Lecture 3 and 4: Anxiety and Related Disorders

Question 1

What is anxiety

Answer 1

(automatic) activation in response to perceived threat

Question 2

what are the three interrelated anxiety systems? give examples. what is important to note?

Answer 2

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.

Question 3

What is impt to note about anxiety in general?

Answer 3

The experience of anxiety is the same in

normal and abnormal anxiety

Question 4

Elaborate on the anxiety systems?

Answer 4

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

Question 5

what is different/same about abnormal anxiety

Answer 5

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

Question 6

How is abnormal anxiety characterised?

Answer 6

Characterised by overestimation of threat:
 Probability of negative outcome
 Cost of negative outcome

Question 7

Elaborate on Panic disorder

Answer 7

can be with or without agoraphobia

Question 8

what are some changes in DSM-5

Answer 8

• 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

Question 9

What is a panic attack

Answer 9

Abrupt and intense fear or anxiety

 Peaks within 10 minutes

Question 10

what is a panic attack characterised by?

Answer 10

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

Question 11

What is DSM5 panic disorder?

Answer 11

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

Question 12

How long do people normally wait to get psychological treatment for panic disorder?

Answer 12

10 years

Question 13

Outline the cognitive theory of PD

Answer 13

bodily sensations
--> misintepretation of sensations
--> anxiety 
--> increased bodily sensation
--> panic 
(--> misinterpretation of bodily sensations)

Question 14

what is specific phobia?

Answer 14

animal, natural environment, blood-injection-injury,

situational, “other”

Question 15

what are some possible causes of specific phobia

Answer 15

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)

Question 16

what is important to note about specific phobia? (3)

Answer 16

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

Question 17

RE Specific Phobias, what is meant by threat to survival? by preparedness and innate?

Answer 17

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.

Question 18

How are specific phobias maintained i.e. why don’t we all have them?

Answer 18

• 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.

Question 19

what is GAD?

Answer 19

Excessive and uncontrollable worry about wide range of outcomes

Question 20

What are the physical symptoms of GAD? what is important to note?

Answer 20

Tension, irritability, restlessness, sleep problems

NB: Does not seem to be associated with panic. (worry to avoid panic)

Question 21

What is GAD associated with (4)? Describe the associations

Answer 21

 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.

Question 22

what is OCD?

Answer 22

Repeated, intrusive, irrational

thoughts or impulses (obsessions) which cause severe anxiety, countered by Ritualized behaviours (compulsions)

Question 23

What is OCD associated with (4)? Describe the associations.

Answer 23

 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.

Question 24

How is exposure for PTSD determined? what is important to note?

Answer 24

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

Question 25

What other requirements are there for PTSD?

Answer 25

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

Question 26

Which requirement is new to DSM 5?

Answer 26

E [Changes in arousal, reactivity (2 +) ]
 Anger, recklessness, self-destructive acts, sleep
disturbance

Question 27

How long do PTSD symptoms have to last to be PTSD?

Answer 27

1 month or more

Question 28

How many people normally experience a traumatic event?

Answer 28

50-60% of people

Question 29

PTSD prevalence? what is the consequence of this?

Answer 29

5-11%
Critical to identify people who need assistance
to prevent post-trauma problems

Question 30

what are the risk factors for PTSD?

Answer 30

 Pre-trauma (e.g., coping style)
 Trauma (e.g., meaning)
 Post-trauma (e.g., social support)

Question 31

what is the aim of CBT? what is done to achieve this?

Answer 31

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?

Question 32

what are some cognitive techniques for CBT?

Answer 32

 Thought-diaries to identify automatic thoughts.
 Thought challenging:
- What’s the evidence (against) the thought/belief?
- Pros and Cons of having the thought/belief

Question 33

what are some behavioural techniques for CBT?

Answer 33

 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

Question 34

what’s the difference between flooding and systematic desensitisation? what are the consequences of each method?

Answer 34

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.

Question 35

How do behavioural techniques affect cognition?

Answer 35

 Exposure to feared stimuli:
–> Reduces judgments of likelihood of harm
 Exposure to feared outcomes:
–> Reduces judgments of cost

Question 36

What is most important for anxiety treatment?

Answer 36

Exposure treatment