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Psychopathology > TASK 3 - (SOCIAL) ANXIETY DISORDER > Flashcards

TASK 3 - (SOCIAL) ANXIETY DISORDER Flashcards

1
Q

social anxiety disorder (SAD)

A

= become so anxious in social situations + are so afraid of being rejected/judged/ humiliated in public

  • preoccupied with worries that their life becomes focused on avoiding social encounters
  • response up to severe panic attack (tremble, feel dizzy)
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2
Q

DSM-5 (SAD)

A.

A

marked fear/ anxiety about one or more social situation in which one is exposed to possible scrutiny by others (e.g. social interactions/ performing in front of others)

  • -> children: anxiety must occur in peer setting, not just during interactions with adults
  • fear of social situation
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3
Q

DSM-5 (SAD)

B.

A

individual fears that he/she will be negatively evaluated

- fear evaluation

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4
Q

DSM-5 (SAD)

C.

A

social situations almost always provoke fear/ anxiety

- constant

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5
Q

DSM-5 (SAD)

D.

A

social situations are avoided or endured with intense fear/anxiety
- avoidance of social situations

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6
Q

DSM-5 (SAD)

E.

A

anxiety is out of proportion to the actual threat posed by the situation/context
- unproportional

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7
Q

DSM-5 (SAD)

F.

A

anxiety/avoidance is persistent (lasts AT LEAST 6 MONTHS)

- persistance

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8
Q

DSM-5 (SAD)

G.

A

anxiety causes clinically significant distress or impairment in social/occupational or other important areas of functioning
- impairment

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9
Q

DSM-5 (SAD)

H.

A

anxiety/avoidance isn’t attributable to substances or other medical condition
- medical exclusion

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10
Q

DSM-5 (SAD)

I.

A

anxiety/ avoidance is not better explained by another disorder (e.g. panic disorder/ ASD)
- psychopathological exclusion

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11
Q

DSM-5 (SAD)

J.

A

if another condition is present, then the fear/anxiety/avoidance must be clearly unrelated

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12
Q

subtypes (SAD)

A
  1. performance only: fear is restricted to speaking or performing in public
  2. moderate fear of variety of social situation
  3. severe fear of many social situations –> generalised social anxiety disorder
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13
Q

prevalence (SAD)

A

3-7%

  • 90%: humiliating experiences as cause (e.g. extreme teasing as child)
  • women: more likely, more severe social fears (particularly with regard to performance situations)
  • develop in early preschool or adolescence
  • co-morbidities: mood & other anxiety disorders (70%)
  • chronic if left untreated
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14
Q

causes (SAD)

- genetics

A
  • general tendency for anxiety heritable

- temperament makes it easier for phobias to be conditioned

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15
Q

causes (SAD)

- cognitive

A
  • excessively high standards for their social performance
  • focus on negative aspects of social interactions + negative evaluation of own behaviours
    notice potentially threatening social cues + misinterpret cues in self-defeating ways
  • possibly comes from critical, negative parents
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16
Q

theories (SAD)

- two-factor model

A
  1. classical conditioning leads to fear of phobic object + 2. operant conditioning helps maintain it
    - avoidant behaviour to prevent exposure to what fear most
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17
Q

theories (SAD)

- interpersonal deficits

A
  • underestimated social performance during speech AND social interactions (stronger for speech though)
    BUT actual social performance deficits only in conversation, not speech
  • possible explanations: speech seen as more structured, unambiguous; specific deficit in interpersonal skills due to lack of knowledge/ experience
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18
Q

theories (SAD)

- interpretation bias + judgment bias

A
  1. interpretation bias = interpret ambiguous event as negative
  2. judgement bias = overestimate costs and probabilities of negative events
    - across all social events, irrespective of valence
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19
Q

theories (SAD)

- memory hypothesis (Clark + Well)

A
  1. before entering social situation: selectively retrieve unfavourable information about how they think they are viewed by others (pre-event rumination) –> already distressed + expect to perform poorly and be negatively evaluated
  2. become concerned that they may fail to make their desired impression –> attention shifts from observation of others to detailed monitoring of themselves
  3. use internal info produced by self-monitoring to infer how they appear –> overestimate how anxious they appear
  4. safety behaviours (= fail to observe positive responses, appear more withdrawn)
  5. post-event rumination
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20
Q

theories (SAD)

- mental representation (Rapee + Heimberg)

A
  1. form mental representation of external appearance –> allocate mental resources to that + perceived threat in the social situation
  2. prediction about what performance audience will expect
  3. discrepancy between mental representation + what audience expects –> anticipate negative evaluation
  4. symptoms –> vicious cycle
    - no pre- and post-rumination
    - include internal + external cues
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21
Q

theories (SAD)

- (Hofmann)

A
  • memory (C/W) + mental representation (R/H)
  • overlaps most with Clark + Well
  • rumination and behaviour keep social anxiety in vicious cycle
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22
Q

treatment (SAD)

- behavioural

A
  • exposure to extinguish fear of situation
    1. systematic desensitisation: learn relaxation techniques, replace anxiety with calm reaction
    2. modelling: in conjunction with 1), through observational learning, associate behaviours with calm response in therapist
    3. flooding: intensively expose to feared situation until anxiety is extinguished
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23
Q

treatment (SAD)

- CBT

A
  • behavioural techniques with cognitive techniques
  • challenge negative catastrophising thoughts
  • individually or in group
    √ as effective as antidepressants, much more effective in preventing relapse
    √ can reduce negative rumination (overthinking) which mediates treatment outcomes (= more rumination = worse outcomes)
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24
Q

treatment (SAD)

- medication

A
  • serotonin-norepinephrine re-uptake inhibitors (SNRIs) –> increase serotonin + norepinephrine
  • antidepressants: SSRIs, monoamine oxidase inhibitors –> increase serotonin levels, have more serotonin in synapse = longer effect of serotonin
  • benzodiazepines: all anxiety disorders
    x no long-term effect, temporary relief
    x relapse soon after discontinue drug
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25
Q

treatment (SAD)

- enhanced CBT

A
  • CBT + medication

- greater treatment effect (longest effect)

26
Q

panic disorder (PD)

A

= when panic attacks become common, not provoked by a particular situation, unexpected

  • changes behaviours as result of worry
  • often fear that they have life-threatening illness
  • often belief that they are going crazy
  • ashamed, try to hide disorder –> no treatment –> become demoralised, depressed
27
Q

panic attack

A

= abrupt surge of intense fear/discomfort that reaches peak within minutes (DSM-5)

  • out of the blue, absence of any environmental triggers
  • most commonly arise in certain situations but not every time
28
Q

DSM-5 (PD)

A.

A

recurrent unexpected panic attacks during which FOUR OR MORE of the following symptoms occur:

  1. palpitations, pounding heart or accelerated heart rate
  2. sweating
  3. trembling/ shaking
  4. sensations of shortness of breath or smothering
  5. feelings of choking
  6. chest pain/ discomfort
  7. nausea or abdominal distress
  8. feeling dizzy/unsteady/light-headed/faint
  9. chills or heart sensations
  10. paraesthesia (= numbness/ tingling sensation)
  11. derealisation or depersonalisation
  12. fear of losing control or going crazy
  13. fear of dying
    - culture-specific symptoms may be seen –> shouldn’t count as one of the four required symptoms
29
Q

DSM-5 (PD)

B.

A

at least one of the attacks has been followed by AT LEAST 1 MONTH of one or both of the following:

  1. persistent concern/ worry about additional panic attacks or their consequences
  2. significant maladaptive change in behaviour related to attacks (e.g. avoidance)
30
Q

DSM-5 (PD)

C.

A

not attributable to substances or other medical conditions

- medical exclusion

31
Q

DSM-5 (PD)

D.

A

not better explained by another mental disorder

- psychopathological exclusion

32
Q

prevalence (PD)

A

3-5%

  • 28% of adults have occasional panic attacks, esp. during times of stress
  • between late adolescence & mid-30s
  • more common in women
  • chronic
33
Q

causes (PD)

- biological

A
  • heritability: 43-48%
  • poorly regulated fight-or-flight response (probably because of poor regulation of some neurotransmitters)
  • dysregulation of norepinephrine systems in locus coeruleus (brainstem) –> pathways to limbic system (fear response)
34
Q

theories (PD)

- cognitive mediation hypothesis

A
  1. pay close attention to bodily sensations
  2. misinterpret these in a negative way –> snowballing catastrophic thinking, exaggerating symptoms + their consequences
    - anxiety sensitivity: unfounded belief that bodily symptoms have harmful consequences (high in PD)
    - interoceptive conditioning
    - the more controllable the situation feels, the less likely to experience attack
    - attention + memory biases
35
Q

theories (PD)

- integrated model

A
  • biological + psychological factors
    1. genetic vulnerability: leads to hypersensitive, poorly regulated fight-or-flight response
  • poor regulation of several neurotransmitters, differences in areas of limbic system (stress response)
    2. cognitive vulnerability: hyper-attention to bodily sensations
  • interoceptive awareness = heightened awareness of bodily cues
    3. misinterpretation of bodily sensations
    4. engage in catastrophic thinking –> increases intensity of initially mild symptoms + hyper-vigilance –> anxiety increases probability that they will have a panic attack
    5. cycle continues
36
Q

conditioned avoidance response

- integrated model (PD)

A

= associate certain situations with symptoms of panic and begin to feel them again if they return to situations; reduce those by avoiding situations

37
Q

interoceptive conditioning

- integrated model + cognitive mediation hypothesis (PD)

A

= cues that have occurred at beginning of previous panic attacks have become conditioned stimuli signalling new attacks

38
Q

treatment (PD)

- biological/medication

A
  • tricyclic antidepressants: reduce panic attacks in majority –> improve functioning of norepinephrine system (maybe other neurotransmitters)
    x side effects, relapse when discontinued
  • selective serotonin re-uptake inhibitors (SSRIs)
    x side effects
  • serotonin-norepinephrine re-uptake inhibitors (SNRIs)
    x side effects
  • benzodiazepines –> suppress CNS, influence functioning of GABA, norepinephrine, serotonin
    √ work quickly
    x physically/psychologically addictive (withdrawal symptoms), can interfere with cognitive/motor functioning
39
Q

treatment (PD)

- CBT

A
  • confrontation of situations/thoughts that arouse anxiety
  • challenge irrational thoughts + helps anxious behaviour to be extinguished
    1. relaxation, breathing exercises
    2. identify catastrophic thoughts
  • therapist helps to collect thoughts, safety
    3. practice relaxation techniques while experiencing panic symptoms
    4. challenge catastrophic thoughts
    5. systematic desensitisation (= expose gradually to situations they fear most while helping maintain control over symptoms)
    √ better at preventing relapse after treatment ends (strategies help prevent recurrence of symptoms)
40
Q

panic disorder with agoraphobia (PDA)

A

= fear of specific, unsafe places/situations –> places where they have trouble escaping, getting help if they become anxious (fear of embarrassing themselves)

  • agoraphobia = fear of dangerous consequences associated with specific situation where one has panicked before
  • about one third to one half of people with PD
41
Q

DSM-5 (PDA)

A.

A

marked fear or anxiety about TWO (OR MORE) of the following five situations:

  1. using public transportation
  2. being in open spaces (e.g., parking lots, marketplaces, bridges)
  3. being in enclosed places (e.g., shops, theatres, cinemas)
  4. standing in line or being in a crowd
  5. being outside of the home alone
42
Q

DSM-5 (PDA)

B.

A

individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms
- fear of not escaping

43
Q

DSM-5 (PDA)

C.

A

agoraphobic situations almost always provoke fear or anxiety

- constant

44
Q

DSM-5 (PDA)

D.

A

agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety
- avoidance of situation

45
Q

DSM-5 (PDA)

E.

A

fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context
- unproportional

46
Q

DSM-5 (PDA)

F.

A

fear, anxiety, or avoidance is persistent, typically lasting for 6 MONTHS OR MORE
- duration

47
Q

DSM-5 (PDA)

G.

A

fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- impairment

48
Q

DSM-5 (PDA)

H.

A

if another medical condition (e.g., inflammatory bowel disease, Parkinson’s disease) is present, the fear, anxiety, or avoidance is clearly excessive

49
Q

DSM-5 (PDA)

I.

A

fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder + are not related exclusively to obsessions (OCD) + perceived defects or flaws in physical appearance (body dysmorphic disorder) + reminders of traumatic events (PTSD) + fear of separation (separation anxiety disorder)
- psychopathological exclusion

50
Q

generalised anxiety disorder (GAD)

A

= anxious all the time in all kinds of situations –> worry about many things in lives

  • focus of their worry shifts frequently
  • physiological symptoms
  • believe that worrying can help them avoid bad events by motivating to engage in problem solving
51
Q

DSM-5 (GAD)

A.

A

excessive anxiety + worry, occurring more days than not for AT LEAST 6 MONTHS in a number of events or activities
- duration

52
Q

DSM-5 (GAD)

B.

A

individual finds it difficult to control the worry

- worry

53
Q

DSM-5 (GAD)

C.

A

anxiety + worry are associated with THREE OR MORE of the following symptoms (with at least one symptoms having been present for more days than not for the past 6 months)

  1. restlessness or feeling keyed up/ on edge
  2. being easily fatigued
  3. difficulty concentrating/ mind going blank
  4. irritability
  5. muscle tension
  6. sleep disturbance
    - physical symptoms
54
Q

DSM-5 (GAD)

D.

A

the above cause clinically significant distress or impairment in social, occupational or other important areas of functioning
- impairment

55
Q

DSM-5 (GAD)

E.

A

not attributable to substances or other medical conditions

- medical exclusion

56
Q

DSM-5 (GAD)

F.

A

not better explained by another mental disorder

- psychopathological exclusion

57
Q

prevalence (GAD)

A

14% meet criteria at some point in their life

  • co-morbidities: 90% have another mental disorder (most often another anxiety disorder)
  • more women
  • chronic
  • begins in childhood or adolescence
58
Q

causes (GAD)

- cognitive

A
  • cognitions are focused on threat (conscious + unconscious level)
    1) conscious: maladaptive assumptions reflecting loss of control –> respond with automatic thoughts that cause anxiety
    2) unconscious: focus on detecting possible threats in environment
  • more intense negative emotions (even more than people with depression)
  • highly reactive to negative events (amygdala)
  • chronically elevated activity of SNS
  • might’ve experienced uncontrollable stressors without warning (esp. interpersonal)
59
Q

causes (GAD)

- biological

A
  • modest heritability (rather general trait of anxiety)

- abnormality in GABA system (deficiency of GABA) –> excessive firing of neurones (particularly in limbic system)

60
Q

treatment (GAD)

A
  • CBT: confront issues they worry about; challenge negative, catastrophic thoughts; develop coping styles
    √ more effective
  • medication: same as for the others
    x only short-term relief, side effects, addictiveness

Psychopathology (9 decks)

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