Task 3 Anxiety disorders Flashcards
Social anxiety disorder
people become so anxious in social situations that they are so preoccupied with their worries that they may focus on avoiding social situations
Prevalence SAD
lifetime prevalence in USA 12% and 3-7% internationally
o Women are more likely to develop it
o Decreases with higher age
Point of onset (SAD)
develops in either the early preschool years or adolescence, when many people become self-conscious and concerned about others opinions of them
Cormobidity (SAD)
SAD often co-occurs with mood disorders and other anxiety disorders (70%)
DSM-5 SAD
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
SAD specify if
Performance only: If the fear is restricted to speaking or performing in public
Cognitive perspective SAD
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
Biological treatment for SAD
o SSRIs and SNRIs (selective serotonin-norepinephrine reuptake inhibitors) reduce symptoms of social anxiety but only for the time of intake
CBT for SAD
exposing people to situations that make them anxious starting with the least anxiety causing situation
Relaxation techniques, role plays,
Mindfulness based interventions
Teaches: being less judgemental about their own thoughts and reactions and more focused on, and relaxed in, the present moment.
Enhanced CBT
Specifically target underlying processes proposed to maintain social anxiety & exposure tasks that make use of a hypothesis-testing approach
Greater treatment effect
Panic attacks
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
Panic disorder
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
Episodes of PD
Might occur in PD e.g. having it one week every day and then not for one week
Prevalence PD
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
DSM-5 PD
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)
Genetic factor PD
Runs in families (heritability 43-48%)
Fight or flight response (PD factor)
Fight or flight response is poorly regulated in PD patients
• Might be due to poor regulation of several neurotransmitter (nor-epinephrine, serotonin, GABA)
Locus ceruleus (factor PD)
well connected to limbic systems and causes it to lowering the threshold for activation of diffuse and chronic anxiety
Women factor PD
Women might get attacks before or while their period caused by unbalanced neurotransmitter
Biological challenge test
Giving the participant a substance that elicits a panic attack
Body view (factor PD)
People are more fine-tuned in view of body responses so even minimal changes can cause hyperreaction
Suffication theory (PD)
- Combination of CO2 and O2 intake triggers oversensitive alarm system
Cognitive factors (PD)
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
Anxiety sensitivity (PD)
the unfounded belief that bodily symptoms have harmful consequences
• Increases likeliness of developing PD and increases the frequency of attacks
Interoceptive awareness (PD)
a heightened awareness of bodily cues (such as slight sensations of arousal and anxiety) that may signal a coming panic attack
Interoceptive conditioning (PD)
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)
Cognitive mediators (Clark) (PD)
- 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)
An integrated model (PD)
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
Biological treatment (PD)
• 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
CBT for PD
• Confront situations that cause anxiety
o Allows clients to challenge and change irrational beliefs about these situations
Cognitive model by Clark and Wells
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
Clark and Well study
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
Memory bias
less recall of positive public self-referent words and more negative ones
Occurs at retrieval not encoding
Interpretation bias
Social phobia patients interpret ambiguous event as negative (context dependent)
o And social situations as more threatening (context)
judgement bias
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
SAD and social performance
• Overestimate their anxious appearance and social mishap and underestimate quality of social behaviour
Conversations ad SAD
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
Speech and SAD
discrepancy between self and observed performance is not significant
Underestimated their own performance esp. in speech
Rapee & Heimberg (PD)
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
