Fear, anxiety disorders and treatment Flashcards
Functionality of Fear
Fear as a natural human reaction with basic survival function
- prepares organism for fight, flight or freeze
Components of anxiety
affective (Fear, Panic, Shame…),
cognitive,
physiological (incr. heart rate, sweating, shortness of breath..),
behavioural (flight, fight, freeze, avoidance…
Anxiety is referred to as pathological when…
… the arousal sytem is hypersensitive and responds to only minor stimuli
… there is extreme anxiety in the absence of actual danger
… intensity, duration, and/ or frequency of anxiety become distressful and chronic
–> leading to severe interference in a person‘s well-being and everyday functioning
List the “Classical” anxiety disorders
- Agoraphobia
- Panic disorder
- Social phobia
- Specific phobia
- Generalized anxiety disorder
(some classification systems add OCD, adjustment disorder, PTSD,…)
What is agoraphobia?
Anxiety in situations or places, e. g. public transport, lifts, shopping malls, crowds, cinema, airplane, long journeys or distances from home, where it is difficult to escape and / or to get help.
+ Avoidance and/ or safety behavior,
dependence on accompanying persons
+ Agoraphobia without (F40.00) or with
panic disorder (F40.01)
What is “Panic disorder”?
- Recurrent and unpredictable panic attacks:
— Sudden onset and rapid increase of anxiety
— Symptoms related to the autonomic nervous system (palpitations, chest pain, shortness of breath, sweating, tremor, dizziness, feelings of unreality etc. …) - Secondary fear of dying, losing control, or going mad
- Anticipatory anxiety with impairment of functioning and behavior change for at least 1 month
What is social phobia?
= Fear of scrutiny by other people in social situations, e. g. speaking, eating, drinking in public or just being in contact with other people,
with the …
… fear to embarrass him- or herself, being critisized or humiliated, particularly by the presence of anxiety symptoms (e. g. blushing,
sweating, tremor … )
- Avoidance and/ or safety behavior (e. g. talking fast during a meeting, breathing techniques etc. … )
Characterize the diagnosis “Specific Phobia” [F40.2 (ICD-10)]
= Exaggerated fear restricted to specific situations or objects
- Avoidance and/ or safety behavior
Examples of specific phobia [F40.2 (ICD-10)]
- Subtypes:
- Animal phobias (Ophidiophobia - Snakes)
- Natural environment phobias (Aquaphobia - Water)
- Blood-injection-injury phobias
- Situational phobias
- Other phobias (e. g. clowns, vomiting etc. … )
Characterize “Generalized anxiety disorder [F41.1 (ICD-10)]”
= Exaggerated anxiety and worries that are generalized to many different topics of everyday life („free-floating“) for at least 6 months and > 50% of time per day
- Difficulty to control or stop the worrying
- Multiple physiological complaints such as muscular tensions, trembling, sweating, etc.…
- Concentration problems, nervousness, insomnia, irritability
What model did the lecture discuss for the pathogenesis of anxiety disorders?
Diathesis-Stress-Model
What are the two main components of the Diathesis-Stress-Model?
Neurobiology (“predisposition”) and learning history
HPA Axis
Hypothalamus produces CRH (Corticotropin-releasing hormone)
–> Pituitary gland: ACTH (Adrenocorticotropic hormone)
–> Adrenal gland: Cortisol
Name 3 Learning theory models
Classical conditioning (Pawlow, dog - bell - saliva),
operant conditioning (Skinner, rewards and punishment)
observational learning (Bandura, bobo experiment - observe aggressive/friendly behaviour)
Explain Mowrer’s Two-Factor-Theory
!no info on slides, taken from internet and notes!
Phase 1. Classical conditioning
- individual transforms a neutral and innocuous stimulus (an airplane, a spider, an event at work, a crowded supermarket, etc.) into a painful or traumatic stimulus
Phase 2. Operant conditioning
- fear is reinforced by avoidance behaviour
e.g. avoiding train rides after a one-time panic attack on the train
What are functional and structural alterations of the brain related to anxiety disorders? (structure and activity change)
Amygdala - increased activity (GAD; panic, social, specific phobia)
ACC - increased (and decreased) (GAD; panic, social, specific phobia)
Insula - increased (panic, social, specific phobia)
Hippocampus - increased (and decreased) (panic, social phobia)
Prefrontal cortex - decreased (and increased) (panic, social phobia)
*sometimes both increased and decreased activity listed on the slide - lecturer pointed out the one that is not bracketed
Overview over substances used in treatment of
Panic disorder, GAD and social phobia respectively:
Summary and Overview Diathesis-Stress-Model
Anxiety disorders always result from a complex interaciton of many factors
- interaction btw. predisposition, (constant) tension and weak/stronger stressors (life events)
Treatments for anxiety disorders
- Psychotherapy: Cognitive
behavioral therapy (CBT) - Psychopharmacotherapy:
Antidepressants - Psychoeducation, relaxation,
exercise/ sport
What are “decision parameters” in treatment selection?
- Expectations of patient
- Diagnosis/ symptomatology
- Severity
- Pre-treatment
- Concomitant illness and medication
- Availability of therapists
- Competencies/ ressources of patient
What options are there for psychopharmacotherapy?
- alteration of monoaminergic neurotransmission (serotonin and noradrenaline) via …
- Selective Serotonin Reuptake Inhibitors (SSRI)
- Selective Serotonin Norepinephrine Reuptake Inhibitors (SSNRI)
- Tricyclic Antidepressants (TCA)
What is the aim of CBT in the treatment of anxiety disorders?
= reduction of avoidance and safety behavior to allow for a corrective experience, i. e.:
! Confronting the anxiety provoking stimulus repeatedly without the occurrence of the feared catastrophy!
- integration of this new and functional experience in the patient‘s everyday life step-by-step
Central element of psychotherapy for anxiety disorders?
Repeated confrontation/exposure to the most feared situation: exposure therapy
–> emotional learning via “corrective experience” (hapituation –> extinction)
How is exposure therapy implemented?
combined with preparatory meetings:
- create therapeutic alliance
- psychoeducation
- cognitive strategies
confrontation with feared situation:
- no safety or avoidance behaviour allowed
- Experience of anxiety until it decreases by itself
- repitition
Which exposures have a stronger therapeutic learning effect?
Exposures with high anxiety experience
Further techniques implemented as part of CBT
Cognitive therapy
Schema therapy
Experience oriented methods
Biography work
Emotion focused therapy
ACT (Acceptance and commitment therapy)
