Lecture 15 + 16 - Anxiety Disorders Flashcards
Anxiety disorder prevalence
- in a year; 12% of Canadians
- Lifetime: 1 in 4
Comorbidity in anxiety disorders
- HIGHLY comorbid
- treating other disorder has strong reduction of anxiety or depressive disorders (E.g. treatment of panic => improvement in Depression and GAD)
- underlying structure of all these is negative affect
Cognitive therapy of anxiety
- CBT and behavioural techniques
Social Anxiety Disorder
- Hypersensitive to criticism and rejection
- Low Self esteem, feelings of inferiority
- Restricted vocational and social achievements
- Prevalence 3 to 13%
- many more people experience anxiety than meet strict criteria
- Impairs daily life functioning
As explained by basic cognitive model:
invite to party –> think: people will judge me, i’m not interesting or attractive –> anxiety and nausea; don’t go
What are the different types of learning
1) Non-Associative Learning: habituation, sensitization
2) Associative Learning:
Classical Conditioning: Reflex-Based
Operant Conditioning: Reward-Based
3) Cognitive Learning: observational Learning
Operant conditioning
- Reinforcement; increases likelihood of behaviour
- Punishment; decreases likelihood of behaviour
- Positive; giving something
- Negative; removing something
Operant conditioning and social phobia
- when someone avoids social situations it’s negative reinforcement
- removing anxiety symptoms by not going out
Other examples or negative reinforcement: - safety behaviors
- Avoiding to go to social events to reduce anxiety
- Self-harm to reduce emotional pain
- Binge-eating/ drinking
Two process theory
- obtain behaviours through classical conditioning
- maintain behaviours through operant conditioning
Properties of associative learning (operant and classical conditioning)
- extinction
- stimulus generalization
Observational learning
Learning by watching others, without
instruction or reinforcement.
- Also called vicarious learning
- Watch someone else being reinforced for doing something and take cues from them
Exposure therapy - 3 types
1) Imaginal: use vivid imagery
2) Interoceptive: provocation of a feared physiological symptom (mostly applicable to panic disorder; provoke symptoms such as sweating, dizziness or short of breath)
3) In vivo: actual encountering the feared stimulus/situation
Issues with exposure therapy
- Drop out rates high
BUT If prepare well and do it gradually the drop out rate is “normal” compared to other therapies
Mechanism of Change in Exposure
- Habituation vs. inhibitory learning
- Fear associations are not removed, but new learning occurs, more tolerance
Steps of exposure therapy
- Psycho-education
- Make with client a list of situations that creates anxiety
- Develop a fear hierarchy and pick collaboratively situations
- Exposure, starting with those that induces moderate fear, gradually go up (use the SUDS to measure)
In-vivo exposure
- Include situations that put the client at risk for rejection or disapproval
- Do ensure safety
- Can be adaptable during therapy
Cognitive-Behavioural Treatment Strategies
- Can be a combination of cognitive strategies (evaluating/re-evaluating automatic thoughts) and exposure techniques
Anxiety sensitivity
- Cognitive perspective
- Fear of anxiety-related symptoms based on the beliefs that these symptoms have harmful physical, psychological and/or social consequences
- Interpreting suddenly occurring physical sensation as dangerous
- Social concerns regarding the symptoms
- High anxiety sensitivity predicts the development of panic disorder among soldiers in training
- Anxiety sensitivity index (measures of anxiety sensitivity)
Social phobia
- Prevalence: 6.8%
- M/F ratio is 1:1
- Not clearly linked to early trauma
- Potential genes: SLC6A4 (serotonin transporter) and COMT
- In children: greater behavioural inhibition predicts social anxiety disorder later on
- Fear that will act in a way that is embarrassing
- Experience anxiety in social situations
- Recognize that the fear is excessive
- Avoidance or severe anxiety
- Panic attacks common, but not unexpected (is not panic disorder because they’re specific)
- Diagnosis is not easy**
Social Anxiety in Childhood/Adolescence
- Childhood and especially adolescent anxiety is predictive of anxiety disorder in adulthood
- Anxiety in childhood/adolescence is predictive of less education, lower income and more stressful life events later in life
- Predictive of mental health problems such as substance abuse and MDD
Brain mechanisms in social anxiety/phobia
- Increased bottom-up activation (ex: amygdala) and reduced top-down brain regulation (ex: dorsal PFC)
- Reduced dopamine activity in striatum (involved in sensitivity to reward/punishment)
Biology of anxiety disorders
- Potential ntrs: dopamine, serotonin
o Ex: reduced serotonin 1a receptor density in insula, amygdala and anterior cingulate - Dopamine: reduced activity in striatum
Cognitive: self-focused attention
- Attention focused externally: other person, environment, task at hand
- Attention focused internally: own arousal, behaviour, thoughts, emotions, or appearance
- Stroop task
- People with social phobia slower to name social threat words, but not physical threat words
• Criticize, blushing vs. cancer
• Unclear if it’s specific for social phobia
- People with social phobia slower to name social threat words, but not physical threat words
Perceived poor social skills in social anxiety disorder
- Most people with SAD seem to possess adequate social skills. But they are inhibited when it comes to applying them in social situations
Avoidance and the use of safety behaviours
o Safety behaviour: behaviours that are intended to reduce the distress or hide a person’s anxiety
o Similar to negative reinforcement
o SAD use often safety behaviours
Panic Disorder
o Disorder is recurrent, unexpected attacks
o At least one month significant concern or worry or maladaptive change in behavior
o Not due to substance of other disorder
o Often goes with avoidance of social situations
o 4.7% lifetime
o Risk factors:
- Female: (F:M = 2:1)
- b/w ages 14-30 (average age of onset 21-23y)
- History of cigarette smoking
- Often life stress at or around first attack
o Long-term course is unpredictable
o Goes with agoraphobia
- Avoidance behaviour = negative reinforcement
Etiology of panic disorder
Genetic Vulnerability: twin studies show concordance rates of 30-40%
- Multiple genes has been linked, but inconsistent
False suffocation alarm theory of panic disorder
- PD patients have lower threshold for
detecting CO2 - The brain’s suffocation monitor incorrectly signals a lack of oxygen (relative to carbon dioxide), and thus
triggers a false suffocation alarm. - This produces sudden respiratory distress followed swiftly by a brief hyperventilation, panic, and the urge to
flee - Specific for Panic disorder
- Effects also visible in healthy first degree relatives
- Reaction to CO2 inhalation can be influenced by serotonin manipulations
- Some evidence that treatment reduces the response
Cognitive view of panic disorder
- catastrophic misinterpretation of bodily symptoms
- treatment with CBT
Cognitive model of panic disorder
Entering a crowded bus, feel a bit warm –> I am going to suffocate, I cannot breath, I get crazy –> Increased sweating and other phyiological responses
Generalized Anxiety Disorder (GAD)
- Core feature: excessive worry, more than 6 months
- Prevalence: 2.8-5 % in the population
- Male/female ratio:1:2
- Highly comorbid (substance abuse, depression, other anxiety disorders)
- Female: more often MDD; Men more often alcohol abuse/dependence
- heritability weak
- Onset childhood/adolescence –> chronic course
Treatment for GAD
SSRIs
CBT
GAD in children
- Excessive worry
- Perfectionism
- Excessive self-criticism
- Convinced about something bad will happen
- Need for reassurance/approval
- Often not aware that anxiety is disproportionate (differerent than in adults)
Treatment STUDY on GAD for kids
- All therapies better than placebo
- Best option was combination (CBT and SSRI)
