Week 2 lecture - Common mental health disorders: Anxiety

Question 1

anxiety

Answer 1

concern about a perceived future threat

Question 2

fear

Answer 2

response to a perceived immediate threat

Question 3

what do anxiety and fear responses involve?

Answer 3

physiological arousal via the sympathetic nervous system

Question 4

anxiety purpose

Answer 4

promotes fight or flight response which is adaptive (normal)

Question 5

state anxiety

Answer 5

response to a particular situation
o High and maladaptive: acute anxiety

Question 6

trait anxiety

Answer 6

range of anxious responses related to personality structure
o High and maladaptive: chronic anxiety

Question 7

symptoms of anxiety

Answer 7

• Psychological arousal
• Sleep disturbance
• muscle tension
• autonomic arousal
• Hyperventilation

Question 8

Anxiety according to DSM5

Answer 8

• Anxiety disorders comprise the following conditions: panic disorder, agoraphobia, social anxiety disorder (social phobia), specific phobia, generalized anxiety disorder (GAD), separation anxiety disorder, and selective mutism.

Question 9

who gets anxiety?

Answer 9

• Lifetime prevalence around world ranges from 9-29%
• More common in females
• 6th largest contribution to non-fatal health loss globally and appears in the top 10 causes of YLD
• Disabling disorders with high impact on day to day functioning: social isolation, homebound

Question 10

dimensions in aetiology of anxiety disorders

Answer 10

biological
psychological
social
sociocultural

Question 11

biological dimension to anxiety

Answer 11

overactive fear circuit in brain

specific genetic contributions

abnormalities in NTs

Question 12

psychological dimension to anxiety

Answer 12

early childhood experience

conditioning

self-control or efficacy

Question 13

social dimension to anxiety

Answer 13

daily environmental stress/community resources

social support

family relationships

Question 14

sociocultural dimension to anxiety

Answer 14

gender differences

cultural factors

ethnicity

Question 15

biological theories to anxiety

Answer 15

amygdala functioning
GABA

Question 16

amygdala as a biological theory

Answer 16

o Key role in formation of emotional memories
o Alert the hippocampus and PFC
o 2 pathways of travel to amygdala
* Direct path for immediate danger
* PFC to override fear responses
o Long route bypassed in anxiety

Question 17

GABA as a biological theory in anxiety

Answer 17

o Inhibitory NT
o Regulatory effects on serotonin, noradrenaline and dopamine
o Anxiety sufferers have lower levels of GABA
o Number of GABAA receptors may be related to stress in the environment
o Benzodiazepines bind to GABAA and facilitate GABA, reducing neuronal excitability

Question 18

when does anxiety become a disorder?

Answer 18

• Threats or dangers are seen where they are not present
• Physiological response to anxiety occurs
• Behavioural response of avoidance, escape and use of safety behaviours perpetuate problem
• Avoidance = does not put themselves in feared situation
• Escape = getting out of it
• Safety behaviours = things they do whilst in the situation to help them deal with it

Question 19

GAD

Answer 19

• Presence of excessive anxiety and worry, which often occurs more than not for at least 6 months
• Associated with:
  o Edginess or restlessness
  o Impaired concentration
  o Irritability
  o Difficulty sleeping

Question 20

psychological theory of anxiety

Answer 20

• Intolerance of Uncertainty (IOU); Dugas & Koerner, 2005

Question 21

• Intolerance of Uncertainty (IOU); Dugas & Koerner, 2005

Answer 21

o Find uncertain or ambiguous situations to be stressful and upsetting, resulting in chronic worry and anxiety about these circumstances
o Belief that that worry will serve to either help them cope with feared events more effectively or to prevent those events from occurring at all
o Model:
* Anxiety leads to negative problem orientation and cognitive avoidance, both of which serve to maintain worry
* Negative problem orientation
 (1) lack confidence in their problem solving ability,
 (2) perceive problems as threats,
 (3) become easily frustrated when dealing with a problem, and
 (4) are pessimistic about the outcome of problem-solving efforts (Koerner & Dugas, 2006).
* Cognitive avoidance:
 Use of cognitive strategies (e.g. distraction, thought suppression) that facilitate avoidance of the cognitive arousal and threatening images associated with worry

Question 22

worry

Answer 22

• Avoidance response: ether of emotional arousal or of negative emotional contrasts (Bokovec and Hu, 1990)
• A sense of uncontrollable worry is both a hallmark of DSM5 manual and part of the cycle leading to development of GAD (Mineka, 2004)

Question 23

types of anxiety in Intolerance of uncertainty scale:

Answer 23

prospective and inhibitory

Question 24

research evidence for Intolerance of uncertainty scale:

Answer 24

o Intolerance of uncertainty predicts GAD symptom severity (Dugas et al., 2004; 2007)
o The model’s primary focus is on cognitions as the key component that drive the development and maintenance of GAD.

Question 25

GAD: cognitive models evaluation

Answer 25

• Diathesis–stress model involving neuroticism (trait), and conditioning experiences (learning) as primarily multiplicative for GAD (Zinbarg et al, 2022)
• Adaptive vs. maladaptive anxiety? (Olatunji et al, 2007)
• IU – Transdiagnostic factor in emotional disorders? Mahoney, A. E., & McEvoy, P. M. (2012).

Question 26

comorbidity and anxiety and depression

Answer 26

• High comorbidity between GAD and MD, with anxiety likely to appear first (57% and 81%)
• MD and Gad found to share a single genetic diathesis
• Hierarchical model with 2 broad factors: internalising and externalising
• Internalising factor: distress/misery (MD, GAD) and fear (phobias and panic disorders)

Question 27

psychological treatment of GAD - rates

Answer 27

• 20.6% of anxiety sufferers seek professional help
• CBT (James et al., 2015, Bandelow et al., 2015)
• Medication
• Applied relaxation

Question 28

further developments in anxiety understanding/treatment

Answer 28

• The tri-partite model (Clark & Watson, 1991)
  o Physiological hyperarousal (anxiety)
  o Low positive affect (depression)
  o Negative affect (shared)
• Non-specific general negative affect factor shared by other disorders (e.g. psychosis; Wilson et al, 2020) – important transdiagnostic factor.