Week 2 lecture - Common mental health disorders: Anxiety Flashcards
anxiety
concern about a perceived future threat
fear
response to a perceived immediate threat
what do anxiety and fear responses involve?
physiological arousal via the sympathetic nervous system
anxiety purpose
promotes fight or flight response which is adaptive (normal)
state anxiety
response to a particular situation
o High and maladaptive: acute anxiety
trait anxiety
range of anxious responses related to personality structure
o High and maladaptive: chronic anxiety
symptoms of anxiety
- Psychological arousal
- Sleep disturbance
- muscle tension
- autonomic arousal
- Hyperventilation
Anxiety according to DSM5
- 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.
who gets anxiety?
- 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
dimensions in aetiology of anxiety disorders
biological
psychological
social
sociocultural
biological dimension to anxiety
overactive fear circuit in brain
specific genetic contributions
abnormalities in NTs
psychological dimension to anxiety
early childhood experience
conditioning
self-control or efficacy
social dimension to anxiety
daily environmental stress/community resources
social support
family relationships
sociocultural dimension to anxiety
gender differences
cultural factors
ethnicity
biological theories to anxiety
amygdala functioning
GABA
amygdala as a biological theory
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
GABA as a biological theory in anxiety
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
when does anxiety become a disorder?
- 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
GAD
- 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
psychological theory of anxiety
- Intolerance of Uncertainty (IOU); Dugas & Koerner, 2005
- Intolerance of Uncertainty (IOU); Dugas & Koerner, 2005
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
worry
- 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)
types of anxiety in Intolerance of uncertainty scale:
prospective and inhibitory
research evidence for Intolerance of uncertainty scale:
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.
GAD: cognitive models evaluation
- 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).
comorbidity and anxiety and depression
- 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)
psychological treatment of GAD - rates
- 20.6% of anxiety sufferers seek professional help
- CBT (James et al., 2015, Bandelow et al., 2015)
- Medication
- Applied relaxation
further developments in anxiety understanding/treatment
- 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.
