Chapter 6 - anxiety Flashcards
1
Q
Approximately ___% of adults have anxiety disorders (including phobia disorders) over the last year ?
A
18%
2
Q
Yerkes-Dodson Law:
- what does it look like?
- 2 axes?
- 3 different categories/zones?
A
- normal/bell curve
- X: arousal level, Y: performance
- Yellow:
→ not aroused enough - Green:
→ optimal arousal & performance - Red:
→ too much arousal, decreased performance
→ where you’re concerned about an anxiety disorder
3
Q
3 elements of anxiety? ex?
A
- thoughts
→ “They don’t really want to hang out with me” - feelings
→ Sad / Lonely - behaviors
→ avoidance
4
Q
Common features / symptoms of anxiety disorders?
A
- Situations that almost always provoke fear or anxiety
- Out of proportion with stressor or event
- Excessive or unreasonable
- Persistent
- Avoid situations or suffer
- Impairment with life
5
Q
Most common form of mental disorder?
A
Anxiety disorders!
(in terms of 1 year prevalence rates)
6
Q
Most common type of anxiety disorder?
A
specific phobia
7
Q
___% of those with MDD meet criteria for one or more anxiety disorder
A
60%
8
Q
People who develop anxiety disorders are much more likely to have experienced ____?
A
a stressful life event
(danger, insecurity, family discord)
9
Q
What is the typical order of onset for a patient with comorbid anxiety and MDD?
A
- Usually anxiety comes first
- Anxiety disorder is more likely to onset earlier than depression
10
Q
4 reasons for comorbidity between depression and anxiety?
A
- Common causes
→ Stressful life events (trauma, break ups, moving, starting college, etc) - Impacted by the same cognitive biases
- Same biological vulnerabilities
→ (ex. Serotonin reuptake issues) - Overlap in diagnostic criteria
→ Issues with concentration, falling asleep, etc
11
Q
Common comorbidity:
People with anxiety are 3x more likely to have _______ disorder than people without anxiety?
A
alcohol use disorder
12
Q
What are the 6 different anxiety disorders we talked about?
A
- Specific phobia
- Social anxiety disorder
- OCD
- Panic disorder
- GAD
- Agoraphobia
13
Q
Typical age of onset for each anxiety disorder (which are youngest to oldest) ?
A
- Specific phobia → childhood
- Social anxiety disorder → adolescence (10-20)
- OCD → adolescence to early adulthood
- Panic disorder → late adolescence - mid 30s
- GAD → late adolescence - mid 30s
- Agoraphobia → adulthood
14
Q
Course & outcomes for anxiety disorders? worse outcomes associated with…?
A
- usually chronic conditions
- long term outcome is mixed and somewhat unpredictable
- most people continue to have problems for many years
- worse outcomes associated with younger age of onset & lack of treatment
15
Q
Demographic predictors:
- what’s the gender difference? - what disorder is there no gender difference for?
A
- Women 2-3x more likely than men for most anxiety disorders
- no gender difference for OCD
16
Q
Demographic predictors:
- which racial group is more likely to have an anxiety disorder?
A
Non-hispanic white americans»_space; black or hispanic americans
17
Q
Only about ___% of people who quality for a diagnosis of an anxiety disorder ever seek treatment
A
25%
18
Q
OCD DSM diagnostic criteria:
A
- Obsessions and/OR compulsions
-
Time consuming or causes distress or impairment
→ Distracting
→ Avoiding
→ Cognitive performance - Symptoms not due to substances or medical condition
- Not better explained by symptoms of another mental disorder
19
Q
OCD Obsessions: DSM def?
A
- Thoughts, urges, or images that are…
→ Recurrent and persistent
→ Intrusive and unwanted (not voluntary)
→ Cause anxiety and distress
2. Individual attempts to ignore or suppress or neutralize them with some other thought or action
20
Q
5 most common types of obsessions:
A
- Contamination
- Repeated doubts
- Order/arranging
- Violent/aggressive
- Sexual obsessions
21
Q
How are OCD obsessions different from normal intrusive thoughts?
A
- more frequent
- last longer
- more discomfort
- more difficulty dismissing
- more likely to interpret them as meaningful
22
Q
OCD Compulsions DSM def?
A
- Repetitive behaviors or mental acts…
→ feels compelled to perform in response to an obsession or according to rules applied rigidly
→ reduces anxiety or prevents some dreaded event from happening
→ Not connected in realistic way OR are clearly excessive
23
Q
5 most common types of compulsions?
A
- Checking (& re-checking)
- Decontamination
- Repeating
- Ordering and arranging
- Mental acts: (Prayers, counting, repeating words)
24
Q
OCD course of disorder?
A
- Typically chronic if untreated
- Revision rates for adults are quite low
25
Big picture goals of CBT for OCD?
- Change how to relate and interpret intrusive thoughts
→ Try to be more accepting of the thoughts
- Learn more adaptive long-term strategies
→ Break cycle of rituals
26
4 common beliefs & misinterpretations in OCD?
1. Responsibility exaggeration
2. Importance of thoughts
→ _Obsessions reveal something true about them_
3. Thought-action fusion
→ thoughts mean you actually did it
4. Need to control thoughts
27
Exposure & Response Prevention:
- Expose client to the fear (thing they’re obsessed about) & prevent them from engaging in compulsions / rituals
- Goal is to show them that they don’t need the rituals
- keep track of resists & submits
28
Panic attacks: def? theory? symptoms?
- discrete episodes of intense fear or dread
- key symptom of panic disorder
- can be considered a normal fear response at inappropriate time
Symptoms:
- Physical (heavy breathing)
- Cognitive (gonna die, crazy)
- Behavioral (fleeing situation)
- _Sudden, abrupt onset, brief duration_
29
3 types of panic attacks? def?
1. Situationally bound
→ Panic attacks are expected or cued by particular thing
2. Situationally predisposed
→ more likely to have a panic attack where she had one before, but having one is not inevitable
3. Unexpected
→ Comes out of the blue, not cued at all
30
Panic disorder criteria?
1. Recurrent, unexpected panic attacks (uncued)
2. Followed by at least one month of one or both of the following:
→ Persistent worry ab having additional attacks or their consequences
→ Significant behavioral change
31
Etiology of panic disorder: cognitive factor? limitation?
- Catastrophic misinterpretation
→ interpret normal body sensations or physiological arousal as response to danger, and they experience it as a panic attack
- cannot account for all panic attacks
--> some happen at night while sleeping
32
3 treatments for panic disorder?
- Situational exposures
→ Confronting places or situations that the person avoids due to fear of having a panic attack
- Interoceptive exposures
→ Confronting bodily sensations that the person associates with panic attacks
→ Exposure to symptoms like shortness of breath and racing heart rate without experiencing panic attack
- Teaching clients distress tolerance
→ Sitting with uncomfortable anxiety w/o a panic attack
33
Agoraphobia def?
- Anxiety about being in places or situations from which:
→ Escape might be difficult or embarrassing
→ Help may not be available if one has a panic attack
- Fear of escape, being embarrassed about panic symptoms occurring in public
34
Specific phobia def?
- focused on specific thing
- irrational
- persistent & excessive or unreasonable
- exposure always provokes fear
- avoidance/anxiety interferes with routine or functioning
35
5 phobia subtypes: (ex / details?)
1. Animals
2. Natural environment
→ Storms, heights, water
→ Usually has childhood onset
3. Blood, injection, injury
→ Giving blood / Needles
→ Don’t go to the doctor,
4. Situational
→ Public transit, bridges, elevators
5. Other
→ Choking, vomiting, clowns, costumes
36
3 theories for etiology of phobias? Limitations?
1. Evolutionary adaptation
→ phobias were at one point useful for survival
→ applies to snakes/spiders, NOT to clowns
2. Negative information
→ hearing negative info from parents/media/news
→ doesn't need to be direct exposure
3. Preparedness/learning model
37
Preparedness model for learning fears?
- organisms are biologically predisposed / prepared to learn certain types of associations
- these associations can lead to conditioned fear responses
38
Treatments for specific phobias? Important concept used?
- exposure therapy
- progressive relaxation
- imaginal & in vivo
_Fear Avoidance Hierarchy_
- pyramid of things that induce fear from least to most stressful
39
Generalized Anxiety Disorder Criteria?
- Excessive anxiety and worry occurring more days than not for at least 6 months
- Beyond reasonable concern, difficult to control worry
- impairs function
- Anxiety accompanied by 3+ of the following:
→ Restlessness,
→ easily fatigues,
→ difficulty concentrating
→ irritability
→ muscle tension
→ sleep disturbance
40
4 cognitive vulnerabilities for GAD?
1. Positive beliefs about worry
2. Sense of uncontrollability
3. Intolerance of uncertainty
4. Focus on threat-related stimuli that may indicate future negative events
→ Focus on negative rather than positive
41
GAD treatment?
- Progressive muscle relaxation is one of the most important parts
- Relaxing the body can relax the mind
- Goal is to be more aware of when your body is tense
42
Social anxiety disorder def?
- Fear of being negatively evaluated by others in one or more social or performance situations
- Fear of humiliation, embarrassment, or rejection
43
2 types of Social anxiety?
- Generalized
→ Performance anxiety, participating in groups, parties, authority figures, eating in public
- Performance only
→ Public speaking, music performance, etc.
44
Social anxiety disorder criteria:
- Persistent fear of 1+ social situations exposed to possible scrutiny
- almost always present anxiety
- Fears they'll be negatively evaluated
- Anxiety is unreasonable or excessive
- Avoids or suffers through with distress
45
2 cognitive biases with SAD?
1. attentional bias
2. maladaptive (often untrue) internal dialogue
→ Internal negative dialogue
→ Fear of positive evaluation
→ Emotional dysregulation
→ less likely to reciprocate self-disclosure
46
SAD treatment??
- exposure to feared situations (in vivo & imaginal)
- includes distress ratings & outcome ratings / predictions
- Simulating a feared situation
47
Benzos: popularly prescribed until when? what NT do they affect? whats their problem?
- popular til the 1990s
- enhance activity of GABA neurons
- side effects: sedation, psychomotor/cognitive impairments
- RISK FOR ADDICTION
48
Tricyclic antidepressants used successfully to treat what anxiety disorder?? Used less frequently because....?
- panic disorder
- unpleasant side effects
- side effects can get so bad that they resemble anxiety itself
