Q&A session - master this first

Question 1

Stress

What is Stress?

Answer 1

Stressor = stressful stimulus
Strain = body’s response to the stressor

Conditions of stress:
1. Physical => direct material or bodily challenges
2. Psychological => how one perceives circumstances in their lives

Examining stress:
- Can be a stimulu, the response to the stimulus and the transaction (the interaction between the stimulus and the response).

Question 2

Stress

General adaptation syndrome

The 3 stages

Answer 2

1. Alarm reaction: fight or flight response to an emergency
   - Mobilizes the body’s resources.
   - Fast acting arousal => Sympathetic NS activates adrenal glands that releases epinephrine and norepinephrine which activates the HPA axis and releases cortisol.
2. Stage of resistance: HPA axiss predominates if the stressor continues.
   - Adaptation to the stressor
   - Physiological arousal is higher than normal and hormones are trying to be replenished.
   - Stage could make individuals vulnarable to health problems.
3. Stage of exhaustion: prolonged arousal is costly
   - Immune system is weakened.
   - Body’s energy reserves are depleted.
   - Stress continues to damage the internal organs

Question 3

Stress

Transaction model (Folkman)

Lecture

Answer 3

The interpretation of stressful events is more important than the events themselves

1. Primary appraisal: how does this affect me? (irrelevant-relevant, good-bad)
2. Secondary appraisal: what types of resources do I have in order to deal with it? Am i capable? (sufficient-insufficient)
3. Stressful appraisal - factors. (Personal, situational,

Question 4

Stress

HPA axis

Answer 4

1. Stressor stimulates the release of Adrenocorticotropic hormone (ACTH) from the anterior pituitary gland.
2. ACTH triggers the release of glucorticoids frm the adrenal cortex
3. Glucorticoids (cortisol) produces the many compoennts of the stress response.

Pathway:
- Hypothalamus => CRH => Anterior pituitary => ACTH => Adrenal cortex => Cortisol

Long-term stress

Question 5

Stress

The Sympathetic Adrenomedullary system (SAM)

Answer 5

1. Stressor activates the sympathetic nervous system
2. The system releases epinephrine and norepinephrine from the adrenal medulla - adrenaline.

• Short term process => fight or flight stress

Question 6

Stress

Inducing stress in the lab

TSST, MAST, SSSP

Answer 6

1. The Trier Social Stress Test: fake induced speech with a math task in between - audience has a neutral-cold attitude and are interruptive with faults.
   - High stress before the speech.
2. The masstricht Acute Stress Test: hand immersion task followed by math - no audience.
   - High stress during hand immersion
3. Simple Singing Stress Procedure: video of singing and believed to be judged - no audience.
   - High stress before signing.

Question 7

Stress

Stress Inoculation Training Treatment

The three phases

Answer 7

1. Conceptualization phase: education of stress, threat appraisal, breakdown of big stressors.
2. Skills acquisition phase: coping skills, cognitive and behavioural skills, individually tailored to the needs of patients.
3. Application phase: using the skills, failure management, peer training, booster sessions.

Effects:
- Lower stress levels before performance compared to control groups.

Question 8

Experimental approaches

LeDoux - the 2 roads of fear

Lecture

Answer 8

1. High road: thalamus > visual cortex (site of awareness) > amygdala = slow, fine-grained, precise.
2. Low road: thalamus > amygdala = fast, coarse, evolutionary advantage, irrational phobias.

Question 9

Experimental approaches

Measuring attentional biases

Dot probe, emotional stroop,

Question 10

Experimental approaches

The amygdala

Answer 10

• The fear hub
• It damaged - fear responses are inexistant.

Question 11

Experimental approaches

Fear conditioning - Classical conditioning

Lecture

Answer 11

Fear learning
1. An unconditioned stimulus (stimulus, event) is associated with a unconditioned response (emotion and physiological response.
2. This is associated with a conditioned stimulus (previously neutral) to a conditioned response.

Terms:
- US = biologically aversive stimulus
- CS+ = stimulus that predicts the presence of a US.
- CS- = stimulus that predicts the absence of a US.
- CR = conditioend responses to the CS

Example: Alex was bitten by a dog, later showing intense reactions to dogs.
- CS = Dog (initially neutral)
- US = Dog bite (biologically aversive)
- CS-US pairing = Getting bitten by a dog
- CR = fear reaction in response to the CS (dog)

Question 12

Experimental approaches

Criticism of Fear conditioning + how are they addressed?

Answer 12

Limitations:
- Ethical considerations
- No direct experience of CS-US pairing = not all patients have a history of fear conditioning, ex: not all dog phobic have gotten attacked by a dog => fear learning via instructions or observational learning or revaluating the US.
- Not everyone develops a phobia/PTSD after CS-US pairing => prior experience (latent inhibition), individual differences.

Advantages:
- Controlled for various confounding variables.
- Controlled environments
- Intensity of threat (US) can be manipulated

Question 13

Experimental approaches

Fear vs Anxiety

Answer 13

Anxiety:
- anticipation of potential threat.
- Unknown source of threat.
- General feeling of apprehension about possible danger.
- Future oriented
- Hypervigilance
- Long-term

Fear:
- Response to a specific, known, stimulus.
- Imminent threat.
- Selective attention to threat.
- Mobilization (HR accelaration, elevated blood pressure)
- Fight or flight response.

Question 14

Experimental approaches

Extinction learning

Answer 14

To repeatedly present the CS+ alone

Question 15

Experimental approaches

Return of fear

Lecture

Answer 15

1. Contextual renewal:

• Acquisition > extinction > renewal test

2. Spontaneous recovery
3. Reinstatement

Question 16

PTSD

Elher’s and Clarks cognitive model

Question 17

PTSD

Emotional processing theory (FOA)

Lecture

Question 18

PTSD

Brain changes

Lecture

Question 19

PTSD

EMDR

Question 20

Panic Disorder

Clark’s cognitive model

Question 21

Panic Disorder

Gorman’s biological model

Question 22

Panic Disorder

Threat-Imminence model

Question 23

Panic Disorder

Revised causal model of PD

Question 24

Panic Disorder

Interoceptve exposure

Question 25

Panic Disorder

In-vivo treatment

Question 26

Generalised anxiety disorder

Intolerance of uncertainty model

Question 27

Generalised anxiety disorder

Metacognitive model

Question 28

Generalised anxiety disorder

Intolerance of uncertainty therapy

Question 29

Generalised anxiety disorder

Metacognitive Therapy

Question 30

Generalised anxiety disorder

Behavioural differences between healthy and GAD

Question 31

Social anxiety disorder

DSM-5 criteria

Lecture

Answer 31

1. Fear about one or more social situations.
2. The fear will act/show anxiety symptoms that will be negatively evaluated by others.
3. The situation almost provokes the fear.
4. The situations are avoided.
5. The fear is out of proportion.
6. The fear is persistent (6 months or more).
7. Causes distress and impairment in more than one context.
8. It not attributable to physiological effects of a substance.

Question 32

Social anxiety disorder

Processing social evaluative situations model

6 steps

Lecture

Answer 32

1. Social situation activates an assumption. Ex: people will make fun of me for giving this speech.
2. This activates the perception of social danger. Ex: People will laugh at me.
3. This activates as sense of Self as a social object/the center of attention. Ex: i can feel my face getting red and hands being sweaty.
4. Symptoms start to show. Ex: I actually start sweating and being visibly red.
5. Safety behaviours are activated. Ex: squeezing my hands so nobody can see they are shaking.
6. The anxiety is maintained and the cycle repeats itself.

Question 33

Social anxiety disorder

Integrated etiological and maintenance model

5 components

Lecture

Answer 33

1. The extent to which social evaluative stimuli are threatening to someone > continuous scale.
2. Factors that influence the SET model: inherited tendencies (temperaments), parent behaviours (learning), peer experiences (negative evaluation), life events, culture.
3. Cognitive processes: self-focus, anticipation and attention towards threat.
4. Behavioural processes: avoidance (to eliminate the threat but always comes back in the future), safety behaviours (reinforce fear), cognitive avoidance (worsen symptoms).
5. All the components together lead to interference in life and social anxiety disorder.

Question 34

Social anxiety disorder

SAD developping during Adolescence

Lecture

Answer 34

1. Begins with seperation anxiety in 5 years old and develops fully at 13 years old on average.
2. Adolescents are focused on peers.
3. The gap between the amygdala development (early) and prefrontal regions (later) is the reason for SAD in adolescents => they can respond intensely to emotions but cannot control them yet.
4. The social brain => automatic and instinctive social responses to understand and read people’s behaviours

Question 35

Social anxiety disorder

Adapting SAD models for adolescents.

Lecture

Answer 35

• Activating assumptions => mental imagery
• Processing self as a social object => very common, associated with higher self-consciousness.
• Safety behaviours => requires parents to step in.
• Factors => parenting factors, friendships/peer victimisation, social media.

Question 36

Social anxiety disorder

Attentional bias modification treatment

Lecture

Answer 36

Modification of the dot probe task => gamified.
Results: all kids show less anxiety but more prominent in the active condition.

Question 37

Social anxiety disorder

Clark and wells’ cognitive model

4 dysfunctional patterns

Answer 37

The interaction between innate behavioural predispositions and life experiences => perceiving the world as dangerous.

Dyfunctional patterns:
1. Attention inward bias: attention to inner thoughts/feelings - subjective and confirms their experience = enhances anxiety.
2. Safety behaviours: behaviours to avoid negative evaluation from others - often increases anxiety.
3. Cognitive distortions: overestimating negative judgement from others - constant monitoring of behaviours = hyper-vigilance and impaired social performance.
4. Attentional bias: anticipatory anxiety before and negative reflection after.

Question 38

Social anxiety disorder

Rapee’s cognitive behavioural model

3, factors, 5 dysfunctional processes

Answer 38

SAD exists on a continuum.
Factors that influence the dysfunctional processes:
1. Genetic factors
2. Negative evaluation bias
3. Acceptance in society

Dysfunctional patterns:
1. Social situations
2. Avoidant behaviours:
3. Negative self-image:
4. Negative evaluation:
5. Post-event processing:

Question 39

Social anxiety disorder

Similarities and differences between Clark and Rapee’s models

Answer 39

Similarities:
1. Importance of avoidance behaviours.
2. Attentional resources to the threatening assessment of others.
3. Cognitions: distorted representation of the self, unrealistically high standards for own performance and consequences.

Differences:
1. Attentional focus: internal (clark) and external (rapee)
2. Safety behaviours: core problem (clark), avoidance is more problematic (rapee).
3. Treatment: tackle safety behaviours + shift focus outward (clark), tackle the avoidance and direct attention to mental representations + indicators.

Question 40

Social anxiety disorder

Cognitive biases in SAD

4 biases

Answer 40

1. interpretation & judgment biases: interpreting ambiguous social cues as negative/threatening.

• Cognitive bias modification => repeatedly exposing individual to ambiguous information to encourage positive interpretations.

2. Selective attention bias: focus on negative information while ignoring positive/neutral ones.

• Unconscious: adaptive to detecting threats for survival => stroop task and dot probe = faster response to threatening stimuli.
• Conscious: focus on negative aspects of themselves related to social performance => stroop task/dot probe/face-in-the-crowd = faster response to threatening stimuli / CBM paradigm: train attention away from threatening stimuli.

3. Post-event processing: ruminating on negative aspects of performance after the interaction => reinforces negative beliefs.

• CBT to change biases.

4. Implicit associations bias: associating social cues with negative outcomes => low self-esteem.

• CBM to lower implicit rejection associations.

CBT + CBM can change bias and lead to reovery.

Question 41

Social anxiety disorder

Maladaptive behaviours in SAD

4 behaviours

Answer 41

1. Avoidance: avoidance of social cues

• Approach-avoidance task/crowd stimuli study/gaze direction manipulation study = supported slower appraoch to threatening stimuli

2. Interpersonal distance: maintaining more interpersonal space than needed.

• Virtual reality study = supported slower appraoch to threatening stimuli

3. Behavioural and facial mimicry: less facial mimicry => cannot understand others’ affective states.

• EMG study = supported diminished appraoch to threatening stimuli

4. Social skills: deficits in acquiring social skill, social performance, fluency and anxious behaviour.
   * Measure social behaviour and facial blood flow.