Anxiety: development and maintenance

Question 1

Introduce anxiety disorders

Answer 1

• Anxiety disorders are characterised by excessive worrying
• Often with accompanying avoidance
• Causes significant psychological distress and/or dysfunction
• One of the commonest mental disorders across children (Whiteside et al, 2016) and adults (Baker, 2018)

Question 2

Describe the overarching theory for anxiety disorders

Answer 2

• Aetiology of GAD and other mental disorders
• Theory of triple vulnerability (Barlow, 2000)
  
  • ​Generalised biological vulnerability
  • Generalised psychological vulnerability
  • Specific psychological vulnerability

Question 3

Discuss the biological predispositions for anxiety disorders

Answer 3

• Genetic predisposition is considered one of the most highly implicated developmental factors for anxiety (Liu et al, 2011)
• GAD demonstrates a significant familial pattern, with 1^o relatives incurring a five-times increased risk
• Genes associated with GAD account for 25-50% of its onset and increased vulnerability to other anxiety and depression disorders (NICE, 2011)
• SAD shares substantial familial links (Spence & Rapee, 2016)
• Temperament is robustly associated with anxiety disorders
  
  • ​High neuroticism is a predisposing factor for GAD (NICE, 2011)
  • Low extraversion or high behavioural inhibition significantly increase risk for SAD (Spence & Rapee, 2016)

Question 4

Discuss how parenting style influences anxiety

Answer 4

• Overcontrolling parental style suggest to constently produce BI
• Also is a predictor of social anxiety (Spence & Rapee, 2016)
• Creates environment lacking warmth, causing insecure attachment and reductions in sense of agency (NICE, 2011)
• This (environment) has been reported in upbrings of individuals with GAD
• Overcontrolling parenting seen in other childhood adversities (abuse), which are additional risk factors for GAD (2011)

Question 5

Discuss the role of culture for anxiety disorders

Answer 5

• Interestingly, East Asian cultures demonstrate an inverse relationship
• Behavioural inhibition confers positive adjustment in children
• Reflects cultural differences, where East Asian culture emphasises social harmony over autonomy (Chen et al, 2009)
• Protective factor in social norms, and risk factor when outside social norms

Question 6

Discuss the general psychological vulnerability for anxiety

Answer 6

• ‘Looming cognitive style’ seen in many anxiety disorders (NICE, 2011)
• A set of cognitive biases towards threat
  
  • ​Increased attention
  • Overestimation of external threat
  • Enhanced memory

Question 7

Discuss how transdiagnostic factors contribute to anxiety

Answer 7

• Several transdiagnostic factor contribute to develop and/or maintenance
• It is extremely difficult to distinguish between causal and maintaining factors from current evidence (Spence & Rapee, 2016)
• Factors specific for SAD are rarely identified
• Insufficient data to establish causation of theoretical explanations such as safety behaviours in SAD (Spence & Rapee, 2016)

Question 8

• Precipitating factors for various mental illnesses often consist of recent stressful life events
• Loss events are associated with onset of depression and GAD
• Dangerous events more often precipitate GAD (NICE, 2011)
• Social stressors reported in SAD, especially negative interactions with peers (Spence & Rapee, 2016)
• Peer victimisation is the only factor to undergo extensive longitudinal study
• It is both a risk factor and a consequnce for social anxiety, showing a cyclical maintaining factor for SAD