Sectional 3 Exam Flashcards
Describe the potentially adaptive value of fear and the difference between fear and anxiety (and how this applies across disorders within this topic).
- “Fight-or-flight” response
- Fear is a defense system against immediate threats
Fear vs. Anxiety
Fear:
- Specific emotional response
- Caused by specific, known stimulus
- Caused by external stimulus
- Involves fight or flight
Both:
- An alerting response to perceived threat
- Share biological processes
- Can be adaptive in some situations
Anxiety:
- General mood state
- Caused by vague, unknown stimulus
- Caused by internal stimulus
- Physiological state of readiness for something bad to occur
Explain the fight-or-flight response (including physiological components, e.g. role of amygdala, autonomic nervous system, HPA axis, cortisol).
“Fight-or-flight” Response
Amygdala -> Hypothalamus -> Autonomic nervous system or endocrine system -> through autonomic nervous system you go to sympathetic nervous system
Endocrine System:
HPA Axis -> Cortisol & Adrenaline -> Changes in internal organs and muscles
hypothalamus -> pituitary gland -> adrenal cortex (where cortisol is produced
HPA Axis Response
Hormone functions:
Cortisol
- Increase glucose in the blood
- Provide negative feedback to hypothalamus
and pituitary gland to shut of HPA axis
response
Identify common, core thinking errors of anxiety disorders.
Thinking errors:
- likelihood
- consequences
Normal vs. Pathological Fears:
- Realistic in this situation?
- Proportional to threat?
- Persist in absence of threat?
- Distressing/impairing?
Explain the role of negative reinforcement, avoidance, and safety behaviors in anxiety disorders.
Avoidance is negatively reinforcing
- In short-term, it reduces anxiety
Safety Behaviors: action to avoid/ reduce anxiety-provoking situations
- Negative reinforcement
- False attribution of safety
- Avoidance of disconfirming evidence
Describe the rationale for and the components of exposure therapy.
Best treatment for anxiety disorders
Involves repeated exposure to anxiety-producing stimulus/situation
- Carefully controlled, gradual exposures to
increasingly anxiety-producing
situations/stimuli
- Phases out use of safety aids
Reinforcing cycles
You have an increase in fear and anxiety so you avoid it then you have that increase of fear and anxiety about that particular thing again
Exposure therapy uses this reinforcing cycle to try to reverse it, you have decrease in fear and anxiety so you have exposure which then decreases fear and anxiety
Explain the difference between panic attacks and Panic Disorder (PD).
Panic Attacks
- amps up within few minutes
- distinct period (<10 minutes)
4+ symptoms:
1) Heart racing/skipping
2) Sweating
3) Trembling
4) Shortness of breath
5) Choking feeling
6) Chest pain
7) Nausea
8) Dizziness
9) Chills/hot flash
10) Numbness/tingling
11) Derealization/depersonalization
12) Fear of going crazy
13) Fear of dying
Cued (expected) – usually within context of another disorder
Uncued (unexpected) – usually in context of panic disorder
Panic Disorder
- Repeated, unexpected panic attacks
- Two or more uncued panic attacks
- With one other symptom of 3 symptoms
Identify the key diagnostic criteria of PD (e.g. uncued panic attacks).
Repeated, unexpected panic attacks
One unexpected attack followed by at least 1 month of any of the following:
- Persistent concern about having another
attack
- Continuous worry about consequences
- A significant change in behavior related to
panic attacks
Not due to substance
Not better explained by medical condition
Not restricted to a phobic context
They can also have cued panic attacks, but they must have at least two uncued panic attacks
Identify biological and psychological theories of PD.
Biological Theories & Treatment of PD
- Genetic factors: ~50% heritable
- Neurotransmitters: dysregulated norepinephrine
- Brain structure & function: limbic abnormalities
Psychological Theories of PD
Anxiety Sensitivity (AS): fear of anxiety symptoms
- Physical
- Cognitive
- Social
More attuned to these sensations and thoughts AND interpret them as dangerous
Cognitive-Behavioral Model of PD
Behavioral:
- Avoidance of bodily sensations
- Avoidance of feared situations
Cognitive:
- Attenuation to bodily sensations
- Catastrophic beliefs about bodily sensations
Describe the concept of anxiety sensitivity and how it relates to PD.
Anxiety Sensitivity (AS): fear of anxiety symptoms
- Physical
- Cognitive
- Social
“My heart is racing… I’m having a heart attack.”
“Nothing feels real… I’m going crazy.”
Identify the most effective treatments for PD.
Antidepressant medications (to prevent)
- e.g. SSRIs (Prozac, Zoloft) or SSNRIs (Effexor)
Anti-anxiety medications (during)
- Benzodiazepines (Xanax, Valium)
(could become a safety behavior though, not really effective)
Cognitive-Behavioral Therapy (most effective treatment for PD)
<-> Thoughts <-> Behaviors <-> Feelings
CBT targets Thoughts and Behaviors
When it targets thoughts it is Cognitive Restructuring
Bring awareness to thinking patterns
- How do your thoughts relate to panic?
Challenge thinking
- Evidence for/against thought
- “How many times have you had a heart
attack during a panic attack?”
- “You’re worried about losing control. What
does it mean to lose control?”
- “What’s the worst-case scenario here?”
- “A thought is just a thought.”
Establish adaptive thinking patterns
- Based in REALITY
When CBT targets Behaviors it is called Interoceptive Exposure
Explain what Interoceptive Exposure is and how it works.
It is the part of CBT that targets Behaviors
What does it do?
Normalizes sensations brought on by ordinary exertion or excitement.
Targets cognitive misinterpretation of physical sensations.
- Learn that feared outcome does not happen.
How?
Repeated “exposure” to production of physical symptoms
- Followed by reduction of these symptoms
Tolerance to these experiences increases over time
Interoceptive Exposure treats Panic Disorder through:
- Repeated exposure to distressing physical
symptoms
- Habituation to these physical symptoms
- Targeting catastrophic beliefs about physical
symptoms
Describe how to target physical fears related to PD.
You target physical fears related to PD by inducing those physical fears to happen, by spinning in circles to induce dizziness and by having the person walk up and down stairs to induce breathing problems.
Describe the primary features of Agoraphobia and distinguish it from PD.
Panic Disorder
Repeated, unexpected panic attacks
One unexpected attack followed by at least 1 month of any of the following:
- Persistent concern about having another
attack
- Continuous worry about consequences
- A significant change in behavior related to
panic attacks
Not due to substance
Not better explained by medical condition
Not restricted to a phobic context
They can also have cued panic attacks, but they must have at least two uncued panic attacks
Agoraphobia
Anxiety about 2+ situations:
- Using public transportation (e.g.,
automobiles, buses, trains, ships, planes).
- Being in open spaces (e.g., parking lots,
marketplaces, bridges).
- Being in enclosed places (e.g., shops,
theaters, cinemas).
- Standing in line or being in a crowd.
- Being outside of the home alone.
Anxiety about 2+ situations IS DUE TO:
- Fear that escape might be difficult or help
might not be available in the event of
developing panic attack symptoms (or other
incapacitating or embarrassing symptoms;
e.g., fear of falling or of incontinence in the
elderly)
- These situations are then persistently
avoided (or require the presence of a
companion or are endured with intense
fear)
Other criteria:
- Situations almost always provoke fear or
anxiety
- Fear or anxiety is out of proportion to actual
danger of the situation
- Distress and/or impairment
- Fear or anxiety lasts for 6 months or more
- Not better explained by another diagnosis
A LOT of comorbidity
- In agoraphobia – fear could be related to having panic attacks, or could be other incapacitating/embarrassing symptoms (e.g. having a seizure and not being able to get help in crowd)
- In PD – may result in avoiding specific places, etc., but not necessarily
- e.g. avoiding exercise because it elicits
similar physical sensations
Describe prevalence and demographics of Agoraphobia and PD.
Agoraphobia
- ~50% of people with agoraphobia have history
of panic attacks, many also have PD - More common in women than men
- Typical age of onset: early 20s
- Increased substance use
Panic Disorder
-Attacks: 28% lifetime
-Disorder: 3-5% lifetime
-Onset: late teens to mid-30s
-Often: First time -> ER
-Relapsing/remitting
-80% have comorbid condition
- More common in women
- 2.5 women: 1 man
- More common in LGBTQ+ population, especially among men
- Slightly more common in white Americans
Identify the diagnostic criteria of Specific Phobias.
A. Excessive or unreasonable fears cued by a specific object or situation.
B. Phobic situation or object must always or almost always produce feared response
C. Fear is out of proportion to actual danger
D. Avoidance OR intense anxiety/distress.
E. 6+ months
F. Distress and/or impairment.
Name the four categories of Specific Phobias.
- Animals (or insects)
- Natural environment
- Situational
These three all produce ‘normal’ physiological fear reactions (e.g. increased heart rate, blood pressure, and adrenaline) - Blood-injection-injury (BII)
- Seeing blood or an injury or receiving an
injection
- Seeing blood or an injury or receiving an
