Chapter 6: Anxiety Disorders Flashcards
What are anxiety disorders?
disorders in which fear or anxiety is overriding and the primary disturbance
What is anxiety?
an unpleasant feeling of fear and apprehension accompanied by increased physiological arousal
What is fear?
a reaction to real or perceived immediate danger in the present; can involve arousal, or sympathetic nervous system activity
What is the difference between anxiety and fear?
- fear tends to be about a threat that is happening now; anxiety tends to be about a future threat
- anxiety often involves moderate arousal, fear involves higher arousal
Why is anxiety an example of an inverse U-curved shape w/ performance?
an absence of anxiety is a problem, a little anxiety is adaptive, and a lot of anxiety is detrimental
What are the five major anxiety disorders included in DSM-5?
- specific phobias
- social anxiety disorder
- panic disorder
- agoraphobia
- generalized anxiety disorder
What is a specific phobia?
fear of objects or situations that is out of proportion to any real danger (ex: flying, snakes, heights)
What is social anxiety disorder?
fear of unfamiliar people or social scrutiny
What is panic disorder?
anxiety about recurrent panic attacks that are unexpected
What is agoraphobia?
anxiety about being in places where escaping or getting help would be difficult if anxiety symptoms occurred (ex: grocery stores, malls, churches); are often unable to leave their house
What is generalized anxiety disorder?
uncontrollable worry
What criteria must be met for a DSM-5 diagnosis of an anxiety disorder to be made?
- symptoms interfere with important areas of functioning or cause marked distress
- 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
What is the suffix -phobia derived from?
the name of the Greek god Phobos, who frightened his enemies
What are two common phobias?
claustrophobia (fear of closed spaces) and acrophobia (fear of heights)
What disorder is often comorbid with social anxiety disorder?
avoidant personality disorder
When is the typical onset of social anxiety disorder?
during adolescence (when peer relationships become particularly important)
What is a panic attack?
a sudden attack of intense apprehension, terror, and impending doom, accompanied by symptoms such as labored breathing, nausea, chest pain, feelings of choking and smothering, heart palpitations, dizziness, sweating, and trembling
What is depersonalization?
a feeling of being outside of one’s body
What is derealization?
a feeling of the world not being real
Which anxiety disorder is most related to marital distress?
generalized anxiety disorder
What percentage of people with anxiety disorders will experience major depression during their lives?
60%
What are some reasons for why women are more vulnerable to anxiety disorders than men?
- social factors (gender roles: men told to face fears)
- higher occurrences of sexual assault
- women show more biological reactivity to stress than men
What is the disorder that occurs among the Inuit people, particularly sea hunters who are alone at sea?
kayak-angst
What is the Japanese syndrome that involves fear of displeasing or embarrassing others?
taijin kyofusho
What is the sudden fear that one’s genitals will recede into the body (reported in southern and eastern Asia)?
koro
What is the intense anxiety and somatic symptoms attributed to the loss of semen through masturbation or excessive sexual activity (reported in China)?
shenkui
What is the belief that a severe fright has caused the soul to leave the body (reported in Latin America)?
susto
What are some factors that increase general risk for anxiety disorders?
- behavioral conditioning (classical and operant conditioning)
- genetic vulnerability
- disturbances in the activity in the fear circuit of the brain
- decreased functioning of gamma-aminobutyric acid (GABA) and serotonin; increased norepinephrine activity
- increased cortisol awakening response (CAR)
- behavioral inhibition
- neuroticism
- cognitive factors
What are the two steps in the development of an anxiety disorder in Mowrer’s two-factor model?
- through classical conditioning - CS is paired with UCS (intrinsically aversive stimulus)
- through operant conditioning - avoiding CS is maintained because it is reinforcing (reduces fear)
What are some criticisms of Mowrer’s early version of the two-factor model?
- many people who have anxiety disorders cannot remember any exposure to a threatening event that triggered their symptoms
- many people who experience serious threats do not develop anxiety disorders
What are three different ways in which classical conditioning can occur, according to an extension of Mowrer’r two-factor model?
- direct experience (dog bites you)
- modeling (see a dog bite someone)
- verbal instruction (hear about dangerous dogs)
What is a neutral predictable unpredictable (NPU) threat task?
a laboratory task designed to test sensitivity to unpredictable vs predictable threats
What are the three conditions of an NPU threat task?
- a neutral condition in which they do not experience an aversive stimulus
- a predictable condition in which they experience an aversive stimulus and receive a warning beforehand
- an unpredictable condition in which they experience an aversive stimulus w/o prior warning
What factors distinguish individuals with anxiety disorders from those without?
people with anxiety disorders are:
- more easily conditioned to fear stimuli
- to sustain conditioned fears longer
- to respond more strongly to unpredictable, uncertain threats
What is the heritability estimate for anxiety disorders?
.5 to .6
What is the fear circuit?
a set of brain structures, including the amygdala, that tend to be activated when the individual is feeling anxious or fearful; especially active among people with anxiety disorders
What is the medial prefrontal cortex?
a region of the cortex in the anterior frontal lobes involved in executive function and emotion regulation that is implicated in mood and anxiety disorders (fear)
Which neurotransmitters are implicated in anxiety disorders?
serotonin, GABA, norepinephrine (sensitivity of norepinephrine receptors)
What is behavioral inhibition?
the tendency to exhibit anxiety or to freeze when facing threat
Which anxiety disorder is behavioral inhibition a particularly strong predictor of?
social anxiety disorder
What are four important cognitive factors in anxiety disorders?
- sustained negative beliefs about the future
- a perceived lack of control
- over attention to signs of threat
- intolerance of uncertainty
What are safety behaviors?
behaviors used to avoid experiencing anxiety in feared situations (ex: tendency of people w/ social phobia to avoid looking at other people)
What did the Little Albert study show?
that intense fears could be conditioned (Little Albert was conditioned to fear a white rat after associating a loud noise w/it)
What is a problem with the behavioral model of the etiology of anxiety disorders?
not sure if people remember/had a conditioning experience or not; and many people who did don’t develop a phobia
What is prepared learning?
a biological predisposition to associate evolutionary-relevant stimuli (such as dangerous animals) readily with unconditioned stimuli
What are some examples of safety behaviors in social anxiety disorder?
avoiding eye contact, disengaging from conversation, standing apart from others
How can cognitive processes intensify social anxiety?
- people w/ SAD appear to have unrealistically harsh views of their social behavior, and overly negative beliefs about the consequences of their social behaviors
- attend more to how they are doing in social situations
What is the brain region in the fear circuit that is especially important in panic disorder?
locus coeruleus (major source of norepinephrine in the brain)
What is interoceptive conditioning?
classical conditioning of panic attacks in response to internal bodily sensations of arousal - after the first panic attack, the person is classically conditioned to fear somatic symptoms
How does the cognitive perspective on panic disorder work?
panic attacks develop when a person interprets bodily sensations as signs of impending doom (ex: interpret increase in HR
as sign of heart attack)
What is the Anxiety Sensitivity Index?
a test that measures the extent to which people respond fearfully to their bodily sensations; predicts the degree to which unexplained physiological arousal leads to panic attacks
What is the fear-of-fear hypothesis?
a cognitive model for the etiology of agoraphobia; suggests the condition is driven by negative thoughts about the consequences of having a panic attack in public
How does generalized anxiety disorder differ from other anxiety disorders?
- people w/ GAD more likely to experience episodes of MDD
- WORRY: decreases volatility of emotion in contrast to other anxiety disorders
What is the contrast avoidance model?
the theory that chronic worry of GAD provides a functional advantage in reducing the volatility of negative emotions and arousal in response to severe stress
What is the common focus of all effective psychological treatments for anxiety disorders?
exposure: people must face what they deem too terrifying to face
What is an exposure heirarchy?
a graded list of the difficulty of someone’s triggers
What are two key principles in protecting against relapse with CBT?
- exposure should include as many features of the feared object as possible
- exposure should be conducted in as many different contexts as possible
What does the behavioral view of exposure therapy state?
works by extinguishing the fear response
What does the cognitive view of exposure therapy state?
works by helping people correct their mistaken beliefs that they are unable to cope w/ the stimulus
What is exposure?
real-life (in vivo) or imaginal confrontation of a feared object or situation, especially as a component of systematic desensitization
What is the significance of David Clark’s version of cognitive therapy?
helps w/ social anxiety disorder so that people learn not to focus their attention internally and combat negative images of how others will react to them
How does CBT for panic disorder work?
therapist persuades client to deliberately elicit bodily sensations associated w/ panic - patient learns to stop seeing physical sensations as harmful
What does the psychodynamic treatment for panic disorder involve?
24 sessions focused on identifying emotions and meanings surrounding panic attacks
How does CBT for agoraphobia work?
systematic exposure to feared situations - ex: gradually tackling leaving home, staying in public places (can be enhanced by including partners)
What is the most widely used behavioral technique for treatment of GAD?
relaxation training to promote calmness
What are anxiolytics?
minor tranquilizers or benzodiazepines used to treat anxiety disorders
What are the two medications most commonly used for treatment of anxiety disorders?
- benzodiazepines (Valium, Xanax)
2. antidepressants (SSRIs, SNRIs, tricyclic antidepressants)
What are benzodiazepines?
any of several drugs commonly used to treat anxiety, such as Valium and Xanax
What is buspirone (BuSpar) used for?
general anxiety disorder
Why are antidepressants often preferred over benzodiazepines?
- people may experience severe withdrawal symptoms when they try to stop using benzodiazepines (can be addictive)
- benzodiazepines can have significant cognitive and motor side effects (memory lapses, drowsiness)
- benzodiazepines related to increase risk of car accidents
Which medications are considered first-choice treatments in anxiety disorders?
SSRIs and SNRIs
Why are psychological treatments considered the preferred treatment of most anxiety disorders (except GAD)?
because most people relapse once they stop taking medications
What is the most common type of psychological disorder?
anxiety disorders
