Lecture 5: Fear and Anxiety: Chapter 6 Flashcards
1
Q
What is the function of emotion?
A
Help to quickly deal with a situation (Adaptive
- Helpful to deal with environment and threats
- Social component
2
Q
What is fear? Name 5 aspects
A
- Basic emotion with cross-cultural similar facial expression
- Present in immediate danger
- Cortisol/adrenaline –> muscle toning, heartrate up, breathing fast
- Behavior –> freeze, flight, fight, fright
- Cognitive idea that there is danger
3
Q
What are hot cognitions in relation to fear?
A
In a fearful state, you have more catastrophic thoughts
4
Q
What is anxiety? (3)
A
- Complex emotion
- Anticipatory anxiety for future threats
- Avoidance/preparation
5
Q
What are 3 aspects of irrational fear?
A
- Stimulus doesn’t justify the fear
- Excessive intense fear
- Excessive long duration of fear
6
Q
What are 2 aspects of an anxiety disorder?
A
- Irrational fears
- Causing serious distress and impairment
7
Q
What is the main age separation anxiety disorder and selective mutism is seen?
A
Children
8
Q
What is the prevalence of panic disorder and are there differences between genders?
A
3,8%
More female (5%) than male (3%)
9
Q
What is the prevalence of agoraphobia without panic and are there differences between genders?
A
0,9%
More female (1,4%) than male (0,4%)
10
Q
What is the prevalence of specific phobia and are there differences between genders?
A
7,9%
More female (10,3%) than male (5,5%)
11
Q
What is the prevalence of social anxiety disorder and are there differences between genders?
A
9,3%
More female (10,9%) than male (9,3%)
12
Q
What is the prevalence of generalized anxiety disorder and are there differences between genders?
A
4,5%
More female (5,4%) than male (3,6%)
13
Q
What is the prevalence of anxiety disorder and are there differences between genders?
A
19,6%
More female (23,4%) than male (15,9%)
14
Q
What is a highly comorbid disorder for anxiety disorder and why (3)?
A
Depressive disorders
- Same systems that account for depression also account for depression (amygdala)
- Negative thoughts and emotions
- Avoidance of fears facilitates not having positive experiences
- Neuroticism is basis of both
15
Q
What are 3 examples of environmental factors that influence diathesis?
A
- Positive/negative experiences
- Parent modelling
- Parenting styles
16
Q
Higher motor activity in 4 month old babies is associated with… (Kagan) Why?
A
More motor activity associated with future shyness and social anxiety
It’s because they have a vulnerable temperament, which makes them more at risk for emotions getting to them and developing social anxiety disorder
17
Q
What happened to little albert? What was the US, UR, CS and CR?
A
US: loud noice
UR: fear response
CS: rat
CR: fear response
He learned to be afraid of rats due to loud noices always coming after seeing rats
18
Q
What is Mowrer’s vision on the etiology of fear? (1950)
A
- Fear acquired through classical conditioning
- Fear is maintained through operant conditioning
19
Q
How does the maintenance of fear work and what is the neurotic paradox?
A
Reinforcement of avoidance
Paradox:
- Short term +: fear lessens temporarily
- Long tem -: pathology maintained
20
Q
Why does avoidance of fearful stimuli lead to maintenance of pathology according to Mowrer?
A
Because you never learn that a CS can be separate from the US. You avoid testing that hypothesis
21
Q
What are 7 criteria of specific phobia?
A
- Marked fear or anxiety for specific thing
- Always fear, immediate
- Avoidance or endured with discomfort
- Out of proportion to actual danger (in context)
- Duration for over 6 months
- Distress/impairment
- Not better explained by other disorders
22
Q
Give examples of specific types of phobia
A
Animal, natural environment, situational etc.
23
Q
What are 3 types of exposure therapy?
A
- In vivo
- Imaginary
- VR
24
Q
What are the 2 styles of exposure therapy?
A
- Flooding
- Gradual (hierarchy)
25
What is a downside of exposure therapy? (2)
1. Fear can return and can be quickly relearned
2. High dropout of clients
26
What is the relation between habituation and exposure therapy?
It would mean the response fading out when presented with CS.
But habituation doesn't really predict therapy success
27
How does extinction in exposure therapy work? And which brain areas are involved
Inhibition of CS-US association in the amygdala by presenting CS-noUS association (pfc & hippocampus)
In successful exposure, the pfc&hippocampus win the competition of inhibiting the amygdala
28
What are 3 points of criticism on Mowrer's learning theory? How can you respond to each of these?
1. More fears for certain stimuli (e.g. snakes)
--> Evolutionary preparedness
2. Fear without traumatic experiences (no conditioning experience)
--> Learning through other things, information transfer (live through someone elses experiences (vicarious)), inflation
3. No fear after traumatic experience
--> Latent inhibition (previous positive experiences), differential learning (some acquire fears easier than others)
29
Give an example of inflation of fear
As a child being licked by a dog and experiencing it as fearful. Later you get to know other fearful stories about dogs and you develop an anxiety for it
30
What is the major paradigm in explaining anxiety disorders?
Learning theory of Mowrer
31
What are 2 types of behavioral therapy of specific phobias?
1. D-cycloserine: cognitive enhancers whilst doing exposure therapy that enhances positive experiences (not a lot of evidence)
2. Beta-blockers: disrupt memory reconsolidation: get fear up really high (still active research, sometimes work, sometimes not)
32
What is the distinctive characteristic of panic disorder vs. other disorders with panic attacks?
Panic disorder: unexpected panic attacks
Other: predictable triggers for panic attacks
33
What is an old and wrong explanation of panic attacks?
Hyperventilation causes dysregulation of blood acidity
--> Wrong because the opposite disturbance can also cause panic
34
What is the new explanation of panic attacks? Which model does it use?
Catastrophic misinterpretation of bodily sensations
Cognitive model of the panic circle
35
Describe the panic circle. What are the 2 points of entry
1. Perceived threat
2. Apprehension or worry (e.g. about panic attack or danger in situation)
3. Body sensations
4. Interpretation of sensations as catastrophic, then going back to 1
Trigger stimulus can be seen as perceived threat (1) or trigger stimulus influences body sensations (3)
36
What are the 5 major anxiety disorders?
1. Specific phobia
2. Social anxiety disorder
3. Panic disorder
4. Agoraphobia
5. Generalized anxiety disorder
37
What are 3 defining symptoms of social anxiety disorder?
1. Marked and disproportionate fear consistently triggered by exposure to potential social scrutiny
2. Exposure to trigger leads to intense anxiety about being evaluated negatively
3. Trigger situations are avoided or else endured with intense anxiety
38
What are the 2 defining symptoms of panic disorder?
1. Recurrent unexpected panic attacks
2. At least 1 month of concern about the possibility that more attacks could occur or the possible consequences of an attack or problematic behavioral changes to avoid attacks/consequences
39
What is a panic attack?
A sudden experience of intense apprehension, terror, feelings of impending doom
Accompanied by at least 4 other symptoms (high heartrate, shortness of breath, sweating, nausea, chills, numbness, tingling sensations, depersonalization, derealization, fear of losing control
40
What is the typical age of onset of panic disorder?
Adolescence
41
What is a defining characteristic of agoraphobia?
Disproportionate fear about situations from which it would be embarrassing or difficult to escape if anxiety symptoms occurred
- The situations consistently provoke fear/anxiety
- The situations are avoided, endured or require companion
42
What are 3 defining symptoms of Generalized Anxiety Disorder (GAD)?
1. Excessive anxiety/worry at least 50% of days for at least 6 months
2. Difficult to control the worry
3. Anxiety and worry are associated with at least 3 of the following:
a. Restlessness or on edge
b. Tired easily
c. Difficult concentrating
d. Irritability
e. Muscle tension
f. Sleep disturbance
43
What are 6 symptoms associated with GAD that you need at least 3 of to get a GAD diagnosis?
a. Restlessness or on edge
b. Tired easily
c. Difficult concentrating
d. Irritability
e. Muscle tension
f. Sleep disturbance
44
What percentage of people with anxiety disorders will experience major depression during their lives?
60%
45
What could be an explanation for females having more anxiety disorders than males? (5)
1. Women are more likely to report their symptoms
2. Men may experience more social pressure than women to face fears
3. Women are more likely to be sexually assaulted
4. Gender roles: men may be raised to believe more in their personal control over situations than women
5. Women have higher neuroticism
46
What is the influence of culture on anxiety? (2)
1. Influences what people tend to fear
2. Express symptoms in different ways
47
In which cultures do anxiety disorders occur more often?
In countries with high levels of income inequality, war and revolution
48
What are 3 ways classical conditioning can occur in Mowrer's 2 factor model? Give examples of each
1. Direct experience (dog bites you)
2. Modeling (see a man bitten by dog)
3. Verbal instruction (hear someone warn that dogs are dangerous)
49
What does a neutral predictable unpredictable threat task (NPU) test? What are the 3 conditions?
Tests responses to unpredictable threats
1. Neutral: no stimulus
2. Predictable: warning + stimulus
3. Unpredictable: stimulus without warning
50
What are outcomes typical to anxiety disorder patients in the NPU threat task?
They are sensitive to unpredictable, diffuse or remote threats rather than acute immediate well-defined tests
51
What 3 factors distinguish individuals with anxiety disorders from those without?
1. More easily conditioned to fears
2. Sustain conditioned fears longer
3. Respond more strongly to unpredictable threats
52
What is the heritability for anxiety disorders?
50%
53
What are some genetic influences on anxiety disorders?
1. Less medial pfc activity --> less regulation of amygdala
2. Neurotransmitters activity (serotonin (modulate emotions), GABA (amygdala), norepinephrine (fight/flight))
54
Which 2 personality traits predict onset of anxiety disorders?
1. Neuroticism
2. Behavioral inhibition
55
What is the fear circuit? What are the main 5 involved regions and their function?
Set of brain structures engaged when people feel anxious or fearful
1. Hippocampus: encoding context of fearful stimuli
2. Amygdala: conditioning fears, processing threat
3. Medial prefrontal cortex: regulate amygdala
4. Anterior cingulate: anticipation of threat
5. Insula: awareness/processing body cues (arousal)
56
What is behavioral inhibition?
Tendency in infants to become agitated and cry when faced with novel toys
57
What are 4 cognitive factors that increase the risk of anxiety disorders?
1. Persistent negative beliefs about future --> safety behaviors
2. Lack of perceived control of environment (bad childhood)
3. Intolerance for uncertainty
4. Too much attention to threats
58
What is prepared learning?
The idea that evolution has biologically prepared us to learn fear of certain stimuli very quickly and automatically (e.g. spiders, snakes)
59
How does Mowrer's 2 factor model explain social anxiety disorder?
Classical condition through negative social experience
Maintenance through avoidance (operant conditioning)
60
What are cognitive factors involved in social anxiety disorder?
1. Negative self-evaluations and worry about negative consequences of their social behavior
2. More attention to how they are doing in social situation and own internal sensations
3. More concern about social rank of hierarchy
61
How can too much focus on internal cues influence social interactions?
1. Don't pay enough attention to others
2. Less reciprocal nonverbal behaviors
62
How is social anxiety related to more concern about social rank?
People with social anxiety show more submissive behavior
63
Which brain region is especially important in fear processing in panic disorders? What is the function?
Locus coeruleus: source of norepinephrine in the brain, which is a neurotransmitter responding to stress and is able to elicit a bodily stress response
People with panic disorder have a more biological response to releases of norepinephrine
64
What is interoceptive conditioning?
Classical conditioning of panic attacks in response to bodily sensations
E.g. when someone experiences somatic signs of anxiety, they are associated with panic attacks because of previous panic attacks, so they actually cause the panic attack
Panic attacks become a conditioned response to somatic changes
65
What is the anxiety sensitivity index?
It measures the extent to which people respond fearfully to their bodily sensations
66
Which model describes the cognitive factors involved in panic disorder?
The panic cycle
67
What is the fear-of-fear hypothesis in agoraphobia?
A cognitive explanation that involves having negative thoughts about consequences of experiencing anxiety in public. They tend to have catastrophic beliefs that their anxiety will lead to socially unacceptable consequences
68
What does the contrast avoidance model explain? What is the core of this model? How does it show when a laboratory stressor is applied?
Why some people worry more than others do
Core = people with GAD find it highly aversive to experience rapid shifts in emotions. People with GAD prefer to sustain chronic state of worry and distress
Lab stressor: GAD people have less increase in mood and psychophysiological arousal
69
What is the main point of the contrast avoidance model in GAD?
Worry might protect people from sudden increases in negative moods by sustaining a more chronically negative mood
70
Match the theory to the model of etiology of:
1. Panic disorder
2. GAD
3. Specific phobias
4. Agoraphobia
5. Social anxiety disorder
1. Anxiety sensitivity
2. Contrast avoidance model: avoidance of changes in negative emotions
3. Prepared learning
4. Fear of fear
5. Too much focus on one's own flaws
71
What is an effective component in treatment of anxiety disorders?
Exposure
72
How does cognitive behavioral therapy work for treating anxiety disorders?
Clients are gradually exposed to things they are afraid of. The goal of exposure is the extinction of the fear response by learning new associations with the feared object/situation
73
What are 2 essential components of treatment to prevent relapse?
1. Exposure must contain as many features as possible of the feared object
2. Exposure must be done in as many contexts as possible
74
What are 2 ways that exposure relieves symptoms of anxiety?
1. Realize they can tolerate feared situation
2. Realize there's no loss of control
75
What is the effectiveness of in vivo exposure compared to VR exposure?
Both equally effective for objects and situations in real life
76
How does extinction of a fear work at a neurobiological level?
Newly learned associations in PFC inhibit activation of fear in amygdala. So extinctions involves learning, not forgetting
77
What is the behavioral view of exposure? What is the cognitive view?
Behavioral: It works because it extinguishes fear response. People with more rapid extinciton of conditioned fears also show better response to exposure treatment
Cognitive: correct mistaken beliefs that the person is unable to cope with the stimulus
78
What treatment works best for phobias? What is a less effective alternative?
Exposure treatments (in vivo)
Systematic desensitization (gradual exposure, whilst at the same time doing some relaxation)
79
What is an effective method for treating social anxiety disorder? What does that treatment look like?
Cognitive behavioral therapy: role play exercises with the therapist or in small groups. Social skills training and relaxation are important as well
80
What does treatment of panic disorder look like?
CBT with focus on bodily sensations. By deliberately eliciting the bodily sensations, the person experiences them under safe conditions. The person practices coping tactics for dealing with the somatic symptoms as well
The person will stop seeing physical sensations as signals of loss of control and see them as intrinsically harmless and controllable
81
What is cognitive treatment in panic disorder?
Help person identify and challenge thoughts that make physical sensations threatening
82
How is agoraphobia treated? How is the patient's partner involved?
With CBT focused on systematic exposure to feared situations. THe person may be coached to gradually tackle leaving home and gradually going farther from home
Partner is taught that recovery rests upon exposures. Partners learn to foster exposure rather than avoidance
83
What is the most often used behavioral technique for people with GAD?
Relaxation training. This is more effective than nondirective treatment
84
How is CBT used in treating GAD?
Used to improve problem solving and to address the thought patterns that contribute to GAD.
It helps to tolerate uncertainty and target worry.
85
How can CBT treat worry in GAD?
By keeping a diary of the outcomes of worrying. It helps focus their thoughts on the present instead of worrying
86
What are 2 types of medication used to treat anxiety disorders? Which one is preferred and why?
1. Benzodiazepines
2. Antidepressants (SSRIs, SNRIs)
Antidepressants are preferred, because benzodiazepines can be addictive and have significant cognitive and motor side effects
87
What are 2 disadvantages of benzodiazepines?
1. Addictive
2. Side effects on cognitive and motor skills (memory, drowsiness)
88
What are side effects from SSRIs and SNRIs?
Gastrointestinal distress, restlessness, insomnia, headache, diminished sexual functioning
89
Why are medications not the best option for treating anxiety?
Side effects are significant, which is a reason why people quit using them. The medication only works in the time they're taken. Most people relapse after stopping medication, so it doesn't really provide any relief
90
For which anxiety disorder is medication an option?
GAD: medication and psychological treatment seem to work equally well
