Lecture 15 + 16 - Anxiety Disorders

Question 1

Anxiety disorder prevalence

Answer 1

• in a year; 12% of Canadians

- Lifetime: 1 in 4

Question 2

Comorbidity in anxiety disorders

Answer 2

• 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

Question 3

Cognitive therapy of anxiety

Answer 3

• CBT and behavioural techniques

Question 4

Social Anxiety Disorder

Answer 4

• 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

Question 5

What are the different types of learning

Answer 5

1) Non-Associative Learning: habituation, sensitization
2) Associative Learning:
Classical Conditioning: Reflex-Based
Operant Conditioning: Reward-Based
3) Cognitive Learning: observational Learning

Question 6

Operant conditioning

Answer 6

• Reinforcement; increases likelihood of behaviour
• Punishment; decreases likelihood of behaviour
• Positive; giving something
• Negative; removing something

Question 7

Operant conditioning and social phobia

Answer 7

• 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

Question 8

Two process theory

Answer 8

• obtain behaviours through classical conditioning

- maintain behaviours through operant conditioning

Question 9

Properties of associative learning (operant and classical conditioning)

Answer 9

• extinction

- stimulus generalization

Question 10

Observational learning

Answer 10

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

Question 11

Exposure therapy - 3 types

Answer 11

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

Question 12

Issues with exposure therapy

Answer 12

• Drop out rates high

BUT If prepare well and do it gradually the drop out rate is “normal” compared to other therapies

Question 13

Mechanism of Change in Exposure

Answer 13

• Habituation vs. inhibitory learning

- Fear associations are not removed, but new learning occurs, more tolerance

Question 14

Steps of exposure therapy

Answer 14

• 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)

Question 15

In-vivo exposure

Answer 15

• Include situations that put the client at risk for rejection or disapproval
• Do ensure safety
• Can be adaptable during therapy

Question 16

Cognitive-Behavioural Treatment Strategies

Answer 16

• Can be a combination of cognitive strategies (evaluating/re-evaluating automatic thoughts) and exposure techniques

Question 17

Anxiety sensitivity

Answer 17

• 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)

Question 18

Social phobia

Answer 18

• 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**

Question 19

Social Anxiety in Childhood/Adolescence

Answer 19

• 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

Question 20

Brain mechanisms in social anxiety/phobia

Answer 20

• 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)

Question 21

Biology of anxiety disorders

Answer 21

• Potential ntrs: dopamine, serotonin
  o Ex: reduced serotonin 1a receptor density in insula, amygdala and anterior cingulate
• Dopamine: reduced activity in striatum

Question 22

Cognitive: self-focused attention

Answer 22

• 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

Question 23

Perceived poor social skills in social anxiety disorder

Answer 23

• Most people with SAD seem to possess adequate social skills. But they are inhibited when it comes to applying them in social situations

Question 24

Avoidance and the use of safety behaviours

Answer 24

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

Question 25

Panic Disorder

Answer 25

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

Question 26

Etiology of panic disorder

Answer 26

Genetic Vulnerability: twin studies show concordance rates of 30-40%
- Multiple genes has been linked, but inconsistent

Question 27

False suffocation alarm theory of panic disorder

Answer 27

• 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

Question 28

Cognitive view of panic disorder

Answer 28

• catastrophic misinterpretation of bodily symptoms

- treatment with CBT

Question 29

Cognitive model of panic disorder

Answer 29

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

Question 30

Generalized Anxiety Disorder (GAD)

Answer 30

• 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

Question 31

Treatment for GAD

Answer 31

SSRIs

CBT

Question 32

GAD in children

Answer 32

• 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)

Question 33

Treatment STUDY on GAD for kids

Answer 33

• All therapies better than placebo

- Best option was combination (CBT and SSRI)