Anxiety Disorders = one of the most common mental disorders BUT only ~25% of people who qualify for diagnosis seek treatment (so estimates are likely off)

Exam 2 - Anxiety Disorders Flashcards by Helena Slotwiner-Nie

Anxiety:

The 5 CORE Anxiety Disorders

Specific Phobias
Social Anxiety Disorder (SAD)
Generalized Anxiety Disorder (GAD)
Panic Disorder
Agoraphobia

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Anxiety: Fear vs. Anxiety

Fear:
* Present focused: response to immediate danger/threat
* Intensity builds quickly

**Anxiety: **
* Future focused: anticipate and prepare
* ongoing feeling/worry of anticipation
* Example: Thinking about an upcoming project that’s due

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Anxiety:

The Yerkes-Dodson Law: Inverted U-Model

There is an optimal level of arousal (stress) that maximizes performance

Low arousal = low performance
Moderate arousal = Optimal Performance
High arousal = declining performance

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Anxiety: (fear/anxiety)

“Normal” to “Disordered”

Disordered when…

Symptoms are pervasive and persistent
It involves excessive avoidance
It causes significant distress and impairment

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Anxiety:

Comorbidity Rates

Internal:

> 50% of ppl with one anxiety disorder meet criteria for another anxiety
disorder

External:

75% meet criteria for another psychological disorder
60% also have depression

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Anxiety: Prevalence

Anxiety Disorders = one of the most common mental disorders

BUT

only ~25% of people who qualify for diagnosis seek treatment (so estimates are likely off)

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Anxiety Disorders: Specific Phobia

Textbook Definition: Persistent, irrational, narrowly defined fears that are associated with a specific object or situation.

DSM-5 Definition: Intense, persistent fear of a specific object or situation that is excessive or unreasonable.

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Anxiety Disorders: Specific Phobia

DSM-5 Diagnostic Criteria

Immediate fearful response to phobia exposure
Avoidance / Endured w intense Distress
Persistent fear, anxiety, & avoidance: 6+ months
Affects daily life

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Anxiety Disorders: Specific Phobia

Prevalence

~12% of the general population (may be an underestimation)
3x more common in women

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Anxiety Disorders: Specific Phobia

Facts (course, age, comorbidity)

Chronic – phobias don’t usually go away with treatment
Age of onset varies widely
Often comorbid with other specific phobias

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Anxiety Disorders: Specific Phobia

Etiology (Causes)

Evolutionary Adaptation - being scared helped protect us from harm

Classical Conditioning - When a stimulus is paired with something scary, we can become conditioned to fear the stimulus.

ie: Baby Albert wasn’t scared of the Rat, but when it was paired with a load noise (feared stimulus) → the baby became conditioned to fear the Rat
- phobia translated

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Anxiety Disorders: Specific Phobia

Treatments

Medications – NOT recommended

Meds = Short-Term Solution (can become a “safety behavior”)
Benzodiazepines = addictive & short-term solution
Beta Blockers = not addictive, but are short-term solutions

Cognitive Behavioral Therapy (CBT) –- Highly Effective and Quick!

Exposure therapy
- In-vivo exposure (real life exposure)
- Imaginal exposure
  Levels of exposure, slowly increase (ie: level 1 = room filled with dog toys, level 10 = petting a dog)

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Anxiety Disorders: Social Anxiety Disorder
(aka: Social Phobia)

Definition

DSM-5 Definition: “Fear or anxiety specific to social settings, where you feel noticed, observed, or scrutinized.”

Social Anxiety Disorder = ALMOST identical to Specific Phobia definition in DSM-5

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Anxiety Disorders: Social Anxiety Disorder

DSM-5 Diagnostic Criteria

Fear of social rejection (and that others will notice your anxiety)
Social interaction cause distress
Social interaction is avoided or endured with intense anxiety/distress
Fear and anxiety are disproportionate to the situation

_KEY COMPONENT: Fear of Evaluation_

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Anxiety Disorders: Social Anxiety Disorder

Prevalence

~12% of the general population
Slightly higher rates in women

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Anxiety Disorders: Social Anxiety Disorder

Facts (course, age, comorbidity, impairment)

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Chronic – doesn’t usually go away with treatment
Onset age: Adolescents – Early Adulthood
High comorbidity with other anxiety disorders and depression
Impairment Ranges: moderate to severe

Anxiety Disorders: Social Anxiety Disorder

Treatments

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Medication:

SSRIs → Very effective
- BUT relapse rates = high when medication is stopped

Psychological Treatments:

Cognitive Behavioral (Preferred method of treatment by AMA)
- ie: exposure, rehearsal, role-play in group settings
Social Skills Training
- ie: Extensive modeling of behaviors
Attention Bias Modification Training
- A computer-based method that helps retreain people to focus on positive stimuli instead of negative stimuli.
- seems to help reduce anxiety (more data needed to know how long affects last)

Anxiety Disorders: Generalized Anxiety Disorder (GAD)

Definition

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Textbook Definition: “Excessive and uncontrollable worry about a number of events or activities, and associated with symptoms of (physical) arousal.”

Anxiety Disorders: Generalized Anxiety Disorder

DSM-5 Diagnostic Criteria

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Excessive worry at least 50%
- Trouble controlling these worries

At least 3 of the following:

Restlessness or feeling “keyed up” or on edge
Easily fatigued
Difficulty concentrating or mind going “blank”
Irritability
Muscle tension
Sleep disturbance (falling asleep, restless sleep)

Anxiety: Generalized Anxiety Disorder vs. Major Depression Disorder

GAD symptoms vs. MDD Symptoms)

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Big Differences:

GAD = Big worries + Trouble controlling worries
MDD = Sad Mood + Anhedonia (difficulty experiencing pleasure)

Anxiety Disorders: Generalized Anxiety Disorder

Prevalence

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Lifetime prevalence ~ 6%
Gender: 2x more women than men (approximately 2:1 ratio)

Anxiety Disorders: Generalized Anxiety Disorder

Facts (course, heritability, comorbidity)

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Often a chronic condition
Heritability ~33%
Comorbidity: High overlap with MDD

Anxiety Disorders: Generalized Anxiety Disorder

Treatment

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Cognitive Behavioral Therapy (CBD)

Identify, track, and challenge worries

Mindfulness Based Cognitive Therapy

Focus on present moment
When mind wanders to ‘what ifs’, gently bring it back to present
Relaxation strategies
Identifying thoughts + emotions remembering anxieties aren’t facts
Self-compassion

Medications
* SSRIs
* Benzos – not a good solution

Anxiety Disorders: Panic Disorder/ Panic Attack

Definition

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DSM-5 (in class) Definition: “A sudden onset of intense apprehension, terror, and/or feelings of impending doom, peaks quickly (10 minutes)”

Anxiety Disorders: Panic Attack Symptoms

Physical Symptoms: * shortness of breath, chills, chest pain, etc... **Psychological symptoms:** * Depersonalization—feel like outside body * Derealization—feel like world isn’t real * Fear of losing control/going “crazy” * Fear of dying

Anxiety Disorders: Panic Attacks / Disorder Prevalence, gender, course

* ~3-4% of the population * 2x as prevalent in women * ~20% of college students have a panic attack *(most only have one)* * Intermittent Course - goes away, but comes back

Anxiety Disorders: Panic Attacks / Disorder Facts

* First attack usually experienced after high stress situation * The _**response**_ to panic attack _determines_ if one develops Panic _Disorder_ * Many adults who experience attack, never go on to develop Panic Disorder

Anxiety Disorders: Panic Disorder DSM-5 Diagnostic Criteria

* Recurrent, unexpected panic attacks * Persistent worry about having another panic attack * or about the consequences of another attack (losing control, having heart attack, “going crazy,” etc.) * Significant change in behavior because of/related to attacks **(ie: avoidance)** * Can occur with or without Agoraphobia *(The Fear of being in a situation difficult to escape or receive help)*

Anxiety Disorders: **Agoraphobia Definition**

**The fear or anxiety about being in situations difficult to escape or receive help**

Anxiety Disorders: Agoraphobia DSM-5 Criteria

Fear or anxiety about being in situations _difficult to escape or receive help_ * These situations are avoided or endured with intense fear/anxiety *Note: Often portrayed as being house bound, but it’s not necessarily the case*

Anxiety Disorders: Panic Disorder Treatment

**Medication:** * Benzodiazepines – **not** recommended, *relapse* frequent **Therapy:** * **Exposure** is key – and very effective! * Interoceptive Exposure: exposure to physical sensations associated w panic attack * _Goal_: watch anxiety go up, cope with it, learn that you will be okay

Anxiety Disorders Genes & Heritability

* Anxiety = 30-60% heritable * Some genes may elevate risk for disorders * Genetic vulnerability for anxiety & depression may overlap

**Anxiety Disorders** Neurobiological / Relevant Brain Regions

**Relevant Brain Regions:** * Limbic System is Key* * Heightened activity in the amygdala / insula * Diminished activity of the prefrontal cortex in response to threatening stimuli **Neurotransmitters:** * Serotonin and GABA are disrupted * Norepinephrine levels increases Sympathetic Nervous system involved: physical symptoms

Anxiety Disorders: Panic Disorder **Positive Feedback Loop**

**Positive Feedback Loop** When a person reacts anxiously to their physical symptoms this increases their anxiety.

Anxiety: Types of Exposure Therapy

**In Vivo Exposure:** Exposed to the fear in real life **Imaginal Exposure:** Imagining a fear vividly **Interoceptive Exposure** Triggering physical sensations to learn they are not harmful **Virtual Reality Exposure:** Being exposed to the fear via VR

Anxiety: Treatment DURING a Panic Attack

During a panic attack – **focus on present moment** * Focus on Breath * What can you see, hear, taste, smell to help bring you to present * wait for symptoms to lessen

Anxiety Disorders: Treatment Across Anxiety Disorders

**Exposure Therapy:** effective for 70–90% of clients who do it **Mindfulness/relaxation and acceptance:** A promising approach **Medications:** Effective, but _high relapse rates_ when medications are stopped *(SSRIs better long-term choice)* **_Psychological treatments_ are the _preferred_ method**

Anxiety Prevention

School prevention programs * may be helpful in reducing future anxiety symptoms / disorders BUT **evidence is mixed**

Exam 2 - Anxiety Disorders Flashcards

(38 cards)