PSY240 3. Anxiety Flashcards
Anxiety
Negative affect
– Somatic symptoms of tension
– Apprehensive anticipation of future danger
Anxiety
- anxiety: worrying about something that hasn’t come
e. g. muscle tension
fear: present reaction to threat
normative emotions
Anxiety
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Fear
Immediate alarm reaction to present danger
– “fight or flight”
Fear
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Adaptive versus Maladaptive Fear
FEAR
Adaptive ===> Maladaptive
Adaptive versus Maladaptive Fear
realistic concerns => unrealistic concerns
e.g. concern is unfounded - unlikely to happen
proportional => disproportional
the amount of fear experience
excessive distress
subsides upon removal of threat => persists after threat also anticipatory anxiety
worked up agitated state of anticipation
incontrollable and helpless
impairing functioning
Adaptive versus Maladaptive Fear
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Adaptive versus Maladaptive Fear
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Common Symptoms of Anxiety
Physical
Cognitive/ Emotional
Behavioural
Common Symptoms of Anxiety
physical: goosebumps, nauseated
emotional: irritability
cognitive: difficulty focusing, hyper vigilance, fear losing control, unreality
behavioural: escape vs avoidance, freeze, aggression
Common Symptoms of Anxiety
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Common Symptoms of Anxiety
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What Makes You Anxious?
public speaking not being good enough interpersonal social: friends, partner uncertainty performance: failure 16% somatic concerns - health 2%
What Makes You Anxious?
54% of college students report feeling overwhelming anxiety
more common type of distress on common
What Makes You Anxious?
academic concerns: exams, tests 34%
money: 1%
misc. : 7%
Anxiety Disorders
Commonalities
• Basic biological causes
• Basic psychological causes
• Effective treatments
Anxiety Disorders
we all experience it and have similar concerns
same commonalities in DSMV disorders
similar causes and treatments
treatments: behavioural treatments
Anxiety Disorders
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Anxiety Disorders
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Anxiety Disorders
- Severe
- Impact quality of life
- Chronicity and frequency
- Interfere with functioning
- Disproportion to real dangers
Anxiety Disorders
not everyone has it - beyond normal experiences
severe: affects life + enjoyment
far more frequent and pervasive
becomes an obstacle: e.g. can’t leave house anymore
Anxiety Disorders
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Anxiety Disorders
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Anxiety Disorders
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Panic Attacks (PAs)
- Not a disorder
- Intense fear/discomfort
- Sudden onset and peaks rapidly (
Panic Attacks (PAs)
-symptoms: sweating, heart rate, muscle tension
cued: suddenly in response to specific stimulus
uncued: out of the blue
suddenly develop all of these symptoms at once
Panic Attacks (PAs)
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Panic Attacks (PAs)
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Panic Attacks (PAs)
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Panic Disorder (PD)
• Recurrent, unexpected panic attacks (PAs)
• Followed by 1+ month of (at least one): – Persistent concern about having another PA
– Persistent concern about implications of PAs – Significant change in behaviour
Panic Disorder (PD)
important for diagnosing panic disorder: only when there’s at least 2 uncued panic attacks
at least 1 month or longer after - constant fear of having another attack and/or the implications of having a heart attack
change in behaviour: e.g. stop riding the subway because it happened there last time - can’t go to work
uncued becomes cued - come to fear that situation or place - would still be diagnosed as PD
Panic Disorder (PD)
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Panic Disorder (PD)
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Agoraphobia
- Anxiety about places / situations where escape might be difficult or help is unavailable
- Situations avoided or endured with distress
Agoraphobia
-condition in itself
fear of wide open space
50% of PD also have agoraphobia
might be able to do it if they had someone with them
Agoraphobia
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Examples of Agoraphobia
e.g. fear of crowds, lines, on trains, on a bridge, being in a house alone or leaving house alone
Examples of Agoraphobia
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Separation Anxiety Disorder
Excessive anxiety concerning separation from the home or primary caregiver(s)
previously in developmental disorder => now anxiety disorder
physical symptoms: being sick - can’t go to school
complain so they can stay - can be real
frequent nightmares of separation
Separation Anxiety Disorder
4+ weeks (6 mos in adults): avoid over-pathologizing responses to transitions
Separation Anxiety Disorder
not a lot of evidence of continuity - maybe it doesn’t continue or a measurement artifact
e.g. earlier in life, parent interview, later in life, self-report
generally when child first goes to school
can come up later in life - can’t recall disorder
Separation Anxiety Disorder
e.g. going to college
e.g. over concern of offspring or spouse
we don’t know as much about condition in adulthood
Selective Mutism (DSM-5)
- Consistent failure to speak in social situations
- Interfereswithachievement
- Duration>1month
- Not due to lack of knowledge of language
- Not better accounted for by other disorders
Selective Mutism (DSM-5)
emerges in childhood - likely to manifest in school age
don’t know much about longitudinal course of disorder
rule out other possibilities such as developmental disorder, difficulty in interaction due to anxiety or language problems
Selective Mutism (DSM-5)
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Selective Mutism (DSM-5)
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Selective Mutism (DSM-5)
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Specific Phobia
- Marked and persistent fear
- Exposure almost invariably provokes fear/anxiety* • Situation avoided / endured with distress
- Fear/anxiety ≠ actual danger posed
Specific Phobia
cannot under any circumstance endure situation or stimulus
intense amount of distress
in childhood: fear may be expressed through screaming, not speaking, tantrums
similar symptoms, but tied to specific stimulus or situation
Specific Phobia
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Specific Phobia
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Specific Phobia – Subtypes
Animal Natural / Environment Blood-injection- injury Situational Other
Specific Phobia – Subtypes
e. g. could have been bitten by dog
e. g. heights
e. g. seeing blood, getting shots
e. g. claustrophobia in elevators
e. g. clowns, #13
Specific Phobia – Subtypes
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Specific Phobia – Subtypes
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Specific Phobia – Subtypes
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Social Anxiety Disorder (Social Phobia)
Fear of being focus of attention/scrutiny
• Fear of being humiliated
– Capacity for age-appropriate relationships* – Must occur in peer settings*
• Exposure almost invariably provokes anxiety • Fear is persistent (6+ months)
Social Anxiety Disorder (Social Phobia)
specific social situations that evoke fear
common
20% of US college students report fear of public speaking
wording change in DSM-V
fearful of humiliation
early on - other disorders may cause symptoms like Autism
anxiety must be occurring not just with adults, but with peers
primary concern to be judged as stupid or weak
significant impairment: e.g. run out of room screaming during a presentation
Social Anxiety Disorder (Social Phobia)
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Social Anxiety Disorder (Social Phobia)
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Social Anxiety Disorder (Social Phobia)
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Generalized Anxiety Disorder (GAD)
Chronic/exaggerated worry / tension (6+ mos) • Unable to control worry • Physical symptoms (3+)* – Restlessness, keyed up, on edge – Easily fatigued – Difficulty concentrating – Irritability – Muscle tension – Sleep disturbance
Generalized Anxiety Disorder (GAD)
worries about a lot of things
feel like you can’t control the worry
in adults at least 3, in kids (
Generalized Anxiety Disorder (GAD)
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Generalized Anxiety Disorder (GAD)
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Generalized Anxiety Disorder (GAD)
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Epidemiology
Disorder l Age of Onset l Prevalence l Gender
Separation Anxiety l ~ preschool l 0.9%–4.0% l F>M
Selective Mutism l M
Social Anxiety l 8 – 15 years l 7.0–12.0% l F>M
Agoraphobia l 17 years l 1.7% l F>M
Panic Disorder l 20 – 24 years l 2.0–3.0% l F>M
Generalized Anxiety l M
Epidemiology
-some disorders such as social anxiety are more common, while mutism is rare because we are ruling it out
anxiety disorders more common in female
manifestation may be different by gender
boys may show indirect symptom - e.g. boys say they have nightmares instead of I don’t wanna go to school
gender differences emerge depending on specific object of phobia
emerge most frequently in adolescents, but in youth may show remission later on
social phobia: males more often diagnosed with because it is inconsistent with expectations of masculinity
Epidemiology
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Epidemiology
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Epidemiology
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Comorbidity
- Anxiety and anxiety
* Anxiety and depression (i.e., internalizing) • Anxiety and substance use disorders
Comorbidity
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Comorbidity
internalizing disorders
inwardly directed emotional problems
externalizing: violence, acting out, substance abuse
in children it’s less clear cut the difference between the two than in adults
social anxiety: e.g. have a drink to calm nerves
issue of self-medicate with alcohol
in most cases, anxiety comes first
Comorbidity
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Biological Approach: Structural Theories
Dual pathway model of fear
Stimulus => Thalamus => Amygdala
Biological Approach: Structural Theories
Stimulus => Thalamus => Cerebral Cortex
Biological Approach: Structural Theories
-understand how brain processes fear
get info from environment that triggers fear response
thalamus: gateway
amydala: registers danger, stores emotional memory
triggers fast reaction
cerebral cortex: to brain for more thoughtful processing of info
Biological Approach: Structural Theories
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Biological Approach: Structural Theories
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Biological Approach: Structural Theories
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