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Flashcards in Anxiety Disorders Deck (42):
1

What is the difference between fear and anxiety?

Fear:
Activated quickly and to specific threats
Activation of fight-or-flight response
Strong urge to escape
Anxiety:
Activated diffusively, can be continuous, ongoing
Future oriented
Tension, chronic over-arousal, prepared for fight-or-flight response
Avoidance – negative reinforcement

2

What are the two major components of anxiety?

the physiological:
the heightened level of arousal and physiological activation
the cognitive:
the subjective perception of the anxious arousal and the associated cognitive processes: worry and rumination.

3

What are the characteristics of anxiety disorders?

Anxiety disorders have an unrealistic, irrational fear/anxiety of disabling intensity at their core and as their principal manifestation.
Partially shared genetic vulnerability – neuroticism
Anxiety disorders tend to be comorbid

4

What major changes were made to Anxiety Disorders when the DSM-5 was released?

Post-Traumatic Stress Disorder (PTSD) is now recognized in DSM-5 as a stress disorder
Obsessive-Compulsive Disorder (OCD) is now classified under “Obsessive-Compulsive and Related Disorders”

5

What is separation anxiety?

Separation anxiety is the anxiety that results from not having contact or the possibility of losing contact with attachment figures.

6

What is adult separation anxiety?

Adults who cannot stand to be alone and are preoccupied with losing contact with loved ones

7

What is phobic disorder?

Persistent and disproportionate fear of some specific object or situation that presents little or no actual danger.
The term “phobia” usually implies that the person suffers intense distress and social or occupational impairment because of the anxiety.
Insight: Recognition that their fear is excessive or unreasonable (may not be the case with children).

8

What are the phobia subtypes? (five factors)

Agoraphobia
Fears of heights or water
Threat fears (e.g., blood/needles, storms/thunder)
Fears of being observed
Speaking fears

9

How do we name phobias?

The suffix phobia is preceded by a Greek word for the feared object or situation.
The suffix from the name of the Greek god Phobos, who frightened his enemies.

10

What are the most common specific phobias?

(1) animal phobias (including insects, snakes, and birds);
(2) heights;
(3) being in closed spaces;
(4) flying;
(5) being in or on water;
(6) going to the dentist;
(7) seeing blood or getting an injection;
(8) storms, thunder, or lightning.
Algophobia: Pain
Monophobia: Being alone
Mysophobia: Contamination
Nyctophobia: Darkness
Pyrophobia: Fire

11

What are some of the rare and unusual phobias?

Dextrophobia: Objects on right side of body
Lininophobia: String
Eophobia: Dawn
Hellenologophobia: Scientific or Greek terms

12

What is a new phobia that has resulted from societal changes?

nomophobia:
a pathological fear of remaining out of touch with technology - experienced by people who have become overly dependent on using their mobile phones (nomophobia meaning no mobile phone phobia) or personal computers.

13

What is an example of a culturally dependent phobia?

China: Pa-leng (a fear of the cold) worries that loss of body heat may be life-threatening.
This fear appears to be related to the Chinese philosophy of yin and yang: yin refers to the cold, windy, energy-sapping, and passive aspects of life, while yang refers to hot, powerful, and active aspects.

14

What is the theorized etiology of phobias?

Deep-seated psychodynamic conflicts -
Fear conditioning
Cognitive diathesis
Evolutionary origins (biological preparedness)

15

What is the psychodynamic theory of phobias?

Phobias are a defense against the anxiety produced by repressed id impulses. Anxiety is displaced from the feared id impulse and moved to an object or situation that has some symbolic connection to it.
These objects or situations then become the phobic stimuli.
By avoiding them the person is able to avoid dealing with repressed conflicts.
Focus on the content of the phobia and see the phobic object as a symbol of an important unconscious fear.
The content of phobias has important symbolic value.

16

What is the fear conditioning theory of phobias?

Classical conditioning:
Unconditioned stimuli lead to unconditioned responses
Conditioned stimuli: stimuli that are paired with unconditioned stimuli
Conditioned stimuli come to elicit what was a previously unconditioned response
Fear can also be acquired through vicarious conditioning.
Before conditioning:
Genetic and temperamental factors
Prior experiences can “immunize”
During conditioning:
Controllability – cognitive (tendency to believe have no control over environment)
After conditioning:
Inflation effect

17

What is the biological preparedness theory of phobias?

Humans are naturally inclined to acquire fear to certain things more than others.
Prepared stimuli

18

Which predisposing biological factors may play into phobias?

People with specific phobia, PTSD, and SAD have greater activity in two areas associated with negative emotional responses: the amygdala and the insula
Autonomic Nervous System
Stability versus lability.
Labile, or jumpy, individuals whose autonomic systems are readily aroused by a wide range of stimuli. Autonomic nervous system is involved in fear and hence in phobic behaviour, a dimension such as autonomic lability assumes considerable importance.
autonomic lability, to some extent, believed to be genetically determined, heredity may have a significant role in the development of phobias.

19

How is a phobia maintained?

Negative reinforcement:
Behaviors followed by the termination of negative consequences will increase
Avoidance behavior is negatively reinforced and prevents extinction
Cognitive biases:
Attentional bias

20

How are phobias treated?

Exposure therapy (60-90% success rate):
In vivo -
Systematic desensitization
Virtual reality

Psychoanalytic - treat underlying conflict

21

Why is the treatment of blood-and-injection phobias different from other phobias?

Relaxation tends to make matters worse for people with blood-and-injection phobias.
After the initial fright, accompanied by dramatic increases in heart rate and blood pressure, a person with a blood-and-injection phobia often experiences a sudden drop in blood pressure and heart rate and faints.
By trying to relax, may contribute to the tendency to faint, increasing their already high levels of fear and avoidance, as well as their embarrassment.
Now encouraged to tense rather than relax their muscles when confronting the fearsome situation.

22

What is social phobia? (Social anxiety disorder)

Disabling fear of one or more discrete social situations in which a person fears that she or he may be exposed to the scrutiny and potential negative evaluation of others

23

What are the characteristics of a socially anxious person?

more concerned about evaluation than are people who are not socially anxious
are highly aware of the image they present to others
high in public self-consciousness
preoccupied with a need to seem perfect and not make mistakes in front of other people
tend to view themselves negatively even when they have actually performed well in a social interaction
are less certain about their positive self-views
relative to people without social phobia, they see their positive attributes as being less important

24

What are the key features of social anxiety disorder?

Avoid or endure
Fear excessive or unreasonable
Interferes with functioning
Specifier: Generalized vs. Non-generalized

25

What is the difference between Generalized and Non-Generalized social anxiety disorder?

Generalized Social Phobia
involve many different interpersonal situations
an earlier age of onset
more severe impairment than specific phobia
Specific SP involves intense fear of one particular situation (e.g., public speaking)

26

What is the behavioural theory of social anxiety disorder?

Inappropriate behaviour or a lack of social skills is the cause of social anxiety
The individual has not learned how to behave so that he or she feels comfortable with others or the person repeatedly commits faux pas, is awkward and socially inept, and is often criticized by social companions.
The timing and placement of social responses in a social interaction are impaired

27

What is the cognitive theory of social anxiety disorder?

Focus on how people’s thought processes can serve as a diathesis and on how thoughts can maintain a phobia
Anxiety is related to being more likely to:
Attend to negative stimuli
Interpret ambiguous information as threatening
Believe that negative events are more likely than positive ones to re-occur

28

What is Post-Event-Processing (PEP)?

A form of rumination about previous experiences and responses to these situations, especially experiences involving other people that did not turn out well.
There is a link between social anxiety and PEP.

29

What is an example of a culturally dependent source of social anxiety?

Taijin Kyofusho (TKS):
Fear of doing something that will embarrass, offend, bring shame to others
Symptoms include fear of eye contact and blushing

30

What are the treatments for social anxiety disorder?

Antidepressant medication (MAOIs, SSRIs)
Understanding the source or underlying causes
Cognitive-behavioral therapy
Exposure to social situations
Cognitive techniques (e.g., examination of evidence, video feedback)
Social skills training

31

What is Panic Disorder?

Characterized by unexpected panic attacks that seem to come “out of the blue”
Recurrent, unexpected panic attacks
At least one attack followed by
persistent concern about having additional attacks
worry about implications or consequences of the attack
significant behavioral change related to the attacks
Absence or presence of Agoraphobia

32

What is Agoraphobia?

Anxiety about being in places or situations from which escape might be difficult or embarrassing, or where help may not be available.
Situations are avoided, restricted or endured with distress or anxiety about having a panic attack or symptoms, or require the presence of a companion

33

What are some examples of Agoraphobia fears?

Being outside the home alone
Being in a crowd or standing in line
Traveling in car, bus, or train
Being on a bridge

34

What are the key features of panic disorder?

Occurrence of “unexpected” panic attacks that often seem to come “out of the blue”
Brevity (brief)
Intensity
Worry or avoidance of situations in which a panic attack may occur

35

What is an example of a culturally dependent panic disorder?

Among the Inuit of Northern Canada and west Greenland, kayak-angst occurs among seal hunters who are alone at sea.
Attacks involve intense fear, disorientation, and concerns about drowning.

36

What are the biological theories of panic disorder?

Moderate heritable component
Many biochemical panic provocation agents (e.g., sodium lactate, caffeine)
Noradrenergic activity can stimulate cardiovascular symptoms (possible implication of locus ceruleus and cortical-limbic fear network

Problem in gamma-aminobutyric acid (GABA)
GABA generally inhibit noradrenergic activity
PET study found fewer GABA-receptor binding sites in people with PD
Therapeutic improvement involves changes in GABA receptors, but this applies to both anxiety and depression

37

What are the cognitive theories of panic disorder?

Interoceptive conditioning - “fear of fear”
Anxiety sensitivity and perceived control
Safety behaviors and maintenance of panic
Cognitive biases and maintenance of panic
The cognitive theory of panic:
There is converging evidence that anxiety sensitivity acts as a risk factor for anxiety psychopathology
Anxiety sensitivity predicts the development of spontaneous panic attacks.
More importantly, independent of a history of anxiety problems and baseline trait anxiety, anxiety sensitivity predicted the development of anxiety diagnoses, including anxiety, mood, and alcohol-use disorders.

38

What are the treatments for panic disorder?

Medications:
Minor tranquilizers (benzodiazepines)
Antidepressants (tricyclics, SSRIs)
Cognitive-behavioral treatments:
Breathing techniques and progressive relaxation
Cognitive techniques (e.g., target catastrophizing)
Exposure

39

What is Generalized Anxiety Disorder? (GAD)

Chronic, excessive or unreasonable anxiety and worry about a number of events and daily activities as well as health
Free-floating anxiety
Difficult to control the worry
Anxious apprehension
The anxiety and worry are accompanied by several of the following:
restlessness or feeling keyed up or on edge
being easily fatigued
difficulty concentrating or mind going blank
irritability
muscle tension
sleep disturbance

40

What are the psychological factors of GAD?

Psychodynamic theory: defense mechanisms aren’t working
Uncontrollable or unpredictable events
Lack of safety signals = hypervigilance
Cognitive biases:
Attentional bias toward threatening information
Negative interpretation of ambiguous information
Vicious cycle: worry, intrusive thoughts, anxiety
Benefits of worry according to GAD patients:
Superstitious avoidance of catastrophe
Actual avoidance of catastrophe
Avoidance of deeper emotional topics
Coping and preparation
Motivating device
Negative reinforcement
Non-occurrence of feared events
Worry suppresses emotional and physiological response to aversive imagery

41

What are the biological factors of GAD?

Mild-modest heritability
Neuroticism could underlie shared genetic vulnerability with Major Depression
GABA deficiency
Neurobiological model for GAD based on fact that benzodiazepines are often effective in treating anxiety
Receptor in the brain for benzodiazepines has been linked to the inhibitory neurotransmitter GABA
Benzodiazepines may  anxiety by  release of GABA
Drugs that block or inhibit the GABA system  anxiety

42

What is the treatment for GAD?

Anxiolytics:
Benzodiazepines
Buspirone
Antidepressants (SSRIs)
CBT:
Worry outcome monitoring
Identifying and targeting core fears
Response prevention (avoidance)
Present-moment focus of attention - mindfulness
Understand the underlying conflicts associated with the anxiety and worry
Work through origins of the defence
Help to experience emotions associated with origin