Lecture 9 - Anxiety Disorders & Obsessive-Compulsive Disorder Flashcards
(19 cards)
What do we man by “anxiety”?
Anxiety, anticipatory anxiety, apprehension, worry, onerousness, panic, fear, scared
Fear- and emotional response to an immediate threat and is more associated with a fight or flight reaction (APA, 2013)
“a primitive automatic neurophysiological state of alarm involving the cognitive appraisal of imminent threat or danger to the safety and security of an individual” Clark and Beck, 2010
Anxiety - associated with anticipation of future concern (APA, 2013)
“a complex cognitive affective, physiological and behavioural response system (i.e. as threat mode) that is activated when anticipated events or circumstances are deemed to be highly aversive because they are perceived to be unpredictable, uncontrollable events that could potentially threaten the vital interests of an individual” Clark and Beck, 2010
Anxiety and arousal
Functional and adaptive
Important and helpful in shaping behaviour and avoiding aversive/dangerous situations
High levels aversive
Yerkes-Dodson law:
- arousal impacts on performance
Autonomic responses in fear/anxiety
Perception of threat tiggers sympathetic nervous system, for “fight-or-flight” response
Stress hormones (inc. epinephrine, norepinephrine, cortisol) trigger and maintain variety
Symptoms:
- sweat
- blood low to muscles increases
- heart-rate increases (tachycardia)
- breath more rapidly (increases respiration)
- light-headedness/dizziness
- nausea
- trembling, shaking
- tense muscles
- dry mouth desire to urinate
- release blood sugar (glucose) and fats
Resolution or threat associated with reduction or activation in sympathetic nervous system, and increased activation of parasympathetic nervous system
Anxiety disorder and anxiety-related difficulties
Anxiety disorders - differ form normal feelings of anxiousness and involve excessive fear or anxiety
Typically lead to avoidance of stimuli/situations which impacts psychosocial functioning (e..g jobs, school work, relationships)
Typically characterised by fear or anxiety out of proportion to the situation and/or significant impact on functioning
Most common group of mental disorders and affect nearly 30% of adults at some point in their lives
Number of effective treatments available
History of anxiety classification DSM
DSM-I psychoneurotic disorders (1952):
- phobic reaction
- anxiety reaction
- obsessive compulsive reaction
- depressive reaction, conversion reaction, dissociative reaction
DSM-II neuroses (1968):
- phobic neurosis
- anxiety neurosis
- obsessive compulsive neurosis
- depressive neurosis, hysteria neurosis, neurasthenic neuroses, hypochondriacal neurosis
DSM-III anxiety disorders (1980):
- agoraphobia with panic attacks, agoraphobia without panic attacks
- social phobia, specific phobia
- panic disorder
- GAD
- OCD
- PTSD
DSM-III-R anxiety disorders (1987):
- agoraphobia without history of panic disorder
- social phobia, specific disorder
- panic disorder without agoraphobia, panic disorder with agoraphobia
- GAD
- OCD
- PTSD
DSM-IV anxiety disorders (1994):
- agoraphobia without history of panic disorder
- social phobia, specific phobia
- panic disorder with agoraphobia, panic disorder with agoraphobia
- GAD
- OCD
- PTSD, Acute stress disorder
DSM-5
Anxiety disorders:
- specific phobia
- social anxiety disorder
- panic disorder
- agoraphobia
- gernalsied anxiety disorder
- separation anxiety
- selective mutism
Obsessive-compulsive related disorders:
- OCD
- body dysmorphic disorder
- hoarding disorder
- trichotillomania
- excoriation
- substance/medication induced OCD
- obsessive-compulsive and related disorder due to another medical condition
- other obsessive-compulsive or unspecified obsessive-compulsive disorder
Trauma and stressor-related disorders
- reactive attachment disorder
- disinhibited social engagement disorder
- PTSD
- accuse stress disorder
- adjustment disorder
- other specified/unspecified trauma and stressor related disorder
Common anxiety disorders
Disorder -> key diagnostic features -> examples of important identified clinical features
Specific phobia - marked fear or anxiety about a specific object or situation, exposure to stimuli elicits an intense fear response -> avoidance/safety behaviours, anxiety sensitivity (fear of fear)
Panic disorder -> recurrent unexpected panic attacks; persistent concern or worry about additional panic attacks or their consequences and/or significant maladaptive change in behaviour related to the attacks -> catastrophic misinterpretation of physical symptoms, avoidance/safety behaviours, self-focussed attention
Social phobia/social anxiety disorder -> persistent fear and avoidance of social and performance situations; fears typically concern potential negative evaluation by others as a result of anxiety symptoms and/or social situations -> negative mental imagery, avoidance/safety behaviours. self focused
Generalised anxiety disorder (GAD) -> chronic, persistent and excessive anxiety and worry about a number of events or activities that individuals find difficult to control -> intolerance of uncertainty, metacognitive beliefs and worry, cognitive avoidance
Agoraphobia -> fear of being in situations where escape may be difficult or embarrassing, or help might bot be available in the event of panic symptoms (e.g using public transport, open spaces, being in enclosed places, in crowd, being outside the home alone) -> avoidance/safety behaviours, anxiety sensitivity (fear of fear)
Posttraumatic Stress Disorder (PTSD)
No longer classified as an anxiety disorder in DSM-5
Develops in some people after extremely traumatic events, such as combat, assault, an accident, or natural disaster
Symptoms typically begin within 3 months after trauma
PTSD consists of variety of clinical symptoms:
- intrusion
- avoidance
- negative alterations in cognitions and mood
- hyperarosual
Relative predominance of different symptoms may vary over time
Common cognitive symptoms in fear/anxiety (clear & Beck, 2010)
Fears of
- losing control/jot coping
- impending death or injury
- negativ evaluation by others
- “going crazy”
Thinking about matters outwith focus of threat may become more difficult
Hyper vigilance
Threat-related imagery/memories
Impaired reasoning processes
Common behavioural and affective symptoms in fear/anxiety (Clark and Beck, 2010)
Behavioural
- avoidance of threat
- behaviours to mitigate against perceived threat (safety behaviours)
- escape/flight
- reassurance seeking
- restlessness/agitiation
- freeze response
Affective
- nervousness
- wound-up
- frightened
- fearful
- jumpy
- jittery
- frustrated
- impatient
Anxiety disorder prevalence
Wittchen & Jacobi (2005) review of 27 studies of AD prevalence (12 month prevalence):
- panic disorder = 0.7-3.1
- agoraphobia = 0.1-10.5
- social phobia = 0.6-7.9
- GAD = 0.2-4.3
- specific phobia - 0.8-11.1
- OCD = 0.1-2.3
Criteria for diagnosis of individuals with DSM-IV anxiety disorder meet criteria for two or more disorders
Often chronic and will not display spontaneous remission of symptoms
Anxiety disorders have a number of shared clinical features and common hypothesised maintenance processes
Mowrer two factor theory of phobia (classical and operant conditioning)
Discrete learning event leading to conditioned fear response
- Pre-conditioning -
Neutral-stimulus (dog) -> no response
Unconditioned stimulus (pain appraisal of immediate danger, heart rate etc) -> unconditioned response (fear/anxeity, evaluated)
- Conditioning (paring for the two stimuli -
Neutral stimulus (dog) with unconditioned stimulus (pain, appraisal of immediate danger elevated heart rate etc) -> unconditioned response (fear/anxiety)
- Post conditioning -
Conditioned stimulus (dog) -> conditioned response (fear, anxiety symptoms)
Operant conditioning theory (Skinner) includes proposal that negative reinforcement (removing aversive stimulus) reinforces behavioural response
Suggests negative affect and maladaptive behaviours can be understood in terms of conditioned reflexes and shaking of behaviour
Escape and avoidance naturally reinforcing, which reduce anxiety, may prevent learning and contribute to generalisation across stimuli
Panic attacks and panic disorder
Panic attack: an abrupt surge of intense fear of intense discomfort that reached a speak within minutes
Symptoms include:
- pounding heart, tachycardia (rapid HR), palpitations
- sweating. trembling, shaking
- experience of choking, shortness of breath
- fears of losing control, dying or going cray
- pain or discomfort in the chest
- tingling sensations
- nausea
- dizziness
- light headedness
- feelings of being detached from self
- hot flashes or chills
Panic disorder:
- individual experiences recurrent panic attacks and experiences persistent concerns regarding occurrence and consequences of attack and/or maladaptive change in behaviour
Cognitive model of panic disorder
- sensation
- appraisal
- anxiety
- panic -> sensations increase -> safety behaviour and counter-productive strategies -> catastrophic misinterpretation (back to panic, then continue round)
Social phobia/social anxiety disorder
Social phobia is characterised by present fear and avoidance of social and performance situations
Lifetime prevalence estimates up to 12% in UK
Onset typically during adolescence (~15 years)
Anxiety symptoms experienced in anticipation of and during social events
Fears typically concern potential negative evaluation by others as a result of anxiety symptoms and/or social performance
Believe that negative evaluation will result in negative social consequences and engage in variety of behaviours to prevent/minimise this non-occurrence of social catastrophe attributed to performance of behaviours
Cognitive maintenance factors
- information and interpretation bias
- interpet performance significantly more critically
- show self-focussed attention
- indulge in excessive post-event processing of social events
Obsessive-compulsive disorder (OCD)
Obsession: current, unwanted, intrusive thoughts, images or impulses that cause distress/interference (e.g. blasphemous, aggressive or sexually repugnant thoughts, images out impulses)
Compulsions: repetitive behaviour that an individual feels driven to perform to reduce distress or to prevent some dreaded event from happening (e.g. washing, checking, counting hoarding)
OCD
Obsessions
- recurrent, persistent, unwanted intrusive thought
- though, urge or mental image containing contamination, sexual and aggressive impulses, body problems, religious aggression
- experienced as beyond person’s ability to control
- generally cause anxiety or distress
Lifetime prevalence estimated 2-6%
Usually begins gradually, in adolescence or early adulthood
Age of onset, sex ratio and kinda of obsession dn compulsions similar in a range of countries
Compulsions and examples
Repetitive behaviours that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly; aimed at preventing or reducing anxiety to distress, or preventing some dreaded event or situation
Not connected in a realistic way with what they are designed to neutraliser or prevent, or are excessive
- compulsive checking (e.g. of doors and windows)
- compulsive washing (to prevent contamination and infection)
- superstitious ritualised movements or thoughts (e.g. counting backwards until a thought has down)
- systematic arranging of objects
- compulsive hoarding
OCD cont
Obsessions are ego-dystonic:
- the content of the obsession is alien/inconsistent with values
- not within their control
- not the kind of thought they would expect to have
- argued that obsessions which threaten self-view more likely to capture attention
Majority of individuals in population (80-90%) experience intrusive thoughts, images and impulses with content similar to clinical obsessions
Appraisal of meaning/importance of unwanted thoughts may be key
Number of cognitive processes implicated e.g. inflated responsibility; thought-action fusion
