Ch. 5 Anxiety, OCD, and Trauma-Related Disorders Flashcards

Week 3 (79 cards)

1
Q

What is anxiety?

A

an affective state whereby a person feels threatened by the potential occurrence of a future negative event

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2
Q

What is fear?

A

a more primitive emotion that occurs in response to a real or perceived current threat.

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3
Q

What is the fight or flight response?

A

a behavioural response to fear where a person will either flee or fight. its the body’s method of preparing physiologically to respond to danger. includes hypervent, faster HR, sweating, mm tension, etc. its a response of the SNS.

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4
Q

What is panic?

A

an exaggerated fear response thats triggered when theres objectively nothing threatening to be afraid of. ie its a false alarm.

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5
Q

How are genetics involved in the etiology of an anxiety disorder?

A

youre more likely to get anxiety if it runs in the family. also if you inherited certain tempermental or dispositional traits such as behavioural inhibition (the tendency for some children to respond to new situations with heightened arousal) you might have higher genetic risk for anxiety disorders.

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6
Q

What does “The genetic risk associated with anxiety disorders, however, appears to be fairly
nonspecific.” mean?

A

rather than inheriting a risk for a specific type of anxiety disorder, the genetic risk for anxiety disorders is more likely passed on in terms of broader temperamental and/or dispositional traits such as behavioural inhibition and neuroticism.

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7
Q

How did Mowrer explain the acquisition of fears and maintenance of anxiety?

A

using the two-factor theory which states that classical conditioning is the cause of the acquisition of fears, and operant conditioning is responsible for the maintenance of these fears bc ppl resort to avoidance which is negative reinforcement, therefore they dont extinguish the conditioning to the stimulus bc they are avoiding it to avoid temporary anxiety.

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8
Q

What is a pro and con of avoiding the thing that we fear?

A

we temporarily are relieved of the anxiety by avoiding it, however when we do end up encountering the thing that we fear, the anxiety worsens and dies not go away. so avoidance feeds the belief that there is smthn to fear.

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9
Q

Aside from classical conditioning how else can fears develop?

A

from vicarious learning, nonassociative learning, or biological preparedness.

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10
Q

What is vicarious learning?

A

learning to fear smthn by watching others fear responses to smthn.

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11
Q

According to Beck, why are ppl afraid?

A

cognitive factors, meaning that ppl are afraid bc of the biased perceptions they have about the world, the future, and themselves. susceptible to anxiety bc they have core beliefs that they are helpless and vulnerable. and they focus on info that is relevant to their fears, meaning that they think of more negative words when faced with their object of fear rather then more pos or neutral words.

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12
Q

how can interpersonal factors influence the development of anxiety?

A

anxious parents raising their children with anxious parenting styles. early attachment relationship where children can develop and anxious-ambivalent attachment style and learn to fear being abandoned by loved ones.

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13
Q

Is there only one factor or multiple factors that play a role in the development of anxiety?

A

there are multiple factors such as, biological (genetic and neurological), psychological (behavioural and cognitive), and interpersonal (parenting behaviours and attachment influences).

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14
Q

What is the most common mental disorder?

A

anxiety disorders.

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15
Q

What is panic disorder?

A

results from recurrent and unexpected panic attacks. usu begins late adolescence or early adulthood

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16
Q

What is a panic attack?

A

a sudden rush of intense fear or discomfort during which an individual experiences a number of physiological and psych symptoms. like a fight or flight response but for no reason.

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17
Q

What is the difference btwn a panic attack experienced by someone with panic disorder versus someone with another anxiety disorder like SAD?

A

in PD the PAs are occur out of the blue and are not cued to obvious triggers, and can even arise when a person is feeling calm. whereas with other SAD a person can have a PA bc theyre initiating social contact, or if someone had arachnophobia they could have a PA when they confront a spider. so these PAs are cued by specific situations or feared objects.

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18
Q

What is needed for a PD diagnosis?

A

at least one of the PAs must be followed by persistent concerns lasting at least a month anout having additional attacks or by worry about the ramifications of the attacks. at least one of the PAs has to result in a significant alteration of behaviour. most ppl are diagnosed in late teen yrs or early adulthood.

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19
Q

What is agoraphobia?

A

anxiety about being in places or situations where a person might find it difficult to escape or in which help would not be readily available should a PA occur.

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20
Q

What is the biological theory about PD and agoraphobia?

A

these disorders tend to run in families. biological challenges (the presentation of a stim intended to induce physiological changes associated with anxiety (hypervent)) induce PAs in ppl with PDs more frequently than those without.

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21
Q

What are the cognitive theories about PD and agoraphobia?

A

ppl experience catastrophic misinterpretation of bodily sensations meaning when theres variability in bodily sensations they misinterpret it as a sign that smthns wrong, which then causes an increase in the actual PA. so, subjective threat causes some PA symptoms –> misinterpretation of bodily sensations –> intensification of bodily sensations –> increased anxiety and fear. also having the tendency to be anxiety sensitive which is the belief that somatic symptoms related to anxiety will have neg consequences that extend beyond the panic episode itself. the alarm theory is when the alarm system is activated by emotional cues and get stress response when dont need it.

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22
Q

What is a specific phobia?

A

an extreme fear over smthn that interferes with daily life, and cause marked distress.

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23
Q

What is required for a diagnosis of a specific phobia?

A

must be marked and persistent fear of an object of situation. and exposure to the feared thing must invariably produce an anxiety related reaction thats excessive and unreasonable. symptoms must interfere with everyday functioning or cause considerable distress.

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24
Q

What are the 5 specifiers of specific phobias?

A
  1. animal type - phobic object is an animal or insect. 2. natural environment type - part of the natural enviro 3. blood injection-injury type - the person fears seeing blood or an injury, or fears an injection or other type of invasive medical procedure. 4. situational type - the person fears spec situations such as bridges, public transportation or enclosed spaces. 5. other type. - used for all other phobias like choking, vomiting, and clowns, as well as illness phobia.
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25
What is the etiology of specific phobias?
two-factor theory, but criticism is it presumes the equipotentiality premise where all neutral stimuli have an equal potential fro becoming phobias. nonassociative model says that the processes of evolution has endowed humans to respond fearfully to a select group of stimuli and thus no learning is necessary to develop these fears. another theory is biological preparedness which states that the process of natural selection has equipped humans with the predisposition to fear objects and situations that represented threats to our species, but associative learning is still necessary to develop a phobia. also disgust sensitivity (the degree to which ppl are susceptible to being disgusted by stimuli) also leads to ppl developing phobias bc the phobic object is disgusting.
26
What is social anxiety disorder?
a marked and persistent (6 months or more) fear of social or performance related situations.fear interacting with others in most social settings. anxiety often focuses in the fear of acting in a way that will be humiliating or embarrassing. underlying fear of being evaluated negatively and frequently worry about what others might be thinking about them.
27
What is one of the most prototypical fears of ppl with social anxiety disorder?
being the centre of attention.
28
how is SAD different from specific performance only phobia?
ppl with SAD fear interacting with others in most social settings whereas those with performance only social phobia fear specific social situations or activities.
29
How do ppl with SAD manage there anxiety in social situations? Why is this not the best approach?
by taking refuge in the periphery of the situation, where anxiety may be less prominent so not talking to strangers, just listening to convos, or avoiding conversation. so methods of avoidance. these patterns of overt and covert avoidance may result in ppl with social phobia becoming considerably lonely and isolated.
30
What factors play a role in the etiology of SAD?
genetic-biological, environmental, cognitive factors. genetic is traits like behavioural inhibition that is an early marker of risk for SAD. bio is neurocircuitry things like the amygdala and HPA axis, which do stress and also regulatory areas of the brain. also dysregulation of NT systems. enviro is things like being bullied as a child or more parental criticism. cog is neg beliefs and judgments about self and others and abnormal processing of social info.
31
What is GAD?
central difficulty involves uncontrollable and excessive worry. pathological bc its excessive, chronic, uncontrollable and essentially takes the joy out of life. the anxiety experienced by ppl with GAD is far in excess of what would be naturally elicited by a given set of life stressors.
32
What are the diagnostic criteria of GAD?
presence of excessive worry which must be present for more days than not over a 6 month period. person must find it difficult to control their worrying. 3 or more other symptoms must be present for 6 mths: restlessness or feeling keyed up, tiring easily, difficulty concentrating, irritability, mm tension, sleep problems. the worry and its associating symptoms must cause significant distress or impairment of functioning. worrying also must not be better explained by smthn else like another psych disorder or med condition.
33
What are the etiological models of GAD?
most models are cognitive. ppl with GAD use worry primarily as a n avoidance strategy. the process of worry tends to decrease somatic arousal, so they worry to escape unpleasant feelings. or worry facilitates avoidance of significant changes in emotional states. another purpose of worry is to avoid future threat. ppl wit hGAD tend to worry so much that it significantly disrupts their life and causes more problems than benefits. intolerance of uncertainty is a cognitive vulnerability factor that ppl with GAD can have. elevated lvls of anger tend to appear.
34
What is intolerance to uncertainty?
a persons discomfort with ambiguity and uncertainty
35
What diagnoses do obsessive-compulsive and related disorders include?
OCD, BDD, hoarding disorder, trichotillomania (hair pulling), excoriation (skin picking).
36
What is OCD?
recurrent obsessions and compulsions that cause marked distress for the person.
37
What are obsessions?
recurrent and uncontrollable thoughts, impulses, or ideas that the individ finds disturbing and anxiety provoking.
38
What are compulsions?
repetitive behaviours or cognitive acts that are intended to reduce anxiety from obsessions.
39
What are neutralizations?
behavioural or mental acts that are used by ppl to try to prevent, undo, or cancel the feared consequences and distress caused by an obsession. compulsions can be used as neutralizers.
40
What is one of the most striking aspects of someone with OCD?
thought-action fusion which is a persons tendency to fuse thoughts and behaviours together. 1. the belief that having a particular thought increases the probability that the thought will come true. 2. the belief that having a particular thought is the moral equivalent of a particular action.
41
What is the diagnostic criteria of OCD?
presence of either obsessions or compulsions. to be considered compulsions, they have to be done to alleviate anxiety, and be considered excessive or have little connection with the thoughts or events they are intended to neutralize or prevent. OCD symptoms have to cause marked distress or significantly interfere with their lives.ie spending more than one hour a day engaged in obsessions and/or compulsions.
42
What is the etiology of OCD?
neurobiological model: basal ganglia and frontal cortex structural or fxnl abnormalities may be responsible for compulsions and obsessions. increased brain activity in some brain regions and decreased activity in others may underlie difficulties in pts stopping compulsions. abnormalities in serotonin system may cause OCD. cognitive-behavioural model: problematic obsessions are caused by a persons reaction to intrusive thoughts. abnormal obsessions arise from catastrophic misinterpretations of these intrusive thoughts, and then want to avoid or neutralize these thoughts.
43
What is BDD?
an excessive preoccupation with an imagined or exaggerated body disfigurement sometimes to the point of delusion. look for significant distress or impairment in aspects of life. spend many hours dwelling on their defect to the detriment of work family or other social situations.
44
What are the similarities btwn OCD and BDD?
both have prominent obsessions and compulsions. tendency for them to occur together in families.
45
What are the differences btwn OCD and BDD?
ppl with BDD tend to be more severely disturbed than those with OCD, with higher rates of suicidal ideation, delusions, major depression, substance abuse, and social phobia.
46
What is PTSD?
when a person gets a profile of symptoms that are experienced after a traumatic incident which must have involved actual or threat of death or serious injury or a threat to the physical integrity of self or others, and have been experienced with intense fear, helplessness, or horror. person with PTSD re-experiences intrusive, unwanted recollections of a past traumatic event.
47
What is the diagnostic criteria of PTSD?
usu do interviews and use results of psychometric scales. have to determine whether additional disorders are present.
48
What are the risk factors that may predispose ppl to be exposed to traumatic events and develop PTSD in response to these?
not every person who has experienced a traumatic event gets PTSD. women are two times as likely to get PTSD, as there are gender diffs in the types of traumatic experiences as well as that women may be more susceptible to developing ptsd once exposed to trauma. pre-event risk factors include being low in socioeconomic status, education, and tested intelligence, having a previous psychiatric history, and experiencing childhood adversity. post-event risk factors are more powerful; severity of the traumatic event, lack of social support, and whether or not additional stressful experiences occur after the traumatic event.
49
What are the two most effective treatments for anxiety disorders?
psychological interventions such as exposure-based behavioural interventions, and cognitive-behavioural therapy.
50
Which interventions are now recommended as first line treatments?
cognitive-behavioural interventions
51
What are the most commonly used and effective medications for the treatment of anxiety and anxiety related disorders?
antidepressant drugs; monoamine oxidase inhibitors for SAD. tricyclic antidepressants block the reuptake of NE and serotonin especially effective for OCD. selective serotonin reuptake inhibitors are the most well-prescribed anxiolytic medications. anticonvulsant pregabalin has recently been recognized as a firstline pharmacological option for treating GAD and SAD.
52
What are the main components of psychological treatments for anxiety disorders?
cognitive restructuring,
53
What is cognitive restructuring?
based on the idea that anxiety and other emotional disorders are in part due to faulty, maladaptive, or unhelpful thinking patterns. goal is to help patients develop healthier and more evidence based thoughts to help them adjust the imbalance btwn perceived risk and resource.
54
What strategies are used in cognitive restructuring?
thought record which is used to help pts understand the NB relationship btwn what they are thinking and how they are feeling. whenever their anxiety increases patients learn to ask themselves what they were thinking before they started to feel a certain way. pts also learn to catch and monitor their automatic thoughts so they can examine the utility and validity in them. the socratic approach involves asking a number of qs to query and evaluate the beliefs and behaviours that contribute to anxiety.
55
What is the main therapeutic ingredient across all psychological interventions for anxiety?
exposure.
56
What is the idea behind exposure techniques?
by facing anxiety provoking stimuli, ones fears become extinguished, new coping skills are developed and significant cognitive changes occur.
57
What is fear hierarchy?
a list of feared situations or objects that are arranged in descending order according to how much they evoke anxiety.
58
What is systematic desensitization?
having pts imagine the lowest feared stimulus and combining the image with a relaxation response. then they gradually work their way up the fear hierarchy so that they can learn to handle increasingly distressing stimuli.
59
What is the rationale underlying systematic desensitization?
anxiety is a learned or conditioned responses, so by pairing a relaxation response with the feared stimulus, counter-conditioning or extinction is believed to occur.
60
What is worry imagery response?
exposure to feared images for 25-30 min by holding the pic in their minds, patients may be encouraged to think about a number of possible outcomes other than the worst case scenario that was initially envisioned.
61
What is gradual exposure?
pts approach the items in their fear hierarchy beginning at a lower lvl if intensity and working up over time to face higher intensity stimuli.
62
What is flooding or intense exposure?
starting at a high lvl of intensity rather than working gradually through the fear hierarchy.
63
What is the main tx of OCD?
exposure and ritual/response prevention; promoting abstinence from rituals that while reducing anxiety in the short term, only serve to reinforce the obsessions in the long run.
64
What is another NB component of exposure?
helping ppl to reduce their subtle avoidance which is distraction strategies or safety behaviours which are covert avoidance strategies that only serve to reinforce anxiety in the long run. ie sitting at the end of the aisle, only talking to ppl you know, going to an event with a safe person.
65
What is problem solving?
based on the assumption that by generating and implementing effective solutions to problems patients will experience less anxiety. starts by encouraging dealing with problems constructively rather than worry about, avoid, or deny them. defne a problem, generate a wide range of alternative solutions, decide and implement one or more of the solution focused strategies.
66
What are relaxation strategies?
aim to reduce anxious arousal directly by mental or physical relaxation. involves guided imagery; client and therapist work together to develop a personalized description of pos thoughts and images that promote a calm and peaceful state.
67
What is progressive mm relaxation?
tensing and then releasing various mm groups and noting the difference in sensations btwn the two.
68
What is breathing retraining?
teaching ots how o breathe using their diaphragm instead of their thoracic mms. diff breathing patterns are asociated with diff emotional states, so thoracic breathing is assoc with relaxed breathing.
69
What do mindfulness-based strategies involve?
combine the practice of sitting and moving meditation with a number of principles intended to promote psychological well being, physical health, and stress management.
70
What is the most well-studied and empirically supported treatment for panic disorder?
CBT bc it produces for powerful longterm results, and is just as effective as drugs in the short term. CBT pts are panic free at the end of tx, and the gains tend to be maintained.
71
What is the efficacy of pharmacological therapy for the treatment of specific phobias?
offer little benefit and can interfere with exposure-based txs by dampening anxiety during these exercises.
72
What is the main form of treatment for specific phobias? What is the efficacy of such approach?
in vivo exposure which is real life exposure to feared stimuli. 80-90% of ppl are treated effectively with exposure.
73
What is the most popular treatment for social anxiety disorder?
cognitive-behavioural group therapy integrates both cognitive restructuring and exposure. participants will practice social interactions and role play situations associated with social anxiety together.
74
What drugs are commonly used to treat GAD? What are the short-term and long-term effects of using these drugs?
benzodiazepines - reduce symptoms in the short term but kong term outcome data are not encouraging.many pts experience an increase in symptoms and relapse following tx.
75
What is the most highly recommended psychological treatment for GAD?
CBT, and trying to reduce intolerance to uncertainty with tx bc it can alleviate anxiety symptoms and reduce worry.
76
What is the main psychological treatment for OCD? Is this effective in the treatment of OCD?
exposure and ritual prevention. pts confront anxiety provoking stimuli or situations while preventing themselves from engaging in avoidance or compulsive behaviours.
77
Are medications effective in the treatment of OCD?
serotonin based meds have supportive results.
78
which strategies are effective for the treatment of PTSD?
involved facing the trauma and discussing it in detail. can be done using imaginal exposure or in vivo exposure. also narrative exposure therapy where one makes a life story that refrains their trauma as a chapter in their lives.
79
Which treatment is regarded as highly effective for anxiety and related disorders?
CBT as it may be more effective then pharmacotherapy in producing long term gains and preventing relapse.