygdala.
-possible disruption of brain activity coordination
-lower amount of GABA receptors or deficiency resulting in excessive firing of neurons especially in limbic system
49
what are some cognitive behavioral treatments for GAD
confront issues of worry, challenge negative thoughts, and develop coping strategies
50
biological treatments for GAD
possible drugs like xanax but have side effects and addictiveness and when you discontinue your symptoms will continue
51
what is social anxiety disorder
individuals become anxious in social situations and so afraid of being rejected, judged, or humiliated in public that they become preoccupied with these worries they focus on them and possible avoid social encounters
52
what are some things that can have a positive impact on those with social anxiety disorder
have a good social support (or a higher level of perceived social support)
53
some characteristics of social anxiety disorder
- when in social situations they may: tremble, perspire, feel dizzy or confused. They think others view their nervousness as weak, stupid, or crazy.
-key feature is situations are social in nature
-12 % lifetime prevalence in US and 1-7% internationally
- women tend to have more severe social fears BUT men tend to seek treatment more
- can co-occur with other mood disorders
-in Japan Taijinkyofu-sho is the idea of shame about persistent fear of causing others offense
54
what are some highlights of the cognitive perspective on social anxiety
individuals with this disorder have excessively high standards for their social performance and believe everyone should like them
-focus heavily on cues from others they are talking to but may interpret them in a self deprecating way
-avoid eye contact, or social situations all together
- after a social situation they will obsessively go over all part of their performance
55
what are some treatments for social anxiety
- meds like: SSRIs and SNRIs but when you stop meds your symptoms usually come back
- Cognitive behavioral therapy: behavioral component includes exposing client to situations that illicit anxiety and cognitive component: identify the negative cognitions client has about themselves and social situations and teaching them how to see these are wrong. Could be in group setting and also teaching relaxation techniques
-ACt: mindfulness based working on acceptance. and values to become more focused and relaxed in present moment than judging themselves
-also starting to make internet based therapy and can meet those patients who are unable or unwilling to use traditional treatment delivery
56
define specific phobias
unreasonable fear associated with specific objects or situations
57
what are the five categories of specific phobias in DSM
animal, natural environment, situational, blood-injection, and other
58
what are the key symptoms to diagnose specific phobia
fear of specific object or situation with that does not correlate to actual risk or danger
-avoidance or intense fear during event
-symptoms of at least 6 months
-clinical distress or impairment that cannot be better defined as relevant to other mental disorder
- when presented with these objects or situations individual experiences immediate spike in fear that could turn into panic attack and anxious over encountering experience again
59
animal type phobia
most common are snakes and spiders - can live in terror of encountering them or create life around ways to avoid them
60
natural environment phobias
events of situations like storms, heights, or water. typical survival tactic to fear these things but becomes phobia when you organize life in way to avoid them
61
situational type phobia
can include bridges, elevators, flying, driving, etc.
62
blood-injecting-injury phobia
seeing blood or injury - likely to faint when they see. Runs more strongly in families compared to other phobia types
63
agoraphobia
fear if they cannot escape when they become anxious - 50% have panic attack history and the rest struggle with history of other forms of anxiety disorder
64
behavioral theories of phobias
classical conditioning leads to fear of object and operant conditioning maintains it. when people avoid what causes their anxiety it becomes a negative reinforcement
- we typically avoid objects that in the past would have been advantageous for evolutionary purposes
- usually those with phobias can not correlate it to a specific traumatic event
-without conditioned stimuli hard to argue phobia is developed through classical conditioning or observational learning
- individuals may just have chronic anxiety which makes them more susceptible
65
define prepared classical conditioning
from evolutionary history we are engrained in some areas to quickly learn associations that may result in a phobia - this theory was tested. Using photos of evolutionary conditioned stimuli (snakes and spiders) and non conditioned (houses, flowers, faces) each photo was paired with a shock. it took longer for fear response to photos of houses and flowers compared to snakes. It took longer to "unlearn" fear response when viewing photos of spiders compared to flowers
66
what is the biological theory of phobias
1st degree relatives 3-4 times for likely to have phobias
67
treatments for phobias
-behavioral therapy: systematic desensitization, modeling, and flooding
- in blood phobias they are taught to tense muscles in arms, legs, to make blood rise to face and increase blood pressure (applied tension technique)
-modeling technique: therapist does action first to show client they do not need to worry
-flooding: is showing client their worst fear and leaving them with it for extended amount of time (ex. fear of dogs so client is left in with dogs in a room overnight) harder to get clients to do this type of therapy
68
biological treatment for phobias
may provide short term relief from symptoms but does not correct the phobia and drugs have side effects and are easily addicting
69
describe obsessive-compulsive and related disorders
all share an obsessive-compulsive component and examples include: (OCD, hoarding disorder, body dysmorphic disorder, trichotillomania (hair pulling), and excoriation (skin picking) they are all related by repetitive behaviors, age of onset and comorbidities, brain circuitry and neurotransmitter abnormalities
70
define OCD
describes individual with obsessions, compulsions, or both. usually obsessions revolve around certain themes (germs, prevent harm or bad luck, forbidden thoughts, symmetry and order) the compulsions usually happen as a way to neutralize and reduce anxiety and distress. Will create rituals that are deliberate, purposeful, and goal oriented
71
what is an overt compulsive ritual
behavioral compulsions
- excessive decontamination
-counting or repeating routine actions
-checking and rechecking
these can become very time consuming for the individual
72
what is an covert compulsion
"cognitive compulsion" like mental counting or compulsive visualization
73
define the difference between obsessions and compulsions
obsessions are the unwanted intrusive thoughts and compulsions are the behavioral or cognitions you do to try and lower anxiety from obsessions
74
demographics of OCD
impacts 1.2% of US adults each year and has a lifetime prevalence of 2.3 percent
-usually onset is 7.5 to 12/5 years old with boys usually developing symptoms earlier in life and becomes predominately female in adulthood.
- 66% of those with OCD have depression
- strong correlation with impulse-control and substance use disorders as well
- world wide 1-3% will develop
75
define trichotillomania
pulling hair (scalp, eyebrows, pubic) and some dont realize they are doing the action (automatic) while others say a hair does not feel right so they pick it (focused)
-impacts for females to males usually develops around 10-13yrs old
76
define excoriation
picking at skin and they cannot stop but feel shame or social embarrassment
77
how OCD, hoarding, trichotillomania, and excoriation are connected
acts are repetitive, behavioral inhibition, and individuals feel tension before and trying to stop themselves and then immediate relief when they complete their behavior
78
characteristics of those with body dysmorphic disorder
excessive concern about physical appearance and do not feel less distressed when others tell them their concerns are not real. Create compulsive rituals to "check" their flaws can spend 3-8 hours a day on these preoccupations and may seek surgery to check
-usually presents around 16 (and equally impacts males and females)
- high comorbidity with depression, substance abuse,
- social media makes it much worse
- high associated with suicide
- if excessive may begin to show delusional thoughts
- 80% of individuals with BDD have a lifetime suicide ideation
79
80
what are the biological theories around OCD and related disorders?
in OCD, trichotillomania, and excoriation individuals show alternations in structure and function of frontal cortex, basal ganglia (specific striatum) to thalamus, anterior cingulate cortex
81
what are the brain alternations based on the biological theories for hoarders
dysfunction in structure and activity levels of frontal cortex and limbic system
82
brain alternations based on bio theories for those with body dysmorphic disease
alternations in processing visual stimuli
83
Cognitive behavioral theories around OCD
have inability to turn off negative intrusive thoughts
-may be generally anxious and makes negative events create more negative intrusive thoughts
-believe their thoughts are more unacceptable
- these negative thoughts cause compulsions through operant conditioning (rituals of praying before handling baby - makes less anxious so continue to do it to stop bad feeling or negative reinforcement)
84
cognitive behavioral theories around hoarding
exaggerated sense of responsibility, feel guilty wasting things and want to be ready for 'just in case' scenarios. Also think they have bad memory and need to keep things in site to know what they have
85
cognitive behavioral theory around BDD
negative interpretations of perceived flaws and overvaluation
86
biological treatments for OCD and related disorders
can use SSRI's but only help to a certain degree and symptoms usually return when drug is discontinued - but also have significant side effects
87
cognitive behavioral treatment for OCD
combine CBT and exposure and response prevention (expose to obsessions without allowing compulsive behavior) while CBT focuses on challenging thoughts on excessive thoughts of responsibility
-69-90% clients saw improvement
88
CBT for hair and skin picking
focus on habit reversal training so they become aware of tells and cues to replace behavior
89
CBT for BDD
focus on feared situations concerning body parts and hierarchy of learning calming skills to tackle most fears areas and allowing others to seem them in public for example
90
what connects PTSD and acute stress disorder (ASD)
both have psychological and physiological consequences of exposure to trauma
most have:
-directly experience of witness traumatic event or learn of it happening to someone they are close to
-experience repeated exposure to details of traumatic event
91
characteristics of PTSD
women are more likely then men to experience because of sexual abuse and rape.
Most have the four symptoms:
-reexperiencing trauma
- avoidance
-negative changes in thought or mood
-hyper vigilance or chronic arousal
92
what is a PTSD flashback as part of experiencing symptom
individuals re-experience traumatic event and cannot tell what is reality or just a memory. could be triggered by something in environment (like smell) or nothing at all. They are emotional intrusive memories of highly selective neural hotspots which are personally significant to the individual
93
define disinhibited social engagement disorder
children act inappropriately comfortable with strangers - have no fear about going up to random individuals and usually associated with severe neglect
94
define reactive attachment disorder
usually in severe abuse, neglect, or maltreatment of children. They cannot form bonds with caregivers and do not seek comfort in times of stress. they have trouble with emotional regulation
95
define adjustment disorder
depressive, anxiety, and/or antisocial behavior within 3 months of stressor. Usually for those individuals who do not fit in PTSD, ASD or other disorder definition
96
ASD
acute stress disorder usually occurs within 1 month of exposure to stressor and does not last past 4 weeks. more common to experience dissociation with this compared to PTSD
97
what trauma is more associated with PTSD
interpersonal violence, sexual violence, repeated experiences of violence, mass shooting survivors
98
what trauma is considered low level risk for PTSD
unexpected death of loved one, witness death or injury of loved one. but may develop prolonged grief disorder (can avoid topic of loved ones death for up to 12 months)
99
what are some environmental and social factors of PTSD
risk factors: severity, duration, and proximity to trauma, availability of social support
100
psychological factors of PTSD
comorbidity of other mental disorders, once trauma occurs and individuals own methods of coping
101
ways to cope with trauma
find sense of purpose or meaning as it relates to the trauma
102
gender and cross-cultural differences in PTSD
in U.S African Amercians most likely usually witnessing domestic violence and being a victim of assault
-in latino cultures may have ataque de nervios (similar symptoms to nervous breakdown)
103
how does ethnic identity relate to psychological factors
usually ethnic identity established during adolescents has positive association with self-esteem, coping, sense of mastery, and optimism (protective factor)
104
biological factors associated with PTSD
PET scan shows differences in amygdala, hippocampus, and prefrontal cortex (areas involving emotional regulation)
-amygdala responds more actively (responsible for processing emotional and threat info)
-medial prefrontal cortex: usually moderates amygdala response is less active
-shrinkage of hippocampus: usually helps with memory but in PTSD individuals may have memory loss and lower control over fear response
105
biochemical findings of PTSD
-possible lower levels of cortisol = prolonged SNS activity
-HPA axis shut down and cant respond to neurotransmitters released for SNS
-childhood stress
- genetics: heritable risk of low cortisol levels
106
treatments for PTSD
-CBT: help client experience traumatic events in a safe way and to reinterpret the trauma
-stress-inoculation therapy: show clients tools to overcome stress in current life
