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Psychopathology > Lecture 3 - Anxiety > Flashcards

Lecture 3 - Anxiety Flashcards

1
Q

Define stress, worry and anxiety

A

STRESS

  • physical/psych response to real/perceived threat
  • fight v flight

WORRY

  • thinking/imagining
  • past or future focussed
  • +ve: resolve/avoid threats; avoid emotions
  • -ve: learned behaviour
  • attempt for mental prob-solving (outcome uncertain but 1+ negative outcomes)

ANXIETY

  • feeling of dread
  • physical sensations
  • triggered by limbic system
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2
Q

Define fear

A
  • immediate alarm response to present danger
  • strong escapist tendencies
  • can be adaptive (flight/fight)
  • sympathetic NS arousal
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3
Q

Define panic

A
  • abrupt intense fear

- physical symptoms (heart palpitations, chest pain, shortness of breath, dizziness)

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4
Q

Explain and neurobiological aspects of anxiety

A
  • neurocircuitry: hippocampus, amygdala, cingulate cortex
  • ANS: sympathetic (fight/flight) and parasympathetic (mobilise, calm down)
  • HPA axis: hypothalamus, anterior pituitary, adrenal gland (cortisol); feedback process
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5
Q

What is the prevalence of anxiety disorders?

A

14.4% (most common)

Panic 2.6%
Agorophobia 2.8%
Social 4.7%
GAD 2.7%
OCD 1.9%
PTSD 6.4%
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6
Q

What are the gender differences in anxiety disorders?

A
  • more in females

WHY?

  • genetics? heritability of neuroticism?
  • hormonal diffs (cortisol, reproductive)
  • higher anxiety sensitivity?
  • gender-specific trauma
  • ruminate more
  • more sensitive to social cues
  • gender socialisation about confronting fears
  • higher appraisals of threats
  • other sociocultural factors
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7
Q

What is the burden and impact of anxiety disorders?

A
  • 4 days/mth out of role (1.5 days in those without anxiety)
  • 47% not in labor force (19% without anx)
  • reduced job-seeking
  • those who are working: 2+ jobs, self-employed/employers, work extreme hours, less satisfied with work accomplishments
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8
Q

How many people with anxiety seek help?

A

38%

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9
Q

What is the comorbidity of anxiety disorders?

A

50% have another dx (others say up to 81%)

GAD (82%) and panic with agoraphobia (72%) have highest comorbidities

Depression. 50%.
Why? interconnections in brain regions, partly shared genetic etiology, shared personality traits (neuroticism)

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10
Q

What are the 6 risk factors for anxiety?

A
  • female
  • illness
  • temperament
  • parenting style (over-protective)
  • early life experiences (bullying)
  • genetics (30-40%)
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11
Q

What are the selective attention/attentional biases in anxiety?

A

attentional system sensitive and biased in favour of threat-related stimuli

selective attention to aspects of environment that agree with thier threat

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12
Q

What are the types of safety behaviours?

A
  • direct avoidance
  • escape
  • subtle avoidance
  • restorative v. preventative
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13
Q

What is Cognitive Attentional Syndrome?

A
  • based on Wells’ meta-cognition
  • using coping strategies that involve controlling thoughts&raquo_space; issues in psychological wellbeing
  • meta-cognition is central to this process
  • meta-cognition: monitor, control, appraise thoughts/learning/memory
  • CAS is caused by extended thinking
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14
Q

What are the diagnostic features of GAD?

A
  • 6mths
  • excessive anxiety and worry more days than not
  • unable to control worry

3+ of

  • restlessness
  • fatigue
  • difficulty concentrating
  • irritable
  • muscle tension
  • sleep disturbance
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15
Q

What is the GAD prevalence, onset and course?

A
  • prev: 2% (2x women)
  • onset: <25
  • course: usually chronic
  • low rate of treatment-seeking
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16
Q

Explain the comorbidity of GAD. Does it occur first or second in most cases?

A

68% comorbid
- usually precedes others MIs

suicide: 17% attempt, 18% ideation
panic: 50%
depression: 25-30%
substance use: 60%

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17
Q

What are the 4 key psychological features of GAD

A
  • biases in thinking and reasoning (intolerant of uncertainty)
  • worry as avoidance
  • beliefs about worry (worry is helpful)
  • meta-cognition (meta-worry)
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18
Q

Explain the meta-cognitive model of GAD

A

Positive beliefs about worry > worry will help me solve problems/allow me to be prepared and cope with the threat

Type 1 worry:

  • external daily events
  • non-cognitive internal events

Type 2 worry:

  • worry about nature/occurence of thoughts
  • worry about worry
  • unable to function due to worry
  • “worrying is harmful”
  • “my worries will take over and control me”
  • outcomes: behaviour (avoidance, distraction), thought control (attempts to suppress), emotion (anxiety, frustration)
  • cog + somatic symptoms viewed as evidence of loss of control or of harmful effects of worry > vicious cycle
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19
Q

What is a panic attack?

A
  • abrupt surge of intense fear or intense discomfort
  • peak within minutes
  • 4+ of: increased HR, sweat, tremble, shortness of breath, choking, chest pain, nausea, feel dizzy/lightheaded, chills/hot flushes, numb/tingling, derealisation or depersonalisation, fear losing control/going crazy, fear dying
20
Q

What are the 3 types of panic attack?

A
  • unexpected / spontaneous: uncued, random
  • expected / situationally bound
  • situationally predisposed
21
Q

What are the alternative contributors to a panic attack?

A
  • CNS stimulants
  • withdrawal from CNS depressants
  • medical conditions
  • exercise
  • stress
  • hyperventilation
22
Q

What is the relationship between panic and hyperventilation?

A
  • hyperventilation has been considered to be a cause, correlate and consequence of panic attacks
  • hypercapnic = too much CO2 in blood
  • hyperventilation model: HPV symptoms lead to fear, which fuels further HPV (anx caused by hypercapnic breathing)
  • false suffocation alarm hypothesis: HPV serves as a way to avoid the anxiety caused by hypercapnic breathing
23
Q

Explain the cognitive model of panic

A
  • PA result from catastrophic misinterpretation of bodily sensations
  • anxiety sensitivity is a vulnerability factor
  • safety behaviours > persistence of panic
  • cognitive biases > maintain panic

Maintenance of panic:

  • selective attention to bodily events
  • safety behaviours
  • avoidance of anxiety-provoking situations
24
Q

How was Clark’s model of panic extended?

A

BANDURA

  • self-efficacy plays a central role (perception of ability to cope)
  • reduce panic by changing self-efficacy, NOT reducing misinterpretations of bodily sensations

BECK

  • catastrophic misinterpretations of bodily sensations
  • individual vulnerability > perceived likelihood of danger + level of coping abilities
25
Q

What is panic disorder?

A
  • recurrent, unexpected panic attacks
  • persistent apprehension over their recurrence/consequences
  • 1 month
  • sig. maladaptive change in behaviour related to the attacks (eg. avoidance)
26
Q

What is the prev and onset of panic disorder?

A
  • 40% of young people have had 1+ PA
  • 12mth prev: 1.1%
  • onset: 15-25yrs
    (onset after 40 suggests depression or possible somatic cause)
27
Q

What is the comorbidity of panic disorder?

A 
substances
medical conditions (eg. hyperthyroidism)
phobias (incl. agoraphobia 33-50%)
OCD
PTSD
separation anxiety
28
Q

What are the myths of panic disorder?

A

going crazy
losing control
heart attack

29
Q

What is agoraphobia?

A
  • marked fear/anxiety about 2+: public transport, open space, enclosed space, line/crown, outside home alone
  • fears/avoids situations bc. they think escape might be difficult/help not available if they need it
  • family or friend company may increase no. of situations that can be endured
  • often become discouraged, depressed and demoralised by the constriction in their lives
30
Q

What is the course and gender split in agoraphobia?

A

75% women

course: usually chronic, can wax and wane

31
Q

What are the risk factors for agoraphobia?

A
  • general vulnerability common to all anxiety disorders
  • personality: neuroticism, perfectionism
  • genetics: -ve affectivity
  • catastrophic misinterpretations
  • anxiety sensitivity: interpret anxiety sensations as harmful
  • Barlow: bio and psych vulnerability factors
32
Q

How can the cognitive model of panic be adapted for agoraphobia?

A
  • panic is strongly associated with the cognition that autonomic arousal is dangerous and can lead to harmful consequences
  • agoraphobia: fear of the dangerous and disastrous consequences is associated with specific situations
  • avoidance is a key maintaining factor in both
33
Q

What is the cognitive model of agoraphobia, according to Clark?

A
  • individual fears/avoids situations where they have had a panic attack
  • situations which are avoided then grow in number and breadth
34
Q

What are the predictors of agoraphobia?

A
  • severity of PA + anticipatory fears about consequences of attacks
  • earlier age onset = longer illness
  • experience of particular panic symptoms (eg. personalisation, chest pain, dyspnea, trembling)
  • anticipated panic &laquo_space;key role, strongest correlate
  • perfectionism
35
Q

What is a specific phobia?

A
  • irrational fear
  • markedly interferes with functioning
  • exposure: anxiety response
  • phobic stimulus avoided or endured
36
Q

What are the subtypes of specific phobia?

A
  • animal
  • natural environment
  • blood-injection-injury
  • situational
  • other

** most people with phobias have multiple phobias of different subtypes

37
Q

What is the prevalence and gender split of phobias?

A
  • prev: 9%
  • M:F = 1:4
  • only severe seek treatment
38
Q

What are the 4 proposed aetiological factors of phobias?

A

PSYCHODYNAMIC

  • Freud, Little Hans
  • castration anxiety + Oedipal complex
  • fear = misplaces fear/conflict

CONDITIONING

  • Little Albert
  • associated threatening stimulus with non-threatening
  • fear maintained by avoidance (lack of ‘testing’)

SOCIAL LEARNING

  • observe trauma in others
  • learnt by hearing about others’ experiences
  • modelled or ‘instructed’

NON-ASSOCIATIVE FEAR

  • feared stimulus represents long-standing danger to species
  • fear/avoidance increases reproductive opps
  • fear/avoidance partly under genetic control
  • biologically relevant
  • people who develop phobias do not ‘habituate’ to overcome ‘innate’ fears
  • habituation depends on: opps for exposure at critical developmental periods + individual diffs in rate of habituation
39
Q

What is the problem with the proposed aetiological factors of phobias?

A
  • many have no clear environmental cause (direct or indirect) > 56% children’s phobias; 68% adult

66% of people without phobia had experienced a conditioning event

40
Q

What is Social Anxiety Disorder according to the DSM-5?

A
  • fear situations with exposure to possible scrutiny by others
  • fear embarrassment and humiliation
  • fear acting in a way that will show anxiety > negative social evaluation
  • social sits almost always provoke fear/anx
  • social sits avoided or endured
  • fear/anxiety out of proportion to actual threat posed
  • persistent (6+ mths)
41
Q

What is the prevalence and gender split of social phobia?

A

lifetime prev: 7-13%

  • shyness: 20-48%
  • more in shy people (18%) relative to non-shy (3%)
  • studies suggest prev is increasing
  • on continuum: shyness > mild social fear > generalised social phobia > avoidant PD

GENDER

  • epidemiological studies: more F
  • clinical studies: equal F/M
42
Q

What is the onset, course, suicide rate and comorbidity of social phobia?

A
  • onset: early-mid teens (95% before age 20)
  • onset of more severe/generalised types especially early
  • course: usually stable and chronic (can fluctuate w life stressors)
  • suicide: 2x general population

COMORBIDITY

  • other anxiety disorders
  • mood disorders
  • substance use
  • social phobia usually precedes other dx
43
Q

What are the internal and environmental risk factors for social anxiety?

A

INTERNAL

  • genetics: heritability
  • cognitive: -ve appraisal of social situations
  • social skills deficit (chicken vs egg?)
  • temperament: behavioural inhibition; self-conscious shyness

ENVIRONMENTAL

  • parent-child interaction: high control + protection, less warmth
  • aversive social experience: teased, bullied, ridiculed
  • negative life events: esp in childhood (parental divorce/death, parent mental illness, family conflict, sexual abuse)
44
Q

What are the 3 key features of the cognitive model of social anxiety?

A

SAFETY BEHAVIOURS

  • exacerbate unwanted symptoms
  • contaminate social situations (seems unfriendly, aloof, uninterested)
  • support attributional bias (non-occurrence of catastrophe attributed to SB not distorted appraisals)
  • avoid eye contact, say little, let partner talk, plan what to say, pretend to be interested in something else

ANTICIPATORY + POST-EVENT PROCESSING

  • rumination
  • plan + rehearse conversations
  • ‘post-mortem’
  • selective abstraction

ASSUMPTIONS AND BELIEFS
3 CORE SCHEMA:
- core self-beliefs (I’m boring)
- conditional assumptions (If I show I’m anxious, people will judge me)
- rigid rules for social performance (I must always sound intelligent)

  • NATs: ‘I don’t know what to say. People must think I’m stupid’
  • self-processing: image of self as plain, unintelligent etc.
45
Q

What is the issue with defining anxiety disorders?

A

boundary b/w normal and pathological anxiety cannot be drawn with great precision or confidence

Psychopathology (14 decks)

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