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PSY240 > Chapter 5: Anxiety & Related Disorders > Flashcards

Chapter 5: Anxiety & Related Disorders Flashcards

1
Q

What is anxiety?

A
  • affective state whereby an individual feels threatened by the potential occurrence of a future negative event
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2
Q

What is fear?

A
  • primitive emotion
  • occurs in response to real/perceived current threat
  • present oriented
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3
Q

What is panic?

A
  • extreme fear reaction triggered even when there is nothing to be afraid of
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4
Q

What are the genetic factors in the etiology of anxiety?

A
  • genetic risk passed down as broader temperamental and/or dispositional traits
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5
Q

What is Mowrer’s two-factor theory of fear?

A
  • attempted to account for acquisition of fear and maintenance of anxiety
  • fears develop through process of classical conditioning and maintained through operant conditiong

PHASE I
- neutral stumulus is paired with inherently negative stimulus

PHASE II
- lessen anxiety by avoiding the conditioned stimulus, behaviour which is negatively reinforced through operant conditioning

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6
Q

What is the problem with Mowrer’s two-factor theory of fear?

A
  • some fears are learned via modelling or just by hearing about something scary
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7
Q

What cognitive factors influence etiology of anxiety disorders?

A
  • Beck proposed that people are afraid because of biased perceptions they have about the world, the future, and themselves
  • anxious individuals see the world as dangerous, the future as uncertain, and themselves ill-equipped to deal with it
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8
Q

What does the “triple vulnerability” etiological model of anxiety consist of?

A
  • generalized biological vulnerabilities
    e. g., genetic predisposition to being highstrung
  • non-specific psychological vulnerabilities
    e. g., diminished sense of control, low self-esteem
  • specific psychological vulnerabilities
    e. g., real danger, alarm
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9
Q

What are the symptoms of a panic attack?

A
  • abrupt surrge of intense fear or intense discomfort that reaches a peak within minutes
  • during which 4+ of the following happens:
  • palpitations, pounding heart, or accelerated heart rate
  • sweating
  • trembling
  • shortness of breath
  • feelings of choking
  • chest pain
  • fear of losing control
  • fear of dying
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10
Q

What is paresthesias?

A
  • numbness or tingling sensations
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11
Q

Compare and contrast derealization and depersonalization.

A

DEREALIZATION:
- feelings of unreality, being in a dream

DEPERSONALIZATION:
- feeling detached from oneself

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12
Q

How common are panic attacks?

A
  • pretty common
  • ~25% of Canadian population has experienced one
  • compare to ~1.5% that have panic disorder
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13
Q

What are the diagnostic criteria for panic disorder?

A
  • panic attacks must be followed by persistent concerns (lasting at least one month) about having panic attacks or worrying about ramifications of panic attacks
  • OR at least on panic attack results in significant alteration in behaviour
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14
Q

What is agoraphobia?

A

Anxiety about being in places or situations where

  • an individual might find it difficult to escape or
  • in which they cannot have help readily available in case of panic attack
  • highly comorbid with panic disorder
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15
Q

What are the diagnostic criteria for panic disorder?

A
  • persistent and pervasive avoidance

- active avoidance of feared situations, needing a companion, or endured only with extreme anxiety

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16
Q

What feature of panic disorder allows for differential diagnosis?

A
  • individuals initially experience unexpected panic attacks
  • have marked apprehension and worry over possibility of additional panic attacks

CONTRAST:
- someone with social phobia may have a panic attack in a crowd but that’s because they’re terrified of being humiliated or embarrassed

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17
Q

What is the behavioural avoidance test?

A
  • assessment of a patient’s avoidance whereby the person determines how close they can come to a feared object
  • during approach patients provide assessment of their fear
  • used to assess initial avoidance and behavioural change through therapy
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18
Q

What is the cognitive theory of panic disorders?

A
  • individuals with panic disorders catastrophically misinterpret bodily sensations because they believe they are caused by harmful events (i.e. death, insanity, etc.)

Trigger stimulus → Perceived threat → Apprehension → Bodily sensations → Catastrophic misinterpretation (leads back to perceived threat in a cycle)

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19
Q

What is the alarm theory of panic disorders?

A
  • proposes “true alarm” occurs when there is a real threat
    → bodies produce adaptive physiological response allowing flight or fight response
  • alarm systems can be activated by emotional cues (“false alarm”)
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20
Q

What are phobias?

A
  • excessive and unreasonable fear reactions
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21
Q

What is the prevalence of specific phobias?

A
  • 12.7% will develop specific phobia at some point in their lives
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22
Q

What are the five specifiers of specific phobia?

A 
1 - Animal type
2 - Natural Environmental type
3 - Blood Injection-Injury type
4 - Situational type
5 - Other type (illnesses, clowns, etc.)
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23
Q

What is a criticism of the classical conditioning/associative model of phobias?

A
  • equipotentiality premise: assumes all neutral stimuli have an equal potential for becoming phobias
    → e.g., developing a phobia around lamps and snakes is equally likely
  • statistically untrue
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24
Q

What is the nonassociative model of phobias?

A
  • proposes that process of evolution has endowed humans to respond fearfully to a select group of stimuli and thus no learning is necessary to develop these fears
  • types of stimuli that elicit fear do so because it is too dangerous for humans to have learned to fear this stimuli from experience
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25
Q

What is social anxiety disorder?

A
  • marked and persistent fear of social or performance related situations
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26
Q

Compare social anxiety disorder and social phobia.

A

SOCIAL ANXIETY DISORDER

  • fear of interacting with others in most social settings
  • tends to be more disabling

SOCIAL PHOBIA

  • performance only social phobia fear is specific social situations or activities
  • include casual speaking, eating, or writing in public, or giving formal speeches
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27
Q

What are some diagnostic criteria for social anxiety disorder?

A

A - marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others

B - individual fears that they will act in a way or show anxiety symptoms that will be negative

C - social situations almost always provoke fear or anxiety

D - social situations are avoided or endured with intense fear or anxiety

E - fear of anxiety out of proportion to actual threat posed by social context

F - typically lasts 6 months or more

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28
Q

What is one of the keys to understanding social anxiety disorder?

A
  • individual is aware of their excessive fear but this logical perspective is overwhelmed by the anxiety they feel
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29
Q

How is social anxiety assessed?

A
  • takes form of a structured or semi-structured interview combined with completion of various self-report measures
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30
Q

Contrat social anxiety disorder and agoraphobia.

A
  • social anxiety avoids social situations because they’re afraid of being negatively evaluated or embarrassed in social situations
  • agoraphobia avoids social situations because they’re afraid of having a panic attack in public/have no escape
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31
Q

What are the biological factors in the etiology of social anxiety?

A
  • genetic factors account for more than half of social anxiety risk
  • inherited predisposition to develop anxiety about social situations
32
Q

What are the early psychosocial events that factor into the etiology of social anxiety?

A
  • negative peer events
    e. g., being bullied or severely teased
  • negative family events
    e. g., overly critical, controlling, or protective parents
  • may develop lack of self-confidence and negative self-focus that creates and reinforces anxiety
33
Q

What are the cognitive factors within the etiology of social anxiety?

A
  • negative beliefs and judgments of self and others
    e. g., greater concern about making mistakes, self-critical
  • abnormal social information processing
    e. g., avoid looking directly at people’s faces but are hyper vigilant for social threats (activity in amygdala)
34
Q

What is public self-consciousness?

A
  • awareness of oneself as an object of attention

- tendency to see one’s actions from the perspective of an outside observer rather than through one’s own eyes

35
Q

What is interpersonal disorder?

A
  • alternate categorization of social anxiety

- condition commonly associated with marked disruptions in ability to relate with other people

36
Q

What is generalized anxiety disorder?

A
  • central difficulty is chronic, excessive, and uncontrollable worry (called pathological worry)
37
Q

What are some of the diagnostic criteria for generalized anxiety disorder?

A

A - excessive anxiety and worry occurring more days than not for at least 6 months

B - difficulty controlling worry

C - anxiety and worry are associated with 3+ of the following:
○ restlessness or feeling keyed up and on edge
○ being easily fatigued
○ difficulty concentrating or mind going blank
○ irritability
○ muscle tension
○ sleep disturbance

D - worry causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

38
Q

What is the main change to generalized anxiety disorder in the DSM-5?

A
  • more inclusive (e.g., shorter length of illness, fewer symptoms necessary)
39
Q

How does worry decrease physiological arousal?

A
  • worry is primarily accompanied by verbal thought and little imagery
  • anxious images elicit arousal while verbal thoughts decrease arousal
40
Q

What are some reasons that people worry?

A
  • motivation
  • problem-solving
  • preparation
  • avoidance
  • distraction
  • superstition
41
Q

How is worrying about future threat reinforced?

A
  • worst-case scenario rarely comes true
  • worry changes your behaviour so that you can avoid/conquer whatever you were worried about
  • may be difficult to go back and do things without the worry motivating you
42
Q

What is the intolerance of uncertainty?

A
  • individual’s discomfort with ambiguity and uncertainty
  • risk factor for generalized anxiety disorder
    → people with GAD have low threshold for uncertainties
43
Q

What are the primary feature of obsessive-compulsive disorder?

A
  • recurrent obsessions and compulsions that cause marked distress for the individual
  • excessive beliefs about personal responsibility and feelings of guilt that their behaviour/thoughts will lead to harm coming to others
44
Q

What is the lifetime prevalence of OCD?

A

1.6%

45
Q

What are obsessions?

A
  • recurrent and uncontrollable thoughts, impulses, or ideas that the individual finds troubling or anxiety-provoking
46
Q

What are examples of common obsessions?

A

Thoughts related to:

  • uncertainty
  • sexuality
  • violence
  • contamination
47
Q

What are compulsions?

A
  • repetitive behaviours or cognitive acts that are intended to reduce anxiety
48
Q

What are neutralizations?

A
  • behavioural or mental acts that are used by individuals to try to prevent, cancel, or “undo” the feared consequences and distress caused by an obsession
  • normal even in people without disorder
49
Q

What is thought-action fusion?

A
  • two types of irrational thinking

1 - belief that having a particular thought increases the probability that the thought will come true (Likelihood-Self and Likelihood-Other)

2 - belief that having a particular thought is the moral equivalent of a particular action (Moral TAF)
→ highly related to religiosity

  • only Likelihood-Other form is considered to be a pathological OCD belief
50
Q

What are the diagnostic criteria for OCD?

A
  • presence of either obsessions or compulsions
  • time-consuming (>1 hour per day) or cause clinically significant distress or impairment in important areas of functioning
51
Q

Compare and contrast obsessions and pathological worry.

A
  • both have intrusive and uncontrollable thoughts that cause impairment in functioning
  • but obsessions tend to be more bizarre and involve more imagery than worries
52
Q

What are the subtypes of OCD?

A
  • checking
  • hoarding
  • ordering/symmetry
  • contamination and washing/cleaning
53
Q

What is the neurobiological model of OCD?

A
  • implicates basal ganglia and frontal cortex
    ○ basal ganglia controls motor behaviours
    ○ frontol cortex responsible for wide range of higher cognitive functions including abstract reasoning, planning, and decision making
  • structural/functional abnormalities may be responsible
  • suggested poor information processing in frontal cortex causes patients to focus on irrelevant details
54
Q

What is the neurochemical model of OCD?

A
  • abnormalities in serotonin system are responsible

- SSRI treatment seems to support this

55
Q

What is the cognitive-behavioural conceptualization of OCD?

A
  • people make catastrophic misinterpretations of their weird, intrusive thoughts
  • high personal responsibility means they must take action to prevent the bad things from happening through suppression of thoughts, avoidant behaviours, or neutralizations (that then become compulsions)
  • compulsions persist because:
    ○ lower severity of anxiety
    ○ lower frequency of obsessions
    ○ “prevent” obsessions from coming true
56
Q

What is the rebound effect?

A
  • paradoxical effect of increasing intrusive thought frequency by trying to suppress them
57
Q

What is post-traumatic stress disorder?

A
  • psychological condition that may begin after a traumatic life event
58
Q

What are the diagnostic criteria of PTSD?

A

A - exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways:
○ direct experience
○ witnessing in person
○ learning it occurred to a close family or friend
○ experience repeated or extreme exposure to aversive details of traumatic events

B - presence of one or more of the following intrusion symptoms:
○ recurrent, involuntary, and distressing memories of traumatic events
○ recurrent distressing dreams in which content and/or affect of dream are related to event
○ dissociative reactions/flashbacks
○ intense or prolonged psychological distress at exposure to external or internal cues that resemble traumatic event

C - persistent avoidance of stimuli associated with traumatic events

D - negative alterations in cognitions and mood associated with traumatic events
○ dissociative amnesia
○ feelings of detachment from others
○ inability to experience positive emotions

D - marked alterations in arousal and reactivity associated with traumatic events
○ hypervigilance
○ exaggerated startle response
○ self-destructive behaviour

F - C, D, E duration of >1 month

(holy crap this is long what)

59
Q

How is PTSD assessed?

A
  • Clinician Administered PTSD Scale (CAPS)
    ○ interview used to quantify frequency and intensity of PTSD symptoms
  • questionnaires
  • physiological measures (heart rate)
60
Q

What is the difference between uncomplicated PTSD and complex PTSD?

A
  • uncomplicated: develop PTSD following a single event, often easy to recover from (e.g., car accident)
  • complex: developed PTSD over the course of long-standing and recurrent traumatic experience (e.g., spousal abuse)
61
Q

Why do women have a much more increased risk of developing PTSD?

A
  • twice as likely than men
  • men are exposed to more traumatic events
  • women are exposed to more events particularly likely to be associated with the development of PTSD, like sexual abuse
62
Q

What are the pre-event factors for onset of PTSD?

A
  • low socio-economic status
  • previous psychiatric history
  • childhood abuse
  • interpersonal trauma (e.g. physical violence) v. non-interpersonal trauma (e.g. natural disaster)
63
Q

What are the post-event factors for onset of PTSD?

A
  • severity of traumatic event
  • lack of social support
  • additional stressors after event
64
Q

What is the problem with using benzodiazepines to treat anxiety symptoms?

A
  • addictive quality so not appropriate for long-term use
  • going off the medication worsens symptoms
  • patient believes that their anxiety symptoms are pathological and only treatable through drugs so they don’t try to work on the underlying life problems causing symptoms
65
Q

What medication is used to treat anxiety-related disorders?

A
  • benzodiazepenes in the short-term

- antidepressants (tricyclic, SSRIs)

66
Q

What is the goal of cognitive restructuring in treating anxiety-related disorders?

A
  • help patients develop healthier and more evidence-based thoughts
  • help adjust imbalance between perceived risk and resource
  • better at monitoring their own automatic thoughts and underlying beliefs and examining the validity of these cognitions
67
Q

What is the Socratic approach to cognitive therapy?

A
  • asking a number of questions to query and evaluate the beliefs and behaviours that contribute to anxiety
68
Q

What is collaborative empiricism?

A
  • therapist and patient operate as a team to conceptualize a patient’s difficulties and modify their beliefs
69
Q

What is systematic desenstitization?

A
  • therapeutic technique whereby patients imagine the lowest feared stimuli and combine this image with a relaxation response
  • patients gradually work their way up the fear hierarchy so that they can learn to handle increasingly disturbing stimuli
70
Q

What is a fear hierarchy?

A
  • list of feared situations or objects that are arranged in descending order of how anxiety evoking they are
  • used in exposure therapy exercises
71
Q

What are subjective units of distress?

A
  • rate how much a situation or object evokes anxiety from 0 (no anxiety) to 100 (anxiety is worst ever experienced)
72
Q

What is worry imagery exposure?

A
  • used to treat generalized anxiety disorder
  • systematic exposure to feared images related to an individual’s worries
  • after half an hour patient may be encouraged to picture other scenarios
73
Q

What is interoceptive exposure?

A
  • induction of physical sensations (e.g., dizziness) by hyperventilating, spinning in a chair, exercising, etc.
  • exposes internal cues to people with panic disorder to help them deal with these sensations
74
Q

What is the problem solving approach to treating anxiety disorders?

A
  • based on assumptions that by generating and implementing effective solutions to problems, patients will experience less anxiety

Begins with Problem-Orientation phase:

  • encouraged to approach problems constructively rather than worrying, avoiding, or denying them
  • accept that life is full of problems and everyone dies and it’s not usually your fault
  • anxiety is a signal of a problem that needs to be solved
75
Q

What is Eye Movement Desensitization and Reprocessing (EMDR)?

A
  • side-to-side eye movements while the client attends to the image of the trauma, thoughts about the trauma, and the physical sensations of anxiety aroused by trauma
  • highly controversial
76
Q

What is the basic problem solving strategy for treating anxiety disorders?

A
  • define problem
  • generate a wide range of alternative solutions
  • decide on and implement one or more of these solutions
  • evaluate outcome
77
Q

What are the most common treatments for anxiety-related disorders?

A
  • **cognitive behavioural therapy** (treatment of choice, mainly for panic disorder, social anxiety disorder, generalized anxiety disorder)
  • in vivo exposure (specific anxiety/phobia disorder)
  • benzidiazepenes (generalized anxiety disorder)
  • exposure and ritual prevention (OCD)
  • imaginal exposure and discussion of trauma (PTSD)

PSY240 (16 decks)

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