core characteristics of anxiety
strong negative emotion, tension, apprehension, a sense of fear/dread
- anticipating future danger
- anxiety is expected in situations that may affect safety or wellbeing (it’s normal)
- but excessive, persistent, debilitating anxiety signals dysregulation of the anxiety response system (too much anxiety is bad)
- it may occur in response to specific stimuli or as a generalized state of worry
symptoms of anxiety
physical: abdominal pain, nausea, vomiting, sweating, dizzy, inc. heartrate, dry mouth, blushing
cognitive: worrying, poor concentration, blanking out, self-critical thoughts, thoughts of being scared/hurt, etc
behavioral: avoidance (most common), crying, screaming, trembling voice, nail biting, shaking, avoidance of eye contact, twitching, etc
anxiety
future-oriented emotional state, feelings of apprehension and lack of control; no danger present
fear
present-oriented, immediate emotional reaction to current danger
panic
unexpected physical symptoms in the absence of threat/danger
associated characteristics of anxiety
cognitive - avg intelligence, probs w/ attention, memory, concentration, cognitive biases, less adaptive coping strategies
physical/health - sleep problems and less risk-taking behaviors
social - lower social competence, problematic peer and sibling interactions, more loneliness (lower self report of self esteem, more shy)
sex and age differences in anxiety
- 10-15% of school-aged children have at least 1 anxiety disorder
- specific phobia, social anxiety, and separation anxiety are more common during childhood and adolescence
- no sex diff in preschool
- for school-aged and older, most anxiety disorders are common in girls (persists into adulthood)
comorbidity
- comorbidity among anxiety disorders and between anxiety disorders and other disorders (depression) makes diagnosis hard
- combos usually persist into adulthood
- anxiety also co-occurs w/ ADHD, eating disorders, and substance use disorders
what factors cause anxiety (just list)
biological
individual
environmental
biological factors
- heritability is moderate (.35) and nonspecific (parent has social anxiety, you are now on path to anxiety, but could be diff type)
- over/underactivity of neural circuits, structural abnormalities, right-left asymmetries
- altered serotonin and norepinephrine functioning
individual factors
- tend to focus on temperament in childhood an personality in adulthood
- behavioral inhibition is a risk factor only (children afraid to try new things)
environmental factors
overprotective parenting, critical parenting, parent modeling of anxious behavior and avoidant coping increases risk
- children learn from modeled behavior
- some parents reinforce child’s anxiety by allowing avoidance behaviors (stay home from school and miss test)
4 types of interventions for anxiety
behavior therapy
CBT
family interventions
medications
- exposure to source of anxiety is main approach
behavior therapy
- graded exposure to fear (make list least feared to most and start talking it through, rate distress SUDS)
- flooding: prevent avoidance behaviors, exposure in prolonged and repeated doses
CBT
- modify maladaptive thoughts to decrease symptoms (if scared of panic attack - spin in circle and tell self i’m okay)
- coping cat ages 7-13: decrease negative thinking, increase active problem solving
family interventions
- children view selves as less competent, parent’s perspective of child may change
- greater parental involvement in modeling and reinforcing coping techniques
medications
- SSRIs can be used
- not first pick, try CBT first
- for some CBT doesn’t work, or anxiety is too severe and need medication to be able to do therapy
core characteristics of separation anxiety
- excessive, prolonged anxiety about being away from home/parents (when developmentally inappropriate)
- reluctance/refusal to attend school or sleep alone, clingy, physical complaints
- typical at 7/8 mos of age; declines after 2yrs old, but expected during transition to school or after major stressor
sex and age differences of separation anxiety
sex: community samples more girls; clinical boys and girls same
age: avg age of onset = 7-8yrs (but 70% or more who develop disorder do so before age 4)
comorbidity of separation anxiety
majority of children have another disorder, usually anxiety, but 1/2 develop comorbid depression. substance use disorder may be found in adolescents
etiology of separation anxiety
biological factors: genetics, neurological factors, inhibited temperament
environmental factors: highly involved parents (overprotective), occurrence of major life stressor is important (moving, death/illness in family, new school)
outcomes of separation anxiety
- SAD may develop suddenly or gradually
- course: some have brief probs, symptoms come/go, for others symptoms are chronic
- chronic course is more likely when older age at onset, parental psychopathology, marital distress, comorbid diagnoses in childhood
core characteristics of social anxiety
- intense fear of social situations thar involve possible scrutiny by others and risk of evaluation or embarrassment
- individuals tend to be unassertive, make less eye contact, seem shy, may find it hard to go to school or activities
- many cases overlooked because shyness common
sex and age differences in social anxiety
sex: community 2X more girls; clinical no diff
age: onset is often in late childhood or early adolescence (80% who develop do so by age 18)
