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Abnormal Psych > lesson 7 (ch 6): anxiety disorders > Flashcards

lesson 7 (ch 6): anxiety disorders Flashcards

1
Q

anxiety vs fear

A

anxiety: apprehension about a future threat

fear: a reaction to immediate danger

anxiety involves moderate arousal/ sympathetic nervous system activity, fear involves higher arousal, fight or flight

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2
Q

how can anxiety be helpful?

A

small amount of anxiety can help us notice/ plan for future threats, but too much can be paralyzing

U-shaped curve with performance- no anxiety is a problem, a little is good, a lot is detrimental

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3
Q

DSM-5 major anxiety disorders (5)

A
  • specific phobias
  • social anxiety disorder
  • panic disorder
  • agoraphobia
  • generalized anxiety disorder
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4
Q

how common are anxiety disorders?

A
  • anxiety disorders are the most common psychiatric disorders
  • 28% report anxiety symptoms, may be more
  • most common are phobias
  • 9th leading cause of disability
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5
Q

(?) DSM-5 Criteria for diagnosis for anxiety disorders

A

(?)

  • symptoms interfere w important areas of functioning/ cause marked distress
  • symptoms not caused by drug or medical condition
  • symptoms persist for at least 6 months, 1 month for panic disorder
  • distinct from symptoms of another anxiety disorder
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6
Q

specific phobias

A

disruptive fear of a particular object or situation

  • fear out of proportion to actual threat
  • awareness that fear is excessive but still goes through great lengths to avoid
  • must be severe enough to cause distress or interfere w job or social life
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7
Q

most common phobias

A
  • acrophobia and claustrophobia
  • most specific phobias cluster around a few feared objects/situations
  • high comorbidity of specific phobias
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8
Q

social anxiety disorder

A
  • persistent intense fear and avoidance of social situations
  • fear of negative evaluation/scrutiny
  • exposure to trigger leads to anxiety about being evaluated negatively
  • called social phobia in DSM-IV-TR
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9
Q

comorbidity in social anxiety

A
  • 33% of those w/ social anxiety also diagnosed w/ avoidant personality (overlap in genetic vulnerability for both)
  • those with broader array of fears are more likely to experience comorbid depression and alcohol abuse
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10
Q

panic disorder

A

frequent panic attacks unrelated to specific situations

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11
Q

panic attack

A

sudden attack of intense apprehension, terror, and feelings of impending doom, accompanied by at least 4 other symptoms

  • wanting to flea
  • possible physical symptoms: shortness of breath, heart palpitations, nausea, upset stomach, chest pains, feeling of choking/smothering, dizziness, lightheaded, faintness, sweating, chills, heat, numbness/tingling, trembling
  • can involve depersonalization (feeling outside ones body), derealization (feeling like world isn’t real)
  • fears of going crazy/losing control/ dying
  • experience sympathetic nervous system arousal as if life threatened
  • usually peak intensity around 10 mins
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12
Q

DSM-5 criteria for panic disorder

A
  • recurrent panic attacks
  • at least 1 month of worry about more panic attacks, or maladaptive behavioral changes
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13
Q

types of panic attacks

A

uncued attacks:
- unexpected
- panic disorder diagnosis requires recurrent uncued attacks
- causes worry about future attacks

cued attacks
- triggered by specific situations, more likely a phobia

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14
Q

agoraphobia

A
  • agora = marketplace
  • anxiety about inability to flee anxiety-provoking situations, like crowds or crowded places
  • causes significant impairment- virtually unable to leave house, or can only do so with great distress
  • in DSM-IV-TR was a subtype of panic disorder, but at least half agoraphobics don’t have panic attacks
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15
Q

DSM-5 Criteria of Agoraphobia

A
  • disproportionate fear/anxiety about at least 2 situations where it would be difficult to escape/receive help
  • these situations consistently provoke fear or anxiety
  • these situations are avoided, require presence of a companion, or are endured w intense fear/anxiety
  • symptoms last at least 6 months
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16
Q

Generalized Anxiety Disorder (GAD)

A

-involves chronic, excessive, uncontrollable worry
- lasts at least 6 months
-interferes w/ daily life (often paralyzed- can’t decide on solution/ course of action)

other symptoms:
- restlessness, poor concentration, tiring easily, restlessness, irritability, muscle tension

common worries:
- relationships, health, finances, daily hassles

often begins in adolescence or earlier “i’ve always been this way”

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17
Q

DSM-5 criteria for GAD (generalized anxiety disorder)

A
  • excessive anxiety and worry at least 50% of days about at least 2 life domains
  • worry sustained for at least 6 months
  • anxiety and worry associated w at least 3:
    • restlessness or feeling on edge
    • easily fatigued
    • difficulty concentrating/ mind going blank
    • irritability
    • muscle tension
    • sleep disturbance
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18
Q

what do people with GAD avoid or do due to their worry?

A
  • avoid situations where neg. outcomes could occur
  • time and effort preparing for situations that may have negative outcome
  • marked procrastination
  • difficulty making decisions due to worry, or repeatedly seeking assurance
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19
Q

when does GAD (generalized anxiety disorder) onset typically?

A

adolescence, typically, and is chronic

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20
Q

comorbidity in anxiety disorders

A

80% anxiety disorder meet criteria for another anxiety disorder
- subthreshold symptoms very common

75% anxiety disorder meet criteria for another psychological disorder
- 60% anxiety also have depression
- substance abuse
- personality disorders
- medical disorders, e.g. coronary heart disease

comorbidity associated w/ greater severity and poorer outcomes

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21
Q

reasons/ causes of comorbidity in GAD

A
  • symptoms used to diagnose anxiety disorders overlap
    (ex: social anxiety and agoraphobia both have fear of crowds)
  • etiological factors may increase risk for more than on anxiety disorder
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22
Q

Prevalence of anxiety disorder

A

US 12 month prevalence: 18%

lifetime prevalence: 28%

severe: 4% of population, 23% of cases

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23
Q

demographics of lifetime prevalence of anxiety disorders

A

sex: women 60% more likely

race: non-hispanic white most likely

age: most common in young and middle adulthood

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24
Q

gender differences- anxiety disorder

A

women twice as likely
why?

  • women may be more likely to report symptoms
  • men might be encouraged more to face fears
  • women more likely to experience childhood sexual abuse
  • women show more biological stress reactivity
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25
Q

culutural anxiety disorders

A

kayak-angst:
inuit (Greenland), similar to panic disorder, lone seal hunters’ fear/ disorientation/concerns of drowning

taijin kyofusho:
japan, fear of displeasing or embarrassing others, overlaps w social anxiety but w/ focus on OTHERS

koro:
south/east asia, fear genitals will recede into body

shenkui:
china, anxiety of loss of semen

susto:
Latin America, fright causes soul to leave body

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26
Q

List of factors that may increase risk for more than one anxiety disorder

A
  • behavioral conditioning
  • genetic vulnerability
  • increased activity in fear circuit of brain
  • decreased func. of GABA and serotonin; increased norepinephrine activity
  • behavioral inhibition
  • neuroticism
  • cognitive factors (including sustained neg beliefs, perceived lac of control, and attention to cues of threat)
27
Q

Two-factor model of behavioral conditioning (Mowrer’s two-factor model)

A
  • conditioned responses to threat
    (classical conditioning- fear neutral stimulus after pairing w averse stimulus)
  • sustained by avoidance or ‘safety behaviors’
    (gains relief by avoiding CS- through operant conditioning, avoidant response is maintained b/c it is reinforcing)
28
Q

problems w/ Mowrer’s two factor model of behavior conditioning (for anxiety)

2 reasons

A
  • most don’t remember exposure to a threatening event
  • many people who experience threats don’t develop anxiety disorders
29
Q

extension of Mowrer’s two factor model of behavior conditioning (for anxiety)

A
  1. classical conditioning can occur in different ways:
  • direct experience
  • modeling (seeing something happen)
  • verbal instruction
  1. also some people are more vulnerable to anxiety disorders than others
30
Q

Neutral predictable unpredictable (NPU) threat task

A

experimental approach for testing responses to unpredictability (anxiety disorders)

  • neutral condition
  • predictable condition (warning of aversive stimulus)
  • unpredictable condition (no warning aversive stimulus

people w/ anxiety disorder fare worse in unpredictable threat conditions

31
Q

genetic risk factors for anxiety disorder

A

twin studies suggest heritability estimate of .5 to .6% for anxiety disorders (means that genes may explain 50-60% of risk for anxiety disorders in population

  • 20-40% for phobias, and GAD
  • 50% for panic disorder

relative w phobia increases risk for other anxiety disorders in addition to phobia

32
Q

Neurobiolobical risk factors for anxiety

A
  • fear circuit overactivity
    • amygdala (sends signals to brain structures involved in fear circuit. elevated activity may be linked to anxiety disorders
    • medial prefrontal cortex deficits (helps regulate amygdala activity)

-neurotransmitters
- poor functioning of serotonin and GABA
- higher levels of norepinephrine

Neumonic: brain anxiety park: fear circuit roller coaster, GABA, Prozac sad and an epipen having fun

33
Q

Risk factors Personality for anxiety disorders

A
  • behavioral inhibition
  • neuroticisim
34
Q

behavioral inhibition

A

tendency to be agitated, distressed/ cry in unfamiliar/ novel settings
- observed in infants as young as 4 months
- may be inherited

predicts anxiety in childhood and social anxiety in adolescence

Neumonic: beehive acting shy in new environment

35
Q

Neuroticism

A
  • personality trait- tendency to experience frequent or intense negative affect
  • linked to anxiety and depression
  • higher levels linked to double the likelihood of developing anxiety disorders
36
Q

cognitive risk factors for anxiety (4)

A
  • sustained neg beliefs about future
  • perceived lack of control
  • over-attention to signs of threat
  • intolerance of uncertainty
37
Q

sustained negative beliefs about future

A
  • bad things will happen
  • engage in safety behaviors
38
Q

perceived lack of control

A
  • belief they lack control over environment
  • more vulnerable to developing anxiety disorder
  • childhood trauma or punitive parenting may foster beliefs
  • serious life events can threaten sense of control
39
Q

attention to threat

A
  • tendency to notice negative environmental cues
  • selective attention to signs of threat
  • used dot-probe test to test
40
Q

intolerance of uncertainty

A

-people who have hard time accepting ambiguity are more likely to develop anxiety disorders

  • predicts increases in worry over time
  • also a difficulty for those with major depressive disorder and obsessive compulsive disorder
41
Q

What do psychological treatments of anxiety all emphasize?

A

EXPOSURE:
face the situation/object that triggers anxiety

  • in CBT, client would make a list of triggers, create an “exposure hierarchy,” and gradually face them
  • should include as many features of the trigger as possible
  • conducted in as many settings as possible
  • 70-90% effective
42
Q

systematic desensitization

A
  • relaxation plus (initially) imaginal exposure
43
Q

cognitive approaches (added to exposure therapy)

A
  • increase belief in ability to cope w/ the anxiety trigger
  • challenge expectations about negative outcomes
44
Q

behavioral view of exposure

A
  • works by extinguishing fear response
  • doesn’t erase underlying fear, rather, newly learned associations inhibit activation of fear

-learning, not forgetting

45
Q

psychological treatment of social anxiety disorder

A

Exposure
- starting with role-playing/ practicing w therapist

social skill training
- reduce use of safety behaviors (avoiding eye contact)

Clark’s cognitive therapy for social anxiety:
- stop focusing attention internally
- helps them combat negative images of how others will react them

  • more effective than medication or exposure

Neumonic: Clark has social anxiety

46
Q

psychological treatment of panic disorder (CBT, cognitive, psychodynamic)

A

CBT for panic disorder also focuses on exposure

  • based on tendency of people w diagnosis to overreact to bodily sensations

PANIC CONTROL THERAPY
- exposure therapy to somatic symptoms of panic in safe space (breathing rapidly for 3 mins)

  • gives coping tactics for dealing with somatic symptoms
  • relaxation, deep breathing

benefits maintained after treatment ends

cognitive treatment:
- therapist helps patient identify and challenge thoughts that make physical sensations threatening

psychodynamic:
- identifying emotions and meanings surrounding panic attacks

47
Q

psychological treatment of Generalized Anxiety Disorder

A

behavioral technique: relaxation training (to promote calmness)

CBT- strategies to improve problem solving and to address thought patterns that contribute to GAD:

  • Challenge and modify neg thoughts
  • strategies to tolerate uncertainty
  • worry only during “scheduled” times
  • focus on present
48
Q

Medications that reduce Anxiety

A

called anxiolytics

  • Benzodiazepenes
    • Valium
    • Xanax
  • Antidepressants
    • tricyclics
    • SSRIS
    • SNRIS (serotonin-norepinephrine reuptake inhibitors)
  • D-cycloserine (DCS)
    • enhances learning during exposure treatment
49
Q

prepared learning

A
  • evolution may have “prepared” our fear circuit to learn fear of stimuli (that could be life-threatning ) very quickly and automatically

Neumonic: I am prepared to be terrified of that snake

50
Q

specific phobias: prevalence

A

12 month prevalence 8.7% of US adults

severe: 21.9% of cases are classified as severe

51
Q

etiology of specific phobias

A
  • conditioning
  • Mowrer’s two-factor model
    • pairing of stimulus w aversive UCS leads to fear (classical conditioning)
    • avoidance maintained through negative reinforcement (operant conditioning)
52
Q

extensions of the two-factor model of conditioning

A
  • modeling: seeing another person harmed by stimulus
  • verbal instruction: being told something is dangerous
  • prepared learning: evolutionary preparation to fear certain stimuli
53
Q

social anxiety disorder prevalence

A

12 month prevalence: 6.8%

severe: 29.9% of cases

age: drops off in older adulthood

54
Q

etiology of social anxiety disorder- cognitive factors

A
  • unrealistic negative beliefs about consequences of behaviors
  • excessive attention to internal cues
  • fear of neg evaluation by others (expect others to dislike them)
  • neg self evaluation (harsh, punitive self-judgement)
55
Q

GAD- General Anxiety disorder- Prevalence

A

12 month: 3.1
severe: 32.3%
age: goes up until senior

56
Q

Etiology of GAD (Generalized anxiety disorder)

A
  • GABA system deficits

Borkovec’s cognitive model:
- worry reinforcing b/c distracts from neg emotions and images
- allows avoidance of more disturbing emotions (previous trauma)
- worrying decreases Psychophysiological arousal
- avoidance prevents extinction of underlying anxiety

textbook calls it CONTRAST AVOIDANCE model
- avoids volatile shifts in emotions by constantly worrying

57
Q

Panic Disorder Prevalence

A

12 month: 2.7%

severe: 44.8% of cases

age: goes up until senior

58
Q

Etiology of Panic Disorders- Neurobiological factors

A
  • heritability of panic is fairly high
  • Locus ceruleus
    • major source of norepinephrine
    • trigger for nervous system activity

Neumonic: a locust having a panic attack

59
Q

Etiology of Panic Disorders- Behavioral factors

A

classical conditioning- could be response to either the situation that triggers anxiety, or somatic changes in the body (interoceptive conditioning)

Interoceptive conditioning
- classical conditioning of panic in response to internal bodily sensations

Neumonic: inception- hands tingling

60
Q

Etiology of Panic Disorders- cognitive factors

A

catastrophic misinterpretations of somatic changes
- interpreted as impending doom (heart attack, etc)
- beliefs increase anxiety and arousal
- creates cycle

anxiety sensitivity index measures fear of bodily sensations

61
Q

anxiety sensitivity index

A

anxiety sensitivity index measures fear of bodily sensations

  • high scores predict development of panic disorders
62
Q

Agoraphobia: prevalence

A

12 month: 0.8%

severe: 40.6% of cases

63
Q

etiology of agoraphobia

A

principle cognitive model for etiology of agoraphobia:

fear-of-fear hypothesis:
- expectations of the catastrophic consequence of having a public panic attack

64
Q

Psychological treatment of agoraphobia

A

Cognitive Behavioral Therapy (CBT)
- systematic exposure to feared situations
- self-guided treatment effective

Abnormal Psych (16 decks)

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