lecture 4 Flashcards
fear and anxiety
- Fear
- A negative emotional state in response to real or perceived
imminent threat to the self.
-Present focused - Anxiety
- A negative emotional state that stems from anticipation of future
threat to the self. - Future focused
components of anxiety
Physiological
* Heightened level of arousal and physiological activation
* Examples: ↑ heart rate, shortness of breath, dry mouth
Cognitive
* Subjective perception of anxious arousal and associated
cognitive processes
* Examples: worry and ruminations
Behavioural (Clinicians often add this component)
* ‘safety’ behaviours
* avoidance
specific phobia
Fear and avoidance of objects or situations that do not
present any real danger
social anxiety disorder
Fear and avoidance of social situations due to possible
negative evaluation from others
panic disorder
Recurrent panic attacks involving a sudden onset of
physiological symptoms, such as dizziness, rapid heart rate,
and trembling, accompanied by terror and feelings of impending doom
Agoraphobia
Fear of being in public places
GAD
persistent, uncontrollable worry, often about minor things
separation anxiety
The anxious arousal and worry about losing contact with and
proximity to other people, typically significant others
selective mutism
Failure to speak in one situation (usually school) when able to
speak in other situations (usually home).
The most common specific phobia subtypes in order were
(1) animal phobias (including insects, snakes, and birds);
(2) heights;
(3) being in closed spaces;
(4) flying;
(5) being in or on water;
(6) going to the dentist;
(7) seeing blood or getting an injection;
(8) storms, thunder, or lightning.
Etiology of Specific Phobias and
Social Anxiety Disorder, theories
- behavioural
1. Avoidance conditioning
2. Modelling
3. Prepared Learning - cognitive
*Cognitive-behavioural models link SAD with certain
cognitive characteristics: - Attentional bias to focus on negative social information
- Perfectionistic standards for accepted social performances
- High degree of public self-consciousness
- biological
- Autonomic Nervous System (stability-lability)
* Having a more labile ANS (jumpy individuals) - Genetic factors
* No specific susceptibility genes have been found thus
far.
- psychoanalytic
These theories about how someone develops phobias
or social anxiety considers that phobias are a defence
against the anxiety produced by repressed id impulses.
* Anxiety is displaced from the feared id impulse and
moved to an object or situation that has some symbolic
connection to it.
Panic attack
A panic attack is not a mental disorder. But they can
occur in the context of any anxiety disorder as well as
other mental disorders and some medical conditions
* When a panic attack occurs, it should be noted as a
specifier (e.g., separation anxiety with panic attacks). For
Panic disorder, the presence of panic attack is constrained
within the criteria for the panic disorder
two kinds of panic attacks
- Unexpected – no obvious cue or trigger (out of the blue)
- Expected – an attack in response to a situational trigger (an
obvious cue or trigger, such as previous situations where panic
attacks have typically occurred)
Agoraphobia
- a cluster of fears centering on public places and being unable to
escape or find help should one become incapacitated - diagnosis requires anxiety in at least 2 of 5 situations:
1. public transportation
2. open spaces
3. enclosed spaces
4. lines/crowds
5. being out of the house alone
biological theories of panic disorder
Physical conditions with panic-like symptoms:
* Mitral valve prolapse syndrome
* Inner ear disease causes dizziness (Ménière’s disease)
Genetic factors:
* Panic disorder runs in families and has greater concordance
in identical-twin pairs than in fraternal twins
Noradrenergic activity theory
The role of gamma-aminobutyric acid (GABA) in panic:
The role of Cholecystokinin (CCK) in Panic attacks
Noradrenergic activity theory
- Panic is caused by overactivity in the noradrenergic system:
- In humans drugs that stimulates activity in the locus ceruleus can
elicit panic attacks
The role of gamma-aminobutyric acid (GABA) in panic:
- GABA generally inhibits noradrenergic activity.
- Positron emission tomography (PET) study found fewer GABA-
receptor binding sites in people with Panic Disorder. - Therapeutic improvement involves changes in GABA receptors, but
this applies to both anxiety and depression
The role of Cholecystokinin (CCK) in Panic attacks
- Peptide that occurs in the cerebral cortex, amygdala,
hippocampus, and brain stem, induces anxiety-like
symptoms in rats and effect can be blocked with
benzodiazepines. - A hypothesis is that panic disorder may be partly due to
hypersensitivity to CCK. - Exposure to CCK induces panic attacks and patients with
panic disorder have a clear sensitivity to CCK.
psychological theories of panic disorder
The fear-of-fear hypothesis
Misinterpretation of physiological arousal symptoms
The role of vicious circles in panic disorder
The role of anxiety sensitivity in panic disorder
The fear-of-fear hypothesis
Suggests that agoraphobia is not a fear of public places per se,
but a fear of having a panic attack in public
Misinterpretation of physiological arousal symptoms
Suggests that people who have autonomic nervous system that
is predisposed to be overly active is coupled with a
psychological tendency to become very upset by these
sensations
Cognitive Model of Anxiety
- Catastrophizing – “It is the end of the world if I get turned down
when I ask for a date.” - Overgeneralizing – “I didn’t get a good grade on this test. I can’t
get anything right.” - Selective abstraction – Only seeing specific details of the situation
(e.g., Seeing the negatives but missing the positive details)
Etiology of GAD: Psychological Theories
learning theories
cognitive theories
The role of Intolerance Of Uncertainty in GAD
The role of Approach-Avoidance Conflicts in GAD
The role of worry as negative reinforcing in GAD:
learning and cognitive theories for GAD
Learning theories
* Anxiety regarded as having been classically conditioned
to external stimuli, but with a broader range of
conditioned stimuli.
Cognitive theories (cognitive vulnerability)
* The perception of not being in control as a central
characteristic of all forms of anxiety
The role of Intolerance Of Uncertainty in GAD
- Related to the idea of control is the fact that predictable events
produce less anxiety than do unpredictable events
Extensive research has shown the role of an intolerance of
uncertainty in the experience of chronic worry and GAD - Uncertainty intolerance is particularly relevant when assessing
ambiguous situations, and appraisals of ambiguous situations
mediate the association between uncertainty intolerance and
worry
The role of Approach-Avoidance Conflicts in GAD
Two factor model of approach-avoidance:
* Intolerance of uncertainty
* Fear of anxiety
- GAD-prone people with an intolerance of uncertainty have a
desire to engage in approach behaviours to reduce their feelings
of uncertainty. - However, they are also characterized simultaneously by a fear of
anxiety that promotes the use of avoidance strategies designed
to limit the experience of anxious arousal
The role of worry as negative reinforcing in GAD
- Therefore, by worrying, people with GAD are avoiding certain
unpleasant images and so their anxiety about these images
does not extinguish. - Metacognitive beliefs about worrying also play a role:
- People can have positive beliefs about worry, such as “worrying helps to
solve a problem”. - People can also have negative beliefs about worry, such as “worrying is
dangerous”. - Metacognitive beliefs can increase worry and anxiety levels
psychoanalytic perspective of GAD
- Unconscious conflict between the ego and id impulses.
- The impulses, usually sexual or aggressive in nature, are
struggling for expression, but the ego cannot allow their
expression because it unconsciously fears that punishment
will follow. - Since the source of the anxiety is unconscious, the person
experiences apprehension and distress without knowing
why.
biological theories of GAD
Neurobiological model for GAD
* Benzodiazepine medications are often effective in treating
anxiety which suggests biological factors contribute to GAD.
* Receptor in the brain for benzodiazepines has been linked to
the inhibitory neurotransmitter GABA.
* Benzodiazepines may decrease anxiety by increasing release of
GABA.
* Drugs that block or inhibit the GABA system increase anxiety.
Behavioural Treatment Approaches:
Anxiety Disorders
exposure therapy
modelling therapy for phobias
social skills training for social anxiety disorder
exposure therapy for anxiety disorder
- Systematic desensitization was the first major behavioural
treatment to be used widely in treating phobias (Wolpe, 1958).
Involves progressive exposure to triggering stimuli - In vivo exposure treatment is often seen as superior using
imagination - Virtual Reality exposure
modelling therapy for phobias
- Fearful clients are exposed to filmed or live demonstrations of
other people interacting fearlessly with the phobic object (e.g.,
handling snakes).
social skills training for social anxiety disorder
- Learning social skills to know what to say/do in social situations
- Can be combined with exposure therapy
behavioural treatment approaches: GAD
- It is difficult to find specific causes of the anxiety suffered by
clients with GAD. - Tend to prescribe more generalized treatment (intensive
relaxation training), in the hope that if clients learn to relax
when beginning to feel tense, their anxiety will be kept from spiraling out of control - Clients are taught to relax away low-level tensions, to respond to incipient anxiety with relaxation rather than
alarm. This strategy is quite effective in alleviating GAD
Cognitive Treatment Approaches: Phobias
Cognitive treatments for specific phobias have been viewed
with skepticism because of a central defining characteristic of
phobias:
* The phobic fear is recognized by the individual as excessive
or unreasonable.
* If the person already acknowledges that the fear is of something harmless, what use can it be to alter the person’s
thoughts about it?
* There is no evidence that the elimination of irrational beliefs alone, without exposure to the fearsome situations, reduces phobic avoidance
cognitive behavioural therapies
- Most commonly used CBT methods involve exposure
and cognitive approaches - One well-validated exposure-based therapy developed
by Barlow and his associates
panic control therapy has three principle components:
- relaxation training
- cognitive restructuring
- exposure to the internal cues that trigger panic (which is
termed – interoceptive exposure
