Lecture 9: Anxiety

Question 1

What is anxiety?

Answer 1

• A generalized feeling of fear and apprehension that may be related to a particular situation or object, often accompanied by increased physiological arousal
• Physiological arousal = heart palpitations, difficulty breathing, diziness, flushing, shaking, gastric distress, muscle tension
• Anxiety is normal and adaptive; can also be incapacitating and cause high levels of stress

Question 2

DSM-5 anxiety disorders

Answer 2

1. Specific Phobia
2. Agoraphobia
3. Social Anxiety Disorders (Social Phobia)
4. Panic Disorder
5. Generalised Anxiety Disorder

Question 3

Prevalence of anxiety disorders

Answer 3

• Life time prevalence rate of nearly 25% in NZ
• Highest prevalence rate for any disorder
• Females more commonly affected

Question 4

Specific Phobia

Answer 4

• Fear and avoidance which is excessive in relation to feared stimulus
• Different types = animal, natural env., blood-injection-injury, situational, other
• Causes clinically significant distress or impairment in social, occupational or other important areas of functioning
• Treatment generally involves graded exposure and relaxation

Question 5

Brain is a machine designed to detect threat (different parts involved)

Answer 5

• Amygdala = turns on flight/fight, stores memories of events
• Hippocampus = regulates memory and emotions
• Prefrontal cortex = thinking/logic/what to do/ evaluation
  = gets ‘turned off’ when anxious

Question 6

Agoraphobia

Answer 6

• Fear and avoidance of being alone in a place from which escape might be difficult or embarassing e.g. using public transport, outside of home alone
• Causes clinically significant distress or impairment in social, occupational or other important areas of functioning
• Treatment generally involves graded exposure and relaxation

Question 7

Social Phobia

Answer 7

• Marked fear/anxiety about one or more social situations in which individual is exposed to possible scrutiny from others
• Fear of negative evaluation
• Social situations avoided or endured with intense distress
• Causes clinically significant distress or impairment in important areas of functioning

Question 8

Panic Disorder

Answer 8

• Recurrent, unexpected panic attacks

- Persistent concern/worry about future panic attacks and/or maladaptive change in behaviour related to panic attacks

Question 9

Panic attack

Answer 9

• Abrupt surge of intense fear, reaches a peak within minutes
• Includes at least four of: heart palpitations/accelerated HR, sweating, trembling, shortness of breath, feeling faint, nausea, fear of losing control or dying

Question 10

Treatment of panic disorder

Answer 10

• CBT
• Psychoeducation on catastrophic misinterpretation of physical symptoms; cognitive restructuring
• Graded exposure to panic inducing symptoms (interoceptive exposure)

Question 11

Treatment of panic disorder

Answer 11

• CBT
• Psychoeducation on catastrophic misinterpretation of physical symptoms; cognitive restructuring
• Graded exposure to panic inducing symptoms (interoceptive exposure) until they no longer produce response (i.e. habituation occurs)

Question 12

Generalised anxiety disorder

Answer 12

• Constant and excessive anxiety and worry about things in general occurring for more days than not for at least 6 months; difficulty controlling worry
• 3 or more symptoms: restlessness (feeling on edge), being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance

Question 13

Treatment of generalised anxiety disorder

Answer 13

• CBT/ACT
• The metacognitive model: two type of worry
  1) worrying about something
  2) worrying about worrying

Question 14

Treatment: NICE guidelines

Answer 14

1) Talking therapy

2) Pharmacology