Chapter 5 - Anxiety, Trauma-and Stressor-Related, and Obsessive-Compulsive and Related Disorders Flashcards
Anxiety
A negative mood state characterized by bodily symptoms of physical tension and apprehension about the future.
- Subjective sense of unease
- A set of behaviors (looking worried and anxious or fidgeting)
- A Physiological response originating in the brain and reflected in elevated heart rate and muscle tension
Fear
An immediate alarm reaction to danger
(It could be good for us by activating a massive response from the autonomic nervous system.)
Panic
The sudden, overwhelming reaction to fear
Name after the Greek god Pan, who terrified travelers with bloodcurdling screams.
Panic Attack
An abrupt experience of intense fear of acute discomfort, accompanied by physical symptoms usually include heart palpitations, chest pain, shortness of breath, and dizziness.
Two Types: Expected and Unexpected
Expected (Cued) Panic Attacks
Knowing that you are afraid of high places or driving over long bridges that could cause panic attacks in these situations but not anywhere else.
More common in specific phobias or social anxiety disorder
Unexpected (Uncued) Panic Attacks
If you don’t have a clue when or where the next attack will occur
Biological Contributions to Anxiety
- Evidence shows that we inherit a tendency to be tense, uptight, and anxious.
- Seems to run in families and probably has a genetic component that differs from genetic contributions of anxiety.
*Stress and other factors can turn these inherited genes on.
*Also associated with certain brain circuits and neurotransmitter systems; for example, depleted levels of GABA (gamma-aminobutyric acid is associated with increased anxiety.
*The CRF (Corticotropin-releasing factor) system is central to the expression of anxiety and depression
Behavioral Inhibition System (BIS)
It gets activated by the signals from the brain stem of unexpected events, such as major changes in body functioning that might signal danger. Danger signals in response to something we see that might be threatening to descend from the cortex to the septal-hippocampal system. The BIS also receives a big boost from the amygdala.
Fight/Flight System (FFS)
The circuit involved in panic originates in the brain stem and travels through several midbrain structures, including the amygdala, the ventromedial nucleus of the hypothalamus, and the central gray matter.
FFS is activated partly by deficiencies in serotonin
Physicological Contributors
- A general “sense of uncontrollability” may develop early due to upbringing and other disruptive or traumatic environmental factors.
- Parents teach children that they have control over their environment, and their responses have an effect on their parents and their environment by being positive and predictable to their needs.
Opposed to
- Parents who are overprotective and overintrusive and who “clear the way” for their children create a situation in which their children never learn to cope with adversity when it comes along.
- An important personality trait called anxiety sensitivity determines who will and who will not experience problems with anxiety under certain stressful conditions.
Social Contributions
Stressful life events can trigger our biological and physiological vulnerabilities to anxiety.,
Triple Vulnerability Theory
Putting all the factors together in an integrated way
1st Vulnerability
Generalized biological vulnerability
We can see that a tendency to be upright or high-strung might be inherited, but a generalized biological vulnerability to develop anxiety is not sufficient to produce anxiety itself.
2nd Vulnerability
Generalized Pyshcological Vulnerability
You might also grow up believing the world is dangerous and out of control, and you might not be able to cope when things go wrong based on your early experiences. If the perception is strong, you have a generalized psychological vulnerability.
3rd Vulnerability
Specific Psychological Vulnerability
You learn from early experiences, such as being taught by your parents, that some situations or objects are fraught with danger (even if they really aren’t)
Comorbidity with Physical Disorders
- Anxiety disorders are uniquely and significantly associated with thyroid disease, respiratory disease, gastrointestinal disease, arthritis,migraine headaches, and allergic conditions. (Generally, the anxiety disorder comes before the physical disorder, indicating that having anxiety might cause or contribute to physical disorders.)
*Panic Attacks often co-occur with certain medical conditions, particularly cardio, respiratory, gastrointestinal, and vestibular (inner ear) disorders.
Disorders grouped together as anxiety disorders
- Generalized Anxiety Disorder (GAD)
- Panic Disorder
- Agoraphobia
- Specific Phobias
- Social Anxiety Disorder
- Separation Anxiety Disorder
- Selective Mutism
Generalized Anxiety Disorder
Unable to focus one’s attention as one’s mind quickly switches from crisis to crisis. Characteristics include:
*muscle tension
*mental agitation
*Susceptibility to fatigue
*some irritability
*difficulty sleeping
Anxiety Sensitivity
The tendency to become distressed in response to arousal-related sensations arising from beliefs that these anxiety-related sensations have harmful consequences.
GAD Psychological symptoms
- Autonomic Restrictors, as in they have a low cardiac vagal tone that leads to autonomic inflexibility because the heart is less responsive to certain tasks.
- People with GAD are chronically tense
GAD Treatment
- Benzodiazepines are most often prescribed for short-term relief (like stressful family events); however, there are risks involved that could impair cognitive and motor functioning.
- Antidepressants are also commonly utilized, like Paroxetine (Paxil) and Venlafaxine (Effexor)
- Psychological treatments work better in the long run
a.) Exposing patients to images to experience emotions associated with the image rather than avoiding feelings.
b.) CBT, where patients learn to use cognitive therapy and other coping techniques to counteract and control the worry process.
c.) Meditation and mindfulness
Meta-cognitions
Cognition (beliefs) about cognitions (worrying)
Panic Disorder
Debilitating anxiety disorder is when individuals experience severe, unexpected panic attacks; they think they’re dying or otherwise losing control.
Agoraphobia
Fear and avoidance of situations in which a person feels unsafe or unable to escape to get home or to a hospital in the event of developing panic, panic-like symptoms, or other physical symptoms, such as loss of bladder control.
Termed by German physician Karl Westphal in Greek, which refers to fear of the marketplace.
Interoceptive Avoidance
Another cluster of avoidant behaviors or avoidance of internal physical sensations,
Susto
A fright disorder in Latin America that is characterized by sweating, increased heart rate, and insomnia
Ataques de Nervios
An anxiety-related culturally defined symptom from the Caribbean which are quite similar to panic attacks although manifestations of shouting uncontrollably and bursting into tears are more common than panic.
Kyol Goeu “Wind Overloaded”
Common amongst the Asian culture (too much wind or gas in the body, which may cause blood vessels to burst) becomes the focus of catastrophic thinking during panic attacks.
Nocturnal Panic
- 60% of people with panic disorder have experienced them at night.
- Occur during delta wave or slow wave sleep which is several hours after we fall asleep in the deepest stage of sleep.
Isolated Sleep Paralysis
A culturally determined condition common in the African American community (the expression “the witch is riding you”)
- Occurs during the transitional state between sleep and waking when a person falls asleep or wakes up.
- During this stage, the individual cannot move and experiences a surge of terror that resembles a panic attack; occasionally, there are also vivid hallucinations.
