Chapter 7 anxiety disorders

Question 1

What is the difference between fear and anxiety?

Answer 1

-Fear is an emotional response to a real or perceived threat that leads to avoidance or flight or fight. Anxiety is this feeling of fear for situations that are not threatening

Question 2

What are the key differences between generalized anxiety disorder and agoraphobia?

Answer 2

GAD is a generalized anxiety of a wide range of situations while agoraphobia is an active anxiety of being in outdoor situations outside of the home

Question 3

Individuals with social anxiety disorder will experience both physical and cognitive symptoms, particularly when presented with social interactions. What are these symptoms?

Answer 3

Physical are blushing, stuttering, sweating, trembling. Cognitive is fear of being judged as stupid, anxious, crazy, boring, or unlikeable

Question 4

What are the common types of specific phobias?

Answer 4

Heights,

different animals,

natural phenomena such as lightning, needles

specific situations like enclosed spaces.

Women experience more phobias but men and women are equal in needle fear.

Question 5

What are the physical and cognitive symptoms observed during panic disorder?

Answer 5

Physical: heart palpitations, sweating, trembling or shaking, shortness of breath, feeling as though they are being choked, chest pain, nausea, dizziness, chills or heat sensations, and numbness/tingling.
Cognitive: feelings of derealization (feelings of unreality) or depersonalization (feelings of being detached from oneself), the fear of losing control or ‘going crazy,’ or the fear of dying

Question 6

What are the key components of panic disorder?

Answer 6

They are unexpected and are recurrent. However, there are expected panic attacks which involve upcoming situations. These happen in different amounts to different people with different intensities

Question 7

Describe how generalized anxiety disorder presents.

Answer 7

Excessive worry or anxiety about a wide range of activities lasting for more days than not for at least six months and are unable to control their worry. You need three or more of the following symptoms for a diagnosis: restlessness, fatigue, difficultly concentrating, irritability, muscle tension, and problems sleeping

Question 8

Describe how specific phobia presents.

Answer 8

Excessive or irrational fear of certain things or situations. 75% of individuals with phobias have them with more than one object. Women experience phobias more.

Question 9

Describe how agoraphobia presents.

Answer 9

An anxiety that result ins active avoidance of being outside and is triggered by either by public transportation, being in big spaces, being in enclosed spaces, being in a crowd or outside alone

Question 10

Describe how social anxiety disorder presents.

Answer 10

Fear or Anxiety of social situations especially being evaluated by other and being judged in a negative way. The clients will usually sweat, blush, stutter or tremble. Maybe like my approach anxiety for women

Question 11

Describe how panic disorder presents.

Answer 11

A series of abrupt surge of fear or doom that is unexpected and furthered by a fear of future panic attacks

Question 12

How do prevalence rates vary as a function of gender, race, nationality, and age?

Answer 12

Tend to be higher for women, white people and those younger in age

Question 13

Describe the epidemiology of generalized anxiety disorder.

Answer 13

2.9% in the US and a 1.3% in women. Occurs more frequently in those of European descent and in high income nations

Question 14

Describe the epidemiology of specific phobia.

Answer 14

8-12% in the US and 6% In European Countries. 2:1 ratio in women to men. Rates are lower in older individuals and those from Asia, Africa and Latin America

Question 15

Describe the epidemiology of agoraphobia.

Answer 15

1% in adolescents, 1.7% in adults. 2:1 women to men ratio. Older adults have a prevalence of 0.5-0.6%

Question 16

Describe the epidemiology of social anxiety disorder.

Answer 16

7% of the US, 0.5-2% for the rest of the world. Higher in younger individuals, women and lower in older individuals, men and nonwhite people

Question 17

Describe the epidemiology of panic disorder.

Answer 17

2-3% in the US. Higher rates in American Indians and Whites. Females are twice as likely as men

Question 18

Describe the comorbidity of generalized anxiety disorder.

Answer 18

Other anxiety disorders, substance use, unipolar depressive disorders also some suicidal ideation

neurodevelopmental, neurocognitive, psychotic, and conduct disorders is less common for those afflicted with generalized anxiety disorder.

Question 19

Describe the comorbidity of specific phobia.

Answer 19

anxiety disorders,

depressive and bipolar disorders,

substance-related disorders,

somatic symptom disorder

personality disorders, in particular dependent personality disorder,

Question 20

Describe the comorbidity of agoraphobia.

Answer 20

anxiety disorders and depressive disorders. Agoraphobia is also comorbid with PTSD and alcohol use disorder. For those with comorbid major depressive disorder, the agoraphobia is more treatment-resistant compared to those with agoraphobia alone. Suicidal ideation.

Question 21

Describe the comorbidity of social anxiety disorder.

Answer 21

other anxiety-related disorders, major depressive disorder, and substance-related disorders. The high comorbidity rate among anxiety-related disorders and substance-related disorders is likely connected to the efforts of self-medicating to deal with social fears. Comorbidity has also been found with body dysmorphic disorder and avoidant personality disorder.

Question 22

Describe the comorbidity of panic disorder.

Answer 22

Panic disorder rarely occurs in isolation, as 80% of individuals report symptoms of other anxiety disorders, major depressive disorder, bipolar I and bipolar II disorder, and possibly mild alcohol use disorder. Some individuals diagnosed with panic disorder also develop a substance-related disorder, likely as an attempt to treat their anxiety with alcohol or other substances. high comorbidity with general medical symptoms. More specifically, individuals with panic disorder are more likely to report somatic symptoms such as dizziness, cardiac arrhythmias, COPD, asthma, irritable bowel syndrome, and hyperthyroidism

Question 23

What other disorders commonly occur with specific anxiety related disorders and why?

Answer 23

Substance abuse to deal with the disorder, depression from isolation, suicidal ideation as a way of alleviating pain or escape of the pain

Question 24

What anxiety-related disorder has a high comorbidity with medical symptoms?

Answer 24

Panic Disorder

Question 25

What is the relationship of the disorders with suicidal ideation and attempts/behaviors? Be specific.

Answer 25

There is a high percentage of comorbidity with suicidal thoughts and ideation with these disorders along with high substance abuse and depression. Most likely the patients are self medicating and increasing chances of suicidal thoughts with sedatives

Question 26

Describe the biological causes of anxiety disorders.

Answer 26

There isn’t a ton. It seems to be more due to environment but there has been link with a mutation to the serotonin transporter gene (5-HTTLPR) that reduces Serotonin activity

Also the amygdala coordinates with the hippocampus and prefrontal cortex to appraise the threat and if threatened it activates the HPA axis to respond

Specifically the locus coeruleus is the on/off switch for norepinephrine transmitters for panic disorders but its complicated. The corticostriatal-thalamocortical (CSTC) circuit or the fear circuit is also involved

Question 27

Describe the psychological causes of anxiety disorders.

Answer 27

Misappraisal or negative appraisals that create maladaptive assumptions to situations such as social situations for social anxiety. We also model specific phobias from authorative figures

Question 28

Describe the sociocultural causes of anxiety disorders.

Answer 28

Stressors manifesting from poverty and discrimination along with abusive upbringing increase chances of anxiety. Women are more likely to be affected then men

Question 29

What is the difference between emotion-focused and problem-focused coping strategies? How do these two coping strategies explain differences in anxiety related disorders?

Answer 29

Emotion focused coping is coping to stressors through emotion which is less effective than problem focused coping which focuses on identifying problems and fixing them

Question 30

What are the effects of prejudice and discrimination on the development of anxiety disorders?

Answer 30

Leads to an increased fear response and more anxiety especially in situations having to do with the discrimination

Question 31

Describe treatment options for generalized anxiety disorder.

Answer 31

Benzo’s have been the main treatment after barbiturates but more side effects are being recorded. So SSRI’s and SNRI’s (Serotonin-norepinephrine reuptake inhibiters are a first line medication.

These help 30-50% of the time but stop once meds stop

Rational-Emotive Therapy: One of the first forms of CBT which believed clients were not aware of the link between their cognitions and behaviors thus resulted in anxiety and depression

CBT: Has a 60% significant reduction of anxiety symptoms by challenging and reappraising maladaptive thoughts

Biofeedback: A machine provides a visual representation of the
persons physical arousal such as EEG and HRV (heart rate variability) which helps them regulate arousal

Question 32

Describe treatment options for specific phobia.

Answer 32

Exposure treatments such as systemic desensitization which states fear and relaxation cannot exist at the same time and trains calming techniques. The therapist will make a fear hierarchy and gradually expose the client to the fear via in-vivo or imaginal exposure. Imaginal is less intense but less effective

Flooding is just exposing the person to their fear

Modeling is the client models the therapist in dealing with the fear.

Most of these treatments tend to be effective

Question 33

Describe treatment options for agoraphobia.

Answer 33

Similar to phobias but are usually less effective when paired with panic disorder. Combine flooding with CBT for aide. Without panic disorder there is a 60-80% success rate but high rates of relapse

Question 34

Describe treatment options for social anxiety disorder.

Answer 34

Exposure, social skills training and cognitive restructuring

Question 35

Describe treatment options for panic disorder.

Answer 35

CBT is the most effective with 80% of people reporting complete remission.

Psychoeducation about the disorder such as the mental and physical symptoms tend to help debunk myths about panic disorder

Self monitoring which is part of CBT, Relaxation training, Progressive muscle relaxation, cognitive restructuring,
Exposure for 30 seconds up to one minute

Pharmacological medications are not very good but often prescribed by Primary care doctors but research shows these are not the most effective since the dull the CBT and exposure experience and they fair worse. So meds are given to people who do not fair well with CBT

Question 36

Epidemiology of the various Anxiety Disorders in the US adults

Answer 36

GAD: 2.9%

Phobias: 8-12%

Social Anxiety Disorder: 7%

Agoraphobia: 1.7%

Panic Disorder: 2-3%