Week 4 - Anxiety Flashcards
What are the shared features among those with anxiety disorders?
Preoccupation with, or persistent avoidance of, thoughts or situations that provoke fear/anxiety
What are the considerations for a diagnosis of anxiety-related disorders? (x5)
Pattern of symptoms: Nature Frequency Severity Duration
What are the differences between anxiety and fear? (x3)
Anxiety is anticipation of future problems - fear is reaction to immediate danger
Anxiety is general/diffuse emotional reaction - fear quickly builds intensity
Anxiety is disproportionate - fear helps behaviour response to threat
When does anxiety become unhelpful (rather than warning us of threats/prompting adaptive behaviour)? (x3)
When person allows it to limit living, by avoiding things that elicit anxiety
Usually occurs when anxiety is very intense
Resulting dysfunction may warrant an anxiety-related disorder diagnosis
What is the prevalence of anxiety disorders? (x4)
One of most common in Oz - more than double mood disorders
Women 50% more likely than men
Across all ages, but decrease with age
PTSD and social phobia most common
What are 3 categories of anxiety-related disorders in the DSM?
Anxiety Disorders
Obsessive-compulsive & Related Disorders
Trauma- & Stressor-related Disorders
What are the features of anxiety-related disorders? (x7)
Physiological symptoms
Avoidance symptoms
Disturbances in attention
Intrusive thoughts
Attentional biases
Re-experiencing symptoms
Subjective feeling of Anxiety
What are 5 anxiety disorders listed in the DSM?
Specific Phobia Social Anxiety Disorder (Social Phobia )Panic Disorder Agoraphobia Generalised Anxiety Disorder
What are the essential features of specific phobias? (x4)
Marked fear/anxiety about /specific object/situation
Exposure to phobic stimuli invariably provokes immediate fear/anxiety
Phobic stimuli actively avoided/endured with intense fear/anxiety
Fear/anxiety is out of proportion to actual danger
What is the prevalence of specific phobias? (x3)
7-9% prevalence rate
Females more affected 2:1
Rates/gender balance vary across stimuli
What are 5 specific phobia specifiers?
Animal Natural environment Blood/Injection injury Situational - bridges, enclosed space Other - choking, costumes
Describe the case study of 12yo boy who developed dentophobia (x5)
Reported traumatic experience
Anxiety grew and generalized
‘Fear of catastrophe’ - of panic attacks
Anticipatory anxiety
Overwhelmed by his dental problems
Specific stimuli perceived as real threat to personal safety
Describe the fear hierarchy developed to treat 12yo boy who developed dentophobia (x5)
Drill, Panic attacks, Sound, Atmosphere, Chair, Embarrassment, Fear of treatment, Fear of no treatment, Injection, Everybody watching over me
What are the characteristics of social anxiety disorder? (x2)
Marked fear/anxiety about one/more social/performance situations in which person exposed to possible scrutiny
Fears he/she will act/show anxiety that will be negatively evaluated (humiliation, embarrassment, rejection, offend)
What is the prevalence of social anxiety disorder? (x1)
5%
What are the clinical features of social anxiety disorder? (x11)
Belief that others see them as inept, stupid, foolish
Often vicious cycle of anxiety -social deficits - anxiety
Hypersensitive to criticism
Non-assertive
Low self-esteem
Comorbid anxiety common
Safety behaviours common
Avoiding eye contact
Talking to ‘safe’ people
Covering face with hair, hands
Take ‘observer perspective’ vantage point for social memories
What information processing biases are present in clinical social anxiety disorder? (x3)
Interpretations of social events
Detection of positive responses of others
Anticipatory and post-event processing
What are the DSM criteria for panic disorder? (x5)
Recurrent unexpected panic attacks
At least one has been followed by one month or more of the following:
*Persistent concern about additional attacks or their consequences
*Significant maladaptive change in behaviour (avoidance)
Rule out specific phobia/other conditions/attacks that are the direct result of a substance (i.e., drug abuse)
What is the prevalence of panic disorder? (x1)
But…(x2)
2.6 %
3 –5% of population experience panic attacks without meeting criteria
*Panic attacks do not equal panic disorder
Define a panic attack (x14)
Abrupt surge of intense fear/discomfort, in which 4+ of the following develop rapidly - peaks within minutes:
Palpitations/pounding heart Sweating Trembling/shaking Sensation of shortness of breath Feelings of choking Chest pain or discomfort Nausea or abdominal distress Dizziness/lightheadedness Chills/Hot flushes Paresthesias (numbness/tingling) Derealisation (unreality)/Depersonalization (detached) Fear of losing control or going crazy Fear of dying
What are the essential features of agoraphobia? (x7)
Marked fear or anxiety about 2+ of the following:
- Using public transport
- Being in open spaces
- Being in enclosed places
- Standing in line or being in a crowd
- Being outside of the home alone
Anxiety about being in places from which escape might be difficult or embarrassing in the event of having a panic attack
What is the prevalence of agoraphobia? (x1)
3%
What are the DSM criteria for generalised anxiety disorder (GAD)? (x10)
Excessive anxiety and worry about numerous events or activities
Difficulty in controlling worry
Experience 3+ of the following:
*Restlessness/on edge
*Easily fatigued
*Difficulty concentrating / mind blank
*Irritability
*Muscle tension
*Sleep disturbance
Anxiety, worry or physical symptoms cause significant interference
What is the prevalence of GAD? (x1)
3%
What characteristics are displayed by those with GAD? (x3)
Less tolerance for uncertainty than others
Underestimate ability to cope with difficult/ambiguous circumstances
Overestimate likelihood of negative consequences
What life experiences may contribute to development of GAD? (x1)
Early experiences of uncontrollability and unpredictable negative events
Name 6 additional anxiety disorders
Separation anxiety disorder
Selective mutism
Substance / Medication Induced Anxiety Disorder
Anxiety Disorder Due to another medical condition
Other specified anxiety disorder
Unspecified Anxiety Disorder
Name 8 disorders related to OCD
Body dysmorphic disorder - fixation on imperfection
Hoarding disorder
Trichotillomania - hair pulling
Excoriation - skin picking
Substance/medication-induced obsessive-compulsive and related disorder
Obsessive-compulsive and related disorder due to another medical condition
Other specified obsessive-compulsive & related disorder
Unspecified obsessive-compulsive & related disorder
Describe the obsessions in OCD (x5)
Thoughts, images or impulses
Repetitive, intrusive - uncontrollable (rebound effects)
Not just excessive worries about real life problems
Cause anxiety or distress
Compel person to ignore, suppress, neutralise obsessions in some way
Describe the compulsions in OCD (x3)
Repetitive overt behaviors (handwashing, ordering, checking) or covert mental acts (praying, counting, repeating words)
Goals are usually to “undo” obsession, prevent harm associated with obsession, or alleviate anxiety.
But - obsessions are not connected in realistic way with what they are designed to neutralize/prevent, or are clearly excessive
What are the 2 key components of OCD?
Thoughts
Behaviour
What are theDSM criteria for OCD? (x5)
Either obsessions, compulsions, or both
Obsessions/compulsions cause distress, are time consuming (>1 hour/day), or significantly interfere
Content of obsession/compulsion not restricted to another disorder (e.g., food obsession in an eating disorder)
Not due to substance/medical condition
Specify if with good or fair insight, with poor insight, with absent insight/delusional beliefs
Describe the prevalence of OCD (x5)
2%
Females affected slightly more
Onset childhood, teenage; after 35 yrs rare
Gradual, insidious onset
Chronic, constant or waxing/waning course - only 15% describe periods of > 3 months symptom free
What forms do obsessions take in OCD? (x3)
Thoughts
Unacceptable/unwanted idea (e.g., idea of stabbing my child)
Images
Troubling/distressing mental visualisations (e.g., one’s elderly grandparents having sex)
Impulses
Unwanted urges/notions to behave in inappropriate ways (e.g., to yell obscenities)
What is the typical content of obsessions? (x3)
Violence
Sex
Blasphemy/sacrilege
In descending order, list common obsessions in OCD (x8)
Multiple obsessions Contamination Pathological doubt Somatic obsessions Need for symmetry Aggressive Sexual Other
Give 6 egs of thoughts/behaviours that don’t qualify as obsessions
Worries about real-life issues (e.g., work)
Depressive ruminations
Recurrent sexual fantasies
Jealousy
Preoccupation with a new car, boyfriend, etc.
Cravings to gamble, steal, drink alcohol, etc.
In descending order, list common compulsions in OCD (x7)
Multiple compulsions Checking Washing Counting Need to ask/confess Symmetry/precision Hoarding
List 7 trauma and stress-related disorders
Posttraumatic Stress Disorder (PTSD)
Acute Stress Disorder
Adjustment Disorder
Other specified trauma and stress-related disorders
Unspecified trauma and stressor-related disorders
Reactive Attachment Disorder
Disinhibited Social Engagement Disorder
Name 4 historical terms for PTSD (which was into’d in DSM 3)
Shell shock
Combat fatigue
War neurosis
Gross stress reaction
Describe the prevalence of PTSD (x6)
6% 18-20% for vets High comorbidity: *80-90% more likely to have depression *Anxiety disorders *Substance abuse
What are some common characteristics not required for a PTSD diagnosis (x5)
Fear, hopelessness, horror, shame and guilt
What are the essential features of PTSD? (x5)
Exposure to actual or threatened death or serious injury, or sexual violence
Presence of 1+ intrusions
Avoidance of stimuli associated with event
Negative alterations in cognitions and mood
Physiological arousal symptoms (2+)
What forms can exposure to actual/threatened death/serious injury/sexual violence take in order to cause PTSD? (x4)
Directly
Witnessing
Learning about it happening to someone close or
Repeated/extreme exposure to aversive details (e.g., first responders)
List 4 of the intrusions in PTSD
Involuntary intrusive distressing memories
Distressing dreams
Dissociative reactions e.g. flashbacks
Distress or reactivity to cues that resemble traumatic event
What negative alterations in cognitions and mood are seen in PTSD? (x7)
Inability to remember important aspects of the trauma
Persistent negative beliefs “The world is completely dangerous”
Distorted cognitions about cause or consequence e.g. blame self
Persistent negative emotional state - fear, horror, anger
Diminished interest in activities
Feelings of detachment or estrangement
Anhedonia
What physiological arousal symptoms characterise PTSD? (x6)
Irritability or anger outbursts Reckless or self-destructive behaviour Hypervigilance Exaggerated startle response Difficulty concentrating Sleep disturbance
What are the essential features of acute stress disorder? (x8)
Duration - symptoms from 3 days to 1 month following trauma (while PTSD is 1+ months)
9+ symptoms from any of 5 categories:
- Intrusive symptoms
- Negative mood
- Dissociative symptoms
- Avoidance symptoms
- Arousal symptoms
Clinically significant distress or impairment
What are the essential features of adjustment disorder? (x7)
Emotional/behavioural symptoms - response to identified stressor (e.g. death, medical diagnosis), within 3 months of stressor
Clinically significant symptoms:
- Distress out of proportion to severity/intensity of stressor
- Significant impairment in functioning
Does not meet criteria for another mental disorder
Not normal bereavement
Once stressor terminated, symptoms do not persist beyond 6 months
What is the psychodynamic perspective of the aetiology of anxiety? (x3)
Caused by conflict between unconscious sexual/aggressive wishes/impulses, and corresponding threats from superego
i.e. is signal that indicates impulse is about to be acted on – signal triggers defences (e.g. repression) to prevent recognition of impulse and reduce anxiety
When impulse is too strong, anxiety overwhelms system = anxiety disorder
What is the evolutionary perspective of the aetiology of anxiety? (x2)
Anxiety evolved to enable protective behaviour to be activated - part of an adaptive system
Anxiety disorders – problems in regulation of system
What biological factors are thought to contribute to the aetiology of anxiety? (x2)
Genetic predisposition
Neurobiology/neurotransmitters
What do twin studies reveal about genetic predispositions to anxiety? (x4)
Higher concordance rates MZ vs DZ twins (34 vs 17%)
Anxiety disorders are modestly to moderately heritable, varying across disorders, ranging
*Social phobia 24-51% to
*Agoraphobia 61%
What role is neuroanatomy/chemistry posited to play in the aetiology of anxiety? (x4 and x1)
Animal studies show threat/danger pathways:
*Subcortical for fight/flight
*Slower one to cortex for more detailed info
That are thought to play role - e.g. inappropriate triggering
Serotonin & GABA dampen stress responses/reduce anxiety
Describe the biological model of OCDS (x2)
Higher activity in “cortical-striatal-thalamic” circuit (prefrontal cortex, thalamus, basal ganglia)
*Area related to filtering out irrelevant information and repetition of behaviour
What social factors are generally associated with anxiety disorders? (x5)
Stressful life events Childhood adversity Parenting style Child temperament/behavioural inhibition Attachment relationships separation anxiety
What does the current psychosocial perspective hold to be psychological factors affecting the aetiology of anxiety? (x6)
Learning theory and processes
- Classical conditioning (Little Albert)
- Operant conditioning
- Vicarious conditioning
- Observational learning
- Information transmission
How does classical conditioning explain the aetiology of anxiety? (x2)
Fear/phobias develop as result of pairing between a neutral stimulus (e.g., a dog)
And an aversive experience (e.g., being bitten by the dog) which provokes a fear reaction
What are the limitations of classical conditioning in explaining the aetiology of anxiety? (x3)
Model offers insight into development of a fear or phobia;
But doesn’t explain maintenance of fear response
Or why some develop it and others not
How does operant conditioning explain the aetiology of anxiety? (x5)
Avoidant behaviours negatively reinforced, maintaining anxiety -
Person never has opportunity to
*Face fears,
*Learn they can tolerate their anxiety,
*Challenge maladaptive beliefs about remaining in situation
Give an example of developing a fear of snakes through operant conditioning (x5)
See snake Become anxious Run away Anxiety decreases Likelihood of avoidance and fear grow
How does vicarious/observational learning explain the aetiology of anxiety? (x4)
Conditioning doesn’t explain why some develop anxiety in absence of aversive experience
Learning through modelling
*Learn to avoid stimuli if one observes others showing a strong fear response to such stimuli
*Adaptive to copy others’ fear
What is the role of cognitive processes such as perception, memory, attention in developing/maintaining anxiety disorders? (x5)
Misinterpret ambiguous situations as dangerous - physical and cognitive distress
Maladaptive thoughts/beliefs can impact memory, attention, information processing
Catastrophic misinterpretation - esp in panic disorder
Attentional bias to threat - hyper vigilance
Thought suppression - causes more intrusions
Describe the ‘fear of fear’ model/cycle of panic attacks (x4)
Catastrophic misinterpretation of physical sensations
Panic attack
Increased physical arousal/worry about another attack
Vigilance of bodily symptoms
How does the ACT hexaflex of psychological rigidity relate to the aetiology of anxiety? (x6)
Fusion of thought and awareness – eg no one likes me - fuses with sense of self through our attention, making it ‘real’
Which makes you avoidant of those situations
Focussed on beliefs about our past, and that future will be same
Values go, because we’re focussed on avoidance
Leads to disorganised behaviour
No safe place, which should be our awareness
What is the take-home message about the aetiology of anxiety? (x1)
It’s a complex relationship between genetics, CSN mechanisms, cognitive, behavioural, social and environmental factors
What biological treatments are available for anxiety disorders? (x3)
Tricyclics - side-effects too bad
SSRIs - combat serotonin depletion associated with anxiety, less harm than tricyclics
Benzos - GABA, effective early in TX, but side-effects and addictive
What elements of CBT are used to treat anxiety? (x4)
Psychoeducation
Relaxation
Cognitive Techniques
Exposure Therapy
What is taught in psychoeducation about anxiety in CBT? (x3)
Anxiety is common, typically short-lived and normal
Anxiety can be adaptive and functional
Can never eliminate anxiety altogether
What role does relaxation play in CBT for anxiety? (x1)
Teaching clients… (x7)
Addresses the physiological component of anxiety Variety of relaxation techniques: *Progressive Muscle Relaxation *Imagery/visualisation *Abdominal breathing Relaxation is a skill, pick the right time Make the time, keep it short and simple Create a relaxing environment
What is involved in cognitive therapy for anxiety? (x4)
ABC model (cognitions as mediators) Identification of anxiety-provoking cognitions (thought monitoring) Cognitive restructuring *Target negative, unrealistic interpretations common to anxiety sufferers
What role does exposure therapy play in treating anxiety? (x1)
Involving… (x2)
Addresses the behavioural component – overcome avoidance, facing your fears
Gradual and repeated exposure using Exposure Hierarchy (most typical)
- Imaginal or In Vivo (real life experiences)
- Gradual or Flooding
Exposure with Response Prevention (ERP)
What evidence supports ACT for treating anxiety? (x3)
Acceptance rationale drawn from ACT seems to increase willingness of clients to complete exposure tasks
As effective as CBT in treating anxiety disorders
Effective in treating treatment resistant clients
How does ACT treat anxiety? (x4)
Defusion – recognise your thoughts as thoughts
Get your awareness away from target, back to present moment
Trying to move away from avoidance,
And experience life, accepting that you might feel bad sometimes
