CH 5 Flashcards

(90 cards)

1
Q

Anxiety

A

mood, negative affect, tension, anticipates future danger/misfortune

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2
Q

Is anxiety good?

A

yes, in moderation

physical & intellectual performances driven & enhanced by anxiety

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3
Q

Fear

A

immediate alarm rxn to danger/life-threatening emergencies

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4
Q

what is the difference b/w fear & anxiety?

A

fear deals with current stressors, anxiety occurs b/c cannot predict future

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5
Q

Panic

A

sudden overwhelming fright/terror

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6
Q

Panic Attack

A

abrupt intense fear/discomfort w/ physical symptoms (ie. dizziness/heart palpitations)

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7
Q

2 types of panic attacks

A
  1. expected (cued) - specific situation (ie. heights), phobias/social anxiety
  2. unexpected (uncued) - no clue when next attack occur, panic disorders
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8
Q

What are the genetic contributions to anxiety?

A

no single gene cause anxiety/panic/disorder BUT collection of genes makes vulnerable when stress/environment turn on/off certain genes

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9
Q

What specific brain circuits are anxiety associated with?

A
  • dec level = inc anxiety
  • noadrenergic system implicated anxiety
  • serotonergic neurotransmitter system also involved

*corticotropin-releasing factor (CRF) central to anxiety & depression

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10
Q

How does corticotropin-releasing factor (CRF) system relate to anxiety?

A

CRF activates HPA axis (part of CRF system) = effects on limbic system - hippocampus & amygdala & locus coeruleus (brain stem) & prefrontal cortex & dopaminergic neurotransmitter system

directly related to GABA-benzodiazepine & serotonergic & noradrenergic neurotransmitter systems

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11
Q

which area of brain is most associated w/ anxiety?

A

limbic system - mediator b/w brain stem & cortex

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12
Q

behavioural inhibition system (BIS) - Jeffery Gray

A

brain circuit in limbic system that responds to threat signals by inhibiting activity & causing anxiety

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13
Q

Fight/Flight System (FFS)

A

brain circuit in animals that when stimulated = immediate alarm & escape response resembling human panic

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14
Q

How does smoking relate to stress?

A
  1. anxiety tendency (fear bodily sensations)
  2. distress tolerance (how much distress person tolerate)
  3. anhedonia (inability to feel pleasure)
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15
Q

What are 4 psychological contributions to anxiety?

A
  1. perception of control (low sense of control = inc anxiety)
  2. parents providing secure home base & encourage exploration = dec anxiety
  3. anxiety sensitivity (personality trait that determines who will/not experience anxiety)
  4. conditioning & cognitive explanations (might not be aware of cues/triggers of severe fear)
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16
Q

Social Contributions to anxiety

A

stressful life events (ie. marriage, divorce, death, physical injury)

trigger physical & emotional reactions (run in family - genetic contribution)

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17
Q

Triple Vulnerability Theory

A
  1. generalized biological vulnerability
  2. generalized psychological vulnerability
  3. specific psychological vulnerability

*if all 3 = inc risk for anxiety disorder after stressful situation

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18
Q

generalized biological vulnerability (Triple Vulnerability Theory)

A

tendency to be uptight might be inherited BUT not sufficient to produce anxiety itself

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19
Q

generalized psychological vulnerability (Triple Vulnerability Theory)

A

grow up believe world is dangerous & not able to cope b/c early experience

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20
Q

specific psychological vulnerability (Triple Vulnerability Theory)

A

learn from early experience (ie. taught by parents some situation/object = dangerous)

ie. parents fear dog -> express anxiety -> you fear dog

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21
Q

What % of Canadians 12+ had diagnosed anxiety disorder? (CCHS)

A

8.6%

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22
Q

Comorbidity

A

co-occurrance of 2+ disorders in 1 individual

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23
Q

What % of Canadians 18+ have a comorbidity among anxiety & depression?

A

31%

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24
Q

presence of anxiety disorder is uniquely & significantly associated with…

A

thyroid disease, respiratory disease, gastrointestinal disease, arthritis, migraine headaches, allergic conditions

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25
for ppl living w/ only anxiety disorder what % had severe disability what % required accommodations at work what % stopped working
30%, 44%, 24%
26
for ppl living w/ anxiety & mood disorder what % had severe disability what % required accommodations at work what % stopped working
50%, 66%, 48%
27
what disorder has the strongest relationship with suicide?
panic disorder
28
Generalized Anxiety Disorder (GAD)
intense, uncontrollable, unfocused, chronic, continuous worry - distressing/unproductive physical symptoms = tenseness, irritability, restlessness
29
How is GAD characterized?
muscle tension, mental agitation, susceptibility to fatigue, irritability, difficulty sleeping
30
What makes GAD different than other anxiety disorders?
mostly worry about minor, everyday life events
31
what age group is GAD most & least common in?
most: 45+ yo least: 15-24yo
32
Anxiety Sensitivity
be distressed in response to arousal-related sensations from beliefs that anxiety-related sensations may have harmful consequences
33
what are the 4 distinct cognitive characteristics of ppl w/ GAD?
1. intolerance of uncertainty 2. positive beliefs about worry 3. poor problem orientation 4. cognitive avoidance
34
What is 1 physiological measure that consistently distinguishes GAD?
muscle tension (ppl w GAD = chronically tense)
35
6 steps to GAD
1. generalized psychological/biological vulnerability 2. stress from life events 3. anxious apprehension (tense) 4. worry process (failed to solve problem) 5. intense cognitive processing, avoidance of imagery, inadequate problem-solving, restricted autonomic response 6. GAD!
36
what is the most prescribed drug for GAD?
benzodiazepines (short-term relief)
37
What are risks of benzodiazepines (drug for GAD)?
1. impair cognitive & motor functioning 2. produce dependence - difficult to stop taking
38
What drugs are better for treatment of GAD (vs benzodiazepine)?
antidepressants - paroxetine (paxil) & venlafaxine (effexor)
39
What treatment for GAD is similar as drugs but more effective in long term?
psychological treatments ie. Cognitive-behavioural Treatment (CBT)
40
Panic Disorder (PD)
recurrent/unexpected panic attacks + concerns abt future attacks = lifestyle change to avoid attacks
41
Agoraphobia
anxiety abt being in place/situation which escape might be difficult
42
How do people cope w/ agoraphobic behaviour?
1. agoraphobic avoidance (safe person/safe place) 2. drugs/alcohol 3. endure w/ intense fear & anxiety
43
Interoceptive Avoidance
ppl w/ panic disorder & agoraphobic avoidance remove self from situation that produce physiological arousal that is similar to beginning of panic attack (ie. exercise)
44
what % of US population meet criteria for 1. panic disorder? 2. agoraphobia?
3.5%, 5.3%
45
when does onset of panic disorder usually occur?
early adult life (mid-teens - 40yo) mean onset = 25-29yo
46
Why are women more likely to have agoraphobia?
cultural more accepted for women to report fear & avoid situations VS men expected stronger & braver, tough it out gender differences in fear of anxiety (women more scared of physical sensations)
47
Nocturnal Panic
60% of ppl w. panic disorder experienced when sleeping (b/w 1:30-3:30am)
48
Isolated Sleep Paralysis
similar to nocturnal panic awake at night - unable to move, heart pounding, feel presence in room with you
49
Learned Alarms
cues associated w/ different internal/external stimuli ie. exercise (internal cue), movie theatre (external cue)
50
7 steps to panic disorder w/ agoraphobia
1. generalized psychological/biological vulnerability 2. stress from life events 3. false/learned alarm 4. specific psychological vulnerability 5.anxious apprehension 6.development of agoraphobia OR 6. panic disorder 7. panic disorder w/ agoraphobia
51
specific psychological vulnerability
belief that unexplained physical sensations are dangerous
52
What did David Clark emphasize in his cognitive theories?
specific psychological vulnerability interpret normal physical sensations in catastrophic way
53
What is the current indicated drug for panic disorder?
Selective-serotonin Reuptake Inhibitors (SSRI) *sexual dysfunction in 75%+ ppl taking this
54
What is exposure-based treatment for panic disorder?
arrange conditions for patient face feared situation & learn nothing to fear
55
What is Panic Control Treatment (PCT) for panic disorder?
exposing patients to interoceptive sensations that remind them of their panic attacks therapist attempts to create "mini" panic attack in office (elevate heart rate)
56
what kind of treatment should be administered first for panic disorder & agoraphobia?
1. psychological treatment 2. drug treatment (if don't respond adequately/psychological treatment unvailable)
57
Specific Phobia
unreasonable fear of specific object/situation that interferes with daily life functioning
58
What are the 4 major subtypes of specific phobia?
1. animal type 2. natural environment type 3. blood-injury-injection type 4. situational type 5. other (ie. costumed characters, vomiting, loud sounds)
59
Blood-Injury-Injection Phobia
unreasonable fear & avoidance of blood, injury, possibility of injection experience fainting & drop in blood pressure runs in family more strongly than other phobic disorder onset ~9yo
60
Situational Phobia
anxieties involving enclosed spaces (ie, claustrophobia) or public transportation (ie. flying) don't experience panic attack outside of context - can relax when don't confront phobic situation runs in family onset 20-25yo
61
Natural Environment Phobia
extreme fear of situations/events in nature, especially heights, storms, water genetic makeup makes sensitive to these situations b/c danger assoicated onset ~7yo
62
Animal Phobia
unreasonable, enduring fear of animals/insects must interfere with daily functioning (ie. can't read magazines onset ~7yo
63
What is a paradox of specific phobias?
specific phobia is common, treatable, well-understood condition BUT ppl with this condition rarely seek treatment
64
Does fear decline with age?
yes for specific phobias BUT performance-related fears (ie. taking a test/talking in a large group) increase with age
65
What are the 3 ways that people develop phobias?
1. direct experience 2. vicarious experience 3. information transmission
66
How do ppl develop phobias w/ direct experience?
experiencing false alarm (panic attack) in specific situation)
67
How do ppl develop phobias w/ vicarious experience?
emotions are contagious, watch someone else have traumatic experience/intense fear
68
How do ppl develop phobias w/ information transmission?
being warned repeatedly about potential danger
69
4 things that need to occur for person to develop phobia
1. traumatic conditioning experience 2. inherited tendency to fear dangerous situations 3. anxiety of possibility event happen again 4. social & cultural factors determine WHO develop phobia
70
What is the main way to help with specific phobias?
structured & consistent exposure-based exercises
71
How do you treat needle phobia?
gradual exposure & applied muscle tension
72
Which areas of the neural circuitry are modified by phobia treatments?
amygdala, insula, cingulate cortex
73
What is a new approach to treatment of phobias?
virtual reality exposure therapy
74
Separation Anxiety Disorder
excessive fear in children that harm will come to them/their parents while apart untreated - extend to adulthood (35% of cases)
75
Social Anxiety Disorder (SAD)
extreme, enduring, irrational fear/avoidance of social/performance situations fear of embarrassment
76
What % of general population experience SAD?
13.3%
77
When does SAD appear?
adolesence, onset = ~15yo young, undereducated, single, economically disadvantaged
78
How does SAD present itself across ethnic groups?
relatively equal prevalence BUT different expressions of SAD asian = lowest rate SAD russian & US = highest rate SAD
79
Olfactory Reference Syndrome
belief that self is embarrassing self & offending others w/ foul body odour
80
What did Heinrichs & Collegues find in their cross-cultural studies on SAD?
collectivistic countries (ie. japan, spain, korea) = more accepting for socially reticent & withdrawn behaviours = more social anxiety & greater fear of blushing INC attention-avoiding behaviour = INC social anxiety
81
What are ppl w/ social anxiety more quickly to recognize?
angry expression react w/ greater activation in amygdala & less cortical control, eye region = most threatening area of face
82
What are the 3 pathways to SAD?
1. inherit generalized biological vulnerability to develop anxiety/ biological tendency to be socially inhibited 2. unexpected panic attack in social situation & associate to social cues 3. experience real social trauma resulting in true alarm
83
Interpersonal Transaction Cycle
individual's interaction w/ ppl in social environment contribute to & maintain social anxiety ppl w/ SAD = biased social perception = behave maladaptive ways
84
What are 2 ways ppl w/ SAD incorrectly interpret others' behaviours?
1. selectively attend to negative social information (ie. cold =. unfriendly) 2. recall + feedback as less + than it actually was
85
What is part of the psychological vulnerability of SAD?
perceiving self-attributes as flawed
86
What CBT group therapy did Heimberg & collegues develop for SAD?
groups of patients rehearse/role-play their socially phobic situations in front of each other uncover & change automatic/unconscious perception of danger 5yrs later - gains maintained
87
What might be a more efficient & cost-effective way to treat SAD?
VR technology
88
What is 1 important reason why SAD is maintained in presence of repeated exposure to social cues?
individuals w/ SAD engage in variety of avoidance & safety behaviours to reduce risk of rejection
89
Which drugs are approved for treatment of SAD?
SSRIs, Paxil, Zoloft, Effexor
90
Selective Mutism
rare childhood disorder, lack of speech in 1+ settings where speaking is socially expected