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Abnormal Behavior > Lecture 5 - Anxiety Disorders > Flashcards

Lecture 5 - Anxiety Disorders Flashcards

1
Q

anxiety

A

a general feeling of apprehension about possible future danger

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2
Q

fear

A

an alarm reaction that occurs in response to immediate danger

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3
Q

Anxiety vs. Fear

A

distinction is whether a clear and obvious source of danger is present that would be regarded as real by most people

  • fear - source is obvious
  • anxiety - cannot specify clearly what the danger is
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4
Q

Fear vs. Panic

A

in both Fear and Panic, the individual may experience sympathetic arousal, but in Panic there is often a cognitive component of fears of dying, going crazy or losing control

  • these cognitive components do not usually accompany fear state
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5
Q

components of fear

A

cognitive: “I am in danger”

physiological: activation of fight/flight - increased heart rate, sweating

behavioral: desire to escape or run

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6
Q

components of anxiety

A

cognitive: “I am worried about what might happen”

  • negative mood, worry
    about possible future threat or danger, self-preoccupation, and a sense of being unable to predict the future threat or to control it if it occur

physiological: tension, chronic overarousal

  • creates a sense of tension and chronic over-arousal
  • no flight/flight, but primed for the response should danger occur

behavioral: general avoidance

  • may lead to avoidance, but no immediate behavioral urge to flee as in fear
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7
Q

anxiety treatment interventions

A

involve changes in all components (cognitive, physiological, behavioral)

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8
Q

adaptive value of anxiety

A

helps us to plan and prepare for possible threat

  • in mild to moderate degrees it can enhance learning and performance, it is adaptive
  • if chronic and severe, anxiety is maladaptive
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9
Q

characteristics of anxiety disorders

A
  • unrealistic, irrational fears or anxieties
  • cause significant distress and/or impairments in functioning, disabling intensity
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10
Q

similarities in anxiety disorders

A

there are similarities in basic causes (biological and psychological) and effective treatments

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11
Q

common biological causes of anxiety disorders

A
  • Genetics: personality trait of Neuroticism (disposition for negative mood states)
  • Brain structures: Limbic System, Cortex
  • Neurotransmitters: GABA , NE, 5HT
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12
Q

common psychological causes of anxiety disorders

A
  • Classical conditioning
  • Perceived lack of control over environment
  • Distorted cognitions
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13
Q

common effective treatments of anxiety disorders

A
  • Graduated exposure
  • Cognitive restructuring
  • Medications
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14
Q

anxiety disorders differ in terms of:

A
  • preponderance of fear/panic versus anxiety symptoms that they experience
  • kinds of object or situations
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15
Q

DSM-IV-TR recognized ___ primary types of anxiety disorders

A

7

  • Specific phobia
  • Social Anxiety Disorder (Social phobia)
  • Panic disorder w/ or w/o agoraphobia
  • Generalized anxiety disorder
  • Obsessive-compulsive disorder
  • Acute stress disorder
  • Post-traumatic stress disorder
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16
Q

DSM-5 anxiety disorders

A

5 instead of 7

OCD removed, (DSM-5 listed in Obsessive Compulsive and Related Disorders)

Acute Stress and PTSD removed (DSM-5 listed in Trauma and Stressor Related Disorders)

  • Specific Phobia
  • Social Anxiety Disorder (Social Phobia)
  • Panic Disorder
  • Agoraphobia
  • Generalized Anxiety Disorder
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17
Q

phobia

A

persistent and disproportionate fear of a specific object or situation that presents little or no actual danger; leads to avoidance of these feared situations

  • most common anxiety disorder
  • three categories: specific phobia, social phobia (social anxiety), agoraphobia
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18
Q

specific phobia

A
  • a strong and persistent fear that is recognized as excessive or unreasonable and is triggered by a specific object or situation
  • anxiety is experienced when in contact with the object or when imagining encountering the object or situation
  • avoidance is a cardial characteristic
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19
Q

DSM-5 subtypes of specific phobia

A
  • Animal: snakes, spiders, rats, dogs
  • Natural environment: storms, heights, water, the forest
  • Blood-injection-injury: seeing blood or injury, receiving an injection
  • Situational: public transportation, tunnels, bridges, driving
  • Other: choking, vomiting
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20
Q

phobic response

A

if an individual approaches the feared object,

  • fear, anxiety, apprehension, distress and sympathetic activation result
  • the behavior is then reinforced every time the person avoids the situation, anxiety decreases
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21
Q

Blood-Injection Injury Phobia

A
  • Primary emotions are disgust and fear
  • Rather than sympathetic activation, people show an initial acceleration followed by a dramatic drop in heart rate and blood pressure
  • Nausea, dizziness and fainting unique to this specific phobia
  • From an evolutionary perspective, fainting may promote survival when attacked
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22
Q

Psychological Causal Factors of specific phobias

A

psychoanalytic viewpoint (from Freud: a defense against anxiety stemming from repressed Id impulses; displacement on an external object, but this is too speculative) vs. phobias as learned behavior

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23
Q

phobias as learned behavior

A
  • Wolpe and Rachman (1960): Classical conditioning
  • Vicarious conditioning
  • Individual differences in learning (risk and protective factors)
  • Evolutionary preparedness
24
Q

biological causal factors of specific phobias

A
  • genetics (variants of genes)
  • temperament (behaviorally inhibited temperament is linked to higher vulnerability to phobias): excessively timid, shy, easily distressed
25
Q

treatment of specific phobias

A

exposure therapy is the treatment of choice for specific phobias

  • participant modeling
  • virtual reality
  • exposure combined w/ medication and cognitive approaches may be more beneficial than either along
26
Q

social phobia (social anxiety disorder)

A

disabling fears of one or more specific social situations; person fears that they may be exposed to the scrutiny and potential negative evaluation of others and to humiliation or embarrassment

  • fear of public speaking is most common
27
Q

two DSM-5 subtypes of social phobia

A
  • performance, specific (public speaking)
  • non-performance situations, more general (eating in public) (often comorbid w/ Avoidant Personality Disorder)
28
Q

psychological causal factors of social phobia

A
  • learned behavior: classical conditioning that is direct or vicarious in nature
  • evolutionary factors: predisposition based on social (dominance) hierarchies; fear of predators
  • perceptions of uncontrollability and unpredictability: lead to submissive and unassertive behavior; expectations of lack of personal control related to overprotective parenting
  • cognitive biases of individuals w/ social anxiety disorder: Beck (1985) -
    Expectations of rejection; Danger Schemas - lead
    them to expect that
    they will behave in an
    awkward an unacceptable fashion, resulting in rejection and loss of status; negatively biased
    interpretations of
    ambiguous stimuli
29
Q

biological causal factors of social phobia

A

genetics, temperament (behavioral inhibition)

30
Q

treatment of social phobia

A
  • cognitive therapy: cognitive restructuring to change distorted automatic thoughts
  • behavior therapy: exposure to social situations that evoke fear
  • medications: antidepressants (MAOIs, SSRIs); relapse rate w/ medication is higher than w/ therapy, particularly CBT approach
31
Q

agoraphobia

A

anxiety about being in places from which escape might be difficult or embarrassing combined w/ fear of a panic attack or getting sick in the following situations:

  • crowds
  • theaters
  • malls
  • cars, buses, trains, planes
  • standing in line
  • elevators
  • other similar situations
32
Q

panic disorder

A

characterized by the occurrence of panic attacks that often seem to come “out of the blue”

  • recurrent, unexpected attacks and worry about additional attacks
  • 13 possible symptoms of panic attacks, 10 of which
    are physical and 3 of which are cognitive
  • attacks are brief but intense
  • at least one of the attacks has been followed by 1 month (or more) of one or both of the following: Persistent Concern or worry about additional panic attacks or their consequences, and a significant maladaptive change in behavior related to the attacks (e.g. avoidance)
33
Q

symptoms of panic attacks

A

an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time 4 (or more) of the following symptom:

  • Palpitations, pounding heart or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, light-headed, or faint
  • Chills or heat sensations
  • Numbness or tingling sensations
  • Derealization (feeling of unreality) or depersonalization (being detached from oneself)
  • Fear of losing control or going crazy
  • Fear of dying
34
Q

comorbidity and panic disorder

A

83% of people w/ panic disorder have at least one comorbid disorder (most commonly-GAD, Social Phobia, Specific Phobia, PTSD, Depression and Substance Use Disorder)

  • 50-70% will experience depression at some point in their lives
  • may also meet criteria for Dependent or Avoidant Personality Disorder
  • increased risk for suicidal ideation and attempts
35
Q

timing of first panic attack

A

attack may appear to be “out of the blue,” first attack frequently occurs when distressed or following a stressful event

36
Q

not all people who have a panic attack will develop panic disorder

A
  • panic attacks are more frequent than panic disorder
  • anxiety attacks are not the equivalent of a panic attack
37
Q

biological causal factors of panic disorder

A

panic disorder has a moderate heritable component

  • several areas of the brain implicated in panic attacks: amygdala, hippocampus (develop conditioned anxiety about having another panic attack), higher cortical centers (overreactions to dangers)
38
Q

neurotransmitter systems most implicated in panic attacks

A

norepinephrine, serotonin, GABA

  • medications: selective serotonin reuptake inhibitors (SSRIs), anxiolytics
39
Q

behavioral and cognitive causal factors of panic disorder

A
  • Cognitive Theory of Panic
  • Comprehensive learning theory of panic disorder
  • Anxiety sensitivity and perceived control
  • Safety behaviors and the persistence of panic
  • Cognitive biases and the maintenance of panic
40
Q

Cognitive Theory of Panic

A

People w/ panic disorder are hypersensitive to their bodily sensations and interpret them negatively

41
Q

Anxiety sensitivity and perceived control

A
  • Anxiety Sensitivity: a trait-like belief certain bodily sensations may have harmful consequences
  • having a sense of perceived control reduces anxiety
  • accompaniment by a “safe” person when undergoing a panic provocation procedure shows less distress
42
Q

Safety behaviors and the persistence of panic - Why maintained if the experience of the panic attack doesn’t lead to a catastrophe?

A
  • Breathing and Medication believed to be the reason that the catastrophe didn’t occur
  • Dropping safety behaviors may be best for treatment
43
Q

Cognitive biases and the maintenance of panic

A
  • interpret ambiguous bodily sensations and situations as threatening
44
Q

cognitive theory of panic: the panic circle

A
  • panic cycle starts w/ a trigger stimulus (internal or external); triggers either perceived threat or body sensations

perceived threat –> apprehension or worry (e.g. about having panic attack or about any distressing situation) –> body sensations –> interpretation of sensations as catastrophic –> cycle begins again …

45
Q

comprehensive learning theory of panic disorder

A
  • initial panic attacks become associated w/ initially neutral internal (interoceptive) and external (exteroceptive) cues through a conditioning process
  • anxiety becomes conditioned to these CSs, and the more intense the panic attack, the more robust the conditioning that will occur
  • panic attacks themselves are likely to be conditioned to certain internal and external cues
  • explains anticipatory anxiety, agoraphobic fears, panic attacks
46
Q

treatments of panic disorder

A
  • exposure therapy
  • interoceptive exposure targeting panic attacks: deliberate exposure to feared internal sensations., stay w/ the sensation until it subsides, habituation
  • cognitive restructuring: Panic Control Treatment (PCT) targets agoraphobic, avoidance and panic attacks (education, breathing, automatic thought challenge, exposure)
  • medications: anxiolytics (Xanax, Klonopin) are GABA agonists, however they cause drowsiness and potential dependence/withdrawal effects; antidepressants (Paxil, Zoloft) are tricyclics, SSRIs, and SNRIs, but while combined treatment may have an initial benefit, there is a high likelihood of relapse when medication is stopped
47
Q

generalized anxiety disorder (GAD)

A

anxiety or worry about many different aspects of life (including minor events); it is chronic, excessive and disproportionate

  • must occur more days than not for a 6-month period, and must be experienced as difficult to control
  • anxiety or worry is associated with 3 or more of the following six symptoms: restlessness, easily fatigued, difficulty concentrating
    or mind going blank, irritability, muscle tension, sleep disturbance
  • the worry must be about a number of different events or activities
  • content cannot be exclusively related to the worry associated w/ another concurrent disorder, such as the possibility of having a panic attack (this is panic disorder)
48
Q

individual characteristics of GAD

A
  • individuals live in future-oriented mood state of anxious apprehension, chronic tension, worry, and diffuse uneasiness
  • vigilance for signs of threat
  • engagement in subtle avoidance activities (procrastination, checking, excessive calling)
  • anxious apprehension is the hallmark
  • constant worry results in discouragement
  • difficulty making decisions
  • rarely experience the present moment
49
Q

psychological causal factors of GAD

A
  • psychoanalytic viewpoint
  • perceptions of uncontrollability, unpredictability and uncertainty
  • a sense of mastery
  • worry
  • cognitive biases for threatening information
50
Q

psychoanalytic viewpoint of GAD

A

Conflict between id and ego, deficient defense mechanisms

  • Freud: primarily sexual and aggressive impulses that are blocked or punished
51
Q

a sense of mastery (GAD)

A

patient has a history of control over their environment

52
Q

worry (Borkovec et al) (GAD)

A
  • benefits noted by individuals w/ GAD: superstitious avoidance of catastrophe, avoidance of deeper issues, coping and preparation
  • negative consequences: worry can lead to a greater sense of danger, increased intrusive thoughts
53
Q

cognitive biases for threatening information (GAD)

A

vigilance to threatening cues

54
Q

biological causal factors of GAD

A
  • it is modestly heritable
  • the neurotransmitters GABA, serotonin, and perhaps norepinephrine all play a role in anxiety
  • neuroendocrine systems may play a role
55
Q

treatments for GAD

A

considered one of the most difficult anxiety disorders to treat b/c have multiple stressors (anxious about everything)

  • medications: anxiolytics, antidepressants
  • cognitive-behavioral therapy (CBT): muscle relaxation and cognitive processing
56
Q

“normal” anxiety treatment

A

cognitive, physiological, behavioral

Abnormal Behavior (8 decks)

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