Week 4 - Anxiety

Question 1

Anxiety

Answer 1

Anxiety involves a general feeling of apprehension about possible future danger

Question 2

Fear

Answer 2

fear is an alarm reaction that occurs in response to immediate danger

Question 3

anxiety disorders

Answer 3

A group of disorders that share symptoms of clinically significant anxiety or fear

Question 4

Anxiety disorders affect approximately ___ percent of the U.S. population at some point in their lives and are the most common category of disorders for _______ and the second most common for _____

Answer 4

29
women
men

Question 5

In any 12-month period, about ___ percent of the adult population suffers from at least one anxiety disorder

Answer 5

18

Question 6

Anxiety disorders have the _______ age of onset of all mental disorders and are associated with an increased preva-lence of a number of medical conditions including ________(6)

Answer 6

earliest

asthma,
chronic pain,
hypertension,
arthritis,
cardiovascular disease,
and irritable bowel syndrome

Question 7

When the fear response occurs in the absence of any obvious external danger, we say the person has had a spontaneous or uncued ___________.

Answer 7

panic attack

Question 8

The symptoms of a panic attack are nearly identical to those experienced during a state of fear except that panic attacks are often accompanied by a subjective sense of______, including fears of _______(3)

Answer 8

impending doom

dying,
going crazy,
or losing control

Question 9

fear and panic have three components:

Answer 9

1. cognitive/subjective components (e.g., “I’m going to die”)
2. physiological components (e.g., increased heart rate and heavy breathing)
3. behavioral components (e.g., a strong urge to escape or flee).

These components are only “loosely coupled” (Lang, 1985), which means that someone might show, for example, physiological and behavioral indications of fear or panic without much of the subjective compo-nent, or vice versa.

Question 10

DSM-5 anxiety disorders:

Answer 10

1. specific phobia
2. social anxiety disorder (social phobia)
3. panic disorder
4. agoraphobia
5. generalized anxiety disorder.

Question 11

Phobia criteria (7)

Answer 11

1. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.
2. The phobic object or situation almost always provokes imme-diate fear or anxiety.
3. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
4. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
5. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
6. The fear, anxiety, or avoidance causes clinically significant dis-tress or impairment in social, occupational, or other important areas of functioning.
7. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapac-itating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separa-tion from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).

Question 12

The most common anxiety disorder is… + def

Answer 12

Phobia

A phobia is a persistent and disproportionate fear of some specific object or situation that presents little or no actual danger and yet leads to a great deal of avoidance of these feared situa-tions.

Question 13

5 types of specific phobia

Answer 13

Animal,
Natural environment (heights, storms etc.),
Blood-injection-injury,
Situational (PT, tunnels, bridges, elevators, flying, driving, enclosed spaces),
Other (Choking, vomiting, “space phobia” (fear of falling when away from supports like walls)

Question 14

two primary neurotransmitter systems are
most implicated in panic attacks:

Answer 14

the noradrenergic and the serotonergic systems

Question 15

Noradrenergic activity in certain _____areas can stimulate cardiovascular symptoms associated with panic

Answer 15

brain

Question 16

GABA is known to _____ anxiety and has been shown to be abnormally ___ in certain parts of the cortex in people with panic disorder

Answer 16

inhibit
low

Question 17

By decreasing noradrenergic activity, these _____decrease many of the cardiovascular symptoms associated with panic that are ordinarily stimulated by _____ activity

Answer 17

SSRIs
noradrenergic

Question 18

The cognitive theory of panic disorder proposes that …

Answer 18

people with panic disorder are hypersensitive to their bodily sensations and are very prone to giving them the most dire interpretation possible

Question 19

interoceptive conditioning (or exteroceptive conditioning)

Answer 19

initially neu-tral internal (interoceptive) and external (exteroceptive) cues through an interoceptive conditioning (or exterocep-tive conditioning) process, which leads anxiety to become conditioned to these CSs (conditioned stimuli), and the more intense the panic attack, the more robust the condi-tioning that will occur

Question 20

anxiety sensitivity

Answer 20

a trait-like belief that certain bodily symptoms may have harmful consequences

Question 21

Treatments for Panic disorder (3)

Answer 21

Prolonged exposure (for agora)
interoceptive exposure (meaning deliberate exposure to feared internal sensations.)
panic control treatment (PCT; both agoraphobic avoidance and panic attacks)

Question 22

interoceptive exposure

Answer 22

deliberate exposure to feared internal sensations.

Question 23

Panic control treatment (PCT)

Answer 23

1. Teach the adaptive explanation for panic attacks
2. Teach to control breathing
3. Teach common logical errors during panic attacks
4. Prolonged exposure

Question 24

DSM-5 Criteria for. . . Generalized Anxiety Disorder

Answer 24

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item is required in children.

1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

Question 25

An anxiety-producing hormone called _________-______ _______ has also been strongly implicated as playing an important role in generalized anxiety

Answer 25

corticotropin-releasing hormone (CRH)

Question 26

When activated by stress or perceived threat, ___-____ ______ stimulates the release of ACTH (adrenocorticotropic hormone) from the pituitary gland, which in turn causes release of the stress hormone cortisol from the adrenal gland

Answer 26

corticotropin-releasing hormone (CRH)

Question 27

(?) Obsessions are persistent and recurrent intrusive thoughts, images, or impulses that are experienced as disturbing, inappropriate, and uncontrollable.

Answer 27

Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

Question 28

__________ involve overt repetitive behaviors that are performed as lengthy rituals (such as hand washing, checking, putting things in order over and over again).

Answer 28

Compulsions

Question 29

DSM-5 Criteria for. . . Obsessive-Compulsive Disorder

Answer 29

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):

1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeat-ing words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
   Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 30

The learning view of obsessive-compulsive disorder is derived from M___ t___-p_____ t____ o__ a____ l____ (1947).

Answer 30

Mowrer’s two-process theory of avoidance learning

Question 31

Learning view of OCD

Answer 31

Conditioning occurs between NS (contamination fear) and CS (door handle)
Behaviour (such as washing hands) reduces anxiety, and is negatively reinforced
Becomes compulsion

Question 32

thought–action fusion

Answer 32

The belief that simply having a thought about doing something (e.g., a mother’s thought about harming her infant) is morally equivalent to actually having done it, or that thinking about the behavior increases the chances of actually doing so.

Question 33

exposure and response prevention (Franklin & Foa, 2007; Stein et al., 2009).

Answer 33

The exposure com-ponent involves having individuals with OCD repeatedly expose themselves (either in guided fantasy or directly) to stimuli that provoke their obsessions (e.g., for someone with contamination fears this may involve touching a toilet seat in a public bathroom). The response prevention component requires that they then refrain from engaging in the rituals that they ordinarily would perform to reduce their anxiety or distress.

Question 34

DSM-5 Criteria for Body Dysmorphic Disorder

Answer 34

A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

B. At some point during the course of the disorder, the indi-vidual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appear-ance with that of others) in response to the appearance concerns.

C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

Question 35

Compul-sive hoarding (as a symptom) occurs in approximately __ to ___ percent of the adult population, and in __ to __ percent of people diagnosed with OCD

Answer 35

3 to 5
10 to 40

Question 36

Agoraphobia

Answer 36

A. Marked fear or anxiety about two (or more) of the following five situations:

1. Using public transportation (e.g., automobiles, buses, trains, ships, planes).
2. Being in open spaces (e.g., parking lots, marketplaces, bridges).
3. Being in enclosed places (e.g., shops, theaters, cinemas).
4. Standing in line or being in a crowd.
5. Being outside of the home alone.

B. The 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 (e.g., fear of falling in the elderly; fear of incontinence).

C. The agoraphobic situations almost always provoke fear or anxiety.

D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.

F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

G. The fear, anxiety, or avoidance causes clinically significant dis-tress or impairment in social, occupational, or other important areas of functioning.

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

I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder—for example, the symp-toms are not confined to specific phobia, situational type; do not involve only social situations (as in social anxiety disorder); and are not related exclusively to obsessions (as in obsessive-compulsive disorder), perceived defects or flaws in physical appearance (as in body dysmorphic disorder), reminders of traumatic events (as in posttraumatic stress disorder), or fear of separation (as in separation anxiety disorder). Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual’s presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned.

Question 37

Criteria for. . . Social Anxiety Disorder (Social Phobia)

Answer 37

A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversa-tion, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.

B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).

C. The social situations almost always provoke fear or anxiety. Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.

D. The social situations are avoided or endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context. F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

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

H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

Question 38

Criteria for. . . Panic Disorder

Answer 38

A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur: Note: The abrupt surge can occur from a calm state or an anxious state.

1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations. 10. Paresthesias (numbness or tingling sensations).
10. Derealization (feelings of unreality) or depersonalization (being detached from oneself).
11. Fear of losing control or “going crazy.”
12. Fear of dying. Note: Culture-specific symptoms (e.g., tinnitus, neck sore-ness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.

B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:

1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, hav-ing a heart attack, “going crazy”).
2. A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamil-iar situations).

C. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).

D. The disturbance is not better explained by another mental dis-order (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder).

Question 39

For certain phobias such as small-animal phobias, flying phobia, claustrophobia, and blood-injury phobia, _____ therapy is often highly effective when administered in a single long session (of up to 3 hours)

Answer 39

exposure

Question 40

In cognitive restructuring the therapist attempts to help clients with social anxiety identify their underlying ______, _______ ______ (“I’ve got nothing interesting to say” or “No one is interested in me”).

After helping clients understand that such automatic thoughts (which usually occur just below the surface of awareness but can be accessed) often involve cognitive distortions, the therapist helps the clients change these inner thoughts and beliefs through logical ______.

The process of logical reanalysis might involve asking one-self questions to challenge the automatic thoughts: “Do I know for certain that I won’t have anything to say?” “Does being nervous have to lead to or equal looking stupid?”

Answer 40

negative, automatic thoughts

reanalysis

Question 41

Moreover, at least one study has now shown that simply training individuals with social anxiety to disengage from negative social cues during a 15-minute lab task that is repeated eight times over 4 to 6 weeks produced such remarkable reductions in social anxiety symptoms that nearly ____ out of _____ of the participants no longer met the criteria for social anxiety.

Answer 41

three out of four

Question 42

Newer versions of these treatments use ______-______ _____ reality social interactions as a means of exposing patients to feared situations and show that such interactions also can lead to significant reductions in symptoms of social anxiety disorder.

Answer 42

computer-generated virtual

Question 43

Effective treatments for Social anxiety disorder (4):

Answer 43

CBT (cognitive restructuring)

Exposure therapy (Prolonged and graduated exposure (assisted by D-cycloserine; faster and more substantial improvements))

Several categories of antidepressants (including the monoamine oxi-dase inhibitors and the selective serotonin reuptake inhibitors discussed (although these aren’t as effective and CBT)

Disengagement training (not sure of actual name) + VR option

Question 44

Panic disorder is defined and characterized by the occurrence of panic attacks that often seem to come “____ ___ ___ ____”

Answer 44

“out of the blue.”

Question 45

According to the DSM-5 criteria for panic disorder, the person must have experienced recurrent, unexpected attacks and must have been persistently concerned about…. for at least a month

Answer 45

having another attack or worried about the consequences of having an attack

Question 46

patients with _____ problems are at a nearly twofold elevated risk for developing panic disorder

Answer 46

cardiac

Question 47

panic disorder causes approximately as much impairment in _____ and _____ functioning as that caused by major depressive disorder

Answer 47

social and occupational functioning

Question 48

Approximately __.___ percent of the adult population has had panic disorder with or without agoraphobia at some time

Answer 48

4.7

Question 49

Among people with severe agoraphobia, approximately ___ to ___ percent are female

Answer 49

80 to 90

Question 50

Panic disorder is about ____ as prevalent in women as in men

Answer 50

twice

Question 51

The vast majority of people with panic disorder (83 per-cent) have at least one comorbid disorder, most often

Answer 51

generalized anxiety disorder,
social anxiety,
specific phobia,
PTSD,
depression, and
substance-use disorders (especially smoking and alcohol dependence

Question 52

Depression is especially common among those with panic disorder, with approximately ___ to ___ percent of people with panic disorder experiencing serious depression at some point in their lives

Answer 52

50 to 70

Question 53

Although people often think of suicide as being especially associated with depression, a major study in the 1980s reported that ________ ______ is a strong predictor of suicidal behavior

Answer 53

panic disorder

Question 54

the first panic attack frequently occurs following feelings of distress or some highly stressful life circumstance such as (4)

Answer 54

loss of a loved one,
loss of an important relationship,
loss of a job,
or criminal victimization (one study found this was the case for 80-90% of participants)

Question 55

The biological causal factors of panic disorder include (3)

Answer 55

genetics,
brain activity,
and biochemical abnormalities

Question 56

30 to 34 percent of the variance in liability to panic symptoms is due to _____ ______.

Answer 56

genetic factors

Question 57

The amygdala is a collection of nuclei in front of the ________ in the limbic system of the brain that is critically involved in the emotion of fear.

Answer 57

hippocampus

Question 58

Today it is recognized that it is increased activity in the amygdala that plays a more central role in panic attacks than does activity in the ______ _______

Answer 58

locus coeruleus

Question 59

Stimulation of the central nucleus of the amygdala is known to stimulate the locus coeruleus as well as the other autonomic, neuroendocrine, and behavioural responses that occur during _____ _____

Answer 59

panic attacks

Question 60

Some research has suggested that the _______ is the central area involved in what has been called a “fear network,” with connections not only to lower areas in the brain like the locus coeruleus but also to higher brain areas like the ______ ______.

According to this view, panic attacks occur when the fear network is activated, either by cortical inputs or by inputs from lower brain areas. So according to this influential theory, panic disorder is likely to develop in people who have abnormally _______ fear networks that get activated too readily to be adaptive.

Answer 60

amygdala
prefrontal cortex

sensitive

Question 61

Abnormally _________ fear networks may have a partially heritable basis but may also develop as a result of repeated stressful life experiences, particularly in _____ life

Answer 61

sensitive
early