Lecture 3 and 4: Anxiety and Related Disorders Flashcards
What is anxiety
(automatic) activation in response to perceived threat
what are the three interrelated anxiety systems? give examples. what is important to note?
Three interrelated anxiety systems:
Physical system. - e.g. butterflies
Cognitive system. - e.g. if there is movement you need to decide whether there is actual apparent danger
Behavioural system - e.g. avoidance
NB: Activation in one means activation of another. Deactivation works in the same way.
What is impt to note about anxiety in general?
The experience of anxiety is the same in
normal and abnormal anxiety
Elaborate on the anxiety systems?
Physical system.
fight/flight response: sympathetic nervous system.
Mobilises resources to deal with threat.
Symptoms: sweating, heart rate, trembling etc
(classic symptoms of autonomic arousal)
Cognitive system.
perception of threat
attentional shift
hypervigilance
difficulty concentrating on other tasks.
Behavioural system.
escape/avoidance
aggression
freezing
what is different/same about abnormal anxiety
Same: physical, cognitive, behavioural aspects and not qualitatively different from normal anxiety
Different: Occurrence is excessive or inappropriate
anxiety occurs in absence of objective threat
anxiety is more intense than objective level of threat
How is abnormal anxiety characterised?
Characterised by overestimation of threat:
Probability of negative outcome
Cost of negative outcome
Elaborate on Panic disorder
can be with or without agoraphobia
what are some changes in DSM-5
- PTSD, Acute stress disorder and OCD are missing from chapter on anxiety disorders. (PTSD and ASD grouped in Trauma- and Stressor-Related
Disorders, OCD into Obsessive-Compulsive and Related
Disorders) - selective mutism (child who refuses to speak in the presence of stranger)
- DSM 5 ordered in age of onset
What is a panic attack
Abrupt and intense fear or anxiety
Peaks within 10 minutes
what is a panic attack characterised by?
Classic symptoms of autonomic arousal
Other associated physical symptoms
Fear of dying, loosing control, going mad
Situationally bound (cued) panic
- occurs in presence or anticipation of feared
stimulus
- can be associated with any anxiety or related
disorder
Unexpected (uncued) panic
- Associated with panic disorder
What is DSM5 panic disorder?
Panic Disorder:
Unexpected/spontaneous panic attacks
At least 2 panic attacks where the person can not
identify the trigger
Anxiety/worry about having another attack
Concerns about heart attack, going mad, epilepsy
Significant behaviour change trying to avoid another attack
Symptoms persist for one month or more
How long do people normally wait to get psychological treatment for panic disorder?
10 years
Outline the cognitive theory of PD
bodily sensations --> misintepretation of sensations --> anxiety --> increased bodily sensation --> panic (--> misinterpretation of bodily sensations)
what is specific phobia?
animal, natural environment, blood-injection-injury,
situational, “other”
what are some possible causes of specific phobia
1) Classical conditioning (Bouton, Mineka & Barlow, 2001)
2) CC May not be a complete account (Menzies & Clarke,1995):
- Conditioning event is not sufficient to cause phobia
- Conditioning event is not necessary to cause phobia
- A lot of people did not have the certain significant experience.
3) Some stimuli are more likely to become phobic than others
- Hammer, needle, dental etc phobias are relatively rare
- Phobic fears: significant threat to survival during evolution
- Genetic ‘preparedness’ (Seligman, 1971; Öhman et al, 1975)
- > Easier to learn to fear?
- Innate/ unconditioned fears? (Clarke & Jackson, 1983)
what is important to note about specific phobia? (3)
1) Problematic or not in diff environments
2) Onset tends to be in childhood but they dissipate
3) If it is adult onset, more likely to stay and be chronic
RE Specific Phobias, what is meant by threat to survival? by preparedness and innate?
threat = If you were the sort of person scared of heights and particular animals you are more likely to pass this down. → evolutionary advantage to have this fear.
preparedness = .g. monkey prepared to learn fear of snakes not flowers. This account still presupposes that some sort of learning/conditioning has taken place.
Innate = e.g. Babies not going across visual cliff, maturation brings fears of e.g. strangers which go away.
How are specific phobias maintained i.e. why don’t we all have them?
- These innate fears are present at a normal level
- As you grow up you expose yourself to these feared objects. (what maintains anxiety is avoidance).
- When no exposure occurs, e.g. through overprotective parenting, phobia is maintained.
what is GAD?
Excessive and uncontrollable worry about wide range of outcomes
What are the physical symptoms of GAD? what is important to note?
Tension, irritability, restlessness, sleep problems
NB: Does not seem to be associated with panic. (worry to avoid panic)
What is GAD associated with (4)? Describe the associations
High trait anxiety - tendency to get anxious and interpret ambiguous information as threatening
Intolerance of uncertainty - GAD people constantly think something wrong with solution
Reduced ability to tolerate distress - Every Time they see uncertainty they wonder about how they will control the future.
Reduced problem solving confidence/success - Emotional regulation account of GAD which says not only want to avoid bad things, but also feeling bad.
what is OCD?
Repeated, intrusive, irrational
thoughts or impulses (obsessions) which cause severe anxiety, countered by Ritualized behaviours (compulsions)
What is OCD associated with (4)? Describe the associations.
Intolerance of uncertainty - (like GAD) need to make sure that that scary thought doesn’t come in. But different to GAD OCD people have option of physical or ritualistic behaviour to deal with it.
Inflated responsibility - e.g. Not only the house will burn down, but it will be my fault.
Thought-action fusion - OCD people cannot dismiss thoughts of e.g. “i want to kill my child” they think that thinking it is as bad as doing it or thinking it would cause me to do it. → catholic people have a higher chance of getting OCD.
Magical ideation - Think that by thinking something they can cause it to happen (or NOT to happen). Magical ideation is basically jinxing.
How is exposure for PTSD determined? what is important to note?
A. Exposure to actual or threatened death,
serious injury, or sexual violence in 1 (or
more) of the following ways:
Directly experiencing the traumatic event(s).
Witnessing, in person, the event(s) as it occurred to
others.
Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or
threatened death of a family member or friend, the
event(s) must have been violent or accidental.
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first
responders
collecting human remains; police officers repeatedly
exposed to details of child abuse)
NB: MUST have experience event
What other requirements are there for PTSD?
B. Intrusion symptoms (1 or more needed)
Memories, dreams, flashbacks of the event
C. Persistent avoidance of stimuli (1+)
memories etc, or external reminders of the event
D. Negative changes in cognition, mood (2+)
Fear, negative beliefs about self, others, the world (have to be on the lookout, paranoia type shit)
E. Changes in arousal, reactivity (2 +)
Anger, recklessness, self-destructive acts, sleep
disturbance
Which requirement is new to DSM 5?
E [Changes in arousal, reactivity (2 +) ]
Anger, recklessness, self-destructive acts, sleep
disturbance
How long do PTSD symptoms have to last to be PTSD?
1 month or more
How many people normally experience a traumatic event?
50-60% of people
PTSD prevalence? what is the consequence of this?
5-11%
Critical to identify people who need assistance
to prevent post-trauma problems
what are the risk factors for PTSD?
Pre-trauma (e.g., coping style)
Trauma (e.g., meaning)
Post-trauma (e.g., social support)
what is the aim of CBT? what is done to achieve this?
Aim to reduce (biased) threat appraisal
Questions asked:
How likely is it that the event will happen?
How bad would it be if it did happen?
what are some cognitive techniques for CBT?
Thought-diaries to identify automatic thoughts.
Thought challenging:
- What’s the evidence (against) the thought/belief?
- Pros and Cons of having the thought/belief
what are some behavioural techniques for CBT?
Exposure to feared stimuli (e.g., public transport).
Exposure to feared outcomes (e.g., negative social
evaluation).
- in vivo vs imaginary exposure
- Flooding vs Systematic desensitisation
what’s the difference between flooding and systematic desensitisation? what are the consequences of each method?
Systematic is creating a gradual exposure schedule. Starting with mildly provoking stimuli, then if they get over that, increase the intensity of the exposure in a gradual fashion. They have to be comfortable at a stage.
Flooding is just touching a snake. People won’t arrive or participate.
How do behavioural techniques affect cognition?
Exposure to feared stimuli:
–> Reduces judgments of likelihood of harm
Exposure to feared outcomes:
–> Reduces judgments of cost
What is most important for anxiety treatment?
Exposure treatment
