Anxiety

Question 1

Is the experience of anxiety in abnormal anxiety different to the normal experience of anxiety?

Answer 1

No- not qualitatively different

BUT excessive or inappropriate occurence

Question 2

Which systems are involved in the experience of anxiety

Answer 2

• Physical- sympathetic nervous system (sweating, heart rate) mobilises resources to deal with threat
• Cognitive- threat perception, appraisal, attentional shift and hypervigilence- difficulty concentrating on other info
• Behavioural- avoidance, agression

Question 3

Eliciting conditions in normal anxiety

Answer 3

Objective threats: physical or social
Specific ‘prepared’ stimuli (Seligman)- evolutionary e.g. insects
Novel Stimuli

Question 4

Process of Anxiety

Answer 4

Threat appraisal-> expectancy of harm-> elicits anxiety

Question 5

What underlies threat appraisal? And what gives rise to these biases?

Answer 5

Perceived probability and cost of threat
Past experience (conditioning) Observational learning and Instruction

Question 6

Trait anxiety- individual differences

Answer 6

Tendency to perceive threat in ambiguous situations
Intensity and duration of the anxiety response
(Inappropriate or excessive occurrence)
Overestimation of cost or probability of harmful outcome

Question 7

Main overestimation for physical and social fears

Answer 7

Physical: overestimation of probability
Social: overestimation of cost

Question 8

What characterises Anxiety Disorders?

Answer 8

Internal dysfunction- anxiety in situations that aren’t objectively dangerous
Socially inappropriate/harmful- interferes with everyday social or occupational activities- dysfunctional
Categorised according to focus of anxiety

Question 9

DSM-IV Anxiety Disorders

Answer 9

Separation Anxiety Disorder
Specific Phobia
Social Phobia- fear of neg. social eval.
Generalised Anxiety Disorder
Panic Disorder (with or without agoraphobia) 
Posttraumatic Stress Disorder
Acute Stress Disorder
Obsessive- Compulsive Disorder

Question 10

DSM-V Anxiety Disorders

Answer 10

Separation Anxiety Disorder (child or adult)
Selective Mutism
Specific Phobia
Social Anxiety Disorder
Panic Disorder
Agoraphobia
Generalised Anxiety Disorder

Question 11

Differences between the DSMs

Answer 11

Selective Mutism added
Agoraphobia its own disorder
PSTD- in own chapter: Trauma- and Stressor-Related Disorders. with Acute, Adjustment, Reactive Attachment Disorder and Disinhibited Social Engagement
OCD- in own chapter with trich (used to be with gambling), hoarding, excoriation (new to DSM), body dysmorphic (used to be in somatoform disorders)

Question 12

What are anxiety disorders comorbid with?

Answer 12

each other, depression and substance use

Question 13

What are the underlying vulnerabilities?

Answer 13

Generalised Biological: genetics, neuroticism- genetic loading
Generalised Psychological: trait anxiety, perceived lack of control, depression
Specific Psychological: past experience, observation or instruction

Question 14

Biological Treatments- don’t treat underlying disorder, just symptoms

Answer 14

Barbiturates (Amobarbital, Phenobarbital)- used to use (dangerous)
 Quick acting, but relapse very common (80-90%)
 Highly addictive, can lead to OD, interact with alcohol
Benzodiazepines (Valium, Xanax, Rohypnol)  Quick acting, but relapse very common
 Less addictive, but interact with alcohol
SSRIs (antidepressants, e.g., Prozac, Zoloft)  Slower acting
 Fewer side effects
 Relapse common (20-60%)

Question 15

CBT aims:

Answer 15

Reduce biased threat appraisal

Increase biased coping appraisal

Question 16

Cognitive Techniques

Answer 16

thought-diaries to identify automatic thoughts

thought challenging: socratic questioning, evidence against, pros and cons of having the thought/ belief

Question 17

Behavioural Techniques

Answer 17

Exposure to stimuli (reduce probability of harm) and outcomes (reduce judgements of cost)
in vivo vs imaginary and flooding vs systematic desensitisation

Question 18

Do clinicians still treat PTSD and OCD like anxiety disorders

Answer 18

Yes, the distinction isn’t too important- closely related to anxiety

Question 19

Required symptoms for Panic Attack

Answer 19

4 (or more): heart racing, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dixxiness, chills or heat sensations, paresthesias (numbness or tingling), derealization (feelings of unreality) or depersonalization (detached from oneself), fear of losing control, fear of dying

Question 20

When do Panic Attacks occur?

Answer 20

Can occur in a terrible situation- normal.
Can occur in any anxiety disorder and some others
Particularly, specific and social phobias and PTSD- in these cases they are CUED by something
UNCUED occur in Panic Disorder

Question 21

How many unexpected (uncued) panic attacks are needed for Panic Disorder Diagnosis?

Answer 21

2

Question 22

Panic Disorder Criteria

Answer 22

 At least two unexpected panic attacks
 Persistent concern or worry about additional
panic attacks or their consequences
 A significant maladaptive change in behavior related to the attacks
 Symptoms persist one month or more
Its the catastrophic misinterpretation of sensations that causes a full blown attack. Fear of lack of control

Question 23

Prevalence of Panic Disorder
Median age of onset
Course
Comorbidity

Answer 23

12-month prevalence: 2-3% 
Lifetime prevalence: 3.5-4.7%
20-29 years 
chronic but waxing and waning 
Other anxiety disorders, alcohol use and depression 10-65%

Question 24

Specific Phobia prevalence

Answer 24

7-9% lifetime prevalence. Less than 1% seek treatment

Question 25

Agoraphobia

Answer 25

not a fear of the external environment, but the fear of panic and its consequences in these environments- not being able to escape if a panic attack occurs 2.3% lifetime prevalence Onset in 20s

Question 26

Cognitive Theory of Panic (Clark 1988)

Answer 26

Results from the fear of bodily sensations Misinterpreting their consequences e.g. stroke, heart attack Maintenance of misinterpretations: safety behaviours to prevent harmful event

Question 27

Agoraphobia- 5 fears

Answer 27

``` Public transport Open spaces Enclosed spaces Standing in line or being in a crowd Being outside of home alone ```

Question 28

Risk factors of Agoraphobia

Answer 28

High dependent behaviour in childhood Doubting ability- weaker beliesf in coping ability Separation Anxiety, School Phobia Physical concerns: dizziness and fainting Social evaluative concerns

Question 29

Treatment of Agoraphobia

Answer 29

Anxiolytics (Barbiturates, Benzodiazapines) Antidepressants Cognitive restructuring Exposure (to interoceptive stimuli/ panic and to avoided situations) Reduce safety seeking behaviours CBT is effective in 80-85% of clients with Panic Disorder

Question 30

Generalised (GAD)

Answer 30

one of the most commonly experienced anxiety disorders, with a lifetime prevalence of 5%- more common in women

Question 31

Generalised (GAD)

Answer 31

one of the most commonly experienced anxiety disorders, with a lifetime prevalence of 5%- more common in women First introduced in DSMIII (1980) Excessive, uncontrollable worry occuring more days than not for at least 6 months At least 3 of 6 somatic symptoms

Question 32

Somatic Symptoms for GAD

Answer 32

``` restlessness irritability muscle tension difficulty concentrating sleep disturbance fatigue ```

Question 33

Problem Solving Theories

Answer 33

Problem solving in pathological worriers results in no solution Good at defining problems- see a lot of problems Good at negatively evaluating solutions- coming up with reasons why solutions aren't good Never come up with good solution- never stop worrying because never solve problem- uncontrollable feeling This may be Type 1 worry

Question 34

Metacognitive Theory

Answer 34

Type 1- worrying to cope with threat Type 2- worry + negative beliefs about worrying Worrying will lead you to death, drive you crazy, inability to sleep- worrying about worrying Ineffective thought-control strategies- suppressing doesn't work

Question 35

Avoidance Theory (Thomas Borkavek?)

Answer 35

Images are aversive so switch to verbal thinking to reduce autonomic arousal symptoms Worry- cognitive avoidance- in words rather than images to avoid symptoms- interferes with emotioanl processing But fear structures remain there in memory structures- avoidance maintains anxiety Experiential Avoidance- avoid internal experiences- low distress intolerance- want to stay at nonemotional level Difficulties in emotion regulation- identifying, tolerating and modulating emotion

Question 36

Treatment of GAD

Answer 36

- Biased threat perception- probability and cost judgments-more general way than in other anxiety disorders - Problem solving theories- 'structured problem solving training'- positive solution evaluation and solution selection - Metacognitive- beliefs about worry- other ways to deal with problem than worry- is it really true that your worry is uncontrollable? - Avoidance- exposure to vivid images of feared event, emotional experience (distress- mindfulness is exposure to thoughts without judgement) or uncertainty

Question 37

Treatment of GAD

Answer 37

- Biased threat perception- probability and cost judgments-more general way than in other anxiety disorders - Problem solving theories- 'structured problem solving training'- positive solution evaluation and solution selection - Metacognitive- beliefs about worry- other ways to deal with problem than worry- is it really true that your worry is uncontrollable?

Question 38

Effectiveness of treatment

Answer 38

modest- 50-60% improvement at follow-up | not very good at treating GAD because causes are diverse