Week 4 Anxiety Disorder Flashcards

Question

Common Compulsions

Answer 1

Checking Washing (decontaminating) Counting Symmetry/Precision Ritual behaviours Hoarding

Answer 2

DSM-5 Criteria  Presence of obsessions, compulsions, or both  Obsessions or compulsions are time consuming (>1 hour/day), or clinically significant distress or impairment  Content of obsession or compulsion is not restricted to another Axis I disorder (e.g., food obsession in an eating disorder)  Specify if with good or fair insight, with poor insight, with absent insight/delusional beliefs  Not due to a substance or medical condition Prevalence  3.1% (2022 – up from 1.9% NSMHW, 2007)  Females affected at a slightly higher rate  Onset childhood, teenage; after 35 years rare  Gradual, insidious onset  Chronic, constant or waxing/waning course Only 15% describe periods of > 3 months symptom free

Answer 3

 Posttraumatic Stress Disorder (PTSD)  Acute Stress Disorder  Prolonged Grief Disorder (introduced in DSM-TR)  Adjustment Disorder  Other specified trauma and stress-related disorders  Unspecified trauma and stressor-related disorders History  ‘Shell shock’, ‘combat fatigue’, ‘war neurosis’ …  Earlier editions of DSM referred to ‘gross stress reaction’  “PTSD” introduced in DSM-III (1980) Prevalence 5.7% in 2022 (6.4% general population (NSMHW, 2007) Up to 18-20% for veterans or those returning from combat High comorbidity More likely to experience depression, anxiety disorders, substance abuse Common Characteristics but not required for diagnosis The presence of fear, hopelessness, horror

Answer 4

 Anxiety arises from psychic conflict between unconscious sexual or aggressive wishes, and corresponding threats from the superego  i.e. anxiety is a signal that indicates that an impulse (sexual or aggressive) is about to be acted on – signal triggers defences (e.g. repression) to prevent recognition of the impulse and reduce anxiety  When impulse is too strong, anxiety overwhelms system and person may develop an anxiety disorder

Answer 5

 Anxiety developed in response to threat - protective behaviour activated at appropriate times – fight vs flight  Anxiety part of an adaptive system  Anxiety disorders – problems in regulation of system which evolved to deal with particular threat

Answer 6

Biological Factors  Genetic Predisposition  Neurobiology

Answer 7

Twin Studies  Higher concordance rates for anxiety disorders for monozygotic compared to dizygotic twins (34 vs 17%)  Anxiety disorders are modestly to moderately heritable  Different heritability estimates (Antony & Stein, 2009):  Panic Disorder ~ 44%  GAD ~ 32%  Agoraphobia ~ 61%  Social Phobia ~ 24-51%  OCD ~ 27-47%

Answer 8

Animal (and human) studies show pathways in brain responsible for detecting and responding to threats or danger: 1 – A subcortical pathway which activates “fight or flight” response 2 – A path which leads to cortex and provides for slower, more detailed analysis of information  These particular brain regions thought to play a role in phobic disorders and panic disorders – e.g., a particular fear pathway may be triggered at an inappropriate time  Serotonin & GABA function to dampen stress responses  When levels of these are increased, anxiety is reduced

Answer 9

Stressful life events (danger; threat to sense of security; interpersonal conflict)  Childhood Adversity (neglect; abuse)  Parenting style (overprotection /control & rejection /negativity)  Child temperament & behavioural inhibition  Attachment Relationships & Separation Anxiety – (insecure attachment may increase vulnerability to threats in interpersonal conflicts)

Answer 10

Learning theory and processes  Classical conditioning (Little Albert)  Operant/instrumental Conditioning  Vicarious conditioning/Observational learning  Information transmission

Answer 11

 Association between an unconditioned stimulus and a conditioned stimulus (Pavlov’s dog)  Fear and phobias develop as a 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  Model offers insight into development of a fear or phobia; but does not explain maintenance of fear response and why some develop it and others do not

Answer 12

 Learning through the consequences of one’s own actions in a particular setting  Escape and avoidance behaviours are negatively reinforced  Avoidance maintains anxiety as don’t have the opportunity to learn can tolerate anxiety, situation not as threatening as thought, can cope etc

Answer 13

 Conditioning fails to explain how some individuals develop anxiety disorders in the absence of a directly aversive experience  Learning through modeling  Learn to avoid stimuli if modelling by significant others

Answer 14

Perceptions, memory, attention can play an important role in development & maintenance of anxiety disorders Catastrophic Misinterpretation: overestimate or interpret neutral stimuli as threatening  Fear of fear in panic disorder Attentional Bias to Threat  Sensitive/hypervigilant to cues that signal future threats  Once attention is focussed on cues; performance of adaptive, problem-solving behaviours disrupted; worry cycle activated Chronic Thought Suppression  Struggling to suppress, control thoughts which provoke anxiety  Rebound effects

Answer 15

Physical Sensation > Catastrophic misinterpretation of physical sensationsions > Panic attack >Increased physical arousal and worry about another attack > Vigilance of body symptoms

Answer 16

Anxiety associated with a depletion of serotonin in the neural synapses SSRIs block the neuron’s normal reuptake mechanism.

Answer 17

Benzodiazepines (GABA transmission)  Widely used prior to 1990s (e.g., Valium, Xanax)  Effects evident early in Tx, longer term effects less evident  Side effects include sedation, mild impairment in psychomotor skills and cognitive abilities such as attention and memory  Most significant adverse effect is risk of addiction  Tricyclics  Have shown benefits but side effects too significant – i.e. weight gain, dry mouth, difficulty sleeping, feeling nervous  Antidepressants (target depletion of serotonin)  SSRIs (e.g. Prozac, Luvox, Zoloft)  Fewer unpleasant side effects than tricyclics

Answer 18

 Free association and dream interpretation  Fear and phobias – signs of internal conflicts  Psychoanalysis – discover and work through conflicts  Limited empirical evidence  Interpersonal psychotherapy  Targets interpersonal conflicts, role transitions, and grief in more structured and skills-based way  Found to be effective for Social anxiety disorder (Lipsitz, et al 1997) and PTSD (Bleiberg & Markowitz, 2005)

Answer 19

 Psychoeducation  De arousal strategies  Exposure Therapy  Cognitive Therapy

Answer 20

 Anxiety is common, typically short-lived and normal  Anxiety can be adaptive and functional  Can never eliminate anxiety altogether  Flight or fight response  Hyperventilation  Safety behaviours  …

Answer 21

 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  Become a “lifestyle” strategy

Answer 22

 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  Become a “lifestyle” strategy

Answer 23

 Addresses the cognitive component of anxiety (appraisals)  ABC model (cognitions as mediators)  Identification of anxiety-provoking cognitions (thought monitoring)  Cognitive restructuring/behavioural experiments  Threat, awfulness and coping  Identify the meaning of symptoms/situations