Anxiety Disorders Flashcards
(57 cards)
1
Q
anxiety
A
response to perceived or anticipated threat (vs actual immediate threat)
2
Q
anxiety: physiological symptoms
A
- racing heart
- difficulty breathing
- GI distress
- sweating
- tense muscles
- trembling/shaking
3
Q
anxiety: cognitive symptoms
A
- anticipate harm
- worry
- exaggerate danger
- difficulty concentrating
- hypervigilance
4
Q
anxiety: behavioural symptoms
A
- avoidance
- escape
5
Q
fight or flight
A
- when our brain detects danger, it sends a signal to mobilize our body to prepare
- sympathetic nervous system activates the body for fight or flight
- necessary for survival, adaptive
- can be helpful, prepares or motivates us
6
Q
prevalence of anxiety disorders
A
- 18-29 years old = 41%
- 30-44 years old = 36%
- 45-49 years old = 31%
- 60 years old or more = 16%
7
Q
etiology of anxiety: biological
A
- overactive fear circuitry in brain
- 5-HTTLPR genotype variations
- neurotransmitter abnormalities
8
Q
etiology of anxiety: fear circuitry in brain
A
- brain structures implied in anxiety disorders
- amygdala, hippocampus, prefrontal cortex
- HPA activity triggers “fight or flight” response
- overactivation may lead to anxiety disorder
9
Q
etiology of anxiety: genetic influences
A
-moderate heritability
10
Q
etiology of anxiety: neurotransmitter abnormality
A
- variation in serotonin transporter genes associated with reduction in serotonin
- increased anxiety-related B
- behaviorally inhibited temperament
11
Q
etiology of anxiety: behavioral
A
- classical conditioning
- modelling of feared responses
- avoidance
- safety behaviour
12
Q
avoidance
A
- can reduce anxiety in the moment
- operant conditioning - negative reinforcement
13
Q
safety behaviours
A
- overt/covert actions performed in order to reduce distress associated with feared cues
- they maintain anxiety (reinforced because it works in the moment)
- prevents the learning of new info about the consequences of the feared event
14
Q
etiology of anxiety: cognitive
A
- negative appraisals
- overestimation of severity (catastrophizing)
- being able to reappraisal, or look at a situation from various perspectives minimizes negative responses
- limited sense of self-controland mastery
- biased info processing and selective attention
15
Q
anxiety sensitivity
A
- tendency to interpret physiological changes in the body as signs of danger
- predicts development of panic attacks and anxiety disorders
- refer to schema in notebook
16
Q
biased info processing and selective attention entails _____
A
- increased attention toward threat
- more quickly to notice feared cues, even at low levels
17
Q
etiology of anxiety: social and sociocultural factors
A
- poverty
- sex and gender
- culture
- exposure to discrimination
18
Q
anxiety disorders
A
- seperation anxiety disorder
- selective mutism
- specific phobia
- social anxiety disorder
- panic disorder
- agoraphobia
- generalized anxiety disorder
19
Q
phobia vs fear
A
phobia is …
- strong, persistent unwarranted fear of specific object or situation
- more intense
- the greater desire to avoid
- distress that interferes with functioning
20
Q
DSM-5 criteria for specific phobia
A
- marked fear/anxiety about a specific object/situation
- phobic object/situation almost always provokes immediate fear/anxiety
- phobic object/situation is actively avoided or endured with intense fear/anxiety
- fear is out of proportion to actual danger
- lasting 6 months +
-causes significant distress or impairment
21
Q
common phobias
A
- animals
- natural envrionments
- situations
- blood-injection-injury
-other (clown, choking, vomit)
22
Q
prevalence and course of specific phobia
A
- lifetime prevalence = 12.5%
- onset childhood and early adolescence
- 2x more common in women
- specific fear can vary across cultures
- only 8% receive treatment
23
Q
etiology of phobias: biological view
A
- genetic contribution
- overactivation of amygdala and HPA axis
- preparedness theory
24
Q
preparedness theory
A
easier for humans to develop fears to which we are physiologically predisposed to
25
etiology of phobias: behavioural
1. development
- classical conditioning
2. maintenance
- operant conditioning
26
treatment for phobias
exposure therapy
1. remove avoidance
- exposure to the feared situation
- takes away negative reinforcement for avoidance
2. relearn conditioned fear responses
- learn to pair relaxed responses with feared stimulus
- systemic desensitization
- exposure techniques with relaxation
27
treatment for phobias: format
in-vivo
- exposure to real feared stimulus
- high drop out rate
virtual reality exposure
28
treatment for phobias: pace
gradual
- development fear hierarchy and start with moderately feared stimulus
flooding
- exposure at full intensity
29
DSM-5 criteria for social anxiety disorder
1. marked fear/anxiety about 1+ social situations in which the individual is exposed to possible scrutiny by others
2. fears that they will act in a way or show anxiety symptoms that they will be negatively evaluated
3. social situations are avoided or endured with intense fear or anxiety
4. fear or anxiety is out of proportion to actual threat
- last 6 months or more
- causes significant distress or impairment
30
prevalence and course of SAD
- lifetime prevalence = 12.1%
- onset adolescence
- 2x more common in women
31
etiology for SAD: biological
- genetics
- chronic activation of the HPA axis
- fear circuit preparedness
32
etiology for SAD: cognitive
- unrealistically high social, perfectionist standards
- interpret ambiguous social situations as negative
- views of themselves as unattractive and socially unskilled
-hypervigilant for early cues of disapproval fromothers
- hypervigilant of own B (self-focused attention)
- overestimate how poorly they performed in social situations
33
etiology for SAD: social
parental Bs influence dev of social anxiety in children
- overprotective
- lack of support for independence
- punitive parenting
victimization by peers during childhood
- ongoing ostracism and bullying maintain and exacerbate social anxiety
34
etiology of SAD: sociocultural
- more common in collectivist cultures (individual B seen to reflect on entire family or group)
- practice of using shame to influence Bs
- strong sense of personal responsibility for social Bs or threat of being ostracized for deviations from social norms
35
treatment for SAD: meds
- not usually primary treatmnet for all anxiety disorder
- prevents experience of anxiety and learning new info about anxiety
- SSRIs (usually combined with CBT)
1. preventing or reducing panic attacks
2. reducing social anxiety
3. reducing general anxiety
36
DSM-5 criteria for panic disorder
1. recurrent unexpected/uncued panic attacks
2. at least 1 of following for 1 month after apanic attack
- persistent concern and worry about additional panic attacks or their consequences
- a significant maladaptive change in B related to attacks
37
panic attack symptoms
- reaches a peak within 10 minutes
- at least 4 symptoms
1. palpitations, pounding heart, accelerated heart rate
2. sweating
3. trembling, shaking
4. sensations of shortness of breath
5. feelings of choking
6. chest pain or discomfort
7. nausea or abdominal distress
8. feeling dizzy, unsteady, light-headed
9. chills or heat sensations
10. paresthesia (numbness/tingling)
11. derealization or depersonalization
12. fear of losing control or going crazy
13. fear of dying
38
prevalence and course of panic disorder
- lifetime prevalence= 4.7%
- isolated panic attacks = 22.7%
- 2x more prevalent in women
- may be a marker of severe psychopathology
- safety B
- often accompanied by agoraphobia
39
typical safety behaviours for panic disorder
- reassurance seeking from doctor (many ER visits)
- medication
- sitting close to an exit
40
DSM-5 criteria for agoraphobia
- last 6 months or more
- causes significant impairment or distress
- fear is out of proportion to actual danger
- marked fear/anxiety about 2+ situations
1. using public transport
2. being in open spaces
3. being in enclosed spaces
4. standing in line/being in a crowd
5. being outside of the home alone
41
prevalence for agoraphobia
lifetime prevalence = 1.3%
42
etiology for panic: biological
- fewer GABA and serotonin receptors among individuals with panic disorders
- hypersensitivity in the neural network associated with respiratory and carbon dioxide regulation
- modest heritability
43
etiology for panic: psychological
anxiety sensitivity
1. catastrophic misinterpretations of benign bodily sensations
- racing heart = heart attack
2. inaccurate cognitions and symptoms create feedback loop that increases anxiety
- refer to schema in notebookoninternal and external stressor loop
44
treatment for panic
- exposure therapy (specifically interoceptive exposure)
- CBT
45
treatment for panic: exposure therapy
induce physiological symptoms of panic to extinguish the conditioning
46
treatment for panic: CBT
- includes exposure exercises
- identify and correct catastrophic thinking about bodily sensations
47
DSM-5 criteria for generalized anxiety disorder
- excessive worry/anxiety about lots of things
- difficult to control the worry
- lasts at least 6 months or more
- causes significant distress or impairment
- at least 3 of the following symptoms
1. restlessness or feeling keyed up/on edge
2. easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbance
48
prevalence of GAD
- lifetime prevalence in adults = 5.7%
- more common women than men
- onset challenging to determine
- typically do not seek treatment, because they report the worries help avoid catastrophes
49
etiology of GAD: biological
GABA abnormalities (too few)
50
etiology of GAD: psychological
behavioural
- worry as negative reinforcer
-avoidmore intense negative emotions or images
- positive beliefs about worries
cognitive
- intolerance of uncertainty
51
treatment for GAD: CBT
-60% showed significant improvement that persisted for 12 months
52
treatments for GAD: mindfulness-based CBT
- become more open and accepting of anxious thoughts and feelings (instead of avoiding/trying to change thoughts)
-teach client to remain non-judgemental in the presence of anxiety
53
treatments for GAD: meds
1. benzodiazepines
- increase GABA
- issues with dependence
- meant for short term use
2. antidepressants (SSRIs)
- lower risk of dependence
54
similarities across anxiety disorders
- perceived threat or anticipation of future threat
-impairment in functioning
- avoidance maintains anxiety
- symptoms
1. physiological
2. cognitive
3. behavioural
55
differences across anxiety disorders
- sources of distress
- content of thoughts
- severity and duration
- specific cognitive vulnerability for certain anxiety disorders
56
common themes: comorbidities
1. 50% of individuals with an anxiety disorder meet criteria for another anxiety disorder
- symptom overlap
- shared vulnerability
2. 75% of those with anxiety disorder meet criteria for another psychiatric disorder
- depression and SUD
3. high rates of comorbidities with other medical conditions
57
common themes: not seeking treatment
- individuals are less likely to seek treatment relative to individuals with other disorders
- lack of recognition of anxiety symptoms
- negative reinforcement
- comorbidity increases help-seeking
