Lecture 4 (Anxiety disorders) Flashcards
(19 cards)
Fear vs Anxiety
And why anxiety can be helpful
Fear = stress response from immediate danger, builds up quickly or intensely -> motivates behavioural responses
Anxiety = anticipation of future problems, emotional experience is out of proportion to threat
Anxiety can act as a positive warning system that threat is imminent, and signals to activate protective responses
Anxiety disorders: general considerations and features
Considerations:
-> differ from norm responses by being excessive, persisting beyond developmentally appropriate periods
-> are not transient fears (do not pass) they are persistent
-> impact life functioning
-> Physiological, cognitive, and behavioural responses fall under emotions
Features:
-> subjective feelings of anxiety
-> expectation of disaster
-> avoidance
-> disturbances in thinking
Epidemiology
Anxiety disorders most common under 12 month mental disorders
Social phobia most common for males and females
Specific Phobia and specifiers
Marked fear or anxiety about specific object or situation
-> exposure to stimuli almost always provokes fear
-> stimuli is actively avoided or endured with intense feelings of anxiety
-> out of proportion to stimuli
-> 6 months or longer
7-9% prevalence
Females 2 x more likely to have
Specifiers
Can be animals, environment (e.g. storm), situational, blood related
Social anxiety disorder and clinical features
->Marked fear about social situation where you are being negatively evaluated or fears they will show anxiety that will be negatively evaluated
-> social situations almost always provoke fear (6 months longer) and results in significant impairment
-> can be performance related only (e.g. speaking in front of crowd) or can be more broad e.g. eating in public, using public toilets, being in situation where someone thinks they may do something foolish
Clinical features:
->belief others see them as stupid
-> Avoidance or use of safety behaviours to reduce anxiety
-> pre and post event analysis
-> focus on internal situations e.g. focus on heart rate and think others notice you have a high heart rate
Panic disorder criteria/epidemiology/symptoms
Recurrent and unexpected panic attacks
-> one attack followed by a month of one or more
-> concern about additional attacks
-> maladaptive change in behaviour (e.g. avoidance of going somewhere to avoid panic attack)
Minor increase in prevalence
3-5% of population experience panic attacks but do not meet criteria for panic disorder
Panic attack =
-> pounding heart
-> sweating / trembling
-> shortness of breath
-> chest pain
-> nausea
-> chills / heat
-> parasthesias (numbing)
-> derealisation / depersonalisation
-> fear of losing control
-> fear of dying
Panic attack to panic disorder (fear of fear cycle) and more
stuck in fear of fear cycle -> fear -> FFF symptoms -> ‘something is wrong’ -> body sensations -> “im dying”
catastrophize physical sensations
-> avoid situations that may produce body sensations e.g. coffee, exercise
-> react to any bodily sensation
Agoraphobia
Fear of being a space where it may be hard to exit when needing to e.g. having anxiety or having panic attack
Anxiety is about being in places because of the thought that escape will be too difficult
6 months or longer
Double in prevalence nearly
GAD and features
Excessive anxiety and worry for more days than not for 6 months about a number of events or activities
Difficulty in controlling worry
3 or more
-> restlessness
-> fatigue
-> concentration
-> irritability
-> muscle tension
-> sleep disturbance due to anxious thoughts
Features:
-> less tolerance for uncertainty (e.g. want to have full weekend planned out)
-> overestimation of negative consequences
-> underestimate coping abilities
-> believe worry is helpful but also dangerous
-> always expecting the worse to happen
OCD -> obsessions and common obsessions
Compulsions = intrusions
-> recurrent and persistent
-> having intrusions are normal but in OCD those intrusions are further evaluated
-> attempts to ignore or suppress or neutralise with some thoughts or actions
common obsessions
-> contamination
-> symmetry
-> harm to self or others
-> taboo or forbidden thoughts e.g. sexual
OCD -> Compulsions
Compulsions are known as neutralising behaviours
-> repetitive behaviours or mental acts
-> real drive to complete these behaviours have to do it the same way
-> aimed at preventing or reducing anxiety or preventing situations
-> not realistically connected or are clearly excessive
e.g. checking, rituals, washing
OCD criteria and epidemiology
Presence of obsessions, compulsions or both
obsessions/consumptions are time consuming (>1 hour a day)
Obsession is not related to another disorder e.g. food related to ED
Have to specify their insight
Double in prevalence
usually starts early and usually a gradual response
PTSD epidemiology/criteria/features
6.4% in general population, but 20% in veterans
veterans usually have high comorbidity with depression/anxiety/substance
Characteristics not required for diagnosis
-> presence of fear, hopelessness, horror, shame or guilt
Criteria
Exposure to something traumatic
Presence of one or more intrusions
-> involuntary distressing memories
-> dreams
-> psychological / physiological distress in response to cues
Avoidance with thoughts/feeling/memories or external reminders of event
Negative alterations 2 or more
-> inability to remember aspects of the event
-> exaggerated negative beliefs about oneself or the world
-> distorted cognitions about the event e.g. i am to blame
-> persistent negative emotional state
-> diminished interest in activities
-> feelings of detachment
-> inability to experience positive emotions
Physiological arousal two or more
-> irritability
-> self-destructive behaviour
-> hypervigilance
-> startle response
-> concentrating
-> sleep disturbance
Has to be longer than one month
Distinguish between distress or dysfunction
Aetiology of anxiety from historical psychodynamic approach
Not contemporary thinking for current diagnosing
-> anxiety arises from psychic conflict between id and threats from the super ego
-> anxiety is signal that indicates an impulse is about to be acted on and triggers defense to prevent recognition of impulse
-> if impulse too strong, anxiety overwhelms system and person develops disorder
Evolutionary/biology/genetics/neuro
Evolutionary
-> anxiety developed in response to threat (protective behaviour when activated at appropriate times)
-> anxiety apart of adaptive system
-> disorders are problems in regulation of system which evolved to deal with threats
Biological
-> MZ highest for panic disorder and agoraphobia
Neuro
-> limbic activation (amygdala)
-> HPA axis
Psychosocial perspective
Event based explanations
Stressful life events
Childhood adversity
Parenting style
Temperament -> problems if their is a mismatch in child and parent temperament
Attachment problems and separation anxiety
Conditioning and Learning models
Classic -> the phobia is the NS (e.g. dog) and is paired with an aversive stimulus (e.g. dog bite) provoking fear reactions
-> model does not explain maintenance of fear response and why some develop it and others dont
Operant -> aversive stimulus -> become anxious -> run away (run away reduces anxiety (e.g. -ve reinforcement so you keep doing it)
Observational learning -> we learn through modelling and learn to avoid stimuli of modelled by sig. others
Cognitive processes and anxiety disorders
Appraisals, expectations, attention and cog avoidance associated with development and maintenance of disorder
Catastrophic misinterpretation -> overestimate stimuli as threatening
Attentional bias to threat -> hypervigilant to cues signalling future threats
Chronic thought suppression -> struggle to suppress and control thoughts which provoke anxiety, rebound effects
Treatment
Meds first treatment
Use of free association and dream association -> use psychoanalysis to discover and work through conflicts
IPT -> targeting interpersonal conflicts, role transitions etc.
CBT -> use of psychoeducation to find triggers, cog restructuring, and ABC model
EXPOSURE THERAPY -> gradual and repeated exposure
Mindfulness and relaxation based therapies to help reduce anxiety levels
