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PSYC3018 Abnormal Psychology > Anxiety Disorders > Flashcards

Flashcards in Anxiety Disorders Deck (42)
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1

What is Anxiety?

Fear/Panic
Response to threat

2

Three systems of Anxiety

Physical: Fight/Flight, SNS activation --> mobilising response
Cog
Behavioural

3

Eliciting conditions for Anxiety

Realistic/objective threat to self
Specific "prepared" stimuli
Novel Stimuli

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

4

Threat appraisal

Generates expectancy of harm (e.g. public transport)
Product of perceived probability and perceived cost
Often based on past experience (cond, rft), obs learning, and instruction

5

Separation Anxiety

Anxious about being away from primary caregiver

6

Specific phobias

Excessive and Inappropriate fear about specific targets

7

Social phobia

Fear of negative social evaluation

8

General Anxiety Disorder (GAD)

Excessive & Uncontrollable worry about a range of outcomes

9

Panic disorder

Unexpected/spontaneous panic attacks
Anxiety about having more panic attacks
Agoraphobia (fear of public/open places) - can result from excessive avoidance of places where panic attacks have previously occurred. Complication of Panic Disorder

10

OCD

Obsession: Intrusive Thoughts/impulses
- Hard to avoid thought
- Belief: Think thought --> bad event will happen
Compulsion: Ritualistic behaviour that relieves anxiety caused by obsession

11

PTSD

Intrusive thoughts/memories about past traumatic event

12

Anxiety: Comorbid conditions

Anxieties comorbid with each other, depression & substance abuse
General bio vulnerabilities: Genetics, Neuroticism
General psych vulnerabilities: Trait anxiety, low perceived control
Specific psych vulnerabilities: Focus of threat-related beliefs

13

Biological treatment for Anxiety Disorders?

Barbituates - quick, common relapse, but addictive & interacts with alcohol
Benzodiazepines - quick, common relapse, interacts with alcohol
SSRIs/antidepressants - slower, common relapse, less side effects

14

Psychological treatment for Anxiety Disorders/CBT? (Cog + behavioural techniques)

CBT:
Aim: To reduce (biased) threat appraisal by reducing perceived probability and cost of event while increasing (biased) coping appraisal.

Cognitive techniques:
- Thought diaries --> increased awareness of anxious thoughts
- Thought challenging - leading questions --> self-realisation of irrationality of thoughts

Behavioural techniques: EXPOSURE
- Exposure: in vivo or imaginary exposure
- Either flooding (highest fear level) or systematic desensitisation
-

15

Anxiety Disorders: Changes from DSM-IV to DSM-V

Selective mutism added
PTSD, OCD and Acute Stress Disorder have their own chapters now

16

DSM-V: Which disorders are in the chapter of Obsessive Compulsive and Related Disorders?

OCD
Hoarding Disorder
Trichotillomania
Excoriation Disorder
Body Dysmorphic Disorder

17

Hoarding Disorder

Excessive hoarding - unwilling to discard items, regardless of value

18

Trichotillomania

Excessive hair-pulling, to relieve anxiety caused by intrusive thoughts/images

19

Excoriation Disorder

Excessive skin-picking, to relieve anxiety caused by intrusive thoughts/images

20

Body Dysmorphic disorder

Preoccupation with perceived defects/flaws in physical appearance. Extreme manifestation of vanity

21

Panic Attack (mention >4 symptoms)

Influx of fear/discomfort within minutes, reflective of >4 symptoms:
- increased HR/palpitations
- sweating
- Trembling
- Choking sensation
- shortness of breath
- dizziness
- nausea
- Chill/heat sensation
- Fear of losing control
- Fear of dying

22

Panic Attack: two types of attack

Expected (cued) attack:
- Trigger: specific or social phobias
- Context: most anxiety disorders
Unexpected (uncued) attack:
- Unidentifiable trigger
- Context: Panic Disorder
- >2 unexpected attacks --> Panic Disorder

23

Panic Disorder

>2 unexpected attacks
Persistent concern/worry about having another attack
Significant maladaptive change in behaviour related to attacks
Symptoms for >1 mth

24

Panic Disorder: Other information (e.g. comorbidity, etc.)

One-year incidence: 2-3%
Median age onset: 20-29
Course: Chronic, but waxing/waning
Comorbid: Other anxieties, Depression, alcohol use (10-65%)

25

Cognitive Theory of Panic (Clark, 1988)

Panic comes from fear of bodily sensations --> misinterpret their consequences (e.g. heart palpitations --> impending heart attack) - positive feedback between increased anxiety and increased symptoms
Misinterpretations are maintained by safety behaviours: protective actions to prevent harmful events
- prevents learning that bodily sensations are safe
Risk factors: neuroticism, anxiety sensitivity

26

Agoraphobia - DSM edition changes, Symptoms

DSM edition changes:
- DSM-IV: Always accompanied Panic Disorder
- DSM-V: Separate entity, as often occurs without panic

Symptoms:
- Avoidance of public transport, open/enclosed public places, being part of a crowd/line, and being outside alone
- Anxiety that they would not be able to escape when panic-like symptoms will occur

- Not like normal phobias: added fear of embarrassment/incontinence, etc, on top of panic symptoms

27

Why does Agoraphobia develop?

(Social fears)
- heightened childhood dependence
- lowered perception of self-coping ability
- History of separation anxiety & social phobia
- physical concerns that weakness --> Panic --> embarrassment/incontinence
- has increased social evaluative concerns

28

Treatment of Panic/Agoraphobia

Biological: Anxiolytics (Barbiturates, Benzos) and Antidepressants
Psych/Cog-behav:
- Cog restructuring
- Exposure to: Interoceptive stim (Panic) or Avoided situations (Agoraphobia)
- decrease safety behaviours
- CBT: Effective in 80-85% of Panic Disorder Patients

29

GAD Diagnostic criteria

Excessive, uncontrollable worry about a variety of events/outcomes
occurs more days than not, for >6mths
>3-6 somatic symptoms: Restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance - NO SNS AROUSAL

30

What is normal worry?

Response to perceived threat
Focus: Adults: Social threat, Older adults: Physical threat
Contains verbal thought (vs imagery)
Perceived positive aspects: e.g. motivates actions, etc.
Worry control: Problem solving, distraction, social support
Normal Worry --> problem solving attempts
Pathological worry --> No solution, due to thwarted problem solving - biased threat perception