CP: Lecture 3 Anxiety Flashcards
emotion aspects
expression
appraisal
feeling
physiology
action tendencies
behaviour
primary function of emotions =
to mobilize the organism to deal quickly with important (interpersonal) encounters
fear =
basic emotion
bij immediate danger
physiology bij fear
heartrate
blood pressure
muscle tone
breathing
behaviour bij fear
freeze, fight, flight, fright
anxiety =
threat in the future, dus anticipatory anxiety
complex emotion
gaat om avoidance + preparation
anxiety disorder: irrationality and distress?
irrationality: stimulus does not justify the fear, long duration of fear
distress: fear is very aversive, due to which avoidance or safety behaviours occur
DSM 5 anxiety disorders
Separation anxiety disorder
Selective mutism
Specific phobia
Social anxiety disorder
Panic disorder
Agoraphobia
Generalized Anxiety Disorder
Substance induced anxiety disorder
Anxiety disorder due to another medical condition
Other specified / unspecified anxiety disorder
prevalence anxiety per gender
bij vrouwen 23 bij mannen 15
anxiety and deptression
high comorbidity
relapse bij anxiety?
vaak relapse naar een andere anxiety disorder…
ethiology and maintenance of anxiety: mowrer 1950
= learning theory!
ethiology: classical conditioning (associating neutral stimulus with unconditioned response)
maintenance: operant conditioning (reinforcement of avoidance)
neurotic paradox =
short term: fear gets less temporarily
long term: pathology is maintains, sometimes grows. dus uiteindelijk meer fear terwijl ze dat juist willen vermijden.
critism of learning theory
- why more fear for certain stimuli?
- why sometimes fear without traumatic experience?
- why sometimes no fear after traumatic experience?
3 antwoorden op die 3 critisms
certain stimuli more fear:
1. Evolutionary preparedness / Prepared learning ->Snakes, Spiders, etc waren gevaarlijk dus meer fear
sometimes fear without trauma:
2. Vicarious learning, Information transfer, Inflation -> Learning ‘through someone else’s experience’
sometimes no fear after trauma:
3. Latent inhibition & Differential learning -> Previous positive experiences & different propensities to acquisition of fear
dus in kort kritiek + antwoorden
sommige stimuli meer: door evolutie
fear no trauma: vicarious learning, information transfer, inflation (via anderen)
trauma no fear: latent inhibition, differential learning (door eigen positieve experiences)
specific phobia dsm criteria
marked fear or anxiety
always, immediate
avoidance or endured
out of proportion to actual danger
6 months or more
distress impairment
not better explained
soorten specific phobias
animal
natural environment
blood-injection-injury
situational
other
heritable aspects of anxiety
neuroticism is 40%
behavioural inhibition
specific genes voor bv panic disorder
environmental factors for anxiety
positive and negative experiences
parent modeling
parenting styles
(bv ouders bang helm fietsen)
behavioural inhibition
temperament; distress in novel situations/people/environments
social anxiety disorder risk later
dit is dus high reactivity!!
low reactivity in children
minder kans op shyness (only 10%) en minder kans social anxiety (only 15%)
high reactivity in children
= behavioural inhibition
46% shy later
45% social anxiety symptoms later
dus… social anxiety does not always have a …. temperament
vulnerable!
waarom werkt exposure voor phobia? 3 verschillende theorieen
- reciprocal inhibition: relaxation response causes inhibition (maar is niet zo, ook response without relaxation)
- erase, replace association -> habituation (no, fear can return)
- extinction -> inhibition of CS-US association by a CS-noUS association (ja!)
inhibition of CS-US association door
amygdala
CS-noUS association door
prefrontal cortex and hippocampus
medical therapy specific phobia
Cognitive enhancers with exposure?
◦ D-cycloserine
Disrupting memory reconsolidation?
◦ Beta-blockers
verschil panic disorder and other anxiety disorders
panic disorder = unpredictable panic attacks. andere disorders hebben predictable triggers
symptoms of a panic attack
surge of fear, within minutes peak
4 van deze:
pounding heart
sweating
short breathing
chest pain
choking
trembling
nausea
dizzy
chills/heat
paressthesisas
derealisation/depersonalisation
losing control/crazy
fear of dying
panic circle
trigger stimulus (internal or external)
|
perceived threat -> apprehension or worry -> bodily sensations -> misinterpreted as catastrophic -> perceived threat etc.
wat was de oude explanation for panic disorder
hyperventilation causes dysregulation of blood acidity
welke anxiety is het meest prominent bij GAD
worries about the future
a criteria GAD
excessive anxiety and worries, more than 6 months, more than 2 domains
B criteria GAD
difficult to control the worry
c criteria
at least 3/6:
restlessness
fatigue
concentration
irritability
muscle tension
sleep disturbance
d, e, f criteria
d = distress
e= substance/medical?
f = other disorder?
ethiology of GAD (4 soorten)
- deficiency of GABA _. dus geen inhibition? (benzodiazepines lijken te werken)
- Borkovec: worrying is avoidance, therefore lowers arousal
- Newman and Llera: worrying induces negative mood, therefore less contrast in case of catastrophe -> reduced uncertainty (which is better than anxiety)
- meta-cognitive model (Wells): 1. worrying helps 2. worrying gets out of control
welke therapy has been proven to be better than CBT for GAD
metacognitive therapy
dus worrying is basically…
maladaptive coping, that maintains a negative emotional state and prevents true emotional processing, which makes the anxiety persists.
GAD and depression overlap misschien door….
◦ Neuroticism?
◦ Trans-diagnostic process?
- Repetitive Negative Thinking
- Future/ uncertain: GAD
- Past / certain: Depression
transdiagnostic =
gelijke symptomen bij verschillende disorders
Fear is adaptive, but it can derail…
Fear is also: behavior and physiology
Genes: general and specific vulnerabilities
Environment: positive vs negative
modelling & experience
Fear learning:
◦ Conditioning, Vicarious, Information transfer
Maintenance: Avoidance & Cognitions
Fear memory persists in amygdala
Treatment: Exposure
◦ Inhibition by newly acquired extinction memory
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