week 3 -. Anxiety Disorders Flashcards

Question

Obsessive Compulsive Disorder common obsessions/prevalance in sufferes

Answer 1

Contamination - 45 percent Pathological Doubt - 42 percent Somatic Obsessions - 36 percent Need for Symmetry - 31 percent Aggressive - 28 percent Sexual - 26 percent Other - 13 percent Multiple Obsessions - 60 percent

Answer 2

Checking - 63 percent Washing - 50 percent Counting - 36 percent Need to Ask/Confess - 31 percent Symmetry/Precision - 28 percent Hoarding - 18 percent Multiple Compulsions - 75 percent Only 2 percent of OCD patients present with pure obsessions, when mental rituals are included as compulsions (Foa et al., 1995).

Answer 3

Fear acquisition and avoidant behaviour maintenance. Some question of empirical support for acquisition by association, but more support for maintenance processes (see below). Touch dirty surface > increase in anxiety >likelihood of touching reduced Anxiety >cleaning behaviour >reduction in anxiety = cleaning behavior reinforced

Answer 4

Having a thought about the action is like performing the action. E.g., If I think, I hope she dies, I have partially killed her Failing to prevent (or failing to try to prevent) harm to self or others is the same as having caused the harm in the first place. E.g., They got sick because I did not wash my hands enough…it is my fault!

Answer 5

Responsibility is not attenuated by other factors (e.g. low probability of occurrence) E.g., 0.001 percent chance is huge! Not neutralizing when an intrusion has occurred is similar or equivalent to seeking or wanting the harm involved in that intrusion to actually happen. E.g., If I do not check the stove then I must want her to be harmed One should (and can) exercise control over one’s thoughts.

Answer 6

Contrast underlying assumption of psychodynamic vs cognitive models of OCD =An urge from within the person results in distress because the person does and does not want to carry it out (psychodynamic) =A thought from within the person results in distress because it is profoundly out of character and against the patient’s desired behaviour/ and thoughts (cognitive)

Answer 7

a. Exposure to actual or threatened death, serious injury, or sexual violence: - Directly experiencing the traumatic event(s) - Witnessing the event, in person, happening to others - Learning that the traumatic event occurred to a close family member or close friend - Repeated extreme exposure to aversive details of the event

Answer 8

- Recurrent, involuntary, and intrusive distressing memories - Recurrent distressing dreams - Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. - Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble the event. - Marked physiological reactions to internal or external cues that symbolize or resemble the event.

Answer 9

c. Persistent avoidance of stimuli associated with the event Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about the event. Avoidance of or efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings about the event

Answer 10

Negative alterations in cognitions and mood associated with the traumatic event - Inability to remember an important aspect of the traumatic event(s) - Exaggerated negative beliefs about oneself, others, or the world - Distorted cognitions about the cause or consequences of the event that lead the individual to blame himself/herself or others. - Persistent negative emotional state - Markedly diminished interest or participation in significant activities. - Feelings of detachment or estrangement from others. - Persistent inability to experience positive emotions

Answer 11

Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: - Irritable behavior and angry outbursts - Reckless or self-destructive behavior - Hypervigilance - Exaggerated startle response - Problems with concentration - Sleep disturbance f. Duration of the disturbance is more than 1 month (if not consider acute stress disorder).

Answer 12

Severity of trauma Past history of stress, abuse or trauma History of behavioural or psychological problems ``` Comorbid psychopathology Cognitive factors (e.g. low IQ, low education opportunity) ``` Genetic factors (e.g. family history of psychopathology) Subsequent exposure to reactivating environmental events Lack of social support

Answer 13

conditioned stimulus (eg, being at a bank) traumatic event = UCS (eg, being held at gun point) which invokes the UCR (eg, fear, anxiety) After the event ---- Conditioned stimulus = being at a bank > conditioned response (fear, anxiety)

Answer 14

positive punishment for approach = Stimulus > approach bank > anxiety fear > reduced approach Negative reinforcement of Avoidance = anxiety fear > avoidance of bank >avoiding bank reduced/elimiates anxiety > increased avoidance

Answer 15

Stimulus generalization occurs, meaning that an increasing number of stimuli elicit the fear response Deficits in specific behavioural skills - interpersonal skills (eg a study found that skills training was equivalent to exposure) - help-seeking behaviour Many more recent cognitive behavioural models of PTSD expand on the basic two-factor model

Answer 16

Exposure Types Direct contact with stimulus (rapid) = flooding Direct contact with stimulus (graduated) = Graded In-Vivo exposure Mental Image or other similar contact with stimulus - -Rapid = Implosion - -Graduated = Systematic Desensitization Other types or extension on original techqniques: Interoceptive exposure, worry exposure, exposure with response prevention, (OCD) Single-session phobia treatment and more.

Answer 17

Exposure Therapy is very efficient -Basically, if you are motivated to do it, you are highly likely to benefit from it! Unfortunately many experience return of fear! Return of Fear occurs via - Spontaneous Recovery – time makes the fear come back - Reacquisition – having had the fear makes the fear come back more easily - Renewal – encountering the phobic stimuli outside of the therapy room brings the fear back - Reinstatement – having another aversive encounter brings the original fear back

Answer 18

Statistics Gender Features -PD+Ag diagnosed three times as often in women Prevalence -Australian Point-Prevalence: 2.3% (Andrews et al., 2003) -Clinical sample - 10% of individuals referred to mental health -Agoraphobia present in 33% to 50% of community PD patients Course -Onset typically in adolescence or mid-30s (bimodal distribution) 72% have identifiable stressors at onset (Craske et al., 1990) Familial Pattern -8x higher risk in first-degree relatives -Twin studies indicate genetic contribution

Answer 19

positive punishment for approach behaviours = behaviour > negative consequence > behaviour decreases Approach > increase in anxiety > likelihood of approach reduced

Answer 20

Negative state > behaviour > negative state reduced (behaviour increases) Anxiety > avoidance behaviour > reduction in anxiety > avoidance increases

Answer 21

Negative outcome expectancies. E.g., I might get a panic attack in the shopping mall Expectations of situational fears (rather than of the panic attack itself). E.g., shopping malls are scary! Expectation of negative social consequences. E.g., people will laugh at me Perception of link between situation and panic attacks. E.g., buses give panic attacks! Self-efficacy perceptions. E.g., I will not be able to take the bus alone!

Answer 22

Anxiety disorders can be caused by Primarily psychological and social factors E.g., PTSD, Phobias, GAD Primarily medical conditions – Anxiety disorder due to general medical condition E.g., Neurological conditions (e.g., cerebral trauma) Endocrine disturbance (e.g.,pituitary dysfunction) Deficiency states (e.g. B12 deficiency) Other conditions (e.g. hypoglycemia) Primarily substance inducement – Substance induced Anxiety disorder E.g., Alcohol, Benzodiazepines, Cannabis, d-LSD25, MDMA, Caffeine

Answer 23

Statistics Prevalence Australian Point-Prevalence: 2.8% (Andrews et al., 2003) Lifetime community prevalence: 3% - 13% Course -Typical onset in late adolesence, often out of a history of childhood shyness -Onset may be insidious or abrupt. -Course is often continuous, chronic and lifelong -May be dependent of life situation (e.g. marriage) Familial Pattern Having a first-degree relative with Social Phobia increases risk.

Answer 24

Inherited Anxiety vulnerability / sensitivity Cognitive theories - Schemas including beliefs about catastrophic nature of negative evaluation - Interpretive bias towards negative evaluation, even when not present - Attentional bias towards threat cues

Answer 25

Vulnerability -Anxiety proneness Hyperventilation -General current idea is that hyperventilation may be one of many routes to panic, but is neither necessary nor sufficient. Biological Models -GABA (inhibitory neurotransmitter) Cognitive factors - Perceived lack of control over bodily sensations - Tendency to interpret ambiguous sensations as threatening - Attentional and memory biases to threat related stimuli Anxiety Sensitivity -A tendency to interpret symptoms of anxiety as threatening

Answer 26

Statistics Gender Features Little specific information regarding gender differences exists. Prevalence - Australian Point-Prevalence: 1.7% (Andrews et al., 2003) - Only 6% of a group of 562 agoraphobics denied a history of panic attacks (Goisman et al., 1994) Course Little is known about the natural course of the disorder

Answer 27

Gender - 55-60% of cases presenting clinically are female - In epidemiological studies the gender ratio is 2:1 Female:Male Prevalence - Australian Point-Prevalence: 4.1% (Andrews et al., 2003) - Overdiagnosis may be present in children - Community one-year prevalence: 3.0% - Community lifetime prevalence: 5.0% - Anxiety Disorder Clinic sample: Approx 25% Familial Pattern - Anxiety as inherited trait - Relationship with genetic factors associated with mood disorder. Course - Typical report of chronic, life-long anxiety - Onset in childhood or adolescence, with post-20 onset not uncommon - Typical course is chronic, fluctuating depending on current stressors.

Answer 28

Gender Features - -Equally common in adult males and females - -Childhood onset OCD more common in boys than girls Prevalence - -Australian Point-Prevalence: 0.8% (Andrews et al., 2003) - -Community lifetime prevalence: 2.5% of adults - -Community lifetime prevalence: 0.7% of children/adolescents - -Community 1-year prevalence: 0.5% - 2.1% of adults - -Community 1-year prevalence: 1.0% - 2.3% of children/adolesc. - -Prevalence appears standard across different cultures.

Answer 29

Onset typically in adolescence or adulthood Childhood onset also recognised Modal onset age for males: 6-15 years Model onset age for females: 20-29 years Onset is usually insidious, but acute onset noted in some cases. Typical course is chronic, with waxing and waning severity 15% show progressive gradual deterioration in social and/or occupational functioning 5% show episodic course, with good inter-episode recovery

Answer 30

Broad domains of beliefs implicated in OCD ``` Inflated personal responsibility Over-importance of thought Beliefs about importance of controlling one’s thoughts Overestimation of threat Intolerance of uncertainty Perfectionism ``` All are highly associated with OCD symptoms BUT…All are also highly correlated with each other

Answer 31

Hoarding Disorder Persistent difficulty discarding or parting with possessions, regardless of their actual value. This difficulty is due to a perceived need to save the items and to distress associated with discarding them. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use.

Answer 32

Preoccupation with one or more perceived defects or flaws in physical appearance. Perceived-self looks ugly, unattractive, abnormal, or deformed ---The perceived flaws are not observable or appear only slight to other individuals. Specifier: with Muscle Dysmorphia --The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular.

Answer 33

Prevalence - Australian Point-Prevalence Rate: 1.7% (Andrews, et al., 2003) - US Community lifetime prevalence: 8.0% of adults - At risk individuals (e.g. rape survivors, combat veterans, ambulance officers, etc) prevalence rates up to 50% Course - Onset at any age, including in childhood years. - Symptoms usually have onset within 3 months of traumatic event - May emerge from Acute Stress Disorder as initial response to trauma - Approximately 50% remit within 3 months of onset - Others experience chronic fluctuating course. - Approximately 33% do not recover, despite professional treatment

Answer 34

Prevalence -Estimates vary due to changes in diagnostic criteria, demographics of sample group, etc. -Large scale epidemioloigcal studies North Carolina point-prevalence = 1.3% Combat related (point-prevalence rates) 15.2% of US servicemen who served in Vietnam` 8.5% of US servicewomen who served in Vietnam Conditional risk following exposure to any trauma as defined in DSM-IV = 9.2% (Breslau et al., 1998)

Answer 35

For a thorough review of current psychological models of PTSD, see Brewin & Holmes (2002) Information processing theory Emotional processing theory Dual Representation Theory Ehlers and Clark’s Cognitive Model (see end of slides for an example)

Answer 36

``` Long recognition of trauma as aetiologically significant in psychological illness (e.g. psychoanalytic theory) Battlefield related symptoms Shell shock “Battle fatigue” Vietnam War Veterans ```

Answer 37

DSM-I Gross Stress Reaction for acute symptoms Chronic symptoms labelled anxiety or mood disorder DSM-II Transient Situational Disturbance for acute symptoms Chronic symptoms labelled anxiety or mood disorder DSM-III Posttraumatic Stress Disorder conceived as diagnosis for asymptomatic individuals who develop psychiatric symptoms following exposure to trauma DSM-IV Change in definition of traumatic event (reduced severity) Witnessing trauma to others included Specification of reaction to event (‘fear, helplessness, horror)

Answer 38

Incorporating earlier emotional processing theory ideas PTSD sufferers show a wide range of negative appraisals “I am a victim” “I deserve for bad things to happen to me.” “I’ll never be able to relate to people again.” “Others think I was a coward.” “I’m a psychological wreck!”

Answer 39

Traumatic memories are poorly elaborated and contextualised Trauma memories are poorly integrated with general autobiographical memory Difficulty with intentional recall Retrieval from memory is cue-driven and unintentional Behavioural factors also contribute to maintenance Use of safety behaviours Maladaptive coping behaviours (e.g. alcohol)

Answer 40

Exposure to a traumatic event, involving actual or threatened death, serious injury, or sexual violation Duration 3 days – 1 month At least nine of the following symptoms: ``` Recurrent, distressing memories Recurrent distressing dreams Dissociative reactions Distress in response to internal or external cues Inability to experience positive emotions Altered sense of the reality Inability to remember an important aspect of the traumatic event(s) Efforts to avoid distressing memories Efforts to avoid external reminders Sleep disturbance Irritable behavior and angry outbursts Hypervigilance. Problems with concentration. Exaggerated startle response. ```

Answer 41

Breathing control The training is a technique usually used with panic disorder patients as a method of reducing the impact of hyperventilation on their condition. Relaxation Patients are trained to recognise the difference between muscle tension and muscle relaxation, they can use increasing tension as a cue to commence arousal management skills.

Answer 42

A broad array of techniques aimed at assisting a patient to identify and evaluate their existing beliefs that are associated with distressing emotions. After evaluation, the patient can be helped to create and integrate less distressing cognitions. C: No one will find me attractive again T: What is your evidence for this? C: She did not reply to my texts T: Can there be any other reasons for her not replying to your text? C: Yes I suppose she could be busy T: So is there room for a more helpful thought to be applied to this situation? C: Yes, she may be interested in pursuing a relationship with me but may simply be busy at the time.

Answer 43

PD - 1 year (~1%), lifetime (~1.5) Agora - 1yr (1%), lifetime (3%) social - 1yr (2%), lifetime (4%) specific - 1yr (2.5%), lifetime (~4.2%) Ocd - 1yr (0.5%), lifetime (1%) PTSD - 1yr (1%), lifetime (2%) GAD - 1yr (2%), lifetime (6%) Any - 1yr (10%), lifetime (16%)