Task 3 Anxiety disorders

Question 1

Social anxiety disorder

Answer 1

people become so anxious in social situations that they are so preoccupied with their worries that they may focus on avoiding social situations

Question 2

Prevalence SAD

Answer 2

lifetime prevalence in USA 12% and 3-7% internationally
o Women are more likely to develop it
o Decreases with higher age

Question 3

Point of onset (SAD)

Answer 3

develops in either the early preschool years or adolescence, when many people become self-conscious and concerned about others opinions of them

Question 4

Cormobidity (SAD)

Answer 4

SAD often co-occurs with mood disorders and other anxiety disorders (70%)

Question 5

DSM-5 SAD

Answer 5

o A Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech)
o B The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated
o C The social situation almost always provoke fear or anxiety
o D The social situations are avoided or endured with intense dear or anxiety
o E The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context
o F The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
o G The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
o H The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition
o I The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder
o J If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive

Question 6

SAD specify if

Answer 6

 Performance only: If the fear is restricted to speaking or performing in public

Question 7

Cognitive perspective SAD

Answer 7

people with social anxiety disorder have excessively high standards for their social performance (e.g. they believe that they should be liked by everyone)
o Also focus on negative aspects of social interactions and evaluate their own behaviour harshly
o Safety behaviour:
 Avoid eye contact
 Or social interactions altogether

Question 8

Biological treatment for SAD

Answer 8

o SSRIs and SNRIs (selective serotonin-norepinephrine reuptake inhibitors) reduce symptoms of social anxiety but only for the time of intake

Question 9

CBT for SAD

Answer 9

exposing people to situations that make them anxious starting with the least anxiety causing situation
 Relaxation techniques, role plays,

Question 10

Mindfulness based interventions

Answer 10

 Teaches: being less judgemental about their own thoughts and reactions and more focused on, and relaxed in, the present moment.

Question 11

Enhanced CBT

Answer 11

 Specifically target underlying processes proposed to maintain social anxiety & exposure tasks that make use of a hypothesis-testing approach
 Greater treatment effect

Question 12

Panic attacks

Answer 12

short but intense periods during which she experiences many symptoms of anxiety: heart palpitations, trembling a feeling of choking and so on
o Might sometimes have no environmental triggers
o Prevalence: 28% of adults have occasionally panic attacks, esp. during time of stress

Question 13

Panic disorder

Answer 13

o when panic attacks are not usually provoked by any particular situations but are unexpected
o when a person starts to worry about having them and changes behaviours as a result of this

Question 14

Episodes of PD

Answer 14

Might occur in PD e.g. having it one week every day and then not for one week

Question 15

Prevalence PD

Answer 15

3-5 % of people will develop panic disorders
 Usually between late adolescence and the mid thirties
 More common in women and tends to be chronic

Question 16

DSM-5 PD

Answer 16

 A Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensation of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, light-headed or faint
9. Chills or heat sensations
10. Paresthesias (numbness or tingling sensations)
11. Derealization (feeling of unreality) or depersonalization (being detached from oneself)
12. Fear of losing control or going crazy
13. Fear of dying
 Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms
 B At least one of the attacks has been followed by 1 month or more of one of both following
• Persistent concern or worry about additional panic attacks or their consequences (e.g. losing control. Having a heart attack)
• A significant maladaptive change in behaviour related to the attacks (trying to avoid panic attacks)
 C The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders)
 D The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder)

Question 17

Genetic factor PD

Answer 17

 Runs in families (heritability 43-48%)

Question 18

Fight or flight response (PD factor)

Answer 18

 Fight or flight response is poorly regulated in PD patients
• Might be due to poor regulation of several neurotransmitter (nor-epinephrine, serotonin, GABA)

Question 19

Locus ceruleus (factor PD)

Answer 19

well connected to limbic systems and causes it to lowering the threshold for activation of diffuse and chronic anxiety

Question 20

Women factor PD

Answer 20

 Women might get attacks before or while their period caused by unbalanced neurotransmitter

Question 21

Biological challenge test

Answer 21

Giving the participant a substance that elicits a panic attack

Question 22

Body view (factor PD)

Answer 22

 People are more fine-tuned in view of body responses so even minimal changes can cause hyperreaction

Question 23

Suffercation around theory (PD)

Answer 23

• Combination of CO2 and O2 intake triggers oversensitive alarm system

Question 24

Cognitive factors (PD)

Answer 24

 1 Pay very close attention to their bodily sensation
 2 Misinterpret these sensations in a negative way (Egg or chicken)
 3 engage in snowballing catastrophic thinking, exaggerating symptoms and their consequences
• Increases subjective sense of anxiety
• This constant arousal makes further attacks more likely

Question 25

Anxiety sensitivity (PD)

Answer 25

the unfounded belief that bodily symptoms have harmful consequences
• Increases likeliness of developing PD and increases the frequency of attacks

Question 26

Interoceptive awareness (PD)

Answer 26

a heightened awareness of bodily cues (such as slight sensations of arousal and anxiety) that may signal a coming panic attack

Question 27

Interoceptive conditioning (PD)

Answer 27

bodily cues that have occurred at the beginning of previous panic attacks and have become conditioned stimuli signalling new attacks
• Slight increase in anxiety might already trigger a panic attack (person does not recognize this process)

Question 28

Cognitive mediators (Clark) (PD)

Answer 28

• Expected effect: Subjects expectation about distress and anxiety they might experience during the procedure
• Interpretation: the explanations that were readily available for sensations experienced during the procedure (most critical probably even more than perceived control)
• Perceived control: subjects perceived control over sensations that might be experienced during procedure (critical)

Question 29

An integrated model (PD)

Answer 29

 People often have hypersensitive fight or flight response, when combined with catastrophic thinking about physiological symptoms can lead to panic attacks
 It also leads to hypervigilance for signs which leads to mild to moderate levels of anxiety all the time which increases the likelihood of panic attacks
 Conditioned avoidance response: When situations get associated with panic attacks people try to avoid these situations
• Leads to Agoraphobia

Question 30

Biological treatment (PD)

Answer 30

• Mostly affecting nor-epinephrine or serotonin systems (SSRI and SNRI)
• Benzodiazepines: supresses CNS and influence GABA serotonin and nor-epinephrine functioning
o Helps to quickly reduce panic attacks and general symptoms of anxiety in most patients

Question 31

CBT for PD

Answer 31

• Confront situations that cause anxiety

o Allows clients to challenge and change irrational beliefs about these situations

Question 32

Cognitive model by Clark and Wells

Answer 32

o Before entering feared social situation:
 High anxious individuals selectively retrieve and dwell on unfavourable information about how they think they are viewed by others, so they already enter in distressed state
o When socially anxious people become concerned that they may fail to make their desired impression their attention shifts from observing others to detailed monitoring and observation of themselves.
 While relying on internal information they use e.g. feelings of anxiety and then fear that people outside can see their anxiety as they do
 May fail to observe positive feedback from others
 Might appear withdrawn to other people that elicits less friendly responses from others
 Enhanced awareness of e.g. bodily symptoms of anxiety
• More arousal more perceived seeableness of anxiety

Question 33

Clark and Well study

Answer 33

 Presented positive & negative words and let them rate those in one of three ways:
• Public self-referent: describes how you think you are viewed by others
• Private self-referent: describes you
• Other-referent: describes your neighbour
 Half the participants were told that they have to give a presentation (social threat)
 Then asked to recall words
 Depression was seen as confounding factor but since both grpups did differentiate in recall of public self-referent words this possibility was ruled out
 Results: when confronted with social threat, high anxiety group retrieved less positive & more negative public self-referent encoded words  memory bias
 Low social anxiety group self-enhanced in threat condition

Question 34

Memory bias

Answer 34

less recall of positive public self-referent words and more negative ones
 Occurs at retrieval not encoding

Question 35

Interpretation bias

Answer 35

Social phobia patients interpret ambiguous event as negative (context dependent)
o And social situations as more threatening (context)

Question 36

judgement bias

Answer 36

overestimate costs (more) and probabilities of negative events (social phobia patients)
o Across all social events, irrespective of valence
o No difference between controls and treatment in overestimation of costs

Question 37

SAD and social performance

Answer 37

• Overestimate their anxious appearance and social mishap and underestimate quality of social behaviour

Question 38

Conversations ad SAD

Answer 38

Seems to actually impair performance of people with SAD
 Caused by two factors:
• The two tasks might be different in level of experience structure (Conversations are unstructured what might lead to the impairment)
o Conversation need interaction whereas a speech only needs action (more control)
• Conversation asks for more sensitive social behaviour than a speech

Question 39

Speech and SAD

Answer 39

discrepancy between self and observed performance is not significant
 Underestimated their own performance esp. in speech

Question 40

Rapee & Heimberg (PD)

Answer 40

 Form mental representation of external appearance -> allocate mental resources to that & the perceived threat in the social sitch -> prediction about what performance the audience will expect
 Discrepancy between mental representation & what audience expects ->anticipate negative evaluation -> symptoms -> vicious cycle