Exam #2 Flashcards
Separation Anxiety Disorder
Single sentence
Recurrent anxiety or fear concerning separation from an individual to whom they are attached.
What is the difference between anxiety and fear?
Anxiety is a higher level emotion and future oriented.
Fear is a primitive emotion and present oriented.
in DSM 5 the terms are interchangeable
What are the three characteristic components of anxiety?
1) Physiological- Heart pounding, heavy breathing, sweating.
2) Cognitive- What are they thinking? often dictated by schemas. *Key cognitive distortion in anxiety disorders is *catastrophizing- imagining worst case scenarios
3) Behavioural- One of the key behaviours for anxiety disorders is avoidance. Treatment- Individual must face the thing they fear.
Treatment: Drug therapy if physiological is high. Cogntitive therapy is cognitive component is high
Two factor theory of conditioning
Classical conditioning during the acquisition and operant conditioning in the maintenence phase. Used to explain phobias.
Etiology of anxiety disorders
No single cause
Moderate level of concordance in families 30-40%. (higher in some conditions, like agoraphobia).
Biological basis: Fear circuit: Percieve it-> Thalamus, Amygdala, hypothalamus, Periaduaductal grey, brain Stem
Behavioural Factors:
-Classical conditioning may be at the basis of many anxiety disorders. Classical conditioning alone can result in anxiety, while classical and operant conditioning can also result in anxiety. Ie Phobias are explained by a combination of classical and operant conditioning, known as two factor conditioning
- Two Factor Conditioning: Classical Conditioning during the acquisition phase and operant conditioning during the maintenance phase
- Vicarious Learning- Modelling can result in anxiety. Ie Watching 911 and acquiring fear of buildings, planes. So not just limited to classical conditioning
Cognitive Factors: Biased perceptions. Ie Person has a tendency to filter and only and only see negatives of a situation, schemas are often danger related beliefs- the world is dangerous. *Common cognitive distortion is catastrophizing- imagining the worst outcome for a situation.
Interpersonal Factors: If you come from a home where parents are critial and catastrophic then children can internalize this dialogue- known as the internal working model- this pessimistic view of reality is internalized by the children and then as adults they live out their life in a particular way.
Selective Mutism
Consistent failure to speak in social situations
- Can speak in other situations
- Interferes with education or employment
- Duration – at least 1 month
- Lack of speaking not otherwise explained
- Can’t occur exclusively during autism, psychotic disorder
Selective Mutism
Consistent failure to speak in social situations
- Can speak in other situations
- Interferes with education or employment
- Duration – at least 1 month
- Lack of speaking not otherwise explained- ie no language difficulty or medical condition
- Can’t occur exclusively during autism, psychotic disorder
Selective Mutism: Associated Features
- Shyness, fear of embarrassment, social isolation
- Compulsive traits, tantrums, negativism
- normal language skills
Selective Mutism
Consistent failure to speak in social situations
-Can speak in other situations
-Interferes with education or employment
-Duration – at least 1 month
-Lack of speaking not otherwise explained- ie no language difficulty or medical condition
-Can’t occur exclusively during autism, psychotic disorder. With autism the child may be quiet across a wide variety of situations, with selective mutism it is only during social situations. With
psychotic disorders they may be silent as well, but there will be additional factors such as hallucinations and delusions.
Selective Mutism: Associated Features
- Shyness, fear of embarrassment, social isolation
- Compulsive traits, tantrums, negativism
- normal language skills
- Anxiety is usually oresent
- Disorder does not occur in isolation
Comorbid Disorders for selective mutism
- Social Anxiety Disorder
- Seperation Anxiety
- Specific Phobia
Etiology of selective mutism
- Usually in children, not adolescents/adults
- Usually occurs before age of 5
- parents may be shy and withdrawn
- risk factors are high neuroticism and behavioural inhibition
- may receive genetic loading of genetic risk factors combined with behavioural modelling.
Separation Anxiety Disorder
Recurrent anxiety OR fear regarding separation from an individual to whom they are attached.
Associated features for Separation Anxiety Disorder
-Social Withdrawal, Apathy, Sadness
-Concentration Difficulties
Misery when away from home
-Unusual perceptual experiences
-anger and aggression
-need for constant attention and demanding
Comorbidity for seperation anxiety disorder
GAD and specific phobia
Separation Anxiety Disorder
Recurrent anxiety OR fear regarding separation from an individual to whom they are attached.
Distress anticipating separation
Worry about losing attached figure
Refusal/Reluctance to go out or be alone
Refusal/reluctance to sleep without being close to attached figure
Must be chronic pattern for 4 weeks in children or 6 months in adults
Must be distress or impairment
Associated features for Separation Anxiety Disorder
-Social Withdrawal, Apathy, Sadness
-Concentration Difficulties
Misery when away from home
-Unusual perceptual experiences
-anger and aggression
-need for constant attention and demanding
-most prevalent in children under the age of 12 (good prognosis,most grow out of/resolve anxiety)
Associated features for Separation Anxiety Disorder
-Social Withdrawal, Apathy, Sadness
-Concentration Difficulties
Misery when away from home
-Unusual perceptual experiences
-anger and aggression
-need for constant attention and demanding
-most prevalent in children under the age of 12 (good prognosis,most grow out of/resolve anxiety)
In Children- Refusal to go to school
in Adults- problems moving out of the house or getting married
Panic Disorder
Must be series of panic attacks, discrete periods of fear
Panic Disorder
Must be series of panic attacks, discrete periods of fear
Peaks within 10 minutes, meets 4/13 of the criteria for Panic Disorder
**Uncued- occurs out of the blue
1 month or more of:
- Concern about the attacks
- Implications of the attacks
- Change in behaviour
Causes of panic disorder
1st attack begins during a stressful period
- caffeine and other stimulants
- vigorous exercise
- alcohol, weed, and nicotine
What is the cognitive model of panic?
some sort of trigger in the environment(may even be a thought), the person then perceives this trigger as a threat, then apprehension. Bodily sensations intensify which results in catastrophic misinterpretation (ie feeling like they are having a heart attack)
Cognitive model of panic: Trigger-> perceived threat-> Apprehension->Bodily Sensations->Catastrophic Misinterpretation-> Perceived threat
Treatment point of view : Model is useful to explain what is happening to the client.
What is the cognitive model of panic?
some sort of trigger in the environment(may even be a thought), the person then perceives this trigger as a threat, then apprehension. Bodily sensations intensify which results in catastrophic misinterpretation (ie feeling like they are having a heart attack)
Cognitive model of panic: Trigger-> perceived threat-> Apprehension->Bodily Sensations->Catastrophic Misinterpretation-> Perceived threat
Treatment point of view : Model is useful to explain what is happening to the client. Address each stage and how it impacts panic, then begin de-escalation. Get them to examine their own experience
Associated features of panic disorder
Constant feelings of anxiety
- Demoralization
- Absent from work/school
- Disrupted Relationships
Comorbid conditions for Panic Disorder
MDD
GAD
Social phobia
What is the general prognosis for most disorders?
1/3 greatly improve, 1/3 improve somewhat, and 1/3 remain ill.
Comorbid conditions for Panic Disorder
MDD(most common)
GAD
Social phobia
Panic Disorder Differential Diagnosis
Due to general medical condition
-Thyroid problems
Panic Disorder Differential Diagnosis
Due to general medical condition
-Thyroid problems
Substance-induced anxiety disorder
-Stimulants, cannabis, depressant withdrawal
Other anxiety disorders
Social phobia, specific phobia, PTSD
What drugs are used to treat panic disorder?
Tricyclics
Monoamine Oxidase Inhibitors
SSRIs
Benzodiazepines
Panic Disorder Differential Diagnosis
Due to general medical condition
-Thyroid problems
Substance-induced anxiety disorder
-Stimulants, cannabis, depressant withdrawal
Other anxiety disorders:
Social phobia, specific phobia, PTSD
*Determine if it is uncued or not. Uncued = panic disorder
5 steps of Panic Control Treatment
Developed by David Barlow
1) Education
2) Cognitive restructuring about misappraisals
3) Breathing Retraining
4) Interoceptive exposure
5) Behavioural exposure
David Barlow
Developed Panic Control Treatment
List and give a brief definition of all anxiety disorders
Separation Anxiety Disorder *Selective Mutism *Panic disorder *Agoraphobia Specific Phobia *Social Anxiety Disorder GAD Substance/Medication Induced Anxiety Disorder Anxiety due to Another Medical Condition Other Specified Unspecified