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psyc 300 > class 5: Anxiety & OCD > Flashcards

class 5: Anxiety & OCD Flashcards

1
Q

Lecture Themes

A
  1. Social Anxiety Disorder
  2. Panic Disorder
  3. Generalized Anxiety Disorder (GAD)
  4. Obsessive-Compulsive Disorder (OCD)
  5. Biopsychosocial (OCD) Etiology
  6. Biopsychosocial (OCD) Presentation
  7. Biopsychosocial (OCD) Treatment
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2
Q

Anxiety Breadth(range):

A
  • **Social Anxiety Disorder **(Social Phobia)
  • Panic Disorder
  • Generalized Anxiety Disorder (GAD)
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3
Q

Social Anxiety Disorder

A

**Disabling fears of 1 or more social situations **

> Fear of scrutiny & (potential) negative evaluation

Subcategories
* Performance(ex:presentation)
* Nonperformance

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4
Q

statistics:

A
  • Lifetime prevalence: ~12%
  • More common in women
  • Onset usually adolescence/early adulthood
  • Often comorbid with other anxiety
    -some of them use alchool to ease anxiety
  • tend to be lower in social statues and carrer oportunities
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5
Q

Examples

A

Giving a speech

Going to a party

Using public washrooms

Speaking to authority figures

Starting conversations

Inviting people to do things

Eating in public

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6
Q

Etiology: Bio

A

Genes
* 30% variance due to genetics (big role)

Temperament
* Behavioral inhibition

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7
Q

Etiology: Cognitive

A

Learned behaviours
* Learning is most likely to occur in people who are genetically or temperamentally at risk
- classical conditioned or watching others

Evolutionary factors

Perceptions of uncontrollability and unpredictability

Cognitive bias toward “danger schemas”

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8
Q

Etiology: Social

A

Social skills deficits?
* Cause vs. effect
* Self-report vs. objective

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9
Q

Maintenance: Cognitive

A
  • Unrealistic performance standards
  • Attentional bias
    -they only see the bad feedback
  • Self-focused attention
    -only seeing the bad in them and no one else
  • Post-event processing
    -when they look bad they only see the things they did wrong
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10
Q

Treatment

A

Cognitive-Behavioural therapy
* Exposure: to possibilities of being judged not just social interactions
* Cognitive restructuring
* Social skills training

Medications
* Antidepressants (relapse is high)-going back to these fears and maladptive thoughts

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11
Q

Panic Disorder

A
  • Panic attacks “out of the blue”
  • Recurrent
  • Worry about future attacks
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12
Q

Panic Attack

A
  • Abrupt autonomic surge
  • Unexpected
  • Uncontrollable
  • Absence of objective threat = “false alarm”
  • pickes in 10 min(breath but intense)
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13
Q

Panic Attack Symptoms

A
  • Pounding heart
  • Short of breath
  • Chest pain/tightness
  • Dizziness
  • Trembling
  • Sweating/Chills
  • Nausea
  • Depersonalization/ Derealization(feeling not like yourself or out of the body)
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14
Q

statistics

A
  • ~5% lifetime prevalence
  • **Women 2x **> men(socialcultural
  • Onset often ages 20-40
  • Chronic, debilitating course
  • 83% have comorbid disorder(s)(another disorder)
  • 50-70% experience depression
  • they might also have suicidel thoughts,sucidal attempst- independent of other disorders
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15
Q

Etiology: Bio

A

Genes
* 33-43% heritable(moderate)

Brain structure
* Sensitive amygdala (“fear network”) – attacks
* Hippocampus dysfunctions– worry re: future attacks (learned response)

Biochemical abnormalities
* ↑ arousal: NE & 5-HT
* ↓ GABA

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16
Q

Etiology: Psycho

A

Cognitive theory
* are hiper sensitive to their body sense
* prone to interprete negative schemas - about their bdoies
* ex: heart beting super fast,’‘im having a heart attack’’

Learning theory
1.The first panic attack happens and gets linked to neutral things (like a fast heartbeat or a specific place).

2.Over time, these cues (internal like body sensations or external like locations) start triggering anxiety because they’re associated with the panic attack.

3.The stronger the panic attack, the stronger this association becomes, making future anxiety more likely when those cues appear.
Anxiety sensitivity & perceived control

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17
Q

Presentation: Psycho

A
  • Safety behaviours & persistence of panic
  • the more they do behaviours to not have panic attack more they will/might persist (learned condition)
  • Cognitive biases & maintenance of panic
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18
Q

Treatment

A

Biological
* Antidepressants (SSRIs, tricyclics)
- some symptoms like the aasevi worry of panic attacks but they dont adress the panic attck themselves
* Benzodiazepines
-addictive
-cognitve and motor side effects (drinking alchool)
- symtoms return after they stop

Psychological
* Exposure(be exposed time and time again to panick attack)
* CBT
-better long term
-not always worksa

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19
Q

Agoraphobia

A

Anxiety about being in places hard to escape or embarrassing

  • Crowds
  • Buses, Skytrain, cars
  • Restaurants, theatres, mall

Fear of fear
* Common complication
* Interferes with functioning

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20
Q

Generalized Anxiety Disorder
(GAD)

A
  • Chronic, uncontrollable worry
  • Persistent, excessive agitation
  • Occurs on most days for 6+ months
  • **Can interfere with functioning **
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21
Q

Worry in GAD

A

Apprehensive expectation (future-oriented)

  • Thoughts
  • Unproductive
  • Uncontrollable
22
Q

Prevalence

A
  • Lifetime prevalence 5.7%
  • Women 2x > men

Onset?
* 60-80% report anxiety most of life (chronic)
- young adulthood
- it seeps in

23
Q

Etiology: Bio

A
  • Genes (moderate)
  • NTs (GABA, 5-HT, NE)
  • Hormones (CRH)
24
Q

Etiology: Psycho

A
  • Perceptions of uncontrollability &
    unpredictability
  • decrese Sense of mastery (sense of loss of control)
  • Negative consequences of worry(intrusive thoughts)
  • Cognitive biases for threatening information
24
**Integrative Model**
**Biological vulnerability** and /or **Psychological vulnerability** = **Life Stress** > **Anxious apprehension** > **Worry Process**: Preoccupation Poor problem-solving skills Avoidance of imagery Restricted ANS responses
24
Treatment
**Biological** * Benzodiazepine -time limited -only last while u take it * Buspirone - focuses on mood **Psychological** * CBT
25
**Obsessive-Compulsive Disorder (OCD)** ## Footnote it used to be related to anxiety but it is not anymore it now falls under compulse control problems
* **Unwanted & intrusive obsessive or distressing images, thoughts, impulses** * **Often accompanied by compulsive behaviours** * **they are also irrational**
26
Obsessions
**Intrusive (ego-dystonic), unwanted, foreign (ego-alien), and recurring:** * Thoughts * Images * Impulses Themes: contamination, aggression, violence, religion, sexuality, order
27
Compulsions
**Repetitive behaviour or mental act that the person feels driven to perform to:** * **Neutralize the obsessive thoughts or images** * **Prevent some dreaded event or situation** * **Provide relief(short-term)** * **Functionally (but not necessarily logically) related to obsessions**
28
Associated Features
* Mental Rituals * Fluctuating Insight(is lrrational - is not) * Family Involvement * Avoidance * Reassurance-Seeking - do reserch
29
Prevalence
* **Lifetime prevalence: 3% ** (no gender/ethnic differences) * Onset typically **early adolescence or adulthood** * **Course often chronic** (only ~40% seek therapy) **Most have multiple obsessions**
30
Comorbidity: other related disorders
* Common (anxiety and mood disorders) * Depression in 80%
31
**Etiology: Bio**
**Genes** Moderately heritable **NTs**(neurotransmitters) 5-HT implicated **SSRIs(seratonin) decrese emotional force** of the obsessions …but decresed in 5-HT function not found
32
Abnormalities in brain function
* **Slight structural abnormalities in basal ganglia (caudate nucleus)** * **higher levels in metabolic levels in other parts of the brain ** (e.g., thalamus – cleaning and checking)
33
Etiology: Psycho
* **Attention to material related to obsessions** (biases) * **Bad thoughts = bad deeds ** (capable of causing harm) * **Self-blame** * **Attempts to suppress thoughts increase them**
34
# Etiology: Psycho Behavioural Theory: Conditioning*
**1. Initial fear classically conditioned** bad thought(UCS) + relif (neutral)= washing hands(UCR) bad thought(CS) = washing hands(CR) at first it would be random with time would be reinforced **2. Compulsions negatively reinforced (operant conditioning)** **3. Stimulus generalization**
35
Etiology: Socia
Behavioural Theory: Conditioning * Social reinforcement - by going along one's fear like cleaning the house super well so the person dont get upset, it only reinforces that the house needs to be clean so something bad dont happen
36
37
**Presentation: Bio** | high biological disorder
**Hyperactivity in neural loop:** orbital frontal cortex > cingulate gyrus > striatum (caudate nucleus and putamen) > globus pallidus > thalamus > back to the frontal cortex
38
**Basal ganglia**
**Typical: Control of motor behaviour** **OCD: Compulsions** (severity of disorder correlates with brain activity?) Treatment (Bio and Psycho) **reduce caudate nucleus activity**
39
**Orbitofrontal cortex (OFC)**
Typical: **Emotion in reward/punishment anticipation** **OCD: Increased activity (preoccupation?)**
40
Presentation: Psycho
Over-importance of thoughts * **Possible and necessary to control thoughts** * **Catastrophic thinking need to thought neutralization** * **Thought-action fusion** (thinking is the same as doing it/happening) Overestimation of threat * **Inflated sense of personal responsibility** **Perfectionism, intolerance of uncertainty** (ex; not doing three times? it wont work)
41
Presentation: Social/cultural
* Content of obsessions : ex religion,sexuality etc. * Whether OCD is considered deviant and in need of treatment ex: if u live in a culture where being gay is wrong and u pushed aside this ideas they may think is healthy to just push them away instead of dealing haed on
42
Treatment: Bio
**Antidepressants (e.g., SSRIs)** * lesser the power of obsession * …but stimulating 5-HT makes OCD worse **Cingulotomy (extreme cases)** * (surgury for cingulum) * huge risl Cingulum: limbic system communicatio
43
Treatment: Psycho
**Cognitive** Challenge maladaptive thinking patterns **Behavioural** Exposure & response prevention (ERP)
44
Cognitive Strategies
**Constructive self-talk** * Realistically assess the difficulty of resisting OCD * Replace maladaptive cognitions with realistic self-statements that emphasize ability to cope with OCD: “This task will be difficult, but I can handle this much anxiety this one time” **Cognitive restructuring** * Analyze catastrophic estimation of danger(ex: this is not a big or real danger) * Look at perceived responsibility for occurrence of catastrophe **Cultivating detachment** * OCD is just a brain hiccup (an automatic thought habit) that comes and goes in its own time (a cloud in the sky) * These hiccups are not in themselves important (no response is necessary because content is meaningless) * I guess I’ll do something pleasant while OCD goes away * **give the hiccups less power**
45
“Thinking Mistakes”
**Black-and-White Thinking** A situation is either one way or another (no “gray area”) **Catastrophizing** The very worst is happening/going to happen **Threat Overestimation** Chances of something bad happening greater then they really are **Mind Reading** You know what others are thinking
46
they might use evaluations
using charts
47
Putting it Together: CBT | slide 59
thoughts(unwanted) > see what the situation is (whats happening to make me feel this way- relisticly) > use tools (how to react to this situation
48
Treatment: Social
**Family/support system behavioural change ** so they no longer reinforcing their behviour

psyc 300 (13 decks)

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