TASK 3 - (SOCIAL) ANXIETY DISORDER Flashcards
social anxiety disorder (SAD)
= 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)
DSM-5 (SAD)
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
DSM-5 (SAD)
B.
individual fears that he/she will be negatively evaluated
- fear evaluation
DSM-5 (SAD)
C.
social situations almost always provoke fear/ anxiety
- constant
DSM-5 (SAD)
D.
social situations are avoided or endured with intense fear/anxiety
- avoidance of social situations
DSM-5 (SAD)
E.
anxiety is out of proportion to the actual threat posed by the situation/context
- unproportional
DSM-5 (SAD)
F.
anxiety/avoidance is persistent (lasts AT LEAST 6 MONTHS)
- persistance
DSM-5 (SAD)
G.
anxiety causes clinically significant distress or impairment in social/occupational or other important areas of functioning
- impairment
DSM-5 (SAD)
H.
anxiety/avoidance isn’t attributable to substances or other medical condition
- medical exclusion
DSM-5 (SAD)
I.
anxiety/ avoidance is not better explained by another disorder (e.g. panic disorder/ ASD)
- psychopathological exclusion
DSM-5 (SAD)
J.
if another condition is present, then the fear/anxiety/avoidance must be clearly unrelated
subtypes (SAD)
- performance only: fear is restricted to speaking or performing in public
- moderate fear of variety of social situation
- severe fear of many social situations –> generalised social anxiety disorder
prevalence (SAD)
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
causes (SAD)
- genetics
- general tendency for anxiety heritable
- temperament makes it easier for phobias to be conditioned
causes (SAD)
- cognitive
- 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
theories (SAD)
- two-factor model
- classical conditioning leads to fear of phobic object + 2. operant conditioning helps maintain it
- avoidant behaviour to prevent exposure to what fear most
theories (SAD)
- interpersonal deficits
- 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
theories (SAD)
- interpretation bias + judgment bias
- interpretation bias = interpret ambiguous event as negative
- judgement bias = overestimate costs and probabilities of negative events
- across all social events, irrespective of valence
theories (SAD)
- memory hypothesis (Clark + Well)
- 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
- become concerned that they may fail to make their desired impression –> attention shifts from observation of others to detailed monitoring of themselves
- use internal info produced by self-monitoring to infer how they appear –> overestimate how anxious they appear
- safety behaviours (= fail to observe positive responses, appear more withdrawn)
- post-event rumination
theories (SAD)
- mental representation (Rapee + Heimberg)
- form mental representation of external appearance –> allocate mental resources to that + perceived threat in the social situation
- prediction about what performance audience will expect
- discrepancy between mental representation + what audience expects –> anticipate negative evaluation
- symptoms –> vicious cycle
- no pre- and post-rumination
- include internal + external cues
theories (SAD)
- (Hofmann)
- memory (C/W) + mental representation (R/H)
- overlaps most with Clark + Well
- rumination and behaviour keep social anxiety in vicious cycle
treatment (SAD)
- behavioural
- 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
treatment (SAD)
- CBT
- 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)
treatment (SAD)
- medication
- 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
treatment (SAD)
- enhanced CBT
- CBT + medication
- greater treatment effect (longest effect)
panic disorder (PD)
= 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
panic attack
= 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
DSM-5 (PD)
A.
recurrent unexpected panic attacks during which FOUR OR MORE of the following symptoms occur:
- palpitations, pounding heart or accelerated heart rate
- sweating
- trembling/ shaking
- sensations of shortness of breath or smothering
- feelings of choking
- chest pain/ discomfort
- nausea or abdominal distress
- feeling dizzy/unsteady/light-headed/faint
- chills or heart sensations
- paraesthesia (= numbness/ tingling sensation)
- derealisation or depersonalisation
- fear of losing control or going crazy
- fear of dying
- culture-specific symptoms may be seen –> shouldn’t count as one of the four required symptoms
DSM-5 (PD)
B.
at least one of the attacks has been followed by AT LEAST 1 MONTH of one or both of the following:
- persistent concern/ worry about additional panic attacks or their consequences
- significant maladaptive change in behaviour related to attacks (e.g. avoidance)
DSM-5 (PD)
C.
not attributable to substances or other medical conditions
- medical exclusion
DSM-5 (PD)
D.
not better explained by another mental disorder
- psychopathological exclusion
prevalence (PD)
3-5%
- 28% of adults have occasional panic attacks, esp. during times of stress
- between late adolescence & mid-30s
- more common in women
- chronic
causes (PD)
- biological
- 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)
theories (PD)
- cognitive mediation hypothesis
- pay close attention to bodily sensations
- 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
theories (PD)
- integrated model
- 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
conditioned avoidance response
- integrated model (PD)
= associate certain situations with symptoms of panic and begin to feel them again if they return to situations; reduce those by avoiding situations
interoceptive conditioning
- integrated model + cognitive mediation hypothesis (PD)
= cues that have occurred at beginning of previous panic attacks have become conditioned stimuli signalling new attacks
treatment (PD)
- biological/medication
- 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
treatment (PD)
- CBT
- 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)
panic disorder with agoraphobia (PDA)
= 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
DSM-5 (PDA)
A.
marked fear or anxiety about TWO (OR MORE) of the following five situations:
- using public transportation
- being in open spaces (e.g., parking lots, marketplaces, bridges)
- being in enclosed places (e.g., shops, theatres, cinemas)
- standing in line or being in a crowd
- being outside of the home alone
DSM-5 (PDA)
B.
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
DSM-5 (PDA)
C.
agoraphobic situations almost always provoke fear or anxiety
- constant
DSM-5 (PDA)
D.
agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety
- avoidance of situation
DSM-5 (PDA)
E.
fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context
- unproportional
DSM-5 (PDA)
F.
fear, anxiety, or avoidance is persistent, typically lasting for 6 MONTHS OR MORE
- duration
DSM-5 (PDA)
G.
fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- impairment
DSM-5 (PDA)
H.
if another medical condition (e.g., inflammatory bowel disease, Parkinson’s disease) is present, the fear, anxiety, or avoidance is clearly excessive
DSM-5 (PDA)
I.
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
generalised anxiety disorder (GAD)
= 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
DSM-5 (GAD)
A.
excessive anxiety + worry, occurring more days than not for AT LEAST 6 MONTHS in a number of events or activities
- duration
DSM-5 (GAD)
B.
individual finds it difficult to control the worry
- worry
DSM-5 (GAD)
C.
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)
- restlessness or feeling keyed up/ on edge
- being easily fatigued
- difficulty concentrating/ mind going blank
- irritability
- muscle tension
- sleep disturbance
- physical symptoms
DSM-5 (GAD)
D.
the above cause clinically significant distress or impairment in social, occupational or other important areas of functioning
- impairment
DSM-5 (GAD)
E.
not attributable to substances or other medical conditions
- medical exclusion
DSM-5 (GAD)
F.
not better explained by another mental disorder
- psychopathological exclusion
prevalence (GAD)
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
causes (GAD)
- cognitive
- 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)
causes (GAD)
- biological
- modest heritability (rather general trait of anxiety)
- abnormality in GABA system (deficiency of GABA) –> excessive firing of neurones (particularly in limbic system)
treatment (GAD)
- 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
