Anxiety/phobia/social anxiety

Question 1

Biological features

Answer 1

Saliva: flow decreases due to digestion slowing down.
Heart rate increases and breathing quickens to increase blood flow to muscles for increase respiration
Muscles tense preparing for fight/flight/freeze
Skin: body perspires to cool itself
Eyes: pupil dilate to increase vision

Mixed findings between anxious and non anxious controls

Question 2

Prevalence

Answer 2

44% women, 34% men
(Kessler 05) - highest specific disorder (12.5%), social phobia (12.1%), PTSD (6.8%), GAD, panic disorder, OCD (1.6%). Higher in females than males apart from equal in OCD

Question 3

Course and outcome

Answer 3

Persists over time, usually don’t grow out of it. Predicts range of disorders in adolescence e.g. depression/ subst. misuse and other anxiety disorders
Neg. impact on social/academic functioning

Question 4

Vulnerability - genetics

Answer 4

Twin studies: 25-60% heritability for phobias, panic disorder and vulnerability to PTSD and OCD (Afifi 10).
Very few studies found genetic reason for dysfunctional biological factor which underpins process of regulating stress response

Question 5

Short allele variant of h-HTTLPR

Answer 5

Regulates expression of serotonin transporter gene
Associated with increased amygdala activation in response to fearful faces (Hariri et al)
Risk factor for PTSD (Cie 09)
However, also vuln. fact. for depression & BPD

Question 6

Neurobiology

Answer 6

Amygdala involved in emotional modulation of memory, evaluation of stimuli with affective significance

Excessive activity of limbic system normally inhibited be frontal cortex. GABA and serotonin facilitate communication between limbic system and frontal cortex.

Efficiency of GABA/reduced in anxiety dis. & increased by anti-anxiety drugs. Beta blockers (zopiclone) effective for those with anx. related tremor but day time sedation, psychomotor impairment, dependence and misuse, hinder/help

Question 7

Temperamental - Kotov et al (10)

Answer 7

All anxiety disorders associated with N, low C (except specific phobia) and introversion (except specific phobia and GAD)

Question 8

Diathesis stress - Turner & Lloyd (04)

Answer 8

stressful life events can activate underlying vulnerability to anxiety (N, genetics).

Retrospective study, N=1800, 6+ major life events and accumulating exposure to lifetime adversity, increased risk of depressive/anxious episodes.

Question 9

Parental influences - Murray et al (08)

Answer 9

Maternal anxiety expressed at 10 months predicted infant avoidance at 14 months

Question 10

Specific phobia -

Answer 10

Intense fear when faced with specific stimulus which is out of proportion to danger posed. Objects avoided/tolerated with intense fear. Contact/entry = catastrophe.
Chapman - Most common: dental (3-5%), blood-injury (3.5%), water (3.3%), animals (1.1%)

Question 11

Classical conditioning (behavioural) - Watson & Rayner

Answer 11

‘Little Albert’ - 11 month old Albert paired pet rat (CS) with loud noise (UCS). CR was crying when rat presented.

Traumatic experiences responsible for acquisition of some phobias (Dental phobia - Davey et al 89), choking (Greenberg et al 88)

Question 12

Mowrer (39) - 2 factor theory

Answer 12

CC and Operant conditioning
Operant: conditioned fear response does not distinguish because avoidant behaviour negatively reinforced each time previously neutral stimuli avoided

Question 13

Criticisms

Answer 13

Some stimuli produce CR easier than others

Many phobias can’t recall trauma (UCS)

Phobias learnt through observational learning/avoidance

Fear of situations can be observed without any avoidance e.g. military situations feared but not avoided

Question 14

Eysenck addition (79) - biological preparedness

Answer 14

Incubation: fear increases in magnitude over successive encounters of trigger. Fear of fear itself reinforces phobic stimulus.

Constitutional vulnerability due to high levels of N and introversion

Question 15

ERP and response

Answer 15

Exposure to feared stimuli and response prevented in order to habituate and anxiety response extinguished.

Nonfearful pairing generated through repeated encounters with feared stimuli without aversive consequences

Aim of treatment: establish a new association between stimuli and lack of fear. Also ensure maximum retrievability of this new association

Question 16

Systematic desensitisation (Wolpe 69)

Answer 16

• Clients deeply relaxed state
• Exposure to increasingly anxiety provoking stimuli
  Wait for habituation until next stimuli

Question 17

Flooding

Answer 17

Exposure for prolonged period of time to most anxiety provoking stimuli until anxiety response extinguished

Question 18

Graded exposure

Answer 18

Stimuli presented in vivo/virtual

Question 19

Evidence

Answer 19

3 hour intensive ERP for specific phobia (Ost 97)

Most successful treatment for OCD - 75% significant clinical improvement

Question 20

Social anxiety/phobia

Answer 20

• Intense fear in 1+ social situations causing considerable distress and impaired ability to function in at least some parts of daily life.
• Fear of neg. eval. from others
• Behaviour: anticipatory worry + safety behaviours to prevent feared situation from occurring
• Underperformance in education and workplace, impaired social relationships

Question 21

Biological model of SA

Answer 21

• Children with SA more likely to have parent with SA
• Moderate genetic influence demonstrated in twin studies
• Personality traits inherited? submissiveness, anxiousness, social avoidance.
• Or may be predisposed to anxiety generally

Question 22

Cognitive model for SA

Answer 22

• Trigger situation
• Activates beliefs and assumptions
• Situation perceived as socially dangerous
• Causing self consciousness, signs and symptoms of anxiety and safety behaviours which may re-activate beliefs and assumptions

Question 23

SA - process self as social object

Answer 23

• Shift attention to detailed monitoring/observation of self
• Internal information used to infer how they appear to other people and what other people are thinking about them
• Feeling anxious = looking anxious

Question 24

SA - safety behaviours

Answer 24

• Preventing disconfirmation of feared catastrophe
• May create some feared symptoms
• Increase self-focus and attention
• May increase likelihood of others perceiving individual negatively

Question 25

Evidence

Answer 25

• Ind. underestimates own social skills (Dodd et al 11)

- Self focused attention higher in SA (Clark & Wells 93)

Question 26

NICE guidelines, social phobia

Answer 26

First: individual cognitive therapy based on model
Second: SSRIs