Lecture 2: Anxiety Flashcards
leerdoelen:
* Maladaptive emotion-regulation strategies
* What is the purpose of fear?
* What is “normal” anxiety?
* What is the prevalence of anxiety?
* What are risk and protective factors?
* How is development of anxiety disorders explained?
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emotion regulation=
the processes involved in influencing which emotions one has, when one has them, and how one experiences and expresses these emotions
- welke emoties
- wanneer
- hoe ervaren
- hoe uitten
3 adaptive emotion regulation strategies
- acceptance: acceptance of experiencing negative emotions, and other internal events (thoughts/memories/bodily sensations)
- cognitive reappraisal: generating different perspectives on emotion-eliciting situations to change their emotional impact in a positive manner
- problem-solving: conscious attempts to change situations that elicit emotional responses
3 maladaptive emotion regulation strategies
- rumination: repetitively focusing on feelings an problems, their causes and consequences, without taking action (self-blame)
- avoidance: avoid aversive situations
- suppression: 1) expressive: hiding and countering emotional expressions, 2) thoughts: attempts to voluntarily suppress thoughts
Transdiagnostic perspective on role of emotion-regulation in psychopathology=
problematic emotion regulation is a common risk factor for the dvelopment of psychopathology (e.g. obesitas, anxiety, depression, behavioural problems, eating disorders, addiction)
maar een ander perspectief op ER is…
emotion regulation difficulties are specific to psychological problems
emotion regulation bij depressie
+ rumination
+ avoidance
- adaptive
behaviour problems: emotie regulatie
suppression of vulnerable emotions (e.g. anxiety) but not anger
behavioural problems in children may be related to parental traditional view on gender, why?
parents may speak with daughters about their emotions, and not with boys. therefore boys never learn to express their emotions
anxiety emotion regulation
+ rumination
+ avoidance
- acceptance
- cognitive reappraisal
what is key in emotion regulation
emotion regulation flexibility! adapting the strategy to the context. it is not always adaptive or maladaptive
what is the difference between fear, anxiety and phobia
- Fear: emotional response to real or perceived immediate threat
- Anxiety: anticipation of future threat
- Phobia: fearful or anxious about or avoidant of circumscribed objects or situations. No specific cognitive ideation
symptoms of anxiety: general terms
- alarm signal (danger)
- preparing the body to act quickly
- keep distance from the danger
emotional symptoms of anxiety, cognitive, physiological and behavioural
emotional/affect: anxious
cognitive: tunnel vision, negative thoughts
physiological: trembling, palpitations, sweaty hands, headache, abdominal pain
behaviour: avoidance and safety behaviours
common threats in typical development
0-6 months: Loss of support, loud noises
7-12 months: Strangers, heights, sudden things
1 year: Separation from parents
2 years: Loud noises, animals, darkness, toilet training
3 years: Masks, dark, animals, supernatural creatures, toilet training
4 years: Separation from parents, noise, dark, supernatural creatures
5 years: Animals, “bad people”, dark, supernatural creatures
6 years: Supernatural creatures, dark, physical injury
7-8 years: Supernatural creatures, thunderstorm, being alone, death, fear based on media (e.g., natural disaster)
9-12 years: School tests and performance, physical injury, death, natural disaster, appearance
Adolescence: see before + soc. achievem., humiliation, health (dental treatm.)
how to know whether something is deviant
- 4 Ds (danger, distress, deviance, dysfunction)
- dsm criteria
kijken naar slides over prevalentie anxiety
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wat zijn belangrijke trends binnen de prevalentie van anxiety
- any anxiety disorder: u shaped, meeste op jonge en oudere leeftijd
- separation anxiety: voornamelijk jong, neemt na 10 enorm af
- GAD, panic disorder and agoraphobia increases with age
- specific phobia remains somewhat the same
which anxiety disorders have onset in childhood (6-12 jaar)
- specific phobia
- selective mutism
- separation anxiety
which anxiety disorders have onset in adolescence
- GAD
- agoraphobia
- panic disorder
- social anxiety
what does anxiety look like for the environment
- Avoiding certain situations, e.g., staying home from school
- Alarming adults
- Clinging
- Physical complaints
- Sleep problems: falling asleep or staying asleep
- Concentration problems
- Feeling small
- Getting angry, easily upset
- Perfectionism
- Lying
- Many “what if” questions, reassurance questions
- A lot of “just in case” behaviour
safety behaviours in anxiety: wat zijn ze en wat zijn de gevolgen
= attempts to prevent or avoid feared outcomes that are viewed by the anxious individual as threatening or catastrophic
safety behaviours may reduce anxiety in the moment, but maintain anxiety in the long run:
1. because the child does not experience that the feared outcomes do not occur without the safety behaviour or learn to cope with it
2. the child attributes the absence of negative experiences to the safety behaviour and not to own effort or abilities
3. safety behaviours can increase the feared outcomes
examples of safety behaviours
- superstitious behaviours
- reassurance seeking (re-reviewing answers, double check, reading notes right before exam, cramming)
genotype of the child that contributes to anxiety
- temperament: behavioural inhibition (as a baby: high reactivity to stimuli, crying and limb movements. as a child: does not approach strangers, stares at them, stays close to mom)
- fear sensitivity and disgust sensitivity
genotype of the parents that contributes to anxiety
- model anxious behaviour
- facilitate negative, threatening interpretations of ambiguous situations
genotype of the child, which influences the way their rearing environment, which contributes to anxiety
control and protect the child to a high degree from emotionally upsetting situations
phenotype of the child that contributes to anxiety
avoidance, negative thoughts, feeling sick and anxious
how does the rearing environment strengthen the phenotype of the child
stimulate and strengthen avoidance, discourage discussions about negative experiences
how does the phenotype of the child affect the rearing environment
avoidance
risk factors in the system
- macro: SES, culture, conflict
- micro: genotype child and parent, parental control and rejection (esp. authoritarian), overprotection, insecure attachment, school
- child: age, gender, genes
- chrono: negative life events (death, domestic violence, divorce, bullying)
school as a risk factor
- leaving home environment (separation anxiety)
- tests, presentations, performance
- bullying risk
- relationships, independence (social anxiety disorder)
functional analysis of school refusal
negative reinforcement:
- avoidance of negative affect
- avoidance of social evaluation
positive reinforcement:
- seeking attention
- pursuit of tangible rewards
global risk factors for anxiety
- More females than males report anxiety disorders (but gender considered as binary)
- 55+ adults report less anxiety disorders than other age categories
- More anxiety disorders in conflict areas than non-conflict areas
- Higher prevalence Euro/Anglo countries (but are diagnostic criteria, assessment instruments, perspective on mental health culture-independent?)
- Lowest anxiety in poor countries (but within a country the relation is reverse: the higher the income, the lower the anxiety)
protective child factors for anxiety
Deliberate control:
* Attention control
* Behavioural control
* Emotion regulation: adaptive strategies & flexibility
Perceived control (also self-esteem)
* Sense of security that new situations can be controlled or tolerated
protective family factors
- Authoritative parenting style
- Family support
- Safety (physical, psychological)
- Predictability
protective school factors
- Positive climate
- Mentors
- Safety (physical, psychological)
- Predictability
3 routes to anxiety
- Classical conditioning/ experiential learning (child has experienced something)
- Model learning (child sees someone else doing /experiencing something)
- Informative learning (e.g., child receives negative information)
mechanisms that can maintain or increase anxiety
- Cognitive biases
- Avoidance
- Common and different factors: Comorbidity anxiety and depressive disorders
cognitive biases=
automatic, implicit cognitive biases
kijken modellen in schrift: onset anxiety disorders, cognitive bias maintains anxiety, avoidance maintains anxiety
echt doen
hoe werken die cognitive biases
Fast response to “threat” stimulus (also: “stressor”):
* Stimulus attracts attention but once detected, one shifts attention to something else
* Implicit association that the stimulus is bad/threatening/negative/will result in negative outcomes
* Stimulus trigger negative memories
kan je cognitive biases aanpakken in therapie
nee, want biases zijn impliciet en unconscious. maar je kan wel de schemas addressen
avoidance maintains anxiety:
can be adaptive because it leads to feelings of relief, but no development of coping with anxious situations on the long run, and anxious thoughts are not invalidated
diathesis stress model applied to anxiety
- Emotion-regulation can contribute to predisposition/diathesis
- Diathesis and stress: each develops
- Diathesis and stress: interact
- Children with low predisposition can also develop anxiety, when stress is high
summary
- Emotion regulation (ER) strategies can be maladaptive or adaptive but flexibility in applying ER strategies is most important
- Problematic ER is related to psychological complaints
- There are different types of anxiety disorders
- Anxiety is maintained via avoidance, cognitive bias
- Risk factors, protective factors in the child and in the environment
- It helps to have a sense of deliberate and perceived control
Are you able to tell the role of parents in maintaining their child’s anxiety?
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