lesson 7 (ch 6): anxiety disorders Flashcards
1
Q
anxiety vs fear
A
anxiety: apprehension about a future threat
fear: a reaction to immediate danger
anxiety involves moderate arousal/ sympathetic nervous system activity, fear involves higher arousal, fight or flight
2
Q
how can anxiety be helpful?
A
small amount of anxiety can help us notice/ plan for future threats, but too much can be paralyzing
U-shaped curve with performance- no anxiety is a problem, a little is good, a lot is detrimental
3
Q
DSM-5 major anxiety disorders (5)
A
- specific phobias
- social anxiety disorder
- panic disorder
- agoraphobia
- generalized anxiety disorder
4
Q
how common are anxiety disorders?
A
- anxiety disorders are the most common psychiatric disorders
- 28% report anxiety symptoms, may be more
- most common are phobias
- 9th leading cause of disability
5
Q
(?) DSM-5 Criteria for diagnosis for anxiety disorders
A
(?)
- symptoms interfere w important areas of functioning/ cause marked distress
- symptoms not caused by drug or medical condition
- symptoms persist for at least 6 months, 1 month for panic disorder
- distinct from symptoms of another anxiety disorder
6
Q
specific phobias
A
disruptive fear of a particular object or situation
- fear out of proportion to actual threat
- awareness that fear is excessive but still goes through great lengths to avoid
- must be severe enough to cause distress or interfere w job or social life
7
Q
most common phobias
A
- acrophobia and claustrophobia
- most specific phobias cluster around a few feared objects/situations
- high comorbidity of specific phobias
8
Q
social anxiety disorder
A
- persistent intense fear and avoidance of social situations
- fear of negative evaluation/scrutiny
- exposure to trigger leads to anxiety about being evaluated negatively
- called social phobia in DSM-IV-TR
9
Q
comorbidity in social anxiety
A
- 33% of those w/ social anxiety also diagnosed w/ avoidant personality (overlap in genetic vulnerability for both)
- those with broader array of fears are more likely to experience comorbid depression and alcohol abuse
10
Q
panic disorder
A
frequent panic attacks unrelated to specific situations
11
Q
panic attack
A
sudden attack of intense apprehension, terror, and feelings of impending doom, accompanied by at least 4 other symptoms
- wanting to flea
- possible physical symptoms: shortness of breath, heart palpitations, nausea, upset stomach, chest pains, feeling of choking/smothering, dizziness, lightheaded, faintness, sweating, chills, heat, numbness/tingling, trembling
- can involve depersonalization (feeling outside ones body), derealization (feeling like world isn’t real)
- fears of going crazy/losing control/ dying
- experience sympathetic nervous system arousal as if life threatened
- usually peak intensity around 10 mins
12
Q
DSM-5 criteria for panic disorder
A
- recurrent panic attacks
- at least 1 month of worry about more panic attacks, or maladaptive behavioral changes
13
Q
types of panic attacks
A
uncued attacks:
- unexpected
- panic disorder diagnosis requires recurrent uncued attacks
- causes worry about future attacks
cued attacks
- triggered by specific situations, more likely a phobia
14
Q
agoraphobia
A
- agora = marketplace
- anxiety about inability to flee anxiety-provoking situations, like crowds or crowded places
- causes significant impairment- virtually unable to leave house, or can only do so with great distress
- in DSM-IV-TR was a subtype of panic disorder, but at least half agoraphobics don’t have panic attacks
15
Q
DSM-5 Criteria of Agoraphobia
A
- disproportionate fear/anxiety about at least 2 situations where it would be difficult to escape/receive help
- these situations consistently provoke fear or anxiety
- these situations are avoided, require presence of a companion, or are endured w intense fear/anxiety
- symptoms last at least 6 months
16
Q
Generalized Anxiety Disorder (GAD)
A
-involves chronic, excessive, uncontrollable worry
- lasts at least 6 months
-interferes w/ daily life (often paralyzed- can’t decide on solution/ course of action)
other symptoms:
- restlessness, poor concentration, tiring easily, restlessness, irritability, muscle tension
common worries:
- relationships, health, finances, daily hassles
often begins in adolescence or earlier “i’ve always been this way”
17
Q
DSM-5 criteria for GAD (generalized anxiety disorder)
A
- excessive anxiety and worry at least 50% of days about at least 2 life domains
- worry sustained for at least 6 months
- anxiety and worry associated w at least 3:
- restlessness or feeling on edge
- easily fatigued
- difficulty concentrating/ mind going blank
- irritability
- muscle tension
- sleep disturbance
18
Q
what do people with GAD avoid or do due to their worry?
A
- avoid situations where neg. outcomes could occur
- time and effort preparing for situations that may have negative outcome
- marked procrastination
- difficulty making decisions due to worry, or repeatedly seeking assurance
19
Q
when does GAD (generalized anxiety disorder) onset typically?
A
adolescence, typically, and is chronic
20
Q
comorbidity in anxiety disorders
A
80% anxiety disorder meet criteria for another anxiety disorder
- subthreshold symptoms very common
75% anxiety disorder meet criteria for another psychological disorder
- 60% anxiety also have depression
- substance abuse
- personality disorders
- medical disorders, e.g. coronary heart disease
comorbidity associated w/ greater severity and poorer outcomes
21
Q
reasons/ causes of comorbidity in GAD
A
- symptoms used to diagnose anxiety disorders overlap
(ex: social anxiety and agoraphobia both have fear of crowds) - etiological factors may increase risk for more than on anxiety disorder
22
Q
Prevalence of anxiety disorder
A
US 12 month prevalence: 18%
lifetime prevalence: 28%
severe: 4% of population, 23% of cases
23
Q
demographics of lifetime prevalence of anxiety disorders
A
sex: women 60% more likely
race: non-hispanic white most likely
age: most common in young and middle adulthood
24
Q
gender differences- anxiety disorder
A
women twice as likely
why?
- women may be more likely to report symptoms
- men might be encouraged more to face fears
- women more likely to experience childhood sexual abuse
- women show more biological stress reactivity
25
culutural anxiety disorders
kayak-angst:
inuit (Greenland), similar to panic disorder, lone seal hunters' fear/ disorientation/concerns of drowning
taijin kyofusho:
japan, fear of displeasing or embarrassing others, overlaps w social anxiety but w/ focus on OTHERS
koro:
south/east asia, fear genitals will recede into body
shenkui:
china, anxiety of loss of semen
susto:
Latin America, fright causes soul to leave body
26
List of factors that may increase risk for more than one anxiety disorder
- behavioral conditioning
- genetic vulnerability
- increased activity in fear circuit of brain
- decreased func. of GABA and serotonin; increased norepinephrine activity
- behavioral inhibition
- neuroticism
- cognitive factors (including sustained neg beliefs, perceived lac of control, and attention to cues of threat)
27
Two-factor model of behavioral conditioning (Mowrer's two-factor model)
- conditioned responses to threat
(classical conditioning- fear neutral stimulus after pairing w averse stimulus)
- sustained by avoidance or 'safety behaviors'
(gains relief by avoiding CS- through operant conditioning, avoidant response is maintained b/c it is reinforcing)
28
problems w/ Mowrer's two factor model of behavior conditioning (for anxiety)
2 reasons
- most don't remember exposure to a threatening event
- many people who experience threats don't develop anxiety disorders
29
extension of Mowrer's two factor model of behavior conditioning (for anxiety)
1. classical conditioning can occur in different ways:
- direct experience
- modeling (seeing something happen)
- verbal instruction
2. also some people are more vulnerable to anxiety disorders than others
30
Neutral predictable unpredictable (NPU) threat task
experimental approach for testing responses to unpredictability (anxiety disorders)
- neutral condition
- predictable condition (warning of aversive stimulus)
- unpredictable condition (no warning aversive stimulus
people w/ anxiety disorder fare worse in unpredictable threat conditions
31
genetic risk factors for anxiety disorder
twin studies suggest heritability estimate of .5 to .6% for anxiety disorders (means that genes may explain 50-60% of risk for anxiety disorders in population
- 20-40% for phobias, and GAD
- 50% for panic disorder
relative w phobia increases risk for other anxiety disorders in addition to phobia
32
Neurobiolobical risk factors for anxiety
- fear circuit overactivity
- amygdala (sends signals to brain structures involved in fear circuit. elevated activity may be linked to anxiety disorders
- medial prefrontal cortex deficits (helps regulate amygdala activity)
-neurotransmitters
- poor functioning of serotonin and GABA
- higher levels of norepinephrine
Neumonic: brain anxiety park: fear circuit roller coaster, GABA, Prozac sad and an epipen having fun
33
Risk factors Personality for anxiety disorders
- behavioral inhibition
- neuroticisim
34
behavioral inhibition
tendency to be agitated, distressed/ cry in unfamiliar/ novel settings
- observed in infants as young as 4 months
- may be inherited
predicts anxiety in childhood and social anxiety in adolescence
Neumonic: beehive acting shy in new environment
35
Neuroticism
- personality trait- tendency to experience frequent or intense negative affect
- linked to anxiety and depression
- higher levels linked to double the likelihood of developing anxiety disorders
36
cognitive risk factors for anxiety (4)
- sustained neg beliefs about future
- perceived lack of control
- over-attention to signs of threat
- intolerance of uncertainty
37
sustained negative beliefs about future
- bad things will happen
- engage in safety behaviors
38
perceived lack of control
- belief they lack control over environment
- more vulnerable to developing anxiety disorder
- childhood trauma or punitive parenting may foster beliefs
- serious life events can threaten sense of control
39
attention to threat
- tendency to notice negative environmental cues
- selective attention to signs of threat
- used dot-probe test to test
40
intolerance of uncertainty
-people who have hard time accepting ambiguity are more likely to develop anxiety disorders
- predicts increases in worry over time
- also a difficulty for those with major depressive disorder and obsessive compulsive disorder
41
What do psychological treatments of anxiety all emphasize?
EXPOSURE:
face the situation/object that triggers anxiety
- in CBT, client would make a list of triggers, create an "exposure hierarchy," and gradually face them
- should include as many features of the trigger as possible
- conducted in as many settings as possible
- 70-90% effective
42
systematic desensitization
- relaxation plus (initially) imaginal exposure
43
cognitive approaches (added to exposure therapy)
- increase belief in ability to cope w/ the anxiety trigger
- challenge expectations about negative outcomes
44
behavioral view of exposure
- works by extinguishing fear response
- doesn't erase underlying fear, rather, newly learned associations inhibit activation of fear
-learning, not forgetting
45
psychological treatment of social anxiety disorder
Exposure
- starting with role-playing/ practicing w therapist
social skill training
- reduce use of safety behaviors (avoiding eye contact)
Clark's cognitive therapy for social anxiety:
- stop focusing attention internally
- helps them combat negative images of how others will react them
- more effective than medication or exposure
Neumonic: Clark has social anxiety
46
psychological treatment of panic disorder (CBT, cognitive, psychodynamic)
CBT for panic disorder also focuses on exposure
- based on tendency of people w diagnosis to overreact to bodily sensations
PANIC CONTROL THERAPY
- exposure therapy to somatic symptoms of panic in safe space (breathing rapidly for 3 mins)
- gives coping tactics for dealing with somatic symptoms
- relaxation, deep breathing
benefits maintained after treatment ends
cognitive treatment:
- therapist helps patient identify and challenge thoughts that make physical sensations threatening
psychodynamic:
- identifying emotions and meanings surrounding panic attacks
47
psychological treatment of Generalized Anxiety Disorder
behavioral technique: relaxation training (to promote calmness)
CBT- strategies to improve problem solving and to address thought patterns that contribute to GAD:
- Challenge and modify neg thoughts
- strategies to tolerate uncertainty
- worry only during "scheduled" times
- focus on present
48
Medications that reduce Anxiety
called anxiolytics
- Benzodiazepenes
- Valium
- Xanax
- Antidepressants
- tricyclics
- SSRIS
- SNRIS (serotonin-norepinephrine reuptake inhibitors)
- D-cycloserine (DCS)
- enhances learning during exposure treatment
49
prepared learning
- evolution may have "prepared" our fear circuit to learn fear of stimuli (that could be life-threatning ) very quickly and automatically
Neumonic: I am prepared to be terrified of that snake
50
specific phobias: prevalence
12 month prevalence 8.7% of US adults
severe: 21.9% of cases are classified as severe
51
etiology of specific phobias
- conditioning
- Mowrer's two-factor model
- pairing of stimulus w aversive UCS leads to fear (classical conditioning)
- avoidance maintained through negative reinforcement (operant conditioning)
52
extensions of the two-factor model of conditioning
- modeling: seeing another person harmed by stimulus
- verbal instruction: being told something is dangerous
- prepared learning: evolutionary preparation to fear certain stimuli
53
social anxiety disorder prevalence
12 month prevalence: 6.8%
severe: 29.9% of cases
age: drops off in older adulthood
54
etiology of social anxiety disorder- cognitive factors
- unrealistic negative beliefs about consequences of behaviors
- excessive attention to internal cues
- fear of neg evaluation by others (expect others to dislike them)
- neg self evaluation (harsh, punitive self-judgement)
55
GAD- General Anxiety disorder- Prevalence
12 month: 3.1
severe: 32.3%
age: goes up until senior
56
Etiology of GAD (Generalized anxiety disorder)
- GABA system deficits
Borkovec's cognitive model:
- worry reinforcing b/c distracts from neg emotions and images
- allows avoidance of more disturbing emotions (previous trauma)
- worrying decreases Psychophysiological arousal
- avoidance prevents extinction of underlying anxiety
textbook calls it CONTRAST AVOIDANCE model
- avoids volatile shifts in emotions by constantly worrying
57
Panic Disorder Prevalence
12 month: 2.7%
severe: 44.8% of cases
age: goes up until senior
58
Etiology of Panic Disorders- Neurobiological factors
- heritability of panic is fairly high
- Locus ceruleus
- major source of norepinephrine
- trigger for nervous system activity
Neumonic: a locust having a panic attack
59
Etiology of Panic Disorders- Behavioral factors
classical conditioning- could be response to either the situation that triggers anxiety, or somatic changes in the body (interoceptive conditioning)
Interoceptive conditioning
- classical conditioning of panic in response to internal bodily sensations
Neumonic: inception- hands tingling
60
Etiology of Panic Disorders- cognitive factors
catastrophic misinterpretations of somatic changes
- interpreted as impending doom (heart attack, etc)
- beliefs increase anxiety and arousal
- creates cycle
anxiety sensitivity index measures fear of bodily sensations
61
anxiety sensitivity index
anxiety sensitivity index measures fear of bodily sensations
- high scores predict development of panic disorders
62
Agoraphobia: prevalence
12 month: 0.8%
severe: 40.6% of cases
63
etiology of agoraphobia
principle cognitive model for etiology of agoraphobia:
fear-of-fear hypothesis:
- expectations of the catastrophic consequence of having a public panic attack
64
Psychological treatment of agoraphobia
Cognitive Behavioral Therapy (CBT)
- systematic exposure to feared situations
- self-guided treatment effective
