Week 4 - Anxiety Flashcards
(21 cards)
Anxiety
Apprehension, future-oriented
Somatic - muscles, heart
Cognitive - thoughts of future threat, worry
Behavioural - avoidance
Fear
Immediate, present-oriented
Somatic - sweating, heart, breath, trembling, nausea (sympathetic)
Cognitive - thoughts of immanent threat
Behavioural - escape
Panic
Abrupt intense fear (expected or unexpected)
Somatic - sweating, trembling, nausea, heart
Cognitive - thoughts of dying, going crazy
Behavioural - escape
Generalised Anxiety Disorder (GAD) DSM + phenomenology
DSM
- Excessive anxiety/worry most days for 6+ months (difficulty controlling)
- At least 3: restlessness, fatigued, concentration, irritability, muscle, sleep
- Clinically sig. distress/impairment, not due to something else
Phenomenology
- Uncertainty intolerant, worry about everything
- World is unpredictable and dangerous
- Procrastination OR overprep
- More distress focused (not fear associated, maps close to MDD)
GAD prevalence and treatment
3% year, 5-6% lifetime (10% in elderly)
Onset - adolescence, YA (chronic)
17-50% given medicine for sleep issues
CBT - exposure to worry/anxiety and coping strategies
Antidepressants - equivalent short-term, less good than CBT long-term
Contrast Avoidance Model (GAD)
Worry is verbal-linguistic (thoughts, not images)
Worry allows avoidance of further neg. emotion increase (spikes)
Worry reinforced by negative event not occurring - relief
Worry prevents effective PS and emotional processing of stress stimuli
Panic disorder DSM
Panic Attacks
- 4+ within 20 mins - heart pounding, sweating, trembling, choking feeling, chest pain, nausea, dizziness, chills/heat, numb extremities, derealisation, crazy fear, death fear
Panic Disorder
- Recurrent, unexpected attacks
- Fear of another attack and behaviour change related
- 1+ month
- Not due to substance/other disorder
Panic disorder cultural variations
Symptoms - tinnitus, sore neck, headache, screaming, crying
Susto (Mexico) - spiritually dispossessed
Ataque de nervios (Cuba) - screaming, crying, aggression, amnesia
Kyol goeu (Cambodia) - wind suffocation/overwhelm, unbalanced energy
Agoraphobia DSM
- Fear of 2+ - public transport, open spaces, closed spaces, queues, outside alone
- Fear of unable to escape or get help in panic event/other symptoms
- Avoids situations, brings companion, suffers with dread
- Disproportionate anxiety
- 6+ months and causes impairment
- Not otherwise explained
Panic disorder and agoraphobia prevalence and treatment
Used to be one disorder, now separate
3% year, 5% lifetime (2F:1M)
Onset - adolescence, YA (wax and wane)
Medication (benzos, SSRIs) - high relapse rate
CBT - exposure to interoceptive cues (i.e. caffeine), feared situations, challenge beliefs
Interactive cognitive model of panic attacks
Trigger (internal/external) > perceived threat > apprehension > body sensations > catastrophic misinterpretation (w/ panic self-efficacy) > back to perceived threat
Specific phobia DSM
- Fear of specific object/situation (almost always brings fear, actively avoided, disproportionate)
- 6+ months
- Clinically significant distress
- Not otherwise explained
Types - blood/injection/injury (BP decrease), natural environment, animal, situational, other
Specific phobia prevalence and treatment
Most prevalent anxiety disorder, 8.7% year, 12.5% lifetime (4F:1M)
Onset - childhood (chronic)
Exposure therapy is best
Relaxation contraindicated
Medication unhelpful (could make worse)
Multifactorial model + associative learning
Normal childhood fears require genetic tendency (overreact, distress) + certain learning experiences = phobia
Specific phobias developed through CC (direct, vicarious, info transmission) and maintained through OC (avoidance)
Social anxiety disorder/social phobia DSM
- Fear of social situations involving possible scrutiny
- Almost always provoke fear, always avoided or endured w/fear
- Disproportionate fear, clinically sig. distress
- 6+ months
- Not better explained
Continuum - transitory shyness, shy personality, non-generalised social phobia, generalised social phobia, AvPD
SAD cultural differences
Taijin kyofusho (Japan/Korea) - fear of offending others or making them uncomfortable (more in men)
SAD prevalence and treatment
7% year, 12% lifetime (1F:1M), 14% (18-29), 7% (60+)
Onset - adolescence (around 13)
CBT, SSRIs, beta-blockers, benzos (long-term not good)
Cognitive behavioural model of SAD
Perceived/anticipated audience > attentional resources focused on how the audience sees you, perceived internal cues and external evaluation indicators > observation of self and audience behaviour, comparison of self with audience expected standard, judgement of probability/consequence of audience evaluation > behavioural/physical/cog. symptoms of anxiety (these symptoms lead back into perceived internal cues and external evaluation indicators, cog. symptoms lead to post-event processing linking back to perceived audience)
Separation anxiety disorder DSM
- Developmentally inappropriate fear re: separation from attachment figures (worry of harm leading to separation, distress anticipating/experiencing separation, refusal to separate, nightmares, physical symptoms)
- 4+ weeks in children, 6+ months in adults
- Clinically sig. distress
- Not otherwise explained
Phenomenology
- Children may withdraw, be sad, poor concentration
- Anger at separation
- Unusual perception experiences
- Fear of monsters, dark, kidnappers, car accidents (not young chlildren)
Separation anxiety disorder prevalence and treatment
4% children, 7% adults
Onset - as early as pre-school (often after stressor)
Treatment - parent training + CBT
Selective mutism
- Failure to speak in social situations
- Interferes with communication
- 1+ month
- Not attributable to lack of language knowledge
- Not better explained by communication dx, ASD, schizophrenia
Prevalence - 0.03-1% children (year)
Presents before age 5 or starting school (may become ASD subtype)
Treatment - CBT best (similar to SAD treatment)
