Lecture 3 Anxiety

Question 1

DSM-IV anxiety disorders (7)

Answer 1

• PD (with/without agoraphobia)
• SAD
• specific phobia
• social phobia
• GAD
• OCD
• PTSD & ASD

Question 2

Change in DSM-V (2 in 2 out)

Answer 2

• selective mutism in
• agoraphobia decoupled from PD
• OCD out
• PTSD & ASD out

Question 3

DSM-V definition of GAD (5)

Answer 3

• excessive, uncontrollable worry about a variety of events/outcomes
• occurs more days than not
• for at least 6 months

-at least 3 of 6 somatic symptoms:
restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance, NOT autonomic arousal

-distinguish from other disorders that also involve excessive worry

Question 4

Characteristics of normal worry

Answer 4

• in response to perceived future threat
• social threat in young adults, physical in older
• more verbal thought than imagery
• can be positive and controlled

Question 5

Steps of social problem solving

Answer 5

• problem definition
• generation of alternative solutions
• solution evaluation (+/-ve)
• solution selection

Question 6

Problem solving theory

Answer 6

worrying involves problem solving attempts

problem solving attempts thwarted:

• worry about more things
• biased threat perception interferes with social problem solving

Question 7

Avoidance theory

Answer 7

• imagery worry highly aversive, cause arousal anxiety symptoms
• worrier reduced imagery, switched to more verbal, =>reduced arousal increased tension
• cognitive avoidance, interferes with emotional processing, maintains fear

Question 8

Experiential avoidance theory

Answer 8

• worriers fear anxiety and distress, intolerance to negative experience
• constantly check for the future, avoid by worrying about them
• difficulties in emotion regulation due to avoiding internal experience:
  e. g. identifying, tolerating, modulating emotion

Question 9

Intolerance of uncertainty theory

Answer 9

• uncertainty causes frustration and stress, prevents action
• worry to reduce uncertainty, keep going to reduce uncertainty to zero but not possible
• preoccupied with details, interferes with problem solving
• aim to reduce uncertainty to 0 but not possible => keep worrying

Question 10

metacognitive theory: Type 1 worry

Answer 10

perception of threat + positive beliefs about worry (worry is helpful)
=> cope with threat

exit by problem solving or reassurance

don’t exit => type 2 because of cognitive biases

Question 11

Type 2 worry

Answer 11

worry about worry

worry + negative beliefs about worry
=> ineffective thought-control strategies (try to stop worrying but it’s ineffective)
=> increased anxiety and worry

lack of worry induces worry

Question 12

Treatment (4)

Answer 12

Biased threat perception
-probability and cost judgement

Problem solving

• structured problem solving training
• concentrate what can go right

Avoidance

• exposure to vivid images of feared event
• worry time
• exposure to anxiety/emo/distress
• exposure to uncertainty

Metacognitive
-challenge beliefs about worry (positive, negative)

Question 13

Treatment outcome

Answer 13

• hard to treat, least successfully treated among all anxiety disorders
• 50-60% improvement followed up
• new treatments with mindfulness and interpersonal approach