Module 4 - Anxiety Disorders

Question 1

What are the 3 distinctive components of emotion?

Answer 1

1) Physiological (changes autonomic nervous system like breathing rate, heart rate, and muscle tone)

2) Cognitive (alterations in consciousness and specific thoughts ie: “I’m going to embarrass myself”)

3) Behavioural (consequences of certain emotions)

Question 2

What is Anxiety?

Answer 2

An affective state whereby an individual feels threatened by the potential occurrence of a future negative event. Thus, anxiety in general is “future oriented.”

Question 3

What is fear?

Answer 3

A more “primitive” emotion and occurs in response to a real or perceived current threat. Therefore, fear is “present oriented” in the sense that this emotion involves a reaction to something that is believed to be threatening at the present moment.

From an evolutionary perspective, fear is a very important emotion because of the behavioural response that it elicits. This behavioural response is popularly known as the “fight or flight” response. (Physiological symptoms involved in the emotion of fear, which include increased heart rate, muscle tension, and breathing rate).

Question 4

What is panic?

Answer 4

Whereas fear is an emotional response to an objective, current, and identifiable threat, panic is an extreme fear reaction that is triggered even though there is nothing to be afraid of (it is essentially a “false alarm”).

Question 5

What are the biological factors in the etiology of anxiety disorders?

Answer 5

Genetics - heritability is 30 to 50 percent depending on disorder. Rather than inheriting a risk for a specific type of anxiety disorder, the genetic risk for anxiety disorders is more likely passed on in terms of broader temperamental and/or dispositional traits, such as behavioural inhibition and neuroticism.

Neuroanatomy - Direct electrical stimulation of the neural fear circuit at low levels causes subjective anxiety in humans and freezing in rats, whereas stimulation at high levels provokes feelings of terror and flight behaviour.

Neurotransmitters - No neurotransmitter system has been found to be solely dedicated to the expression of fear, anxiety, or panic. It’s an assortment. GABA is the most pervasive inhibitory neurotransmitter in the brain, and receptors for this transmitter are well distributed along the neural fear circuit. Serotonin and norepinephrine systems are also involved.

Question 6

What is the most pervasive inhibitory neurotransmitter in the brain?

Answer 6

Gamma-aminobutyric acid (GABA).

Question 7

What are the behavioural factors in the etiology of anxiety disorders?

Answer 7

Anxiety and fear are acquired through learning (based on Pavlov’s classical conditioning). Mowrer suggested that fears develop through the process of classical conditioning and are maintained through operant conditioning.

Not all fears develop through classical conditioning. Ie: it is possible to develop fears by observing the reactions of other people (vicarious learning or modelling).

Question 8

What are the cognitive factors in the etiology of anxiety disorders?

Answer 8

1) Beck proposed that people are afraid because of the biased perceptions that they have about the world, the future, and themselves. Anxious individuals often see the world as dangerous, the future as uncertain, and themselves as ill-equipped to cope with life’s threats. Individuals who are susceptible to anxiety often have core beliefs that they are helpless and vulnerable. These individuals also selectively attend to and recall information that is consistent with their views of self as helpless and the world as threatening.

Question 9

What are the interpersonal factors involved in the etiology of anxiety disorders?

Answer 9

Parents who are anxious themselves tend to interact with their children in ways that are less warm and positive, more critical and catastrophic, and less granting of autonomy when compared to non-anxious parents. Such parenting styles may foster beliefs of helplessness and uncontrollability in children that contribute to a general psychological vulnerability to anxiety. The early attachment relationship may be important in the development of anxiety.

Question 10

What is Barlow’s (2002) “triple vulnerability” etiological model of anxiety?

Answer 10

1) Generalized biological (e.g., a genetic predisposition to being high-strung, behaviourally inhibited, nervous)

2) Nonspecific psychological (e.g., diminished sense of control, low self- esteem)

3) Specific psychological (i.e., experiencing a real danger, false alarm, or vicarious exposure)

= vulnerabilities interact to increase risk.

Question 11

True or False?

The reduced quality of life reported among individuals with anxiety disorders is comparable to and in some instances worse than other major medical illnesses.

Answer 11

True.

Without treatment, anxiety disorders tend to be chronic and recurrent, and are associated with significant distress, suffering, and impairment.

Question 12

What is panic disorder?

Answer 12

Individuals with panic disorder experience recurrent and unexpected panic attacks.

Question 13

True or False?

A panic attack is a mental disorder.

Answer 13

False.

Question 14

DSM Criteria for Panic Attack Specifier:

Answer 14

An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:

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.

Paresthesias (numbness or tingling sensations).

Derealization (feelings of unreality) or depersonalization (being detached from oneself). 12. Fear of losing control or “going crazy.”

Fear of dying.

Question 15

What is agorophobia?

Answer 15

is anxiety about being in places or situations where an individual might find it difficult to escape or in which he or she would not have help readily available should a panic attack occur.

(This diagnosis is made only when feared situations are actively avoided, require the presence of a companion, or are endured only with extreme anxiety; and is made irrespective of whether panic disorder is present.)

Question 16

Panic disorder and agoraphobia are highly comorbid, and the occurrence of panic attacks often instigates agoraphobia.

Answer 16

(Just a fact we might need to know)

Question 17

What is the cardinal feature of panic disorder?

Answer 17

Individuals initially experience unexpected panic attacks and have marked apprehension and worry over the possibility of having additional panic attacks.

(In contrast, panic attacks associated with other anxiety disorders are usually cued by specific situations or feared objects.)

Question 18

What are factors implicated in the etiology of panic disorders and agorophbia?

Answer 18

Biological - runs in families.

Cognitive - catastrophic misinterpretations of their bodily sensations.

Question 19

What is anxiety sensitivity?

Answer 19

The belief that the somatic symptoms related to anxiety will have negative con- sequences that extend beyond the panic episode itself.

Question 20

In terms of specific phobias, fear of ________ appears to be the most prevalent.

Answer 20

Animals.

Question 21

What are the five specifiers of specific phobia?

Answer 21

1) Animal Type

2) Natural Environment Type: (ie: thunderstorms, water, heights).

3) Blood Injection–Injury Type

4) Situational Type: The person fears specific situations (ie: bridges, public transportation, and enclosed spaces).

Other Type: Used for all other phobias not covered in the other categories, such as extreme fears of choking, vomiting, and clowns. This category also includes what is known as illness phobia.

Question 22

How does illness phobia differ from hypochondriasis?

Answer 22

Illness phobia = intense fear of DEVELOPING a disease they don’t currently have.

Hypochondriasis = people believe they CURRENTLY have a disease/medical condition.

Question 23

What is the equipotentiality premise?

Answer 23

It assumes that all neutral stimuli have an equal potential for becoming phobias.

(It’s one of the main criticisms of this conditioning model

Question 24

Contrary to the associative (conditioning) model of phobias is the _______ model.

Answer 24

Nonassociative.

(proposes that the process of evolution has endowed humans to respond fearfully to a select group of stimuli)

Question 25

What is the theory of biological preparedness?

Answer 25

Combines elements of both the associative and the nonassociative models. Similar to the nonassociative model, it is believed that the process of natural selection has equipped humans with the predisposition to fear objects and situations that represented threats to our species over the course of our evolutionary heritage. BUT associative learning is still necessary to develop a phobia. Hence, this explains why learning to fear snakes is easier than learning to fear lamps.

Question 26

What is Disgust sensitivity?

Answer 26

The degree to which people are susceptible to being disgusted by a variety of stimuli such as certain bugs, types of food, and small animals.

(Supports the notion that the cause of phobias may not always involve only fear of danger, but other emotions, such as disgust and possibly fear of contamination.)

Question 27

Flip to see the DSM Criteria for Social Anxiety Disorder

Answer 27

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).

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 situation and to the sociocultural context.

F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

G. The fear, anxiety, or avoidance 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 (e.g., a drug of abuse, a medication) or
another medical condition.

I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or
avoidance is clearly unrelated or is excessive.

Question 28

True or False?

Individuals with social anxiety are generally well aware of the fact that their fears are excessive and unreasonable.

Answer 28

True.

Thus, one of the keys to understanding their condition is that their fears persist despite this knowledge.

Question 29

Individuals with both social anxiety and agoraphobia may experience anxiety in public places. How do we distinguish between the two disorders?

Answer 29

The fear that characterizes social anxiety involves being negatively evaluated or embarrassed in social situations.

Question 30

What is the etiology of social anxiety disorder?

Answer 30

Genetic factors - what seems to be inherited is a predisposition to develop anxiety about social situations rather than the disorder itself.

Interactions among structures involved in fear recognition and conditioning (e.g., amygdala), arousal, and stress (e.g., hypothalamic-pituitary- adrenal axis), and the regulation and areas of the brain that monitor negative affect (e.g., anterior cingulate cortex, pre-frontal and orbitofrontal cortex).

Dysregulation of serotonin, norepinephrine, and other neurotransmission systems during stress responses.

Early psychosocial experiences play a large role in shaping an individual’s risk for social anxiety (bullying/teasing, parental criticism, overprotection & control)

Cognitive factors - both negative beliefs and judgments about self and others, as well as abnormal processing of social information. (Concern about making mistakes and feel inferior to others, vigilance for signs of social threats)

Question 31

Social anxiety is an interpersonal disorder. What doe this term mean?

Answer 31

A condition that is commonly associated with marked disruption in the ability to relate with other people.

Question 32

Worry is a prominent feature in many of the anxiety disorders, so what distinguishes GAD from other anxiety disorders?

Answer 32

In contrast to the worries of individuals with other anxiety disorders, which tend to be restricted to a single domain or theme, individuals with GAD “worry about everything.” They often worry about several things at once and report a long history of worrying.

Question 33

Flip to see the DSM Criteria for Generalized Anxiety Disorder (GAD)

Answer 33

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (e.g., work, school performance).

B. The person finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.

(1) restlessness or feeling keyed up or on edge

(2) being easily fatigued

(3) difficulty concentrating or mind going blank

(4) irritability

(5) muscle tension

(6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another mental disorder.

Question 34

What is Intolerance of uncertainty (IU)?

Answer 34

Refers to an individual’s discomfort with ambiguity and uncertainty.

IU is responsible for creating and exacerbating “what if . . . ” questions.

Question 35

While not a necessary diagnostic criterion of GAD, elevated levels of ________ appear to be an associated feature and often characterize individuals with this disorder.

Answer 35

Anger.

Question 36

Given that worry is the central symptom in GAD, it is not surprising that many of the etiological models are primarily ___________ in nature.

Answer 36

Cognitive.

Question 37

What are obsessions?

Answer 37

Recurrent and uncontrollable thoughts, impulses, or ideas that the individual finds disturbing and anxiety-provoking.

Common obsessions: thoughts related to uncertainty (e.g., doubting if one has locked the door or turned off the stove), sexuality (e.g., homosexual imagery), violence (e.g., harming a child), and contamination (e.g., believing one is dirty and covered with germs).

Individuals with OCD often consider their obsessions to be so disturbing that they try to conceal them from others, even their therapists.

Question 38

What are compulsions?

Answer 38

Repetitive behaviours or cognitive acts that are intended to reduce anxiety.

Behaviours: handwashing, checking, and rigidly maintaining order and organization.

Cognitive acts = counting numbers, praying, and repeating words or phrases over and over.

Question 39

What are neutralizations?

Answer 39

Behavioural or mental acts that are used by individuals to try to prevent, cancel, or “undo” the feared consequences and distress caused by an obsession.

Question 40

One of the more striking aspects of individuals with OCD is their excessive beliefs about ____________ and feelings of ________.

Answer 40

Personal responsibility, Guilt.

Question 41

What is thought-action fusion (TAF)?

Answer 41

Two types of irrational thinking:

1. the belief that having a particular thought increases the probability that the thought will come true (e.g., “If I think about getting hit by a car, I’m more likely to get hit by a car”)
2. the belief that having a particular thought is the moral equivalent of a particular action (e.g. having a thought about harming someone is the moral equivalent of actually doing it).

Question 42

What characteristics distinguish obsessions from worries?

Answer 42

Obsessions tend to be more bizarre and involve more imagery than do worries.

Question 43

Flip to see DSM Criteria for Obsessive Compulsive Disorder

Answer 43

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and
unwanted, and that in most individuals cause marked anxiety or distress.
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or
action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that
the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or
situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsions symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder

Question 44

What are the 2 most prominent models for the etiology of OCD?

Answer 44

1) the neurobiological model

2) the cognitive-behavioural model.

Question 45

Most neuropsychology models of OCD implicate the basal ganglia and ___________.

Answer 45

Frontal cortex.

(Patients with OCD have less brain volume in parts of the frontal cortex and more brain volume in parts of the basal ganglia than do individuals without OCD.)

Question 46

People with OCD are more likely to be affected by poor memory ________ , as opposed to poor memory accuracy.

Answer 46

Confidence.

Question 47

The cognitive-behavioural conceptualization of OCD posits that problematic obsessions are caused by the person’s ______ to intrusive thoughts.

Answer 47

reaction

Question 48

True or False?

In OCD, obsessions are believed to persist because of the person’s maladaptive attempts to cope with them.

Answer 48

True.

Question 49

What is the rebound effect?

Answer 49

Trying to suppress obsessional thoughts can have the paradoxical effect of increasing their frequency.

Question 50

What characterizes Body dysmorphic disorder (BDD)?

Answer 50

Excessive preoccupation with an imagined or exaggerated body disfigurement, sometimes to the point of a delusion.

Question 51

Individuals with BDD have prominent obsessions and compulsive behaviours, similar to patients with OCD. What are some differences between the disorders?

Answer 51

Individuals with BDD tend to be more severely disturbed than those with OCD, with higher rates of suicidal ideation, delusions, major depression, substance abuse, and social phobia.

Question 52

What is the central feature of PTSD?

Answer 52

The individual continues to re-experience intrusive, unwanted recollections of a past traumatic event.

Question 53

Flip to see DSM Criteria for Post-Traumatic Stress Disorder (PTSD)

Answer 53

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a
family member or friend, the event(s) must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human
remains; police officers repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic events(s), beginning after the traumatic event(s) occurred.
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)
Note: In children, there may be frightening dreams without recognizable content.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the
traumatic event(s).
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events(s).
2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse
distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

D. Negative alternations in cognitions and mood associated with the traumatic event(s) (typically due to dissociative amnesia and not to
other factors such as head injury, alcohol, or drugs).
1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors
such as head injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be
trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame
himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward
people or objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Question 54

A number of risk factors for the development of PTSD have been identified, including:

Answer 54

Pre-Event Factors: low in socio-economic status, education, childhood adversity etc

Post-Event Factors: severity of the traumatic event, lack of social support, additional stressful experiences etc.

Question 55

Are pre-event factors or post-event factors somewhat more powerful predictors of PTSD?

Answer 55

Post-event risk factors.

Question 56

Is exposure to interpersonal traumas (e.g., related to physical violence or sexual abuse) or exposure to non-interpersonal traumas (e.g., natural disaster, car accident) generally more likely to provoke PTSD?

Answer 56

Exposure to interpersonal traumas.

Question 57

Biological Theory of PTSD says:

Answer 57

1) individuals with this disorder have dysfunctional neurocircuitry in areas of the brain implicated in processing and responding quickly to threat. (brainstem, amygdala, and frontotemporal cortex, HPA axis).

2) The volume of the hippocampus is less in individuals with PTSD than in those without the disorder. (But unclear whether these reductions in hippocampal volume represent a cause or effect of PTSD.)

Question 58

What is Dual Representation Theory?

Answer 58

Details differences in the way that traumatic memories and non-traumatic memories may be stored and retrieved.

Traumatic memories may be initially stored and retrieved in a non- verbal sensory-based form, whereas non-traumatic memories are typically encoded and retrieved in a verbal form.

(Therefore, sensory-based memories may need to be transferred into verbal form in order for the individual to effectively process the traumatic experience.)