Task 3 - Anxiety Disorders Flashcards
Social Anxiety Disorder (SAD)
Definition
A severe and persistent fear of social or performance situations
DSM-5 Criteria for SAD
A. Fear or anxiety about one or more social situations in which the individual is exposed to scrutiny by others
B. The indivudal fear that they 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 situation is often avoided
E. The fear is out of proportion to the actual threat
F. Lasting for 6 months or more
G. Causes significant distress
H. Not explained by substances or medical condition I. or mental condition
J. If other condition present, fear is unrelated or excessive
Prevalence of SAD
- Between 4-13% in Western societies, but rates are significantly lower in South-East Asian countries
- A gender prevalence of 3:2 females to males
Genetic Factors of SAD
Constructs related to SAD that have a genetic component are:
* Submissiveness
* Anxiousness
* Social Avoidance
* Behavioral Inhibition
Behavioral inhibition
Definition
A construct used to define the characteristics in some children of seeming quiet, isolated and anxious when confronted either with social situations or with novelty
Familial and developmental factors of SAD
Parents of children with social anxiety disorder:
* Exert greater control over their children
* Show less warmth
* Are less sociable
* Use shame as a method for discipline
Cognitive factors of SAD
- Information processing and interpretation biases
- Overcritical evaluation of their performance in social situations
- Self-focused attention
- Excessive post-event processing
Voncken et al.: Social performance deficits in SAD
- Involved two tasks: a speech and a conversation, which were randomly assigned to participants
- Findings: Found that patients with SAD were characterized by both biased estimations and social performance deficits
Voncken et al.: Interpretation and judgmental biases
- The Interpretation and Judgmental Questionnaire (IJQ) was used to assess interpretation and judgmental biases in social and non-social events
- Findings: Social phobic patients interpreted social events as more negative and judged social events as more threatening compared to the normal control group
- No differences between the two groups in their ratings of non-social events
- These results confirm the hypothesis that interpretation and judgmental biases in social phobia are content-specific
Attention Bias Modification
A therapy for SAD
* Attentional biases toward threatening information are addressed through computer-based ABMT, aiming to redirect attention away from socially threatening stimuli.
* Debate about its viability as a treatment
Panic disorder
Definition
An anxiety disorder characterized by repeated panic or anxiety attacks
Panic attack
Definition
An abrupt surge of intense fear or discomfort in which four or more of a list of symptoms (DSM-5) develop suddenly
DSM-5 Criteria for Panic Disorder
A. Recurrent unexpected panic attacks
B. At least one of the attacks has been followed by 1 month or more of persistent concern about additional panic attacks or maladaptive change iin behavio to avoid panicking
C. Not attributable to substances or medical condition or D. Another mental disorder
The role of hyperventilation in Panic Disorder
- Hyperventilation can produce the symptoms of panic attacks that are recognized as anxiety
- Has been supported by studies using biological challenge tests
- This evidence has given rise to suffocation alarm theories
This evidence has given rise to suffocation alarm theories
Definition
Research in which panic attacks are induced by administering carbon dioxide (CO²) enriched
air or by encouraging hyperventilation
Suffocation alarm theories
Concept
Models of panic disorder in which a combination of increased CO² intake may activate an
oversensitive suffocation alarm system and give rise to the intense terror and anxiety experienced during a panic attack
Role of noradrenergic overactivity in Panic Disorder
- Disorder may be caused by overactivity in the noradrenergic neurotransmitter system
- Patient with panic disorder are deficient in gamma-aminobutyric (GABA) neurons that inhibit noradrenergic activity (PET studies have supported this view)
Role of classical conditioning in Panic Disorder
- “Fear of fear”: Meaning when they detect any sign of a panic attack, they immediately become fearful of the
possible consequences - Leading to interoceptive classical conditioning, with an internal cue (e.g. dizziness), became established as a CS
predicting a panic attack (US). But it is a circular explanation
Anxiety sensitivity
Definition
Fears of anxiety symptoms based on beliefs that such symptoms have harmful consequences (e.g.
that a rapid heartbeat predicts an impending heart attack)
Role of anxiety sensitivity in Panic Disorder
Panic disorder sufferers become extremely anxious when they detect any cues that may be indicative of a panic
attack and this leads to a panic attacks, because they have developed anxiety sensitivity
Catastrophic misinterpretation of bodily sensations
Definition
A feature of panic disorder where there is a cognitive bias towards accepting the more threatening interpretation of an individual’s own sensation
Clark’s model of panic disorder
Concept
Perception of a threat triggers
apprehension and then bodily sensations associated with that apprehension are interpreted catastrophically. This causes further anxiety which feeds into a vicious cycle that triggers a full-blown panic
attack
Khawaja et al.: Catastrophic cognitions in Panic Disorders and Agoraphobia
- There is empirical support for the concept of catastrophic cognitions in panic disorder and agoraphobia
- Patients frequently engage in thoughts of dramatic consequences, particularly during elevated anxiety
and panic - Hypervigilance and selective attention are important aspects of the process of catastrophic misinterpretation
Safety Behaviors
Definition
Activities deployed by sufferers of panic disorder as soon as they think they are having a panic attack, developed in the belief that this activity has saved them from a catastrophic outcome
Role of safety behaviors in Panic Disorder
Might uphoald fears because people keep thinking the only reason
everything went well is because of their safety behavio
Criteria for determining if Biological Challenge test are cognitively mediated (Clark et al.)
- Panic disorder patients tend to interpret bodily sensations as signs of impending physical or
mental disorders more than other anxiety disorder patients or normal controls. - Panic attacks induced by CO2 inhalation are accompanied by catastrophic cognitions like “I am
going to die” - Experimental manipulations of cognitive variables impact an individual’s panic during biological
challenge tests
Rapee et al.: Manipulating interpretations of CO2 inhalation effects via pre-challenge explanations
- Detailed explanation group reported fewer catastrophic cognitions and less panic during inhalation compared to
the minimal explanation group. - Social phobics showed low panic ratings, confirming CO2’s panic-inducing effect is specific to panic disorder
patients
Sanderson et al.: Manipulation of perceived control
- Deceptively manipulated perceived control during a 20-min 5% CO2 inhalation in panic disorder patients (told them they could control the CO2 flow
- Illusion of control group reported fewer catastrophic cognitions and less panic, despite not having actual control over CO2 flow
Margraf et al.: Manipulating patients expectations
- Investigated hyperventilation challenge test, manipulating patients’ expectations before the procedure.
- Patients expecting a “biological panic attack test” reported more panic symptoms compared to those expecting a “fast-paced breathing task”
Rapee et al.: Reassuring observer during BCT
- Explored the impact of a reassuring observer during CO2 inhalation on panic disorder patients with agoraphobia
- Manipulation of perceived safety levels did not effectively differentiate panic occurrence between groups
Clark et al.: Emphazising normalcy of sensations in BCT
- Investigated sodium lactate-induced panic by allocating panic disorder patients to different pre-infusion instructional sets
- Experimental instructions emphasizing normalcy of sensations resulted in less reported anxiety and fewer instances of panic compared to control instructions
The main cognitive mediators of BCT-induced panic attacks
Manipulating interpretation of sensation or perceived control affected panic response, while manipulating expected affect didn’t always influence panic frequency
Clark & Wells model of cognitive deteminants of anxiety and rumination in SAD
- Dysfunctional beliefs triggering fear of negative evaluation
- Self-focused attention, anxiety responses, and disregarding
contradictory social cues - Reliance on safety behaviors reinforcing social incompetence beliefs
- Pre-event rumination on past failures and post-event rumination on negative self-perception
Rapee & Heimberg’s model of cognitive deteminants of anxiety and rumination in SAD
- Emphasis on positive appraisals and assumption of inherent criticism by others
- Anticipating negative evaluation reinforcing negative self-image
- Focus on the discrepancy between expected performance and perceived standards
Hofmann’s model of cognitive deteminants of anxiety and rumination in SAD
- Unrealistic social standards and poorly defined goals contributing to apprehension
- Inward attention, negative self-image, anticipation of social mishap, and reliance on safety behaviors
- Post-event rumination and heightened anxiety due to perceived discrepancies
Post-event rumination
It occurs after a social situation and is characterized by consolidating negative impressions about oneself, negative memories, and assumptions about future social situations.
Pre-Event rumination
Involves preoccupation with thoughts regarding past failures and predictions of poor performance before encountering a feared social situation
Agoraphobia
Definition
A fear or anxiety of any place
where the sufferer does not feel safe or feels trapped, and is accompanied by a strong urge to escape to a safe place
