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Question 1

characteristics of anxiety

Answer 1

affective state wherby an individual feels threatened by the potential occurrence of a future negative event Physiological, behavioural, emotional components o Hyperventilation, sweating, etc.
- Panic: like a false alarm. No concrete identifiable threat. Overwhelming. Not adaptative.
- Fear: more primitive. In response to a threat in the moment. Elicits fight-or-flight
- Worry: cognitive response to threat. Preparing. Can be problematic when chronic
- Can be good in small amounts.

Question 2

separation anxiety disorder

Answer 2

mostly in children, most common anxiety disorder in children, distress when separated from the attachment figure, can be triggered by an event such as a death in the family, 1/3 after develop anxiety or other depressive disorders

Question 3

prevalence for separation anxiety

Answer 3

Childhood and adolescence: girls = boys
o Adulthood: more women
o Childhood: SAD (5%), GAD (3%), phobia (2.5%)

Question 4

development trajectory of separation anxiety

Answer 4

Homotypic continuity (predicts itself)
o 1/3 will develop GAD, depression, substance abuse

Question 5

temperament and brains structure as a separation anxiety etiology

Answer 5

High stress reactivity (physiologically) may be heritable
▪ Behavioural inhibited (BI) children show avoidance of others and atypical
autonomic nervous system responses
* May be due to abnormal functioning in the amygdala
▪ Some children are more laidback than others. More activity in right frontal lobe. Others are more easily frightened. Exaggerated response in left frontal lobe

Question 6

prenatal risk factors as separation anxiety etiology

Answer 6

Elevated levels of cortisol in mother during pregnancy. HPA axis becomes too
sensitive
▪ Cortisol is also correlated with low socioeconomic status because these mothers
are more often stressed (50-57% of children with SAD)
▪ Especially relevant for SAD

Question 7

Genetics as separation anxiety etiology

Answer 7

Runs in families. Could be shared environmental factors?
▪ General anxiety levels, not specific kinds of anxiety disorders

Question 8

psychosocial risks for separation anxiety etiology

Answer 8

Learn to fear by observing anxious parents
▪ Conditioned experiences > avoidant behaviour > fear/anxiety
▪ Being more proactive makes a big difference in overcoming anxiety

Question 9

gene environment interaction for Separation anxiety

Answer 9

Behavioural inhibition/amygdala dysfunction (predisposition) combined with a
conditioned fear experience (environment) creates anxiety

Question 10

interventions for separation anxiety

Answer 10

Psychointerventions: explaining it to the child, parents, teachers o CBT (cognitive behaviour therapy)
▪ Reframing anxious thoughts into assertive behaviours
▪ Enhancing self-efficacy, exposure to reduce avoidance and extinguish fear responses
o Behaviour therapy: for very young children. Help feel more confident. Not examining thoughts.
o Medications:
▪ SSRIs + CBT (more common for teens, but also kids)
▪ Tricyclic antidepressants and benzodiazepines (common but questionable
efficacy especially with children)

Question 11

history of anxiety

Answer 11

Neurosis: until 1980, anxiety disorders were classified with dissociative and somatoform
disorders under the label of neurosis
▪ Presumed nervous system disturbance
o Freud focused on the difference between objective fears and neurotic anxiety ▪ Anxiety was a signal that the defense mechanisms were failing
o Modern views: behavioural, cognitive-behavioural, and biological factors

Question 12

biological etiology of Anxiety disorder

Answer 12

▪ Heritability ranges from 30-50%
▪ Broad dispositional/temperamental traits
* High neuroticism, behavioural inhibition
▪ Neural fear circuit: thalamus > amygdala > areas of the hypothalamus >
midbrain > brainstem > spinal cord > autonomic output
▪ GABA (big effect. Inhibitory transmitter. Has a calming effect), norepinephrine,
serotonin play a role
* Benzodiazepines target these
▪ Regular exercise helps stress
▪ Oxytocin (“love” hormone) helps

Question 13

Behavioral etiologies for anxiety disorder

Answer 13

Anxiety can be acquired through learning
▪ Two-factor model: fears are acquired through classical learning and maintained
through operant conditioning (negative reinforcement)
* Limits: fears are sometimes unexplained or acquired by vicarious
learning/modeling or information transmission (hearing about fears)
* Doesn’t account for biological predispositions to fear deep water,
heights, etc.

Question 14

cognitive etiologies for anxiety disorder

Answer 14

Emotions are influenced by the way people appraise the future, themselves, the world
▪ Beliefs: affected by experiences. Beliefs about helplessness, vulnerability
▪ Schemas
* 18 early maladaptive schemas (EMSs). Broad, pervasive traits. Cause
patterns of behaviour. Can perpetuate anxiety. Approval-seeking, abandonment, self-sacrifice, punitiveness, social isolation, etc.
o 5 domains: disconnection and rejection, impaired autonomy and performance, impaired limits, other directedness, overvigilance and inhibition
*
▪ Information processing biases: confirmation bias
▪ Automatic thoughts

Question 15

interpersonal etiologies for anxiety disorder

Answer 15

Parents who exert excessive control, foster beliefs of helplessness, and fail to promote self-efficacy/independence create children that are anxious- ambivalent.
▪ Helicopter parenting = unable to practice coping mechanisms
▪ Snowplow parenting = removing all barriers

Question 16

Panic disorder

Answer 16

Panic attacks: can happen in anyone. Feel like you’re dying
▪ Trembling, rapid heartrate, dizziness, hypertension, sweating, shortness of
breath, etc.

Question 17

DSM criteria for panic disorder

Answer 17

Panic attack: periods of intense fear or discomfort (usually short. 10 ish minutes?) accompanied by at least 4 of 13 symptoms
* Palpitations, pounding heart, or accelerated heart rate
* Sweating
* Trembling or shaking
* Sensations of shortness of breath or smothering
* Feelings of choking
* Chest pain or discomfort
* Nausea or abdominal distress
* Feeling dizzy, unsteady, light-headed, or faint
* Chills or heat sensations
* Paresthesia (numbness or tingling sensations)
* Derealization (feelings of unreality) or depersonalization (being
detached from oneself)
* Fear of losing control or ‘going crazy’
* Fear of dying

Question 18

cognitive perspective of panic disorder

Answer 18

Alarm theory: system can be activated by emotional cues triggering false alarms. Small changes in the body become a signal to panic. ANS becomes more sensitive. Misinterpretation of bodily sensations as emergencies. Fear of the panic attack can provoke a panic attack.
▪ Panic self-efficacy: perceived ability to cope with panic attacks. Important mechanism in CBT

Question 19

multi method assessment of panic disorder

Answer 19

Interviews
▪ Behavioural avoidance test
▪ Symptom induction test: observing the individual’s reactions to uncomfortable
bodily sensations
* Ex: spin in a chair to induce dizziness

Question 20

Agoraphobia

Answer 20

erson is considered that they will not be able to escape/get help in the event of a panic
attack or other incapacitating/embarrassing symptoms ▪ Avoiding at least 2 situations
▪ Lasts at least 6 months
o Panic disorder and agoraphobia are separate but comorbid

Question 21

Specific phobia

Answer 21

Excessive and disproportionate fear o Must interfere significantly with life o Subtypes:
phobia: marked and persistent fear and avoidance of a specific object or situation
▪ Animal
▪ Natural environment
▪ Blood/injection/injury (often associated with fainting) ▪ Situational (flying, tunnels, elevators, etc.)
▪ “Other” (vomiting, illness, etc.)

Question 22

Associative model of phobia

Answer 22

associating things with fear
* Criticism: equipotentiality premise

Question 23

non associative model of phobia

Answer 23

Biological predisposition for certain phobias
* Failure to habituate + genetic vulnerability to anxiety = specific phobias

Question 24

Disgust sensitivity of phobia

Answer 24

Emotions like disgust (not danger) can also trigger specific phobias

Question 25

social anxiety disorder

Answer 25

intense fear of social (center of attention, small talk, first impressions, eating, etc.) or performance situations o Must be consistent, excessive, unreasonable o Interpersonal disorder o Can be mistake for agoraphobia, but that is more about escape, not socializing o Self-fulfilling prophecy. Intense fear of showing signs of anxiety. Worry that they will behave in a socially inept manner o Onset: late childhood, adolescence o Highly comorbid with depression (low self-esteem), substance abuse o Around 3% of population. Equal gender rates

Question 26

biological etiology of social anxiety disorder

Answer 26

Genetic factors: ~50% ▪ Behavioural inhibition (temperament) * Strong early risk marker in toddlers ▪ Brain structures involved in fear recognition and conditioning (amygdala) ▪ Anxious arousal and stress (HPA axis) ▪ Monitoring of negative affect (prefrontal and orbitofrontal cortex) * Misinterpretation of social situations. Catastrophizing. ▪ Dysregulation of serotonin, norepinephrine, etc. during stress responses

Question 27

Environmental etiology of social anxiety disorder

Answer 27

Victimized (bullying, etc.) during childhood. Linked to dysfunctional HPA axis * Intrusive/overprotective parents. Anxious parents. No problem-solving.

Question 28

Cognitive etiology of social anxiety disorder

Answer 28

* Self-focused attention. Self-critical * Public self-consciousness * Dishonest self-disclosure. Less authentic manner in social interactions

Question 29

generalized anxiety disorder criteria

Answer 29

3 out of 6 symptoms most days, for at least 6 months (quite physiological): ▪ Restlessness, feeling on edge ▪ Easily fatigued ▪ Difficulty concentrating, mind going blank ▪ Irritability ▪ Muscle tension ▪ Sleep disturbances o GAD tends to be more like depression than other anxiety disorders. Less fear, more anxious-misery symptoms ▪ Involves repetitive, ruminative thinking (about future)

Question 30

Generalized anxiety disorder prevalence

Answer 30

9% of population at some point in life o More frequent in women than men o General risk factors: ▪ Verbalizing aspects of worry dampens uncomfortable anxious arousal. Short term help. Reinforced coping mechanisms. Unhelpful long term ▪ Intolerance of uncertainty: discomfort with ambiguity and uncertainty (targeted during therapy/treatment)

Question 31

OCD obsessions

Answer 31

persistent, unwanted, and distressing thoughts, images, or urges

Question 32

OCD Compulsions

Answer 32

repetitive behaviours or mental acts performed to reduce anxiety/distress and prevent a feared outcome ▪ Short term relief reinforces the compulsions

Question 33

OCD neutralizations

Answer 33

brief behavioural or mental acts that individuals employ in response to an intrusion to prevent/undo feared situations

Question 34

Diagnostic of OCD

Answer 34

The behaviour music be time consuming of more than 1 hour a day and cause significant distress and impairment

Question 35

2 types of thought action fusions

Answer 35

Belief that “thinking is just as bad as doing” ▪ Belief that having a thought about a situation will increase the likelihood of it happening * Superstitions, manifestations are a mild form of this

Question 36

Neurobiological etiology of OCD

Answer 36

Basal ganglia (motor behaviour) and frontal cortex: structural/functional abnormalities. Less brain volume in frontal cortex, more in basal ganglia. * SSRIs: serotonin neurotransmission

Question 37

Cognitive behavioral model of OCD

Answer 37

Obsessions are caused by the person’s reaction to their own intrusive thoughts * Catastrophic misinterpretations of these thoughts * Unhelpful efforts to control the intrusions (thought suppression, etc.)

Question 38

Checking as a component of OCD

Answer 38

No evidence of actual memory deficiency. ▪ Low confidence in memory. Repeated checking lowers memory confidence, intensifies doubt, and sustains repeated checking. Vicious cycle.

Question 39

PTSD

Answer 39

non-recovery (more than a month) in response to an event that threatened one’s life or bodily integrity o Trauma related, NOT anxiety in DSM. o More common in women

Question 40

symptoms of PTSD

Answer 40

Recurrent re-experiencing of traumatic event (nightmares, hallucinations, etc.) ▪ Persistent emotional or physiological arousal in response to reminders of the trauma ▪ Maladaptive changes in thinking patterns (world is dangerous) and mood (emotional numbing) ▪ Hyperarousal and hyperreactivity (chronic startle, quick to anger)

Question 41

Diagnosis of PTSD

Answer 41

Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) ways * Usually, interpersonal trauma * Can be witnessed or lots of indirect exposure (first responders) * Could be learning about a traumatic event that happened to a loved one ▪ Presence of one (or more) of intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred * Flashbacks, nightmares, physiological reactivity, etc. ▪ Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred ▪ Negative alternations in cognitions and mood associated with the traumatic event(s) ▪ Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred

Question 42

Etiology of PTSD, pre event

Answer 42

Low socio-economic status * Lower education * Lower intelligence * Childhood history of abuse

Question 43

Etiology of PTSD post event

Answer 43

Severity of triggering event * Lack of social support * Presence of stressful experiences after the trauma