Anxiety & Trauma related disorders Flashcards Preview

Abnormal Psychology > Anxiety & Trauma related disorders > Flashcards

Flashcards in Anxiety & Trauma related disorders Deck (18):
1

What is considered normal worry?

- Occurs in response to perceived threat: mainly social threat in adults, more about physical threat in older adults
- Contains verbal thought vs. imagery
- Perceived positive aspects: Motivates action, helps to problem solve, avoid negative outcomes, distract from more distressing topics

2

What is the Problem Solving Theory of worry?

Worrying involves problem solving attempts, but problem solving attempts of pathological worriers
are ‘thwarted’ (often due to biased threat perception)

Social Problem Solving Stages:
1. Problem definition
2. Generation of alternative solutions
3. Solution evaluation (positive / negative)
4. Solution selection
Last two stages are problematic in high worriers

Treatment: change biased threat perception, probability and cost judgements, problem solving training

3

What is the Metacognitive Theory of worry?

Two types of worry:

Type 1 Worry:
- Perception of threat + positive beliefs about worry, worry to cope with threat
- possible exit by problem solving or reassurance

Type 2 Metaworry:
- Worry + negative beliefs about worry
- ineffective thought-control strategies increase anxiety and worry
--> Excessive and uncontrollable worry

treatment: challenge beliefs about worry (positive and negative)

4

What is the Avoidance Theory of Worry?

Worry: more verbal thought than imagery; Images of possible negative event are highly aversive & cause anxiety symptoms (= sympathetic arousal)
- Reduced imagery => reduced arousal/anxiety (GAD is associated with tension symptoms)

Worry = cognitive avoidance
- Cognitive avoidance interferes with emotional
processing
- Fear structures are maintained => keep worrying

Experiential Avoidance
- worry is associated with difficulties in emotional regulation, stress intolerance, fear of anxiety, and avoidance of stimuli

Treatment: Exposure to vivid images of feared event, exposure to emotional experience / distress, exposure to uncertainty

5

What is Intolerance of Uncertainty theory?

- Uncertainty reflects badly on a person, causes
frustration and stress, and prevents action
- Worry to reduce uncertainty --> Leads to preoccupation with details
- Interferes with problem solving
◦ Worriers aim to reduce uncertainly to zero (not possible)

treatment: Exposure to uncertainty, challenge cognitions about uncertainty

6

What is Generalised Anxiety Disorder (GAD)?

First introduced in DSM-III-R (1980) DSM-IV (1994) and DSM-5 (2013) definition:
- Excessive, uncontrollable worry about a variety of
events / outcomes
- Occurs more days than not for at least 6 months
- At least 3 of 6 somatic symptoms: Restlessness, fatigue, difficulty concentrating, irritability, muscle
tension, sleep disturbance
- Does not include autonomic arousal

7

What is Post-Traumatic Stress Disorder (PTSD)?

A. Exposure to actual or threatened death, serious
injury, or sexual violence in one (or more) of the
following ways:
- Directly experiencing the traumatic event(s).
- Witnessing, in person, the event(s)
- Learning that the traumatic event(s) occurred to a close family member or close friend.
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)

B. Intrusion symptoms (1 or more needed); Memories, dreams, flashbacks
C. Persistent avoidance of stimuli (1+); memories etc, or external reminders of the event
D. Negative changes in cognition, mood (2+); Fear, negative beliefs about self, others, the world
E. Changes in arousal, reactivity (2 +); Anger, recklessness, self-destructive acts, sleep
disturbance
D. Duration of symptoms is 1 month or more

8

What is the prevalence and aetiology of PTSD?

50-60% of people experience traumatic event, about 25% of those develop post-traumatic problems (PTSD prevalence: 5-11%), distress drops substantially within 3 months in about 75% of people

Risk Factors:
- Pre-trauma factors; childhood trauma, prior psychiatric history, family instability, substance abuse, social/economic disadvantage
- Trauma factors; Degree of life threat or loss, severity of exposure, location of trauma (safe place vs elsewhere), Individual’s role in the trauma, Meaning (e.g., uncontrollability)
- Post-trauma factors; Social support, coping style, ongoing stressors

9

What are the current treatments for PTSD?

Biological treatments; benzodiazephines, antidepressants

CBT; Assess suitability, psychoeducation, anxiety management techniques, cognitive restructuring, prolonged exposure

EMDR: Eye Movement Desensitization and
Reprocessing (EMDR) Now used to treat a variety of anxiety disorders, training has to be provided by EMDR Institute

10

What are the major features of anxiety?

Physical system: fight/flight: sympathetic nervous system, Symptoms: sweating, heart rate, trembling etc

Cognitive system: perception of threat, attentional shift and hypervigilance, difficulty concentrating on other information.

Behavioural system: escape/avoidance tendencies, aggression

Eliciting conditions: Realistic/objective threat to self, physical vs social threat, specific ‘prepared’ stimuli

Threat appraisal --> Expectancy of harm --> automatically Elicits Anxiety

11

What differs anxiety and abnormal anxiety?

Abnormal anxiety is not qualitatively different from normal anxiety (how it is experienced)
Anxiety becomes abnormal when it is excessive or inappropriate occurrence (usually characterised by overestimation of threat)

Anxiety disorders:
- Reflect an internal dysfunction (reactions to non-dangerous things)
- Are socially inappropriate/harmful/unexpected (Interfere with everyday social or occupational activities)
- Categorised according to focus of anxiety

12

What are the commorbidities of anxiety disorders?

Anxiety disorders are highly comorbid with
- each other,
- depression,
- substance use

13

What are the common treatments for anxiety disorders?

Medication: SSRIs (slow acting, few side effects, common rate of relapse 20-60%) Benzodiazepines (fast-acting, addictive, high rate of relapse, react with alcohol)

CBT: aim to reduce biased threat appraisal, increase biased coping appraisal (thought diaries, thought challenging)

Behavioural techniques; exposure therapy (desensitization, reduction of threat appraisal)

14

What were the changes from the DSM-IV to V for anxiety related disorders?

PTSD; is now under stressor related disorders
OCD: is now under obsessive compulsive related disorders

Phobias: can be diagnosed under 18

addition: selective mutism and separation anxiety (moved from early childhood onset disorders)

15

What is a panic attack?

An abrupt surge of intense fear or discomfort, peaks within minutes, includes 4 (or more) symptoms

Can occur in the context of any anxiety disorder

Expected (cued) panic attack
- Usually occur in context of other anxiety disorders (Specific phobia,Social phobia, PTSD)

Unexpected (uncued/spontaneous) panic attack
- Person can not identify the source of fear
- Occur in context of Panic Disorder

16

What is Panic Disorder?

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

Prevalence: 12-month prevalence: 2-3 %, median age of onset: 20-29 years
Course: chronic but waxing and waning
Comorbid with other anxiety disorders, alcohol use, and depression: 10-65%

17

What is the Cognitive Theory of Panic?

Clark (1988)
Panic results from fear of bodily sensations (Misinterpreting: their consequences, their cause)
Risk factors: neuroticism, anxiety sensitivity
Maintenance of misinterpretations: 'safety behaviours'

18

What is Agorophobia?

A. Marked fear or anxiety about two (or more) of :
Using public transportation, being in open spaces, being in enclosed places, standing in line or being in a crowd, being outside of the home alone.
B. Escape might be difficult or help might not be
available in the event of developing panic-like, or
other incapacitating or embarrassing symptoms

Risk Factors: dependency, separation anxiety, lack of belief in own coping ability, physical concerns (fainting)

Treatment: medication (SSRIs, Benzos) CBT (exposure, reduction of avoidance behaviours) CBT is successful in 80-85% cases