PSY311 Midterm 2 Flashcards
What is anxiety?
“Anxiety is a negative mood (1) state characterized by bodily symptoms of physical tension (2) and apprehension about the future” (3).
'’perceived threat’’
describe the graph about anxiety, arousal and weakstrong and low/high arousal
optimal arousal and optimal performance = middle arousal. Moderate arousal for strong performance because some anxiety is good! = optimal
little or too high arousal does not work
Anxiety disorder all combined.
What is aoo?
Childhood and adulthood (like GAD)
Anxiety disorder, what is the biological contributions?
Inherit a tendency (anxious, tends…etc.)
Anxiety is associated with (dys)regulation of various hormones, neurotransmitters and circuits
What is the HPA axis?
hypothalamus, anterior pituitary
(very close to hypothalamus) and adrenal cortex → it is our primary response to stress. ACTH travels all the way to the adrenal gland(also called adrenal cortex) that are located above the kidneys and they secrete various thing like adrenaline and cortisol). the negative feedback loop is very important because it kinda ask: did you deal with the stressor or not? Ideally, you are not suppose to be always in the alarm state. once you deal with the stressor you are supposed to calm down. that’s why the negative feedback is important.
Is there a specific NT related to anxiety?
No! serotonin, gaba, norepinephrine and others
gaba levels is known to decrease serotonin level, increase norepinephrine level. there is a lot!
What is Gray’s motivation theory?
BAS/BIS/FFF
BAS: behavrioral activation system. it is saying something like, we are sensitive to reward (could be praise, validation, money etc.). = work more, try new things. more novelty seeking , extraverty. the NT Dopamine is very important+
BIS: behavioral inhibition system –> highly overactive. In case of anxiety, it works too much. high neuroticism, anxiety, high apprehension
Sensitive to punishment, to threat
Avoidance behavior: anxiety, tendency to apprehensively
evaluate the situation (potential threats)
Bidirectional activation: PFC (prefrontal cortex) ↔ limbic system
FFF: fight/flight/freeze
all related to the sympathetic nervous sustem: stress response: burns energy
What are some psychological contributions to anxiety disorders? + what are some important cues?
Classical conditioning (e.g. Little Albert) (ex. just seeing a dog…)
Sense of control: is develop quite early with parental aptitude, early-life foster a sense of foster (can either see a safe or uncontrollability work)
Anxiety sensitivity: can be predisposed, might also be fearful to anxiety symptoms. ‘’like being anxious to be anxious’’ ‘’fear to be overwhelmed with anxiety’’ (it is something that feeds the panic cycle in panic disorder - ex. you won’t need to see the dog, just thinking about it will trigger you, remembering how it felt).
Important cues
External cues: environment similar to where initial panic attack occurred
Internal cues: inner cognitive and physiological processes
associated with initial panic attack
What are some social contributions to anxiety disorders?
Exposure to stressful life events (e.g. death of a loved one, divorce, growing up in low socioeconomic environment, violence)
Lack of social support (it plays a lot, it worsen a lot the others one)- having a good social support can protect the person to develop mental disorder
Societal factors (e.g. media, societal values)
What is the anxiety disorders: biopsychological model
psychological (faulty cognition + maladaptive learning) + biological (evolutionary predispositions +geneticpredispositions + biochemical disturbances) + sociocultural (cultural pressures)
From Barlow, 2000. describe the anxiety disorders: triple vulnerability model
Generalized biological vulnerability: genetic, heritable, uptight, personality traits (neuroticism, stress response)
Generalized psychological vulnerability: across all anxiety symptoms
Specific psychological vulnerability: what might other think? creates apprehension. Ex. developing an apprehension of dog because you’re parents are scare of them, life experience too
–> it comes together, at least two, to develop an anxiety disorder
what is comorbidity in terms of anxiety disorder?
High comorbiidtybetween anxiety disorders and suicidal ideation & attempts
- common with anxiety and depression
Comorbidity between anxiety-related disorders
Anxiety disorder often occurs first (before physical disorders)
GAB: diagnostic criteria
Excessive anxiety and worry, occurring more days than not for at least 6 months
Finds it difficult to control the worry Anxiety or worry is associated with ≥3 of the following six symptoms: 1 Restlessness or “on edge” 2.Being easily fatigued 3.Difficulty concentrating (or “mind going blank”), scared of the future 4.Irritability 5.Muscle tension 6.Sleep disturbance
Symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning
Disturbance is not due to substance abuse or medical condition
Disturbance is not better explained by another mental
disorder
GAB: statistics
What is the course? What is the age of onset? What is the sex ratio? What is the comorbidity? What about the elderly? and side effect of tranquilizer?
Course: Chronic
In individuals who face(d) stressful life event(s)
Onset ≈age 30 years
More insidious (gradual) development relative to other anxiety disorders, gradually getting more intense
Sex ratio: ≈2:1 in women (on the exam) twice then men
Comorbidity:
Women: greater comorbidity with mood and other anxiety disorders
Men: greater comorbidity with substance abuse
More prevalent in the elderly
More in age 45+ years (vs. young adults)
≤10% Often prescribed minor tranquilizers (valium, zanac), but side effects (small motor impairment- like muscle jammer, decrease of motor coordination-, memory impairment- important cuz there is a link with getting older and that (similar to amnesia but not that intense, irritable, sleep disturbance)
minotorize it
GAB: etiology
- genetic component
- Distinct cognitive characteristics (Dugas, Ladouceur et al., 1998)
- intolerance of uncertainty: worry about not being in control
- positive beliefs about worry: hold stronger that belief that worry is effective
- poor problem orientation: won’t face it ex. a friend of a friend told me that dogs bite, then I’ll avoid them altogether. Avoiding activities, people, places, addiction
- cognitive avoidance: trying to distract themselves in hopes to not think about what is stressing them
Borlow image on GAD
Generalized psycho + biological vulnerabiity – stress – anxious apprehension –> worry process (a loop of intense cognitive processinfm inadequate, avoidance of imagery, restricted autonomic response) = GAD
What are the treatment for GAD?
Pharmacological:
**Benzodiazepines (short-term) -tranquilizer. modest term effect.
** Antidepressants (SSRI= selective serotonin reuptake inhibitors- most common antidepressants) inhibit reuptake. can release a part of the anxiety system and will help reduce depression symptoms. It is often taken for a longer time than benzodiazepines would. side effect: sleep disturbances, nausea, sexual dysfunction
today we won’t rely only on drugs
Psychosocial:
Cognitive-behavioral therapy
Mindfulness meditation : increasing in popularity. detach observation, breathing, yoga, mindful eating, be in the present.no fixation on emotion
What is a panic disorder?
Panic attacks are periodic, short bouts of panic that occur suddenly, reach a peak, and pass
Those who suffer often fear they will die, go crazy, or lose control
Panic attacks typically happen in the absence of a real threat
it is difficult to pinpoint how many panic attack implies a panic disorder and are often accompanied with agoraphobia within the first year (they feel unsafe, unable to escape)
Name the panic disorder: diagnostic criteria
A. Recurrent unexpected panic attacks
B. At least one of the attacks has been followed by ≥1 month of one or both of the following:
I. Persistent concern or worry about additional panic attacks or their consequences
II. A significant maladaptive change in behavior related to the
attacks
C. Disturbance is not attributable to the physiological effects of a substance or another medical condition
D. Disturbance is not better explained by another mental disorder
Name some symptoms of Panic disorder including the main 4
AT LEAST 4 of them
Need at least 4 of them (often the first 4)
1. Palpitations, pounding heart or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. 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 sensation (i.e. Paresthesia)
- Derealization or depersonalization: detach from reality, dissociation
- Fear of losing control or “going crazy”
- Fear of dying
- Other symptoms (e.g., neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.
Panic disorder and agoraphobia (explain it)
Agoraphobia: marked fear or anxiety about two or more of the following five situations: Using public transport Being in open spaces Being in enclosed places Standing in line or being in a crowd. Being outside of the home alone
Explain the maladaptive side effect to the panic disorder
Agoraphobic avoidance: look at the escape place, avoided place where they don’t feel safe. it is difficult, if you’re a student and scare of places… you need to endure anxiety and keep going.
Enduring anxiety: need to travel for job but they are scared.
Interoceptive avoidance: avoidance of internal physical sensation. Ex. also doing exercise = heart rate increase =remind you of the feeling of getting a panic attack.
Substance (ab)use;
Panic disorder: statistic, sex ratio, onset, cultural differences
Sex ratio More common in women 3-4 women Agoraphobia (and avoidance) and women Alcohol and men AOO: ≈25-29 years Most 1st unexpected panic attacks occur at/post- puberty
Cultural differences
Susto in Latin America: sweating, heart rate, insomnia less worrying
Ataques de nérvios in Caribbean: bursting into tears
Kayak-angst in Inuit: intense fear of drowning and disorientation (fisher at sea)
Panic disorder: etiology
Inherited tendency to be overly reactive to daily stressful events
Misattribution of bodily responses as being catastrophic: ex being short of breath and automatically attributed that to a panic attack and they are aware of that so they trigger it.
Association between situation(s) and biological response are quick to form. where and what happens is associated very quickly. Ex: i should not be in this place, because thinking about it, triggers an alarm right away
Panic disorder: treatment
Pharmacological:
Selective Serotonin Reuptake Inhibitors (SSRIs)
Benzodiazepines
Psychosocial:
- **Cognitive restructuring: element of cognitive therapy. it is about challenging these maladaptive thoughts.
- *relation techniques: deep breath
- *interoceptive exposure: counteract the exposure. it is at first in a supervised environment. Trying to get a headache to trigger you, spinning on a chair. the point is to face those feeling and sensation and to see that there are not related to a panic attack
The three above are panic control treatment (PCT) → works best on the long run
Explain what it takes to have a specific phobia
A. Marked fear or anxiety about a specific object or situation
B.The phobic object or situation almost always provokes immediate fear or anxiety
C.The phobic object or situation is actively avoided or endured with intense fear or anxiety
D.The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context
E.The fear, anxiety, or avoidance is persistent, typically lasting for 6
months or more
F.The fear, anxiety, or avoidance 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
Explain different types of a specific phobia
Animals: around 7 years. Fears of spiders, snakes, dogs…
Natural environment: water, storm, height (tend to lcuster) 7 years old.
Blood-injection-injury:
**Physiological reactions: Strong vasovagal response
**Phobia develops over fear of fainting
**Autonomic system system is activated reacardio (causing the heart to drop, its an expression)
**it affects the nerve, the blood vessel (widen), legs arm (extremities) = blood pressure drop and it goes to your ed more and more = brian is very deprive with oxygen until fainting occurs
**fear of fainting - the panic cycle. very specific to a situation
AOO: ≈9 years
Situational: ex. dentist (agoraphobia) and closephoria
E.g. Fear of public transportation, fear of small spaces,
fear of flying, going to the doctor, work, etc.
AOO: ≈20-25 years
Specific phobia: statistics
Lifetime prevalence - not at the exam Women: 9.8% Men: 4.9% AOO average of all of them: ≈8 years Course: chronic People often don't seek treatment: prefer to adapt their lifestyle
Developmental awareness: need to consider what is appropriate for the age bracket (monster under the bed is not a phobia…!) it tends to develop as an anxiety disorder if it continues
