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Chapter 6 Flashcards

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1
Q

Anxiety def

A

Apprehension over an anticipated problem

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2
Q

Fear def

A

A reaction to immediate danger

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3
Q

Both ____ and ____ involve physiological arousal

A
  • Both anxiety and fear involve physiological arousal
  • Anxiety – moderate arousal (e.g., restless energy, tension)
  • Fear – higher arousal (e.g., overpowering urge to run)
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4
Q

Anxiety

A
  • Anxiety increases preparedness
  • “U-shaped” curve
  • Absence of anxiety interferes with performance
  • Moderate levels of anxiety improve performance
  • High levels of anxiety are detrimental to performance
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5
Q

What does anxiety increase?

A

preparedness

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6
Q

Fear

A
  • Fear triggers “fight or flight” response
  • In the right circumstance, fear saves lives
  • Fear system seems to misfire in some anxiety disorders
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7
Q

describe anxiety on a graph:

A
  • “U-shaped” curve (really looks more bell curve)
  • Absence of anxiety interferes with performance
  • Moderate levels of anxiety improve performance
  • High levels of anxiety are detrimental to performance
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8
Q

Anxiety Disorders

A
  • DSM-5 Anxiety Disorders
  • Specific phobias
  • Social anxiety disorder
  • Panic disorder
  • Agoraphobia
  • Generalized anxiety disorder
  • Most common psychological disorders
  • 28% of people report anxiety symptoms
  • 10th leading cause of disability worldwide in 2015
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9
Q

*DSM-5 Anxiety Disorders

A
  • DSM-5 Anxiety Disorders
  • Specific phobias
  • Social anxiety disorder
  • Panic disorder
  • Agoraphobia
  • Generalized anxiety disorder
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10
Q

what is the most common psychological disorders

A 
anxiety disorders (Specific phobias
Social anxiety disorder
Panic disorder 
Agoraphobia
Generalized anxiety disorder)
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11
Q

10th leading cause of disability worldwide in 2015

A

Anxiety Disorders

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12
Q

DSM-5 Criteria: Panic Disorder

A
  • Recurrent unexpected panic attacks
  • At least 1 month of concern about the possibility of more attacks occurring or the consequences of an attack, or maladaptive behavioral changes because of the attacks
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13
Q

Criteria for Anxiety Disorders: DSM-5 criteria for each disorder:

A
  • Symptoms interfere with important areas of functioning or cause marked distress (clinically significant)
  • Symptoms are not caused by a drug or a medical condition
  • Symptoms persist for at least 6 months or at least 1 month for panic disorder
  • The fears and anxieties are distinct from the symptoms of another anxiety disorder
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14
Q

Panic disorder: how many month(s)

A

1

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15
Q

how to distinguish panic disorder (from other anxiety disorders)

A

panic disorder is for at least 1 month, the others are for at least 6 months

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16
Q

Specific Phobias

A
  • Disproportionate fear caused by a specific object or situation
  • Great lengths taken to avoid feared object or situation
  • Most specific phobias cluster around a few feared objects and situations
  • High comorbidity among specific phobias
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17
Q

DSM-5 Criteria: Specific Phobia

A
  • Marked and disproportionate fear consistently triggered by specific objects or situations
  • The object or situation is avoided or else endured with intense anxiety
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18
Q

Social Anxiety Disorder

-has overlap with…

A
  • Persistent, unrealistically intense fear of social situations that might involve being scrutinized by or exposed to unfamiliar people
  • *Fear of negative evaluation or scrutiny leads to avoidance of social situations
  • Common fears include: public speaking, meeting new people, talking to people in authority
  • 33% also diagnosed with Avoidant Personality Disorder
  • Overlap in genetic vulnerability for both disorders
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19
Q

Common fears of Social Anxiety Disorder

A

Common fears include: public speaking, meeting new people, talking to people in authority

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20
Q

DSM-5 Criteria: Social Anxiety Disorder

A
  • Marked and disproportionate fear consistently triggered by exposure to potential social scrutiny
  • Exposure to the trigger leads to intense anxiety about being evaluated negatively
  • Trigger situations are avoided or else endured with intense anxiety
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21
Q

Panic attacks

A

*Sudden attack of intense apprehension, terror, and feelings of impending doom
*Accompanied by at least four other symptoms:
Physical symptoms can include:
-Shortness of breath, heart palpitations, nausea, upset stomach, chest pain, feelings of choking and smothering, dizziness, lightheadedness, faintness, sweating, chills, heat sensations, numbness or tingling sensations, and trembling
*Depersonalization - feeling of being outside one’s body
*Derealization - feeling of the world not being real
*Fears of going crazy, losing control, or dying

  • Symptoms come on rapidly and peak in intensity within 10 minutes
  • Many people interpret symptoms as having a heart attack
  • Misfiring of the fear system
  • Physiological response similar to what most experience when faced with immediate threat
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22
Q

how do people describe panic attacks

A

Many people interpret symptoms as having a heart attack

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23
Q

panic attacks vs panic disorder

A

Panic attacks triggered by specific situations (e.g., phobia) should not be considered in diagnosing panic disorder

-panic disorder def: recurrent and unexpected panic attacks (except those caused by phobias)

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24
Q

panic disorder

A
  • Recurrent panic attacks unrelated to specific situations
  • Worry about having more panic attacks
  • Panic attacks triggered by specific situations (e.g., phobia) should not be considered in diagnosing panic disorder
  • 25% of the general population of people will experience a single panic attack
  • -Not the same as panic disorder
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25
Q

DSM-5 Criteria: Panic Disorder

A

Recurrent unexpected panic attacks
At least 1 month of concern about the possibility of more attacks occurring or the consequences of an attack, or maladaptive behavioral changes because of the attacks

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26
Q

Agoraphobia

-how many people with agoraphobia will experience panic attacks

A

*Anxiety about situations in which it would be embarrassing or difficult to escape if anxiety symptoms occurred
E.g., crowds, stores, malls, churches, trains, bridges, tunnels, etc.
*Causes significant impairment
-Unable to leave house or leaves house with great distress
*About half of people with agoraphobia experience panic attacks

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27
Q

DSM-5 Criteria: Agoraphobia

A
  • Disproportionate and marked fear or anxiety about at least 2 situations where it would be difficult to escape or receive help in the event of incapacitation, embarrassing symptoms, or panic-like symptoms
  • These situations consistently provoke fear or anxiety
  • These situations are avoided, require the presence of a companion, or are endured with intense fear or anxiety
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28
Q

Generalized Anxiety Disorder (GAD)

-Def

A

DSM def: Uncontrollable worry

  • Excessive, uncontrollable, and long-lasting worry about minor things
  • Worry : Cognitive tendency to chew on a problem and to be unable to let go of it
  • Common worries: Relationships, health, finances, daily hassles
  • Also includes: difficulty concentrating, tiring easily, restlessness, irritability, and muscle tension
  • Typically begins in adolescence
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29
Q

DSM-5 Criteria: Generalized Anxiety Disorder

A
  • Excessive anxiety and worry at least 50% of days about a number of events or activities (e.g., family, health, finances, work, and school)
  • The person finds it hard to control the worry
  • The anxiety and worry are associated with at least three (or one in children) of the following:
  • Restlessness or feeling keyed up or on edge
  • Easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance
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30
Q

Comorbidity of anxiety disorder

  • among anxiety disorders
  • with other disorders… specifically
A
  • More than 50% of those with anxiety disorder meet criteria for another anxiety disorder
  • 75% of those with anxiety disorder meet criteria for another psychological disorder
  • Disorders commonly comorbid with anxiety:
  • 60% also have depression
  • Obsessive compulsive disorder also common
  • Comorbidity is associated with greater severity and poorer outcomes of the anxiety disorders
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31
Q

what percent of people will experience a panic attack

A

25% of people will experience a single panic attack

Not the same as panic disorder

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32
Q

Treatment of the Anxiety Disorders: Commonalities Across Psychological Treatments

A
  • Exposure: Face the situation or object that triggers anxiety
  • Virtual reality vs. in vivo (real-life) exposure are equally effective
  • Mindfulness and acceptance treatments also show promise
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33
Q

Exposure as a treatment as Anxiety disorder
(how effective?)
(behavioral vs cognitive view)

A
  • Exposure: Face the situation or object that triggers anxiety
  • E.g., exposure hierarchy: graded exposure to a list of triggers
  • Effective for 70-90% of clients
  • Behavioral view: Newly learned associations inhibit fear
  • Cognitive view: Corrects mistaken beliefs
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34
Q

Psychological Treatment of Phobias

A

*Exposure
-In vivo (real-life) exposure
-For phobias involving fear of animals, injections, or dental work:
Very brief treatments lasting only a couple of hours have been found to be highly effective
-Most people experience relief from phobic symptoms

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35
Q

Exposure as a treatment as Anxiety disorder

behavioral vs cognitive view

A

*Exposure: Face the situation or object that triggers anxiety
-E.g., exposure hierarchy: graded exposure to a list of triggers
Effective for 70-90% of clients
Behavioral view: Newly learned associations inhibit fear
Cognitive view: Corrects mistaken beliefs

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36
Q

Psychological Treatment of Phobias

A

*Exposure
In vivo (real-life) exposure
For phobias involving fear of animals, injections, or dental work:
Very brief treatments lasting only a couple of hours have been found to be highly effective
Most people experience relief from phobic symptoms

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37
Q

Social skills training

as a psychological treatment of Social Anxiety Disorder

A

Provides extensive modeling of behaviors

Reduces use of safety behaviors (e.g., poor eye contact)

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38
Q

Clarks’ cognitive therapy for social anxiety

A

Reduce internal focus of attention
Reduce the idea that people are looking at you
Challenge negative images of how others will react

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39
Q

Psychological Treatment of Agoraphobia

A
  • CBT for agoraphobia
  • Systematic exposure to feared situations
  • Coached to gradually leave home and engage in community activities for short periods of time
  • Enhanced by involving patient’s partner
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40
Q

Clarks’ cognitive therapy for social anxiety

A
  • Reduce internal focus of attention
  • Reduce the idea that people are looking at you
  • Challenge negative images of how others will react
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41
Q

Professor thinks this is the best approach to GAD

A

Cognitive behavioral methods

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42
Q

Medications

A

*Anxiolytics: drugs that reduce anxiety
-Benzodiazepines (e.g., Valium, Xanax)
Can be addictive and cause severe withdrawal symptoms
Side effects: cognitive and motor difficulties
-Antidepressants (e.g., Tricyclics, SSRIs, SNRIs)
Side effects: jitteriness, weight gain, elevated heart rate

  • Most people relapse once they stop taking medications
  • Psychological treatments are considered the preferred treatment of most anxiety disorders
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43
Q

Benzodiazepines as a means to reduce anxiety

-a type of…

A

Benzodiazepines (e.g., Valium, Xanax)
Can be addictive and cause severe withdrawal symptoms
Side effects: cognitive and motor difficulties

-a type of Anxiolytics

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44
Q

Benzodiazepines as a means to reduce anxiety

A

Benzodiazepines (e.g., Valium, Xanax)
Can be addictive and cause severe withdrawal symptoms
Side effects: cognitive and motor difficulties

45
Q 
Gender Factors (for anxiety) 
*Possible explanations for gender differences:
A
  • Women are twice as likely as men to have an anxiety disorder
  • And experience greater functional impairment
  • Possible explanations for gender differences:
  • Women may be more likely to report symptoms
  • Men more likely to be encouraged to face fears
  • Women more likely to experience sexual assault : May interfere with sense of control
  • Women show more biological reactivity to stress
46
Q

Cultural Factors (in regards to anxiety)

A

Culture and environment influence what people fear

  • Culturally specific syndromes
  • Kayak-angst: Inuit disorder in seal hunters at sea similar to panic disorder
  • Taijin kyofusho: Japanese fear of displeasing or embarrassing others similar to social anxiety disorder
  • Rate of anxiety disorders varies by culture
  • Prevalence is highest in Europe and US than other countries
47
Q

Kayak-angst

A

Inuit disorder in seal hunters at sea similar to panic disorder
-example of cultural factors

48
Q

*Culturally specific syndromes (examples)

A

Kayak-angst
Inuit disorder in seal hunters at sea similar to panic disorder
Taijin kyofusho
Japanese fear of displeasing or embarrassing others similar to social anxiety disorder

49
Q

Fear Conditioning

A
  • Mowrer’s two-factor model (pure behaviorism)
  • Classical Conditioning (to start)
  • Operant Conditioning (keeps it going)
50
Q

-Classical Conditioning (in regards to fear conditiniong)

A

A person learns to fear a neutral stimulus (CS) that is paired with an intrinsically aversive stimulus (UCS)

51
Q

-Operant Conditioning : in regards to fear conditioning - (keeps it going)

A

A person gains relief by avoiding the CS

Avoidance maintained though negative reinforcement

52
Q

Extensions to Mowrer’s Model

A

*Classical conditioning can occur in different ways:
-Direct experience
-Modeling
Seeing someone else experience feared situation
-Verbal instruction
E.G., hearing a parent say dogs are dangerous

*People with anxiety disorders:
-Acquire fears more readily through classical conditioning
-Experience more persistent fears once conditioned
-Are sensitive to unpredictable treats
Neutral predictable unpredictable (NPU) threat task
People with anxiety disorders show high physiological arousal to unpredictable threat conditions compared to health controls

53
Q

Genetic Factors for anxiety

-percent

A

*Twin studies suggest heritability of about 50 to 60%
*Some genes may elevate risk for several anxiety disorders
E.g., a family member with a phobia is associated with increased risk of developing a phobia and other anxiety disorders

54
Q

bipolar heritability

A

= 90%

55
Q

Neurobiological Factors for anxiety

A
  • Fear circuit: Amygdala, Medial prefrontal

* Neurotransmitters

56
Q

Amygdala : role in anxiety

A

*part of the fear circuit
Assigns emotional significance
Involved in the conditioning of fear

57
Q

Personality Factors

A
  • Behavioral inhibition

* Neuroticism

58
Q

*Behavioral inhibition

A

-a Personality Factor for anxiety

*Tendency to become agitated, distressed, and cry in unfamiliar or novel settings
Observed in infants as young as 4 months
May be inherited
*Predicts social anxiety in adolescence

59
Q

*Neuroticism

A
  • a Personality Factor for anxiety
  • Tendency to experience frequent or intense negative affect
  • Predicts onset of anxiety disorder and depression
  • People with high levels are twice as likely to develop anxiety disorders than those with low levels
60
Q

Cognitive Factors in regards to anxiety

A
  • Sustained negative beliefs about future
  • Belief that one lacks control over environment
  • Attention to threat
61
Q

Cognitive Factors in regards to anxiety : Sustained negative beliefs about future

A

*Sustained negative beliefs about future
Bad things are likely to happen
Engage in safety behaviors, which maintain negative cognitions

62
Q
  • Belief that one lacks control over environment

- how is this fostered

A

Negative childhood experiences (e.g., abuse) and severe life events may foster the belief that life is uncontrollable

63
Q

Etiology of Specific Phobias (3)

A
  • Two-factor model (the mowrer’s model) of behavioral conditioning
  • Risk factors act as diatheses
  • Vulnerabilities influence development of phobias
  • Prepared learning
  • Evolutionary preparation to fear certain stimuli
  • Potentially life-threatening (heights, snakes, etc.)
64
Q

*Attention to threat as a

Cognitive Factors in regards to anxiety

A

Tendency to notice negative environmental cues
Selective attention to signs of threat
*Attention training interventions show promise for reducing anxiety

65
Q

Etiology of Specific Phobias: Two-factor model of behavioral conditioning

A

*Two-factor model (the mowrer’s model) of behavioral conditioning

  • Phobias are a conditioned response to threat : Classical conditioning
  • Sustained by avoidant behaviors : Operant conditioning
66
Q

Etiology of Social Anxiety Disorder

A
  • Behavioral factors

* Cognitive factors

67
Q

*Behavioral factors as Etiology of Social Anxiety Disorder

A

*Factors similar to specific phobia: Classical and operant conditioning
*Safety behaviors maintain and intensify social difficulties
E.g., avoiding eye contact, disengaging from conversation, standing apart from others

68
Q

*Cognitive factors as Etiology of Social Anxiety Disorder

A

*Overly negative in evaluating their social performance
E.g., consequences of their behaviors
*Excessive attention to internal ( e.g., heart rate) vs. external (e.g., social) cues

69
Q

Etiology of Panic Disorder: Neurobiological Factors

A

Locus coeruleus

70
Q

Locus coeruleus as Etiology of Panic Disorder: Neurobiological Factors

A
  • Major source of norepinephrine

* People with panic disorder are more sensitive to drugs that trigger the release of norepinephrine

71
Q

Etiology of Panic Disorder: Behavioral factors

A
  • Interoceptive conditioning
  • Classical conditioning of panic in response to internal bodily sensations
  • -A person experiences somatic signs of anxiety
  • -Followed by a panic attack
  • -Panic attacks become a conditioned response to somatic changes
72
Q

Etiology of Panic Disorder: Cognitive Factors

A
  • Catastrophic misinterpretations of somatic changes

* Anxiety Sensitivity Index

73
Q

*Catastrophic misinterpretations of somatic changes as Etiology of Panic Disorder:

A
  • a Cognitive Factor
  • Catastrophic misinterpretations of somatic changes
  • Interpreted as impending doom
  • I must be having a heart attack!
  • Beliefs increase anxiety and arousal
  • Creates vicious cycle
74
Q

*Anxiety Sensitivity Index as Etiology of Panic Disorder:

A

-a Cognitive Factor

  • Measures intensity of fear in response to bodily sensations
  • High scores predict onset of panic attacks and anxiety disorders
  • “Unusual body sensations scare me.”
75
Q

Etiology of Agoraphobia

A
  • Risk related to genetic vulnerability and life events

* Fear-of-fear hypothesis

76
Q

*Fear-of-fear hypothesis as Etiology of Agoraphobia

A
  • Negative thoughts about the consequences of experiencing anxiety in public
  • Catastrophic beliefs that anxiety will lead to socially unacceptable consequences
77
Q

Etiology of GAD

A
  • Contrast Avoidance Model
  • People with GAD find it highly aversive to experience shifts in emotions
  • To avoid shifts, they prefer a constant state of worry
  • Helps them feel as if they are preparing for the worst
  • Worry can help a person keep a more stable emotional, albeit uncomfortable, state
78
Q

Yerkes-Dodson

A

performance vs level of stress

  • calm
  • eustress
  • distress
79
Q

Types of Specific Phobias

A 
animal
natural environemnt
blood, injecection, injury 
situational
other:
80
Q

Which of the anxiety disorders involves fear of objects of situations that is out of proportion to any real danger?

A

specific phobia

81
Q

If someone has social anxiety disorder, what other disorder are they likely to also be diagnosed with?

A

33% also diagnosed with Avoidant Personality Disorder

82
Q

25% of people will experience a single panic attack

-does this mean that 25% of people have panic disorder?

A

NO

83
Q

About _____ of people with agoraphobia experience panic attacks

A

About half of people with agoraphobia experience panic attacks

84
Q
  • 75% of those with anxiety disorder meet criteria for another psychological disorder
  • Disorders commonly comorbid with anxiety: (2)
A
  • 60% also have depression

- Obsessive compulsive disorder also common

85
Q
  • Rate of anxiety disorders varies by culture

- the US in comparison….

A

-Prevalence is highest in Europe and US than other countries

86
Q

Factors that Increase General Risk for Anxiety Disorder (8) see slide 31

A
  • behavioral conditinioning
  • genetic vuluberablity
  • distrubrance in the fear curtuit of the brain
  • decreased functioning of gamma-aminobutyirc acid (GABA) and serotoning; increased norpephrine acvtitiy
  • increased cortisol awakening response (CAR)
  • behavioral inhibition
  • neurotiscism
  • cognitive factors, including sustained negative beliefs, perceived lack of control, oer-attention to cues of threat, and intolerance of uncertainty
87
Q

Anxiety often involves __________ arousal, and fear involves __________ arousal.

A

moderate; high

88
Q

The central feature of Generalized Anxiety Disorder in children is ________.

A

uncontrollable worry

89
Q

Figure 6.1 Two Factor Model of Conditioning as Applied to Dog Phobia

A

Step 1) Classical conditiniong
-UCS: dog bite
-CS: dog
-CR: classiclaly conditioned fear of dogs
Step 2) operant conditioning: strong fear motivates the person to avoid dogs, avoidance is reinforced because it relieves the fear

90
Q

n Japan, taijin kyofusho involves

A

the fear of embarrassing others.

91
Q

Medial prefrontal cortex

in regards to neurobiological factors for anxiety

A

-part of the fear circuit
Regulates amygdala activity
Involved in extinguishing fears
Processes anxiety and fear

92
Q

Neurotransmitters in regards to neurobiological factors for anxiety

A

Disruptions in serotonin and GABA
Norepinephrine
Increased levels and changes in sensitivity of receptors

93
Q

T/F Success rates are generally lower for GAD treatment than they are for other anxiety disorders.

A

TRUE

Success rates are generally lower for GAD treatment than they are for other anxiety disorders.

94
Q

Fear Circuit Associated with Anxiety Disorders

A

-see image slide 38
Fear and anxiety appear to be related to a set of structures in the brain called the fear circuit. The amygdala and the medial prefrontal cortex are particularly involved in anxiety disorders.

95
Q

Cognitive Factors for anxiety : Attention to threat

A

Tendency to notice negative environmental cues
Selective attention to signs of threat
Attention training interventions show promise for reducing anxiety

96
Q

Psychological Treatment of Social Anxiety Disorder

A

*CBT for Social Anxiety
Graded hierarchy of exposure
Involves role playing or practicing with a small group
*Social skills training
Provides extensive modeling of behaviors
Reduces use of safety behaviors (e.g., poor eye contact)
*Clarks’ cognitive therapy for social anxiety
Reduce internal focus of attention
Reduce the idea that people are looking at you
Challenge negative images of how others will react

97
Q

Psychological Treatment of GAD

A

*Relaxation training to promote calmness (deep breathing, 5 senses: connecting to the presence)
*Cognitive behavioral methods
Improve problem-solving
-Challenge and modify negative thoughts
-Increase ability to tolerate uncertainty
Worry only during “scheduled” times
Focus on present moment
He thinks that cognitive is a better approach

98
Q

Medications

A

Anxiolytics: drugs that reduce anxiety
Benzodiazepines (e.g., Valium, Xanax)
Can be addictive and cause severe withdrawal symptoms
Side effects: cognitive and motor difficulties
Antidepressants (e.g., Tricyclics, SSRIs, SNRIs)
Side effects: jitteriness, weight gain, elevated heart rate
Tends to work pretty well

Most people relapse once they stop taking medications
Psychological treatments are considered the preferred treatment of most anxiety disorders

99
Q

T/F All of the anxiety disorders are associated with decrements in quality of life.

A

TRUE

100
Q

T/F all anxiety disorders must be present for 6 months

A

FALSE

-panic disorder must be present for 1 month

101
Q

*____% of people report anxiety symptoms vs _____% of the general population of people will experience a single panic attack

A
  • 25% of the general population of people will experience a single panic attack vs
  • 28% of people report anxiety symptoms
102
Q

More than ____% of those with anxiety disorder meet criteria for another anxiety disorder

  • ___% of those with anxiety disorder meet criteria for another psychological disorder
  • Disorders commonly comorbid with anxiety:
  • __% also have depression
  • Obsessive compulsive disorder also common
A

More than 50% of those with anxiety disorder meet criteria for another anxiety disorder

  • 75% of those with anxiety disorder meet criteria for another psychological disorder
  • Disorders commonly comorbid with anxiety:
  • 60% also have depression
  • Obsessive compulsive disorder also common
103
Q

T/F when treating phobias- people should use exposure therapy for a long time over many sessions

A

FALSE

Very brief treatments lasting only a couple of hours have been found to be highly effective

104
Q

People with high levels of ______ are twice as likely to develop anxiety disorders than those with low levels

A

People with high levels of neuroticism are twice as likely to develop anxiety disorders than those with low levels

105
Q

Some of the most commonly prescribed medications for social anxiety disorder are __________, which are proposed to work by ____________.

A

beta blockers; diminishing the effects of adrenaline on the body

106
Q

Classical conditioning of panic attacks in response to bodily sensations is called

A

interoceptive conditioning.

107
Q

Researchers training those with GAD to focus on a positive set of words over a long period of time using the dot probe task have found that participants

A

report less anxiety in both interview and self-report measures following the trainings.

108
Q

While a therapist might consider adding cognitive therapy to treatment of _________, research suggests that outcomes are no better when cognitive therapy is added in the treatment of ________

A

social anxiety disorder; specific phobias.

109
Q

Exposure treatment is effective in __________ of clients.

A

70-90%

Abnormal Psychology (13 decks)

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