Flashcards in Anxiety Disorders (Exam 2) Deck (131):
What is the definition of anxiety?
Defined clinically as uneasiness stemming from the anticipation of danger
What is the definition of fear?
Defined as a reaction to specific threat from the real, physical world
What is the distinction of anxiety from fear?
-anxiety: worried about something bad happening
-fear: worried about a specific threat from real world
What activates the fight or flight response?
Sympathetic nervous system activation (anxiety is evolutionary useful feeling)
How is the fight or flight response useful?
useful to have a response of energizing to get out of situations before they occur (get away from anxiety)
How is anxiety diagnosed?
-anxiety must be out of proportion to the perceived threat
-anxiety is recognized by the individual seeking treatment to be excessive, unrealistic, or unreasonable
What are the components of anxiety?
1. Physical component
2. Cognitive component
3. Behavioral component
What is the physical component of anxiety?
increased heart rate, queasiness/upset stomach, rapid breathing
What is the cognitive component of anxiety?
thoughts described as "fast", "irrational", "confusing"
What is the behavioral component of anxiety?
escape and avoidance behavior
What is an example of the behavioral component of anxiety?
-Avoid studying because of anxiety
-self medicating with alcohol or drugs
What theory explains escape or avoidance learning (behavior)?
Mowrer's two-factor theory
What are the two factors in Mowrer's two-factor theory?
-acquisition of anxiety
-maintenance of anxiety
What is the acquisition of anxiety component in Mowrer's two-factor theory?
classical conditioning of stimuli (CS) with natural fear response (UCS-UCR)
What is the maintenance of anxiety component in Mowrer's two-factor theory?
-escape and avoidance responding
-negative reinforcement (remove stimulus and behavior is increased)
Can anxiety behaviors be easily extinguished naturally?
no, they are not easily naturally extinguished
Why don't anxiety behaviors extinguish naturally?
the chance for extinction to happen isn't always given (Mowrer's Theory)
How does operant conditioning contribute to the maintenance of anxiety behaviors?
escape and avoidance learning
ex: if stimulus is encountered = escape
What is the consequence of operant conditioning for the maintenance of anxiety behaviors?
-aversive feelings reduced
-negative reinforcement of escape response
What does Mowrer's Theory say about why behaviors are not easily naturally extinguished?
-escape/avoidance effectively prevents this from occurring
-continue to have anxiety to "feared" stimulus
What are anxiety disorders based on?
formal topographical features
What are the topographical features for anxiety disorder?
-should be distinct
-will see much overlap within an Anxiety as category (ex: panic may overlap with PTSD)
-Also see overlap between other categories outside of anxiety disorders (ex: OCD symptoms and eating disorders)
What are the DSM-5 and the new breakout diagnostic groups for anxiety?
-trauma-and stressor-related disorders
-obsessive-compulsive related disorders
What is the definition of a specific phobia?
anxiety (extreme irrational fear) related to specific kind of situations or objects
What is the criteria of a specific phobia?
-persistent fear of one or two objects (simple phobia)
Why are specific phobias more common in females?
males do not express their feelings
When is a diagnosis given for a specific phobia?
when avoidant behavior interferes with:
-person's normal routine
-relationships with others
-if there is marked distress about having the fear
What is the definition of social anxiety disorder?
extreme anxiety related to being in social situations where might be evaluated by others
ex: public speaking falls here
What is the separate diagnosis from specific phobia from social anxiety disorder? (originally called?)
When does social anxiety disorder develop?
late childhood or early adolescence
What is the biological explanation of phobias?
Is the preparedness hypothesis for the biological explanation of phobias good?
no, not good at finding biological explanation
What is the popular explanation of phobias?
What is the psychoanalytic theories of phobias?
phobias are displaced anxiety
What are the types of treatments for the psychoanalytic theories of phobias?
-long term therapy
-uncovering past conflicts
What is the goal of the treatments for the psychoanalytic theories of phobias?
treatments are about releasing energy used in ego defenses
What is the mechanism of change of the treatments for the psychoanalytic theories of phobias?
uncovering past conflicts
How long do the treatments take for the psychoanalytic theories of phobias?
long term therapy
Where does the behavioral theories of phobias come from?
Mowrer's two-factor learning theory
What does Mowrer's two-factor learning theory say about behavioral theories of phobias?
-acquisition through classical conditioning to feared stimulus
-avoidance is negatively reinforced with operant principles
How long do the treatments take for the behavioral theories of phobias?
interventions tend to be fairly brief
What is the mechanism of change for the behavioral theories of phobias?
focus on anxiety provoking stimuli
What is addressed when we focus on anxiety provoking stimuli? (behavioral theories of phobias)
-will address coping strategies
-address all types of escape and avoidance behavior
What type of treatments are used for the behavioral theories of phobias?
exposure therapies (treatments)
What are exposure treatments for behavioral theories of phobias?
-need to have presentation of CS w/o UCS so that CS no longer elicits CR
-prevent operant escape response
What are the models for the exposure treatments?
-systematic or gradual exposure (desensitization)
-flooding or rapid exposure
What are the principles of systematic desensitization? (behavioral theories of phobias)
-develop hierarchy around feared situation (lowest to highest levels of anxiety)
-teach relaxation techniques
-have client relax while they imagine frightening situations
-gradually desensitize to feared stimulus
-transfer to real life exposure
What are the principles of flooding? (behavioral theories of phobias)
-real life exposure (vivo)
-put person in situation and don't let them escape
-person is flooded with anxiety
-this extinguishes their fear
-may happen more naturally (not just in therapy)
What is the outcome data for exposure therapies?
flooding and systematic desensitization have been empirically shown to be very effective
What is the key to exposure therapies?
-preventing client from emitting escape response during anxiety (or escape response = negatively reinforced)
What is the symptom substitution for behavioral treatments controversy?
if we treat symptom, and not underlying cause, then another symptom will emerge
What theory is worried about symptom substitution for behavioral treatment controversies?
psychoanalytic theory (never addressing underlying cause)
What is the empirical evidence for symptom substitution?
-NO empirical evidence for symptom substitution
-behaviorally based treatments of exposure with response prevention are consistently successful
What is the definition of a panic attack?
a discrete period of intense fear or discomfort
What are some examples of symptoms for a panic attack?
must exhibit 4+ of these symptoms
-palpations, increased heart rate
-shortness of breath
How long do panic attacks last?
develop abruptly and reach peak within 10 minutes
How is panic disorder diagnosed?
one of the attacks followed by
-persistent concern about having additional attacks or worry about implications of attack/consequences
What is the definition of agoraphobia?
-afraid to go out of the house
-fear of being in public places from which escape might be difficult or help not available in case of incapacitation
What is a "safe person"?
the only person someone will leave the house with because they will know what to do with the onset of a panic attack
What are the physiological differential (abnormalities) diagnoses to rule out for diagnosing panic disorder?
-stimulant or amphetamine intoxication
What symptoms does hyperthyroidism rule out for panic disorder?
mimics panic attack feelings
What do cardiac issues rule out for panic disorder symptoms?
-mitral valve prolapse
-leads to panic symptoms in some people
What does stimulant or amphetamine intoxication rule out for diagnosing panic disorder?
rules out chemical cause
What are the components for panic treatment?
What is the cognitive model of panic?
physical arousal triggers -> physical sensations -> "faulty" threat interpretation -> PANIC
What are the steps for cognitive therapy in the cognitive-behavioral perspective for panic disorders?
1. educate clients
2. teach clients to apply more accurate interpretations
3. teach clients skills for coping with anxiety
What does cognitive therapy attempt to do?
attempts to correct people's misinterpretations of their bodily sensations
How do you educate clients during cognitive therapy and correct people's misinterpretations of their bodily sensations?
-about panic in general
-about causes of bodily sensations
-about their tendency to misinterpret the sensations
When do you teach clients how to apply more accurate interpretations?
especially when stressed
How do you teach clients skills for coping with anxiety?
-induce panic attack
How are phobias displaced anxiety? (psychoanalytic theories)
-Id impulse is so threatening that ego displaces anxiety onto something else
-displacement is a defense mechanism
-phobic response is symbolic (ex: fear of bees not really about bees)
How effective is treating panic disorder with CBT?
CBT is often helpful in treating panic disorder
How effective is treating panic disorder with agoraphobia with CBT?
only sometimes helpful for panic disorder with agoraphobia
Which neurotransmitter is believed to be involved in the biological perspective for panic disorder?
What is the evidence for the involvement of norepinephrine in the biological perspective for panic disorder?
-irregular in people with panic
-research suggests panic reactions are related to changes in norepinephrine activity in the locus ceruleus
What are the pharmacological treatments for panic disorder?
-Serotonin Reuptake Inhibitors (SRRSIs or SRIs)
-Benzodiazepines (fast acting, acute attacks)
What are the efficacy of pharmacological (meds) and psychotherapy for treating panic disorder?
equally effective if applied separately
What is the efficacy of a combination of pharmacological and psychotherapy for treating panic disorder?
worse outcome than separate w/ Benzodiazepines
Why is there a worse outcome with a combination of Benzodiazepines and psychotherapy for treating panic disorder?
exposure never occurs
What is agoraphobia without history of panic disorder?
limited symptoms of panic attacks (not able to be diagnosed with panic disorder)
What is the definition of Generalized Anxiety Disorder (GAD)?
characterized by chronic, unrealistic and excessive anxiety about 2 or more areas of functioning
What are the behaviors or symptoms of GAD?
-drug alcohol abuse to control anxiety
How is GAD diagnosed?
must interfere with normal functioning
What is the cognitive perspective for GAD?
those with GAD hold unrealistic silent assumptions that imply imminent danger
What is the biological perspective for GAD?
-GABA too low to trigger feedback system
What are the biological treatments for GAD and is it a good long term solution?
Benzodiazepines found to reduce anxiety but is not a good long term solution
What do the cognitive therapies for treating GAD target?
target maladaptive assumptions
What is the behavioral perspective for treating GAB?
excessive worry is learned the way any other behavior is learned
-negative reinforcement is present
What are the behavioral therapies for treating GAB?
-behavioral rehearsal, relaxation
-acceptance based strategies
What are the different types of psychological treatments for GAB?
What are the psychodynamic therapies for treating GAB?
help patients identify and settle early relationship conflicts
How is OCD characterized?
by obsessions and/or compulsions
What is the definition of obsessions?
recurrent and persistent thoughts, impulses, or ideas
What is the definition of compulsions?
-behaviors that are repetitive and intentional or rituals performed in response to the obsession in order to relieve the anxiety
-behaviors or mental acts aimed at preventing or reducing distress or preventing some dreaded event or situation
What happens if compulsions are avoided?
behavior is maintained
What is the biological explanation of theories of OCD?
involved neurotransmitter serotonin
What does the involvement of serotonin do for the biological treatment of OCD?
-leads to use of antidepressants for treatment (SSRIs)
-high relapse following discontinuation
What is the behavioral theory for theories of OCD?
two factor learning theory
What is the two factor learning theory for the theories of OCD?
-classically conditioned acquisition
-maintained by avoidance behavior
What is the most effective treatment for OCD?
real life (in vivo) exposure with response prevention (ERP)
What is the data for OCD treatment?
excellent that treatment provides significant, long-lasting improvements for most patients
What is the DSM reorganization of OCD spectrum disorders?
now its own category with Hoarding and Body Dysmorphic Disorders
What is the definition of Hoarding?
excessively collecting or keeping items regardless of their value and difficulty discarding items, usually due to a fear that one will need them later
What is the definition of psychological trauma?
-experiencing or witnessing an event that overwhelms a person's capacity to cognitively and emotionally process their experience
-emotional shock, and a breakdown in cognitive processing that results in a stress disorder
What are the stress disorders?
-acute stress disorder
-post-traumatic stress disorder (PTSD)
What is acute stress disorder?
symptoms begin within 4 weeks of the trauma and last for less than one month
What is PTSD?
symptoms can begin at any time following the trauma but must last for longer than one month (may develop from acute stress disorder)
What are the general statistics for men and women for developing disorders?
After trauma, 20% of women and 8% of men develop disorders (ratio of women to men 2:1)
What are the events that are more likely to cause disorders than others?
combat, disasters, abuse, victimization
How does combat lead to trauma?
soldiers experience distress during combat
How do disasters lead to trauma?
may follow natural/accidental disasters
How does victimization lead to trauma?
sexual assault/rape can lead to lingering stress symptoms
What are some of the statistical predictors of trauma?
-younger the person, more vulnerable to being traumatized
-having other psychiatric problems makes a person more vulnerable to being traumatized
-prior history of trauma makes person more vulnerable to future trauma
What are the Criterion A for PTSD?
1. directly experiencing the traumatic event(s)
2. witnessing, in person, the event(s) as it occurred to others
3. Learning that the traumatic event(s) occurred to a close family member or close friend
4. experiencing repeated or extreme exposure to aversive details of the traumatic event(s)
What are the symptoms of PTSD?
-persistent intrusion, or re-experiencing of traumatic event
-negative alterations in mood or cognitions
What are examples of persistent intrusion or re-experiencing of traumatic event?
What does avoidance of stimuli associated with the trauma look like?
-inability to recall events
-diminished interest or pleasure in activities
-feeling detached or estranged
What do negative alterations in mood or cognitions look like?
-memory problems exclusive to the event
-negative beliefs or thoughts about one's self or the world
What does increased arousal look like?
What are the general statistics for men and women for prevalence of experiencing a Criterion A traumatic event?
61% of men
51% of women
What are the general statistics for men and women for development of diagnosable PTSD?
6.2-9.5% of men
13-17% of women
How does mediated by nature of trauma contribute to PTSD prevalence?
-assault vs accident vs combat
-chronically can predict PTSD
-discussed as violation from held assumptions of safety
What is PTSD with the specifier "With Delayed Onset"?
symptoms may begin right after trauma for some people, and for others it may take longer (6+ months after event)
What are the other issues with PTSD?
often see problems with drug or alcohol abuse
-avoidance of emotional experiences
What are the treatments for PTSD?
-psychological exposure (Cognitive Processing Therapy)
What is the pharmacological treatment for PTSD?
-treat depressive symptoms
-treat anxiety symptoms (high risk of dependence)
-not effective by itself
What is the psychological exposure (Cognitive Processing Therapy) treatment for PTSD?
-activate memory by either info about the stimuli, responses, or meaning
-systematic desensitization to the traumatic memory in safe environment
-form new schema with new info that is incompatible with current fear structure
What are the major changes to the PTSD criteria in DSM-5?
-Issues of witnessing event
-learning it occurred to person close to client
-exposure to aversive details
What are other trauma and stress related disorders?
-reactive attachment disorder
-disinhibited social engagement disorder
What is reactive attachment disorder?
child rarely or minimally turns preferentially to an attachment figure for comfort, support, protection. and nurturance