module 4 PT.2 Flashcards
(75 cards)
1
Q
anxiety disorders
A
characterized by individuals experiencing excessive fear and anxiety that impacts daily functioning and causes behavioural disturbances
2
Q
fear
A
- emotional response to real or perceived threat in the present moment
- triggers fight or flight
- e.g. it is how you feel if a tiger ran into the room
3
Q
anxiety
A
-anticipation of future threat
- experience symptoms such as muscle tension due to hypervigilance
- vigilance in preparation for future danger
4
Q
anticipatory/adaptive anxiety
A
- task oriented thoughts + helpful behaviours
- e.g. focusing on the task at hand, sitting down and studying for an exam; will contribute to dealing with a future challenge
5
Q
excessive/maladaptive anxiety
A
- task-interfering thoughts + maladaptive behaviors
- can also result in over preparedness
- e.g. “i’m going to fail this exam,” “i can’t do this,” not helpful thoughts and combined with maladaptive behaviors such as procrastination or avoidance
6
Q
clinically significant anxiety looks at
A
- endurance: how long does it last?
- intensity: is intensity of anxiety elevated compared to peers or what would be typical in said scenario?
- interference: impairment of functioning of self or others
7
Q
anxiety is difficult to study because it can be defined as:
A
- a subjective sense of unease, which is difficult to study
- a physiological réponse beginning in the brain resulting in elevated HR and tension; meaning there are a variety of bodily responses when anxious
- differences in sets of behaviours (i.e. worrying, fidgeting)
- anxiety can look like any or all of these
8
Q
fear vs. panic
A
- fear is an immediate alarm reaction to perceived danger
- panic is an abrupt experience of intense fear of discomfort, paired with severe and abrupt physiological changes
9
Q
panic attack
A
- abrupt experience of intense fear or discomfort, accompanied by severe and abrupt changes in physiology
- panic attacks typically last between 5-20 minutes
- often lead to development of panic disorders out of fear of having more panic attacks
- cued and uncued panic attacks
10
Q
cued panic attack
A
expected; when you know the situation will bring it about, why it’s happening
11
Q
uncued panic attack
A
unexpected; no clue when, why or where it will happen
12
Q
causes of anxiety
A
- biological factors
- psychological factors
- social/environmental factors
13
Q
biological factors contributing to anxiety
A
- genetic heritability
- neurotransmitters
- behavioural inhibition system (BIS)
- fight or flight system
14
Q
genetic heritability as a cause of anxiety
A
your parents having an anxiety disorder just means you are predisposed to anxiety disorders generally not that specific one
15
Q
neurotransmitters as a cause of anxiety
A
high norepinephrine (NE) and low GABA, serotonin and dopamine
16
Q
BIS as a cause of anxiety
A
- series of circuits that go from the brainstem to the limbic system and then to the frontal cortex
- when activated causes you to freeze and then actually determine if there is a threat
- no threat = calm down, activation of parasympathetic nervous system
- threat = activates fight or flight response
17
Q
fight or flight system as a cause of anxiety
A
- amydalga, hypothalamus, and central grey matter of the brain
- once activated your immediate response is alarm and escape, freeze, or fight
18
Q
psychological factors contributing to anxiety
A
- classical and operant conditioning
- dysfunctional beliefs and cognitive distortions
- anxiety sensitivity/temperament
19
Q
anxiety sensitivity as a cause of anxiety
A
- anxiety sensitivity: a general tendency to respond fearfully to anxiety symptoms
- people with high anxiety sensitivity notice physiological changes faster
- e.g. racing heart = dangerous
20
Q
temperament style of behavioural inhibition
A
- easily frightened, don’t like novelty, newness or change
- this temperament has been linked to anxiety disorders and shyness
21
Q
social environmental factors contributing to anxiety
A
- attachment styles to parents; typically insecure/anxious attachment
- social modelling and gender roles
- stressful life events
- physical influences
22
Q
causes of anxiety - integrated model
A
- recognize how factors together can contribute to a psychological disorder
- triple vulnerability theory which is how researchers have integrated biological, psychological, and specific factors that make you more vulnerable to an anxiety disorders
23
Q
integrated model - biological vulnerability
A
- heritable contribution to negative effects
- world views
- neuroticism
- “glass is half empty” type of people
- are they irritable or driven people?
24
Q
integrated model - generalized psychological vulnerability
A
- sense that events are uncontrollable/unpredicted
- general trait that can contribute to an anxiety disorder such as a tendency toward lack of self-confidence, low self-esteem or inability to cope
25
integrated model - specific psychological vulnerability
- e.g. physical sensations are potentially dangerous)
- health anxiety/illness anxiety disorder (hypochondria); fear of symptoms of health issues
- fear of social evaluation; inclined to avoid social situations
26
suicide & anxiety
- the presence of anxiety disorder uniquely increases likelihood of having suicidal thoughts and suicide attempts
- relationship stronger in those with panic disorder or PTSD
- in one study, 20% of people with panic disorder had attempted suicide (Weisman et al., 1989)
- individuals with anxiety disorders have a comparable risk of suicide attempts as individuals with major depression
27
generalized anxiety disorder (GAD)
- experience excessive worry and anxiety about multiple events or activities
- difficulty controlling the worry
- express 3 or more physiological symptoms to receive a diagnosis unless they are children in which case they need 1/6 symptoms
- symptoms must be present for 6 months
- slightly more common in women
- rare in childhood with the average age of onset being 30
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symptoms of GAD
- restlessness
- easily fatigued
- difficulty concentrating
- irritability
- muscle tension (specific to GAD)
- sleep disturbances
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biological model of GAD
- high norepinephrine and low serotonin
- medications include benzodiazepines to target GABA systems and slow things down; but are not typical due to chronic nature of GAD
- other medications: SSRIs and SNRIs
30
CBT model of GAD - cognitive avoidance model
- the cognitive avoidance model (Borkovec) claims that worry has a verbal linguistic nature and acts as an avoidance strategy to inhibit clear mental images and associated somatic and emotional activation
- staying in a verbal loop inhibits somatic response, processing emotional fear and prolongs worry
- worry is an avoidance of emotion and actually thinking about the things we are scared of
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cognitive avoidance model - treatment
- challenge the beliefs about worry
- exposure to worried about scenarios
- applied relaxation
32
CBT model of GAD - metacognitive model
- distinction between two types of worry
- type 1 worrying: worrying about everyday, non-cognitive events/external situations; such as worrying about the weather or grades
- type 2 worrying/meta worry: worrying about worry meaning people have certain appraisals of their worry
- etiology = negative belies about worrying and meta-worry
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treatment - metacognitive model
- challenge negative beliefs about worry
- exposure to intense worrying
- exposure to worried about scenarios
34
panic disorder (PD)
- individuals experience recurrent, uncued, panic attacks
- at least one attack is followed by a month of either or both persistent concern of additional attacks or consequences of attacks and significant changes in behaviour
- must experience and abrupt surge of physiological symptoms that peaks within minutes and must have a least 4/13 symptoms
- significantly higher rates in women and is rare to be diagnosed in childhood
- average age of onset is 20
35
agoraphobia (A)
- people fear being unable to escape or find help if panic like symptoms develop
- experience significant or recurrent fear or anxiety about at least 2/5 situations
- symptoms must be present for at least 6 months
- rates if significantly higher in women and the ager of onset is between 17-24
- agoraphobia is comorbid with a lot of disorders
36
5 main fear/anxiety situations of agoraphobia
1. public transit
2. open spaces
3. enclosed places
4. lines or crowds
5. being outside of the home alone
37
PD & A biological model
- to much norepinephrine and to little GABA, serotonin, dopamine
- Capnometry-Assisted Respiratory Training (CART): which changes the ratio of O2/CO2 that produces panic and works to retrain breathing so as to breath in a more shallow way reducing O2 in inhales
38
PDA CBT model - panic control treatment model (PCT)
- learned alarms develop through conditioning and negative reinforcement
- anxiety sensitivity and catastrophic thinking
- catastrophic thinking skyrockets fear and beliefs that physiological symptoms will have catastrophic consequences
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treatment - perceptual control theory (PCT) model
- gives skills for individuals to manage physical, cognitive and physiological aspects of anxiety
- manage physical aspects of anxiety; such as through progressive muscle relaxation
- challenge dysfunctional beliefs; such as through critically examining their own estimations of the likelihood of something happening
- graded therapeutic exposure; interoceptive, imaging and in-vivo
40
social anxiety disorder (SAD)
- individuals will experience significant and recurrent fear or anxiety of one or more social situations where the individual may face scrutiny
- fears actions or symptoms will be judged harshly and negatively
- situations almost always provoke fear or anxiety and are avoided or endured with intense distress
- symptoms must be present for 6 months
- rates tend to be similar between men and women but more adolescent women report it then men
- onset is common between the ages of 8 and 15
41
comorbidity & social anxiety
- social anxiety disorder is often comorbid with:
1. other anxiety disorders
2. major depressive disorder
3. substance use disorders
42
social anxiety - biological model
- Iindividuals with social anxiety disorder tend to have dysregulation of the amygdala and medial temporal lobe
- low GABA, serotonin, dopamine
- angry faces provoke greater reactions in their amygdala and medial temporal lobe meaning they remember those angry faces even more
- in addition to benzos. SSRIs & SNRIs, beta blockers are a common medication b/c they block adrenaline receptors
43
CBT model - social anxiety disorder
- suggests that individuals with social anxiety disorder have such high self standards they can't even meet them & they believe and fear that everyone else judges them
- engage on avoidance by avoiding social situations or circumstances that ,ay involve socializing
- engage on safety-seeking behaviours; lessen anxiety while staying in the anxiety-provoking situation
44
CBT model of social anxiety - treatments
- cognitive restructuring: challenge beliefs and automatic thoughts
- e.g. post-event processing: can’t stop thinking about what they did
45
temperament & behavioural inhibition
- behavioural inhibition (BI) is the persistent pattern of resistance, fearfulness and avoidance in novel situations
- 10-15% of children have been identified as having this temperament
- experience increased reactivity and negative emotionality in response to novelty, hypervigilance, and higher CNS arousal and alertness
- BI in early childhood increases risk for development of anxiety disorders later specifically SAD\
- kids that have this temperament style, naturally try to avoid novelty and will not seek out social environments but instead familiar environments
- experience anxiety sensitivity
46
psychological treatment
1. Cognitive behavioural therapy (CBT): challenge negative, automatic thoughts
2. exposure therapy: roleplay social scenarios that climb the fear hierarchy
3. acceptance and commitment therapy: applying mindfulness and acceptance base principles to become more accepting of fears and thoughts while separating the self from them
47
specific phobias
- significant and recurrent fear or anxiety of specific objects or situations
- provoked immediate fear or anxiety and it is either actively avoided or endured with intense distress
- symptoms must last for 6 months to be diagnosed & rates are twice as high as women than men
- age of onset is common between 7-11
- phobias often go away on their own
48
subtypes of specific phobias
1. animals
2. natural environment (heights, storms, water)
3. situational (airplanes, enclosed spaces, elevators)
4. blood-injection-injury (highest genetic loading)
5. other (costume characters, choking, vomiting)
49
biological model of specific phobias
- prepared learning helps us understand why certain associations or fears are more readily than others
- involves a dysregulation of GABA
- treatment includes benzos
50
CBT model of specific phobias
- true alarms: something actually happened to cause the fear such as actually being bit by a dog
- learned alarms: can be false alarms or true alarms
- false alarms: when you have a response of fear where there is no danger; your brain then makes associations sin the environment that leads you to develop a fear of whatever was happening in the moment fear occurred
- vicarious learning: see someone who has the fear, so you also become scared of it
51
CBT model of specific phobias - treatment
- graduated exposure: fear ladder
- virtual reality therapy: beneficial for situational phobias
52
obsessive-compulsive disorder (OCD)
- can receive a diagnosis with having either obsessions or compulsions, or both
- no time frame criteria for OCD, it is up to clinicians judgment
- average age of onset is 20 and rates tend to be similar between men and women
53
OCD - obsessions
- recurrent & persistent thoughts, images, or urges that are considered intrusive and unwanted
- ecodistonic: thoughts impulses and behaviors that are distressing, unacceptable or inconsistent with values and beliefs of the person
- ecosintonic: thoughts and images that are aligned with your own beliefs and values
- individual makes repeated attempts to ignore, suppress, or neutralize the thoughts
54
OCD - compulsions
- repetitive, compulsive, ritualistic behaviours or mental acts in response to obsession or internal rigid rules
- unrealistically designed, or completed to an excessive degree, to prevent or reduce anxiety, distress, or future events
55
biological model of OCD
- the etiology of OCD is multifaceted
- heightened activity between the cortex, basal ganglia, and thalamus
- the basal ganglia is associated with habitual behaviour
- quick to think something is dangerous but struggle to inhibit to need to carry out habitual/repetitive behaviours
- high norepinephrine, low serotonin and dopamine
56
CBT model of OCD - integrated CB model
- the integrated model states that individuals with OCD consistently engage and experience cognitive distortions
- experience 2 faulty cognitions:
1. overestimate the probability of danger
2. exaggerate the severity of consequences of said danger
- treatment: exposure and ritual prevention; this however has limited effectiveness for obsession based OCD
57
etiology of the integrated CB model - CBT of OCD
- fear structures develop with excessive associations between stimuli and distress
- compulsions are repeated due to a lack of signs that a situation is safe and the prediction of a high risk danger
58
CBT model of OCD - cognitive model
- believed individuals with OCD engage of 5 basic assumptions related to responsibility:
1. thoughts and actions are the same
2. causing harm is the same as not preventing harm
3. despite difficult events, personal liability for harm continues
4. not engaging in harm related rituals is the same as having the intention to harm
5. controlling one's thoughts is a personal obligation
59
etiology of the cognitive model - CBT of OCD
- inflated sense of responsibility to engage in obsessive/compulsive behaviours
- inflated sense of possibility and seriousness of harm
60
post traumatic stress
- PTSD is an anxiety Ddisorder that occurs/develops in response to a traumatic event such as physical injury or severe mental or emotional distress
- PTSD is most commonly develops as a result of human on human violence because humans often hold a core beliefs people don’t want to harm us so when we experience violence or see violence between humans it shakes that foundation we hold and makes the world seem much less safe
- there are 5 criteria for PTSD
- e.g. war, assault, car accidents, natural disasters, sudden death of a loved one
61
PTSD & symptoms
- symptoms must last more than a month with symptoms lasting less than a month being characterized as acute stress disorder
- symptoms normally occur within 3 months of the traumatic events; in some cases though it may be delayed
- half of adults with recover fully on their own within 3 months
- rates are almost twice as high in women
- the average age of onset is 23 (though it is dependent on when the event that triggers it happens)
62
4 main categories of symptoms (criteria B-E)
1. reliving
2. avoiding
3. negative cognitions/mood
4. increased arousal
63
criteria A - PTSD
- exposure to actual or threatened death, serious injury, or sexual violence (in one or more ways):
1. direct experience (experienced it yourself)
2. witnessing the events happen to others
3. learning about a traumatic event happening to family member/friend
4. repeated exposure to aversive details of traumatic event (e.g. 1st responders)
64
criteria B PTSD - reliving
- experience 1 or more intrusion symptoms:
1. recurrent, distressing memories of the traumatic event
2. recurrent distressing dreams (content related to traumatic event)
3. dissociative reactions (e.g., flashbacks) in which the person feels like the event is recurring
4. intense or prolonged psychological distress at exposure to cues that resemble an aspect of the event
5. physiological reactions at exposure to cues that resemble an aspect of the even
65
criteria C PTSD - avoiding
- at least 1 sign of avoidance of associated stimuli
- e.g. avoid people, situations, etc anything that reminds them of the trauma
66
criteria D PTSD - negative cognitions/mood
- at least 2 negative changes to cognition or mood
- e.g. memory; struggling to recall the event, difficulty with concentration, mood changes; feeling blame, detachment, anhedonia
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criteria E PTSD - increased arousal
- at least 2 negative changes in arousal and reactivity, typically in the nervous system
- e.g. sleep disturbances, more jumpy, increased BP or HR
68
PTSD - biological model
- areas designed to process threatening input are hypersensitive
- dysregulation/hypersensitivity of the hypothalamic-pituitary-adrenal gland (HPA) axis
- norepinephrine, serotonin, dopamine
- medications include SSRIs & SNRIs
69
PSTD CBT model - dual representation model
- VAMs and SAMs are 2 separate memory systems that run parallel during memory
- model states that during a traumatic event the VAMs system is impaired because conscious attention is now narrowly drawn to threat related information
- SAMs system captures vivid, sensory information during the traumatic event that is now automatically recalled through exposure to trauma related triggers
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VAMs
- verbally accessible memories
- contains information that is consciously encoded/processed and therefore can be voluntarily recalled later
- choosing to remember it
71
SAMs
- situationally accessed memories (SAMs)
- contains unconsciously processed sensory information that cannot be voluntarily recalled
- believed to be responsible for flashbacks and nightmares (symptoms of PTSD)
- SAMs memories can be difficult to control because we can’t always predict what we will be exposed to
- are associated with primary emotions
72
PTSD CBT model - treatment
- exposure to activate and modify SAMs
- cognitive restructuring to modify VAMs because all the attention was so narrowly focussed we need to expand on them, to create a story beyond the sensory experience (SAMs)
73
PTSD CBT model - etiology
- conditioning/reinforcement of primary emotions, and development of secondary emotions
- primary = initial emotion (fear)
- secondary = response emotion (anger)
74
PTSD CBT model - EMDR
- during a traumatic event, memories and emotions get encoded together, so much so that the memory of the event still brings up those intense feelings
- EMDR focuses directly on the memory stored in the brain and gets the individual to focus on the memory of the event while simultaneously experiencing bilateral stimulation
- untangle memory and emotion
75
PSTD - EMDR treatment
- eye-movements (or auditory tones), accompanied by exposure and body scan
- bilateral stimulation (visual, auditory, or tactile)
