Lecture 4: Anxiety Disorders Flashcards
What is fear?
- A negative emotional state in response to real or perceived imminent threat to the self.
- Present focused
What is anxiety?
- A negative emotional state that stems from anticipation of future threat to the self.
- Future focused
Why are fear and anxiety important?
- Both are adaptive and essential for survival
What are the different 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 and avoidance
When does anxiety become a problem?
- The anxiety must be chronic, relatively intense, associated with role impairment, and causing significant distress for self or others.
- What distinguishes chronically anxious people is their
propensity to perceive threat and to be concerned/worried
when there is no objective threat or the situation is ambiguous. - Situational factors are important because it is normal to feel anxious in those situations that are truly upsetting or when there are actual threats to survival.
What is known about the prevalence of anxiety disorders?
- 12% of Cdn population are struggling with an Anxiety Disorder at any given time
- Anxiety is often comorbid with depression (co-occurrence rates of 60%)
- Anxiety disorders are more common in women than in
men across all age groups - International prevalence
– one-year prevalence: 10.6%
– lifetime prevalence: 16.6%
What are the major anxiety disorders in the DSM?
- Specific Phobia
- Social Anxiety disorder
- Panic Disorder
- Agoraphobia
- Generalized anxiety disorder (GAD)
- Separation anxiety (not covered in class- 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).
What is the duration of Specific Phobia?
- Tends to be long-lasting
- mean duration of 20 years
- only 8% of people with a specific phobia received treatment
What are the most common specific phobia subtypes (In order)?
(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
What specific phobia?
Fear and avoidance of objects or situations that do not
present any real danger
What are some of the symptoms of specific phobia that were presented in the vignettes?
- increased physiological arousal when exposed to feared stimulus
- experiences of intense fear
- avoidance
- fearful thoughts
- intense worry
- recurrent, vivid images of feared stimulus
What is the diagnostic criteria for specific phobia?
A) marked fear or anxiety about a specific object or situation
B) the phobic object or situation almost always promotes anxiety or fear
C) the phobic object or situation is actively avoided or endured with intense fear/anxiety
D) the fear/anxiety is out of proportion to the actual danger that is posed by the specific object or situation and to the sociocultural context
E) the fear, anxiety or avoidance is persistent, typically lasting 6 months or more
F) causes clinically significant distress or impairment in social, occupational or other important areas of functioning
G) the disturbance is not better explained by the symptoms of another mental disorder
What is social anxiety disorder?
Fear and avoidance of social situations due to possible
negative evaluation from others.
What are some of the symptoms of Social anxiety disorder that were presented in the vignettes?
- afraid of drawing attention to himself
- avoided meeting with others
- Dry mouth, increased HR (physiological symptoms)
What are the 3 main subtypes of social anxiety disorder?
- Public speaking (qualitatively and quantitatively recognized as being distinct from other SA subtypes because it is performance-based not interacting with people)
- Social interactions
- Being observed in public
What is the diagnostic criteria for SAD?
A) Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.
B) the individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated
C) the social situations almost always provoke fear or anxiety
D) the social situations are avoided or endured with intense fear or anxiety
E) the fear or anxiety is out of proportion to the actual threat posed by the social situationa nd to the socialcultural context
F) the fear, anxiety or avoidance is persistent, typically lasting 6 months or more
G) causes clinically significant distress or impairment in social, occupational or other important areas of functioning
H) the fear anxiety or avoidance is not attributable to the physiological effects of a substance or another medical condition
I) the disturbance is not better explained by the symptoms of another mental disorder
J) if another medical condition is present, the fear, anxiety or avoidance is clearly unrelated or is excessive
What are some of the characteristics of socially anxious people?
- are more concerned about evaluation than are people who are not socially anxious
- are highly aware of the image they present to others
- are high in public self-consciousness.
- are preoccupied with a need to seem perfect and not make mistakes in front of other people
- tend to view themselves negatively even when they have actually performed well in a social interaction
- have excessive self-criticism
What do behavioural theorists believe is the etiology of specific phobias and SAD
1) avoidance conditioning
2) modelling
3) prepared learning
According to cognitive theories, people who experience phobias or anxiety disorder are more likely to…
- attend to negative stimuli;
- interpret ambiguous information as threatening; and
- believe that negative events are more likely than positive ones to re-occur.
- Engage in post-event processing of negative social experiences.
What do cognitive-behavioural theorists believe is the etiology of specific phobias and SAD?
- 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
What do biological theorists believe is the etiology of specific phobias and SAD?
- Autonomic Nervous System (stability-lability). Having a more labile ANS (jumpy individuals)
- Genetic factors/. No specific susceptibility genes have been found thus far.
What do psychoanalytic theorists believe is the etiology of specific phobias and SAD?
- Psychoanalytic theories consider phobias to be 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. - These objects or situations then become the phobic
stimuli. - By avoiding them the person is able to avoid dealing with repressed conflicts.
What is a 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.
What is depersonalization and derealization (in regards to panic attack)?
- depersonalization (a feeling of being outside one’s body).
- derealization (a feeling of the world not being real, as well as fears of losing control, of going crazy, or even of dying).
What is the diagnostic criteria for a panic disorder?
A) recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which four or more of the following symptoms occur (e.g., sweating, trembling or shaking, shortness of breath, chills or heat sensations, fear of dying etc.)
B) at least one of the attacks has been followed by 1 month (or more) of one or both of the following:
1. Persistent concern or worry about additional panic attacks and their consequences.
2. a significant maladaptive change in behaviour related to the attacks (e.g., avoidance of exercise)
C) the disturbance is not attributable to the physiological effects of a substance or another medical attention
D) the disturbance is not better explained by another disorder
