Lecture 2 - Anxiety Disorders Flashcards
What is anxiety?
An unpleasant emotional state characterised by fearfulness & unwanted and distressing physical symptoms and thoughts
What is fear?
emotional response to real or perceived imminent threat; surges of autonomic arousals necessary for fight/flight, thoughts of immediate danger and escape behaviours.
How is anxiety described in the DSM-V?
anticipation of future threat; more often associated with muscle tension and vigilance in preparation for future danger, and cautious/avoidant behaviours.
What is the evolutionary preparedness of anxiety?
Fight or flight response system
- Evolutionary mechanism involving primitive brains areas and decision making (e.g., limbic system)
- transmits ‘adrenaline’ surge
What is the genetic risk of anxiety?
- Possible; may be disruption to those who have more/less ‘autonomic liability’ (readiness to arousal)
- E.g., those with close (1st degree) relative with agoraphobia have greater risk of agoraphobia and other phobias (but also role-modeling of fear is an important factor)
What does the avoidance - conditioning theory say about anxiety?
Some things are, with no exposure, frightening, but we can be made to fear pretty much anything e.g. learn to fear a neutral stimulus if it is paired with an intrinsically fearful stimuli
- Reinforced for avoiding situations by drop off in arousal state
- This stops people from “unlearning” the “faulty learning” (stuck in an avoidance loop)
What does the associative learning: classical conditioning theory say about anxiety?
- “Pairing” a “stimulus” with a “response” for a new behaviour
- Pavlov’s Dog
- James Watson: Little Albert
What is generalisation?
Reaction that is given to stimuli that are similar to the stimulus used during training
What is extinction?
If the reaction that is given to the trained stimulus is presented repeatedly without being followed by the reward, this conditioned response will diminish or cease
What is spontaneous recovery?
Following extinction, the conditioned can spontaneously re-appear after a delay
What does operant conditioning say about anxiety?
- Context is crucial part of associative learning: Learning always takes place in a context and to the organism (context conditioned responses in drug use)
- Something is learned about a contingency, given a context
What is associative learning in clinical psychology?
Associative learning leads to many associations between the environment and our behaviour, as well as our internal states.
What are specific phobias?
Specific phobia is a disproportionate fear caused by a specific object, animal or situation
When are phobias diagnosed?
- a fear that is out of proportion to the actual threat of the object/situation (e.g. of spiders in UK, but not Oz)
- recognized by person as a largely groundless
- disrupting to their life
What is the prevalence rate and risk of fears and phobias?
- 6 in 100 people have phobic responses
- women twice as likely than men (4:2)
- 2 in 100 have phobia at a clinical level (I.e. a phobic disorder)
What causes phobias?
- Vicarious conditioning
- Trans-generational and/or peer-generated
- Role modeled fear/anxiety by parent/friend
- e.g. “fear of flying”
- Reinforced by others
- Media influence (e.g., Jaws and shark phobias) - Evolutionary advantages to pick up what’s a danger (n.b., animal research studies)
What treatments are there for simple phobias?
- Systematic desensitisation
- Exposure therapy
What is systematic desensitisation?
- Unlearning the fear response (avoidance loop)
Learn a coping response through:
- breathing/relax
- managing Negative Intrusive Thoughts (NITS) & developing coping thoughts
- over progressive stages, from least worrisome to most
What is exposure therapy?
- Assessment and fear hierarchy
- Start with the least fearful stimulus
- Exposure session
- Stay in the situation
- Repeated exposure
- Progressing through the hierarchy
What does LM’s case say about phobias?
Scared of daddy long legs
Assess and treat:
- no problems in relationships
- sister/mother had insect phobias
- phobia interferes with ability to be a medical student e.g. running off from ward round, and avoiding places when cranefly “in season”
graded hierarchy
- relaxation exercises
- pictures/spiders/crane fly etc.
Outcome
- catching & releasing crane fly
- Mother/sister started to use self-help
What does CB’s case tell us about treatment of anxiety?
- Had dense retrograde amnesia following an RTA
- After his self-report he didn’t trust himself to remember activities and was developing suicidal thoughts
- Treated with CBT where he worked through a hierarchy
- Outcome was successfull
What is generalised anxiety disorder?
is a common mental health condition where you often feel very anxious about lots of different things
What beliefs are related to generalised anxiety disorder?
- Catastraphising
- Intolerance of uncertainty
- Overestimation of threat
- Perfectionism
- Need for control
- Safely behaviours
- Excessive responsibility
- Negative beliefs about worrying
What is catastraphising?
They tend to believe that the worst possible outcome is likely to occur in any given situation. For example, they might believe that minor problems will escalate into major disasters or that small mistakes will lead to catastrophic consequences.
What is intolerance of uncertainty?
They have difficulty tolerating uncertainty and ambiguity, often feeling the need to know and control every aspect of their lives. They may believe that uncertainty is intolerable and that they must have complete certainty to feel safe and secure.
What is overestimation of threat?
They tend to overestimate the likelihood and severity of potential threats or dangers in their environment. They may interpret ambiguous or neutral situations as highly threatening and respond with excessive worry or anxiety.
What is perfectionism?
They hold rigid standards for themselves and fear making mistakes or falling short of expectations. They may believe that they must achieve perfection in order to be acceptable or worthy, leading to chronic worry about performance and outcomes.
What is need for control?
They believe that they must maintain control over their surroundings, emotions, and outcomes to prevent negative consequences. They may engage in excessive planning, monitoring, or reassurance-seeking behaviors in an attempt to exert control over uncertain situations.
What are safety behaviours?
They rely on safety behaviors or rituals to reduce anxiety and prevent feared outcomes. These behaviors may provide temporary relief but ultimately maintain the cycle of anxiety by reinforcing the belief that certain actions are necessary to avoid harm or discomfort.
What is excessive responsibility?
They feel overly responsible for preventing harm or protecting themselves and others from potential threats. They may believe that they are solely responsible for ensuring the safety and well-being of themselves and those around them.
What are negative beliefs about worry?
They may believe that worrying is necessary or productive, viewing it as a way to prevent bad things from happening or to prepare for potential dangers. They may struggle to see worry as unhelpful or excessive, even when it interferes with daily functioning.
What is the cause of generalised anxiety disorder?
- Evidence to suggest GAD may run in families. Studies of twins and families have found that individuals with a family history of anxiety disorders are at increased risk of developing GAD themselves
- Stressful life events, trauma, and chronic stress can contribute to the onset or exacerbation of GAD. Adverse childhood experiences, such as abuse, neglect, or parental conflict, have been linked to an increased risk of developing anxiety disorders later in life
- Social learning from parents and other important people can play a role
What is social anxiety disorder?
Social situations provoking fear or anxiety
What are functional consequence of social anxiety disorder?
- Elevated risks of school drop outs
- Decreased well-being and employment
- Issues in relationships
