Unit 5

Question 1

Anxiety

Answer 1

-future orientated mood state because you can predict or control upcoming events
-sense of unease, set of behaviours, or physiological response originating in the brain

Question 2

fear

Answer 2

-immediate emotional reaction to danger
-activates autonomic nervous system
-motivates us to attack or flee (fight or flight)

Question 3

panic

Answer 3

-alarm response of fear when there is no danger
-abrupt experiences of intense fear or acute discomfort, accompanied by physical symptoms:
-hear palpitations
-chest pain
shortness of breath
-dizziness
-clammy hands
-shaking

-can be expected or unexpected

Question 4

Biological causes of anxiety (whats inherited)

Answer 4

genetics factors
-tendency to be tense, uptight and anxious can be inherited
-tendency to panic can also be inherited

Question 5

biological contributions of anxiety: brain

Answer 5

brain circuits and neurotransmitters:
-depleted GABA is associated with anxiety
-corticortopin-releasing factors (CRF) system: activates the HPA axis. - affects the limbic system (emotional), brain stem (autonomic processes), prefrontal cortex, dopaminergic system
-anxiety and panic have distinct brain circuits

• panic originated in brain stem (fight or flight)
  -anxiety limbic system is an over response

Question 6

psychological contribution to anxiety :childhood

Answer 6

-from childhood you may develop a general sense of uncontrollability: role of parents (overprotective and over intrusive)
- child learns they can control the environment

Question 7

psychological contribution to anxiety: anxiety sensitivity

Answer 7

-anxiety sensitivity: general tendency to respond fearfully to anxiety symptoms
-sensitive to the fear of anxiety

Question 8

psychological contribution to anxiety: conditioning responses

Answer 8

• initial symptoms may have occurred during extreme stress or danger (true alarm): occurred during a stressor
  -external or internal cues becomes associated with fear response causing emotional reaction (conditioning process)
  -ex you are shopping and there is an active shooter at the mall. you are scared and now develop fear of open crowded places. now you have those physiological responses when in open crowded spaces or the mall, which is conditioning.

Question 9

social contributions to anxiety

Answer 9

• stressful life events trigger biological and physchological vulnerabilities to anxiety: like the diathesis stress model
  -gender: more women diagnosed with anxiety disorders: feel less control
  -stigma, discrimination, racism increases risk for anxiety disroder

Question 10

the triple vulnerability theory for anxiety

Answer 10

1. biological vulnerability ( heritable contribution to negative affect)
   - glass is half empty
   -irritable
   -driven
2. specific psychological vulnerability (eg. physical sensations are potentially dangerous)
   -hypochondriac ?
   -nonclinical panic?
3. generalized psychological vulnerability (sense that events are uncontrollable/ unpredictable)
   -tendency toward lack of self-confidence
   -low self-esteem
   -inability to cope

Question 11

the statistics on anxiety

Answer 11

-anxiety disorders often co-occur (comorbid)
-shared features of anxiety and panic
-shared vulnerabilities (biological and psychological)

Question 12

suicide

Answer 12

-having anxiety or related disorders increase the chances of having suicidal ideation or making suicidal attempts: relationships is strongest with panic disorder
-20% of patients with panic disorder attempt suicide: comparable to people with major depression
-people with GAD and social anxiety disorder who engage in self-harm are at risk of attempting suicide

Question 13

Generalized anxiety disorder (GAD)

Answer 13

at least 6 months of excessive anxiety and worry, more days than not: chronic state no acute
-difficult to turn off or control the worry: is persuasive to every aspect of life
-symptoms (3 of 6)
–restlessness or feeling keyed up or on edge
–being easily fatigued
–difficulty concentrating/mind going blank
–irritability
–muscle tension
–sleep disturbance

Question 14

statistics of generalized anxiety disorder (GAD)

Answer 14

-few people with GAD come from psychological treatment compared to other anxiety disorder
-they think its normal once its apart of life
-more likely to seek help from primary care doctors (less access to psychological treatment: think its other issues like sleep causing their problems)
-2/3 individuals with GAD are girls and women
-associated with earlier and more gradual onset than other anxiety disorders
course is chronic

Question 15

causes of generalized anxiety disorder (GAD): genetic

Answer 15

genetic contributions
-tends to run in families
-tendency to become anxious (rather than GAD)

Question 16

causes of generalized anxiety disorder (GAD): psychological/ cognitive characteristic

Answer 16

-intolerance of uncertainty (things are more dangerous)
-positive beliefs about worry (think worrying helps them)
-poor problem orientation (threats to be avoided not problems to be faced)
-cognitive avoidance

Question 17

causes of generalized anxiety disorder (GAD): social

Answer 17

-stress from life events
-ex the pandmeic
-social anxiety, what are you allowed to do, what if, uncertainty, economically, no routines

Question 18

worry as an avoidance strategy: brokovec and Hu

Answer 18

-individuals with GAD use worry as an “avoidance strategy”- decreases somatic arousal
-brokovec and Hu (key discovery)
–had participants worry before exposing to phobic image
-worrying decreased physiological reaction by inhibiting cardiovascular activity (reduced somatic arousal)
-avoid future threat by strategy to prevent future threat

Question 19

Intolerance of uncertainty

Answer 19

-individuals discomfort with ambiguity and uncertainty- “what if…” questions
-less tolerance=greater reduction in heart rate variability during worry(more likely to benefit from worrying)
-individuals with GAD have selective bias for uncertainty, see it as more threatening

Question 20

Treatments for generalized anxiety disorder (GAD)

Answer 20

-benzodiazepines
– (+) somme relief short term
– (-) seem to impair cognitive and motor functioning (cant drive brain fog)
– (-) seem to produce dependence

-antidepressants (SSRIs and SNRIs)
–paxil, effexor

-psychological treatment: same benefits as drug treatment and more effective long term
–cognitive behavioural therapy (CBT)
–meditation, mindfulness approaches

Question 21

Cognitive behavioural therapy (CBT)

Answer 21

effective
-large treatment effects compared to control conditions
-robust improvements maintained long term
-show them worrying is not working

strategies
-cognitive restructuring to challenge beliefs about usefulness of worry
-increase ability to tolerate uncertainty (behavioural experiments)
-process threatening information using images, exposure to feeling of anxiety
-relaxation strategies

Question 22

panic disorder and agoraphobia

Answer 22

experience severe, unexpected panic attacks and substantial fear about possibility of another attack (fear of having a panic attack)
-can be accompanied with agoraphobia-fear and avoidance of situations in which a person feels unsafe or unable to escape in the event of developing panic symptoms or other physical symptoms (very closely related)
–panic disorder and agoraphobia are separate diagnoses, but often go together
-fear of fear-interoceptive avoidance

Question 23

panic disorder: requirments

Answer 23

-experience of recurrent and unexpected panic attacks (have at least 2 attacks
-panic attack symptoms (at least 4 required)
-they are short (10 mins) not long lasting

Question 24

agoraphobia

Answer 24

-anxiety about being in places or situations where it might be difficult to escape
-feared situation must be actively avoided
-often a complication of experiencing panic attacks

Question 25

panic attacks vs panic disorder

Answer 25

-panic attacks are very common: 21% of Canadians experience at least 1 panic attack in their lifetime --common feature of other anxiety disorders -panic disorder is less common --attacks occur out of the blue --persistent concern about having additional attacks or worry about ramifications of attack --results in change in behaviour --more common in females

Question 26

statistics of panic disorder

Answer 26

-onset of PD usually occurs in early adult life -more women than men have PD and agoraphobia -men with panic disorder tend to consume alcohol as coping mechanism --can lead to alcohol addiction

Question 27

treatment for panic disorder

Answer 27

-medications: SSRIs (prozac, Paxil), benzodiazepine’s (xanax), SNRIs (effexor) --SSRIs are the indicated drug for panic disorder -benzodiazepine are effective, but cause dependence --60% of patients are free of panic as long as they stay on effective drug --relapse rates are high (50%) once medication is stopped

Question 28

psychological intervention for panic disorder

Answer 28

-CBT is effective for panic disorder -exposure to feared situations (reduce avoidance) -exposure to interoceptive sensations (interoceptive exposure) -cognitive therapy to challenge faulty cognitions about dangerousness of feared situations -relaxation training

Question 29

combined psychological and drug treatments

Answer 29

-how do these treatments work together? -1. CBT alone vs 2. drug alone vs. 3. drug+CBT vs. 4. placebo+CBT vs. 5. placebo - 1,2,3,4> 5 initially -those receiving CBT without drugs retained gains after 15 months -drugs may lead to quicker response, but upon follow up drugs= psychological treatment -fro some patients, a quick response is more important -other patients may prefer not to take medication

Question 30

interoceptive exposures

Answer 30

-unique to panic disorder -confront the fear to expose the psychological factors -mimic how it feels to have a panic attack -ex-run on spot, spin in circles, breath through straw, hold breath, getting up fast done over and over to show that they are not dangerous to experience and that its normal -exposure therapy

Question 31

specific phobia

Answer 31

-irrational fear of a specific object or situation that interferes with an individuals ability to function -fear and anxiety out of proportion (no real danger) -4 subtype of phobias: --blood-injury-injection --natural environment (eg. heights, storms, water) --animals --situational (planes, enclosed spaces)

Question 32

blood-injury injection phobia

Answer 32

-differ in physiological reaction compared to other phobias --marked drop in heart rate and blood pressure, fainting -tends to run in families more strongly than other phobias (visal ragal response) -average age of onset is 9 years old

Question 33

situational phobia

Answer 33

-claustrophobia, fear of public transportation -tends to emerge around 20-25 -runs in families

Question 34

situational vs agoraphobia+panic disorder

Answer 34

situational: only in specific circumstances.-- Tied to situations agoraphobia+ panic disorder: fear of having panic attack anywhere and being in a place where there is no escape

Question 35

natural environment phobia

Answer 35

-heights, storms, water -tends to cluster- if you fear one, you are likely to fear another -situations have some danger , so mild fear is adaptive -peak age of onset 7 years old -must be persistent and interfere with functioning

Question 36

animal phobia

Answer 36

-animals and insects -common fears, when do they become a phobia? -age of onset is around 7 years old

Question 37

statistics of situational phobia

Answer 37

-few who have specific fears qualify as having a phobia -only the most severe cases present for treatment (because they are easy to avoid) -people are likely to successfully avoid phobic stimuli

Question 38

causes to phobias

Answer 38

-inherited tendency to fear situations that have been dangerous to humans over time -pathways to phobias: --direct, traumatic experiences (dog bites child) --by observing someone else experiencing severe fear (seeing someone else have severe fear when riding a bus makes you have fear) -by being told about danger (informational transmission) -by experiencing a false alarm (panic attack) in a specific situation (panic attack on cruise, you associate being on a boat or water with the fear of pathways)

Question 39

treatments for phobias

Answer 39

-CBT is effective (main treatment) -exposure-based exercises modified for different phobias -can do it in 2-6 hours (OST, one session and done) -virtual reality exposure therapy --effective for phobias of heights, spiders, flying, and small spaces -helpful when it is not convenient to access these types of situations in-vivo (means in person)

Question 40

social anxiety disorder

Answer 40

-marked fear or anxiety focused on one or more social or performance situations --eg. having conversations, going to a party, giving a speech --fear of showing anxiety symptoms that will be negatively evaluated by others -performance anxiety is a subtype of SAD; usually do not have difficulty with social interactions -anxious only when others are presents

Question 41

social anxiety disorder statistics

Answer 41

-sex ratio favours females only somewhat 1.4:1.0 -typically begins during adolescence -more prevalent among young people undereducated, single, and economically disadvantaged

Question 42

taijin kyofusho

Answer 42

-intense fear that ones body parts or functions displease, embarrass, or are offensive to others (like sweating) -leads to social avoidance -kind of resembles social anxiety but this is more based on the relationship with other

Question 43

causes of social anxiety

Answer 43

**Biological survival mechanism**: Humans are predisposed to fear angry, critical, or rejecting people and learn to fear angry expressions more quickly. - **Temperament**: Some infants are born with an inhibited temperament, increasing the risk of developing social anxiety. - **Genetic and psychological vulnerability**: People may inherit a general predisposition to anxiety or social inhibition. - **Unexpected panic attacks**: A panic attack in a social setting may create a lasting association with social cues. - **Real social trauma**: A traumatic event can trigger a true alarm, leading to anxiety in similar social situations.

Question 44

interpersonal model of social anxiety by alden, taylor, and buhr

Answer 44

-innate physiological reactivity + early social experiences (can have 1 or both)---> beliefs about self, beliefs about others ("people don't like me")---> expectations feared outcomes ("because i am awkward people will think i am stupid")---> behviour (interpersonal message: avoid talking to people and act awkward)-----> others reactions (" sees them as not wanting to be here")---> self judgment ("no one talks to them")---> expectations feared outcomes

Question 45

treatment for social anxiety

Answer 45

Cognitive Behavioral Group Therapy (CBGT): - Role play phobic situations with peers. - Therapist helps challenge and change automatic perceptions of danger. Cognitive Behavioral Therapy (CBT): - Engage in real-life experiences to disprove fears. - Practice social mishap exposures (e.g., spilling something, smudging lipstick). - Reduce safety behaviours that lower rejection risk. Virtual reality can also be a helpful tool. -psychological treatment is more effective -medication can be effective compared to placebo: SSRIs

Question 46

selective mutism

Answer 46

-childhood disorder characterized by lack of speech in one or more settings in which speaking is socially expected (talks a lot at home but not at all in public) -hight rates of comorbidity with SAD -negative reinforcement cycle (need to break this cycle)

Question 47

negative reinforcement cycle

Answer 47

child is prompted to talk or engage--> child gets (too) anxious--> child avoids--->someone rescues---> childs and adults anxiety are lowered--->