Exam 2 - Anxiety Disorders Flashcards
Anxiety:
The 5 CORE Anxiety Disorders
- Specific Phobias
- Social Anxiety Disorder (SAD)
- Generalized Anxiety Disorder (GAD)
- Panic Disorder
- Agoraphobia
Anxiety: Fear vs. Anxiety
Fear:
* Present focused: response to immediate danger/threat
* Intensity builds quickly
**Anxiety: **
* Future focused: anticipate and prepare
* ongoing feeling/worry of anticipation
* Example: Thinking about an upcoming project that’s due
Anxiety:
The Yerkes-Dodson Law: Inverted U-Model
There is an optimal level of arousal (stress) that maximizes performance
- Low arousal = low performance
- Moderate arousal = Optimal Performance
- High arousal = declining performance
Anxiety: (fear/anxiety)
“Normal” to “Disordered”
Disordered when…
- Symptoms are pervasive and persistent
- It involves excessive avoidance
- It causes significant distress and impairment
Anxiety:
Comorbidity Rates
Internal:
- > 50% of ppl with one anxiety disorder meet criteria for another anxiety
disorder
External:
- 75% meet criteria for another psychological disorder
- 60% also have depression
Anxiety: Prevalence
Anxiety Disorders = one of the most common mental disorders
BUT
- only ~25% of people who qualify for diagnosis seek treatment (so estimates are likely off)
Anxiety Disorders: Specific Phobia
Textbook Definition: Persistent, irrational, narrowly defined fears that are associated with a specific object or situation.
DSM-5 Definition: Intense, persistent fear of a specific object or situation that is excessive or unreasonable.
Anxiety Disorders: Specific Phobia
DSM-5 Diagnostic Criteria
- Immediate fearful response to phobia exposure
- Avoidance / Endured w intense Distress
- Persistent fear, anxiety, & avoidance: 6+ months
- Affects daily life
Anxiety Disorders: Specific Phobia
Prevalence
- ~12% of the general population (may be an underestimation)
- 3x more common in women
Anxiety Disorders: Specific Phobia
Facts (course, age, comorbidity)
- Chronic – phobias don’t usually go away with treatment
- Age of onset varies widely
- Often comorbid with other specific phobias
Anxiety Disorders: Specific Phobia
Etiology (Causes)
Evolutionary Adaptation - being scared helped protect us from harm
Classical Conditioning - When a stimulus is paired with something scary, we can become conditioned to fear the stimulus.
- ie: Baby Albert wasn’t scared of the Rat, but when it was paired with a load noise (feared stimulus) → the baby became conditioned to fear the Rat
- phobia translated
Anxiety Disorders: Specific Phobia
Treatments
Medications – NOT recommended
- Meds = Short-Term Solution (can become a “safety behavior”)
- Benzodiazepines = addictive & short-term solution
- Beta Blockers = not addictive, but are short-term solutions
Cognitive Behavioral Therapy (CBT) –- Highly Effective and Quick!
- Exposure therapy
- In-vivo exposure (real life exposure)
- Imaginal exposure
Levels of exposure, slowly increase (ie: level 1 = room filled with dog toys, level 10 = petting a dog)
Anxiety Disorders: Social Anxiety Disorder
(aka: Social Phobia)
Definition
DSM-5 Definition: “Fear or anxiety specific to social settings, where you feel noticed, observed, or scrutinized.”
- Social Anxiety Disorder = ALMOST identical to Specific Phobia definition in DSM-5
Anxiety Disorders: Social Anxiety Disorder
DSM-5 Diagnostic Criteria
- Fear of social rejection (and that others will notice your anxiety)
- Social interaction cause distress
- Social interaction is avoided or endured with intense anxiety/distress
- Fear and anxiety are disproportionate to the situation
_KEY COMPONENT: Fear of Evaluation_
Anxiety Disorders: Social Anxiety Disorder
Prevalence
- ~12% of the general population
- Slightly higher rates in women
Anxiety Disorders: Social Anxiety Disorder
Facts (course, age, comorbidity, impairment)
- Chronic – doesn’t usually go away with treatment
- Onset age: Adolescents – Early Adulthood
- High comorbidity with other anxiety disorders and depression
- Impairment Ranges: moderate to severe
Anxiety Disorders: Social Anxiety Disorder
Treatments
Medication:
- SSRIs → Very effective
- BUT relapse rates = high when medication is stopped
Psychological Treatments:
- Cognitive Behavioral (Preferred method of treatment by AMA)
- ie: exposure, rehearsal, role-play in group settings
- Social Skills Training
- ie: Extensive modeling of behaviors
- Attention Bias Modification Training
- A computer-based method that helps retreain people to focus on positive stimuli instead of negative stimuli.
- seems to help reduce anxiety (more data needed to know how long affects last)
Anxiety Disorders: Generalized Anxiety Disorder (GAD)
Definition
Textbook Definition: “Excessive and uncontrollable worry about a number of events or activities, and associated with symptoms of (physical) arousal.”
Anxiety Disorders: Generalized Anxiety Disorder
DSM-5 Diagnostic Criteria
- Excessive worry at least 50%
- Trouble controlling these worries
At least 3 of the following:
- Restlessness or feeling “keyed up” or on edge
- Easily fatigued
- Difficulty concentrating or mind going “blank”
- Irritability
- Muscle tension
- Sleep disturbance (falling asleep, restless sleep)
Anxiety: Generalized Anxiety Disorder vs. Major Depression Disorder
GAD symptoms vs. MDD Symptoms)
Big Differences:
- GAD = Big worries + Trouble controlling worries
- MDD = Sad Mood + Anhedonia (difficulty experiencing pleasure)
Anxiety Disorders: Generalized Anxiety Disorder
Prevalence
- Lifetime prevalence ~ 6%
- Gender: 2x more women than men (approximately 2:1 ratio)
Anxiety Disorders: Generalized Anxiety Disorder
Facts (course, heritability, comorbidity)
- Often a chronic condition
- Heritability ~33%
- Comorbidity: High overlap with MDD
Anxiety Disorders: Generalized Anxiety Disorder
Treatment
Cognitive Behavioral Therapy (CBD)
- Identify, track, and challenge worries
Mindfulness Based Cognitive Therapy
- Focus on present moment
- When mind wanders to ‘what ifs’, gently bring it back to present
- Relaxation strategies
- Identifying thoughts + emotions remembering anxieties aren’t facts
- Self-compassion
Medications
* SSRIs
* Benzos – not a good solution
Anxiety Disorders: Panic Disorder/ Panic Attack
Definition
DSM-5 (in class) Definition: “A sudden onset of intense apprehension, terror, and/or feelings of impending doom, peaks quickly (10 minutes)”
Anxiety Disorders: Panic Attack
Symptoms
Physical Symptoms:
- shortness of breath, chills, chest pain, etc…
Psychological symptoms:
- Depersonalization—feel like outside body
- Derealization—feel like world isn’t real
- Fear of losing control/going “crazy”
- Fear of dying
Anxiety Disorders: Panic Attacks / Disorder
Prevalence, gender, course
- ~3-4% of the population
- 2x as prevalent in women
- ~20% of college students have a panic attack (most only have one)
- Intermittent Course - goes away, but comes back
Anxiety Disorders: Panic Attacks / Disorder
Facts
- First attack usually experienced after high stress situation
- The _response_ to panic attack determines if one develops Panic Disorder
- Many adults who experience attack, never go on to develop Panic Disorder
Anxiety Disorders: Panic Disorder
DSM-5 Diagnostic Criteria
- Recurrent, unexpected panic attacks
- Persistent worry about having another panic attack
- or about the consequences of another attack (losing control, having heart attack, “going crazy,” etc.)
- Significant change in behavior because of/related to attacks (ie: avoidance)
- Can occur with or without Agoraphobia (The Fear of being in a situation difficult to escape or receive help)
Anxiety Disorders:
Agoraphobia Definition
The fear or anxiety about being in situations difficult to escape or receive help
Anxiety Disorders: Agoraphobia
DSM-5 Criteria
Fear or anxiety about being in situations
difficult to escape or receive help
- These situations are avoided or endured with intense fear/anxiety
Note: Often portrayed as being house bound, but it’s not necessarily the case
Anxiety Disorders: Panic Disorder
Treatment
Medication:
- Benzodiazepines – not recommended, relapse frequent
Therapy:
-
Exposure is key – and very effective!
- Interoceptive Exposure: exposure to physical sensations associated w panic attack
- Goal: watch anxiety go up, cope with it, learn that you will be okay
Anxiety Disorders
Genes & Heritability
- Anxiety = 30-60% heritable
- Some genes may elevate risk for disorders
- Genetic vulnerability for anxiety &
depression may overlap
Anxiety Disorders
Neurobiological / Relevant Brain Regions
Relevant Brain Regions:
- Limbic System is Key*
* Heightened activity in the amygdala / insula
* Diminished activity of the prefrontal cortex in response to threatening stimuli
Neurotransmitters:
- Serotonin and GABA are disrupted
- Norepinephrine levels increases
Sympathetic Nervous system involved: physical symptoms
Anxiety Disorders: Panic Disorder
Positive Feedback Loop
Positive Feedback Loop
When a person reacts anxiously to their physical symptoms this increases their anxiety.
Anxiety:
Types of Exposure Therapy
In Vivo Exposure: Exposed to the fear in real life
Imaginal Exposure: Imagining a fear vividly
Interoceptive Exposure Triggering physical sensations to learn they are not harmful
Virtual Reality Exposure: Being exposed to the fear via VR
Anxiety:
Treatment DURING a Panic Attack
During a panic attack – focus on present moment
- Focus on Breath
- What can you see, hear, taste, smell to help bring you to present
- wait for symptoms to lessen
Anxiety Disorders:
Treatment Across Anxiety Disorders
Exposure Therapy: effective for 70–90% of clients who do it
Mindfulness/relaxation and acceptance: A promising approach
Medications: Effective, but high relapse rates when medications are stopped
(SSRIs better long-term choice)
Psychological treatments are the preferred method
Anxiety Prevention
School prevention programs
- may be helpful in reducing future anxiety symptoms / disorders BUT evidence is mixed
