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
2
Q
What is fear?
A
- primitive emotion
- occurs in response to real/perceived current threat
- present oriented
3
Q
What is panic?
A
- extreme fear reaction triggered even when there is nothing to be afraid of
4
Q
What are the genetic factors in the etiology of anxiety?
A
- genetic risk passed down as broader temperamental and/or dispositional traits
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
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
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
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
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
10
Q
What is paresthesias?
A
- numbness or tingling sensations
11
Q
Compare and contrast derealization and depersonalization.
A
DEREALIZATION:
- feelings of unreality, being in a dream
DEPERSONALIZATION:
- feeling detached from oneself
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
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
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
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
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
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
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)
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”)
20
Q
What are phobias?
A
- excessive and unreasonable fear reactions
21
Q
What is the prevalence of specific phobias?
A
- 12.7% will develop specific phobia at some point in their lives
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.)
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
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
25
What is social anxiety disorder?
- marked and persistent fear of social or performance related situations
26
Compare social anxiety disorder and social phobia.
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
27
What are some diagnostic criteria for social anxiety disorder?
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
28
What is one of the keys to understanding social anxiety disorder?
- individual is aware of their excessive fear but this logical perspective is overwhelmed by the anxiety they feel
29
How is social anxiety assessed?
- takes form of a structured or semi-structured interview combined with completion of various self-report measures
30
Contrat social anxiety disorder and agoraphobia.
- 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
31
What are the biological factors in the etiology of social anxiety?
- genetic factors account for more than half of social anxiety risk
- inherited predisposition to develop anxiety about social situations
32
What are the early psychosocial events that factor into the etiology of social anxiety?
- 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
What are the cognitive factors within the etiology of social anxiety?
- 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
What is public self-consciousness?
- 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
What is interpersonal disorder?
- alternate categorization of social anxiety
| - condition commonly associated with marked disruptions in ability to relate with other people
36
What is generalized anxiety disorder?
- central difficulty is chronic, excessive, and uncontrollable worry (called pathological worry)
37
What are some of the diagnostic criteria for generalized anxiety disorder?
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
What is the main change to generalized anxiety disorder in the DSM-5?
- more inclusive (e.g., shorter length of illness, fewer symptoms necessary)
39
How does worry decrease physiological arousal?
- worry is primarily accompanied by verbal thought and little imagery
- anxious images elicit arousal while verbal thoughts decrease arousal
40
What are some reasons that people worry?
- motivation
- problem-solving
- preparation
- avoidance
- distraction
- superstition
41
How is worrying about future threat reinforced?
- 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
What is the intolerance of uncertainty?
- individual's discomfort with ambiguity and uncertainty
- risk factor for generalized anxiety disorder
→ people with GAD have low threshold for uncertainties
43
What are the primary feature of obsessive-compulsive disorder?
- 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
What is the lifetime prevalence of OCD?
1.6%
45
What are obsessions?
- recurrent and uncontrollable thoughts, impulses, or ideas that the individual finds troubling or anxiety-provoking
46
What are examples of common obsessions?
Thoughts related to:
- uncertainty
- sexuality
- violence
- contamination
47
What are compulsions?
- repetitive behaviours or cognitive acts that are intended to reduce anxiety
48
What are neutralizations?
- 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
What is thought-action fusion?
- 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
What are the diagnostic criteria for OCD?
- 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
Compare and contrast obsessions and pathological worry.
- 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
What are the subtypes of OCD?
- checking
- hoarding
- ordering/symmetry
- contamination and washing/cleaning
53
What is the neurobiological model of OCD?
- 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
What is the neurochemical model of OCD?
- abnormalities in serotonin system are responsible
| - SSRI treatment seems to support this
55
What is the cognitive-behavioural conceptualization of OCD?
- 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
What is the rebound effect?
- paradoxical effect of increasing intrusive thought frequency by trying to suppress them
57
What is post-traumatic stress disorder?
- psychological condition that may begin after a traumatic life event
58
What are the diagnostic criteria of PTSD?
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
How is PTSD assessed?
- Clinician Administered PTSD Scale (CAPS)
○ interview used to quantify frequency and intensity of PTSD symptoms
- questionnaires
- physiological measures (heart rate)
60
What is the difference between uncomplicated PTSD and complex PTSD?
- 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
Why do women have a much more increased risk of developing PTSD?
- 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
What are the pre-event factors for onset of PTSD?
- low socio-economic status
- previous psychiatric history
- childhood abuse
- interpersonal trauma (e.g. physical violence) v. non-interpersonal trauma (e.g. natural disaster)
63
What are the post-event factors for onset of PTSD?
- severity of traumatic event
- lack of social support
- additional stressors after event
64
What is the problem with using benzodiazepines to treat anxiety symptoms?
- 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
What medication is used to treat anxiety-related disorders?
- benzodiazepenes in the short-term
| - antidepressants (tricyclic, SSRIs)
66
What is the goal of cognitive restructuring in treating anxiety-related disorders?
- 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
What is the Socratic approach to cognitive therapy?
- asking a number of questions to query and evaluate the beliefs and behaviours that contribute to anxiety
68
What is collaborative empiricism?
- therapist and patient operate as a team to conceptualize a patient's difficulties and modify their beliefs
69
What is systematic desenstitization?
- 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
What is a fear hierarchy?
- list of feared situations or objects that are arranged in descending order of how anxiety evoking they are
- used in exposure therapy exercises
71
What are subjective units of distress?
- rate how much a situation or object evokes anxiety from 0 (no anxiety) to 100 (anxiety is worst ever experienced)
72
What is worry imagery exposure?
- 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
What is interoceptive exposure?
- 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
What is the problem solving approach to treating anxiety disorders?
- 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
What is Eye Movement Desensitization and Reprocessing (EMDR)?
- 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
What is the basic problem solving strategy for treating anxiety disorders?
- define problem
- generate a wide range of alternative solutions
- decide on and implement one or more of these solutions
- evaluate outcome
77
What are the most common treatments for anxiety-related disorders?
- ******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)
