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Flashcards in Anxiety Disorders Deck (62):
1

Differences between anxiety and fear

Anxiety is a mood, whereas fear is an emotion
Fear is present-oriented, whereas anxiety is future-oriented
Fear is more intense than anxiety

2

Components of anxiety

Cognitions: apprehension, worry, dread
Behavior: avoidance
Physiology: stress response (cortisol)

3

Components of fear

Cognitions: danger
Behavior: escape
Physiology: fight or flight sympathetic arousal (adrenaline)

4

Anxiety disorders general characteristics

Pervasive and persistent anxiety or fear
Intense need for avoidance and escape
Clinically significant distress and/or impairment

5

Largest mental health problem in US

Anxiety disorders
20% lifetime prevalence

6

Panic attack

Abrupt period of intense fear that reaches its peak within minutes
Sympathetic response: pounding heart, sweating, shaking, shortness of breath, nausea/abdominal distress, paresthesias (numbing through various parts of body), chills or heat sensation, feeling dizzy or faint, chest pain/discomfort, feelings of choking, derealization or depersonalization, fear of losing control, fear of dying

7

Specific phobia description

Marked fear/anxiety about specific objects or situations
Exposure provokes a fear response
Object is avoided
Fear is out of proportion to danger

8

Types of specific phobia

Animal (spiders, mice, etc.)
Situational (small spaces, flying in airplane, etc.)
Natural environment (tornado, thunderstorm, etc.)
Blood injection injury (unique: person passes out)
Other (clowns, dolls, etc.)

9

Specific phobia epidemiology

Age of onset: teen years (11-17)
Chronic course
4:1 female to male
Relatively high lifetime prevalence (11%)

10

Specific phobia biological causes

Genetic vulnerability (moderate influence; don't inherit phobia, but tendency)
BIS
HPA

11

BIS (Behavioral inhibition system)

Influence in all anxiety disorders
Drive to avoid danger
If high, then cautious

12

HPA (hypothalamus, pituitary, adrenal)

Influence in all anxiety disorders
Increased activity, then more likely to develop anxiety disorder

13

Specific phobia learning pathways

Classical/operant conditioning
Vicarious conditioning (observation)
Information transfer (someone tells you to fear something)
Prepared learning: people develop fears to some things more quickly than others (things that posed danger in human history)

14

Treatments for specific phobia

Cognitive behavioral therapy: exposure, flooding, graduated exposure
Medications rarely used

15

Exposure

Facing fear and discovering that nothing bad will happen
Used to treat phobias and panic attacks

16

Flooding

Put person in feared situation until fear response disappears
Not commonly used

17

Graduated exposure

Systematic desensitization using subjective units of discomfort
Used in treating phobias

18

Subjective units of discomfort

Patient rates levels of discomfort: 0 is not scary at all, 100 is extremely scary
Start out at low levels of discomfort and work up until patient is desensitized to feared stimulus

19

Panic disorder description

Recurrent, unexpected panic attacks
At least one month of worry about future attacks and behavioral change related to attacks

20

Panic disorder epidemiology

Age of onset: teens (11-17) and late 30's
Course: chronic
33% of ER billing (similar symptoms to heart attack)
Gender: 2:1 female to male

21

Panic disorder learning pathways

Classical/operant conditioning
Fear response to interoceptive cues (learn to fear panicky feeling)
Cognitive: catastrophic misinterpretations of internal sensations

22

Panic disorder therapy treatments

CBT
Exposure, especially interoceptive exposure
Cognitive restructuring

23

Interoceptive exposure

Exposure to physical symptoms of panic attack without fear response
Ex- have patient breathe through straw

24

Cognitive restructuring

Changing the way people think
Challenging belief system

25

Panic disorder medication treatments

Benzodiazepines (GABA): lower anxiety, but interfere with exposure therapy (take away fear)
SSRIs and SNRIs: increase serotonin
High relapse when discontinued (treats symptoms, not cause)

26

Agoraphobia

Anxiety about being in places/situations in which escape/help may be difficult in the event of a panic attack
Can happen without panic disorder, but is most common with panic disorder
Feared places/things: public transportation, open spaces, enclosed spaces, crowded place

27

Social anxiety disorder description

Marked fear/anxiety of social situations where there is possible scrutiny by others
Fear of humiliation/embarrassment
Situations are avoided
Problem isn't with social skills

28

Social anxiety disorder epidemiology

Age of onset: around 15
Course: chronic
Most common of anxiety disorders: 13% lifetime prevalence
Slightly more common in females

29

Social anxiety disorder subtype

Performance only

30

Social anxiety disorder learning pathways

If someone laughs at you, you learn to fear being laughed at
Cognitive: irrational beliefs ("Others are always judging me" or "I always mess up")
Attentional biases: people read anger or judgment out of neutral faces

31

Social anxiety disorder therapy treatments

CBT, exposure, cognitive restructuring
Gradually help people face fears: have them draw attention to themselves and force them to make social mistakes, helping them to realize that nothing bad will happen

32

Social anxiety disorder medication treatments

Antidepressants: SSRIs and SNRIs
Beta-blockers (adrenaline antagonist)
Relapse high when discontinued

33

Generalized anxiety disorder description

"What if" disorder
Excessive and uncontrollable worry more days than not and across multiple domains
Somatic symptoms of stress (restlessness, fatigue, difficulties concentrating, irritability, muscle tension, sleep issues)

34

Worry in GAD

Worry about low probability events (catching ebola, building collapsing, etc.)
Positive beliefs about worry (worrying=problem solving)
Emotion regulation strategy: verbal vs. imaginal (talking about things isn't as bad as visualizing things; worry keeps things in verbal)

35

GAD epidemiology

Age of onset: teens-early 20's
Course: chronic
2:1 female to male
Presents to primary care
Highly comorbid with depression, other anxiety disorders, and substance abuse disorders

36

GAD genetic influence

Little evidence for genetic influence

37

GAD treatments

Most difficult of anxiety disorders to treat: medications aren't very effective and exposure doesn't work (nothing to be exposed to)
Only treatment is restructuring, with relatively poor outcomes (worry is generalized and spreads)

38

Posttraumatic stress disorder description

Exposure to actual/threatened death, serious injury, or sexual violence
Exposure can be through experiencing, witnessing, learning about trauma in close family member or friend, or repeated exposure to details of traumatic events
Disturbance lasts more than 1 month

39

PTSD symptom clusters

1. Re-experiencing: nightmares, flashbacks ("1 foot in reality and 1 in situation"), vivid memories
2. Avoidance of events that cause remembrance of trauma
3. Alteration of mood/cognitions (depression, numbness of emotion, changes in relationships, stop planning for future)
4. Hyperarousal (hypervigilance, exaggerated startle response, difficulty concentrating, irritability, sleep difficulty)

40

Most common causes for PTSD by gender

Men: combat
Women: sexual assault

41

Impacts to development of PTSD

Genetic vulnerability
BIS & HPA
Intensity of trauma
Nature of trauma (grossed out and in fear: more likely to develop PTSD)
Multiple traumas
Feeling of helplessness

42

#1 protective factor against PTSD

Social support

43

PTSD learning pathways

Classical/operant conditioning
Single trial learning: all it takes is 1 exposure to develop response
Cognitions: belief that world is neither safe nor predictable

44

Impact of PTSD on neurological network

Associations between nodes in neural network that are related to trauma become strengthened

45

PTSD medication treatments

Medications don't target PTSD
SSRIs and SNRIs as well as benzodiazepines can be used
If stopped, symptoms come back

46

PTSD therapy treatments

Exposure (prolonged exposure)
Cognitive restructuring: challenging beliefs about safety and trust

47

Prolonged exposure

Very successful in treating PTSD
2 types: imaginal (think about trauma repeatedly, breaking connection between memory and emotions) and in vivo (exposure to avoided stimuli)

48

Obsessions

Recurrent thoughts, urges, or images that are intrusive and unwanted
Individual attempts to ignore, suppress, or neutralize them
"Not quite right" feeling

49

Compulsions

Generally occupy about 2 hours/day
Repetitive behaviors or mental acts the individual feels driven to perform
Attempts to neutralize obsessions or reduce anxiety
Must be done until things "feel right"

50

Common obsessions

Contamination fears
Violent impulses
Sexual themes
Religious transgressions ("I have to do this just right or God will be angry")

51

Common compulsions

Cleaning rituals
Checking rituals

52

Thought-action fusion

Symptom of OCD
Having thought is the moral equivalent of performing action (thinking of hurting someone is the same as actually hurting the person)

53

OCD epidemiology

Age of onset: early adulthood
Course: chronic
Slightly more common in females
Most disabling and most hospitalizations of the anxiety disorders

54

OCD learning pathways

Classical/operant conditioning: learn to fear outcomes
Negative reinforcement: compulsions relieve stress of obsessions
Cognitions: distorted beliefs about the world

55

OCD therapy treatments

Exposure and response prevention: expose to obsession and prevent compulsion
Cognitive restructuring

56

OCD medication treatments

SSRIs are typically used
Relapse upon discontinuation

57

OCD last ditch effort treatments

Cingulotomy: surgery to remove part of brain
Deep brain stimulation: plant electrode in brain that is hooked up to pacemaker

58

Body dysmorphic disorder description

Classified in DSM IV as somatoform, but under OC spectrum in DSM V
Preoccupation with a defect in physical appearance that is not observable or minor to others
Repetitive behaviors in response to perceived defect
Equally common in males and females

59

Associated behaviors with body dysmorphic disorder

Hide defect
Correct defect (plastic surgery, etc.)
Mirror behavior (monitoring defect)
Comparing self to others either in mind or by asking others ("Is my chin as big as his?")

60

Hoarding

Persistant difficulty discarding or parting with possessions
Obsession: "I may need this in the future"
Distress associated with getting rid of items
Results in accumulation of possessions that congest and clutter living areas
Not necessarily useful items: can be trash

61

Trichotillomania

Habit/impulse control disorder in DSM IV, but under OC spectrum in DSM V
Recurrent pulling out of one's hair resulting in hair loss
In extreme cases, may eat hair
Repeated attempts to stop

62

Excoriation

Habit/impulse control disorder in DSM IV, but under OC spectrum in DSM V
Recurrent skin picking that results in lesions
Repeated attempts to stop