1
Q
What is fear
A
- Emotional response attributed to something negative
- Usually about a perception of danger or harm
- Very adaptive
- Immediate physiological response
- Actual threat, true alarm
2
Q
Fear vs anxiety
A
- Fear happening now
- Anxiety is about something that will happen in the future
3
Q
What is anxiety
A
- Anticipation of future threat with a dread
- Think about seeing a bear @ keji → don’t go to keji
- Leads to being unable to do things
4
Q
Panic
A
- Particular type of fear response, intense
- Abrupt, not anticipated
- Alarm response
- Quickly reaches a peak of intensity
- Lasts several minutes
- Physiological symptoms
o Palpitations, shortness of breath, abdominal distress, dizziness, sweating, numbness - May include psychological symptoms like
o Fear of losing control, going crazy or dying, feeling of unreality or of being detached from oneself - May or may not be related to panic attack
- Related to anxiety disorder if → feel panic attack, is it going to happen again? (angst around panic)
- Panic and fear can become associated with specific situations
5
Q
Panic attacks
A
- May be cued (tied to anxiety) or uncued
- Commonly accompany anxiety disorders
- May occur in the absence of a psychological disorder
- High level of fight or flight for a long period of time
- Peak at 10 min
6
Q
What is an anxiety disorder
A
- Persistent and pervasive symptoms of anxiety and fear
- Characterized by extreme avoidance
- Characterized by extreme levels of impairment → many things people limit themselves on
- Specific phobias: specifically aimed so you can often aboud and not be impaired
- Situation can be endured but with extreme distress
7
Q
Biological vulnerabilities
A
- Genetics → diathesis stress model
- General tendency for anxiety inherited
- Neurotransmitters
o Low levels of GABA related to increased anxiety
o One of medication treatments = SSRIs - Brain circuit
o Neural fear → limbic an cerebral cortex
o Panic circuit → fight or flight, originates from brain stem, travels to limbic system structures
o Amygdala overly sensitive to info in environment and cortex doesn’t buffer HPA axis
o Implicated with neurotransmitters being related to anxiety
8
Q
Psychological vulnerabilities
A
- Personality traits and behavioral tendencies
- Temperament
o How are we typically: shy, angry etc. - Anxiety sensitivity
o Fear of arousal related somatic sensations
o Feel one of panic attack symptoms →> have anxiety disorder take more seriously, freak out
o Overly sensitive to these things have genetic links
o More likely to experience fear, tendency to respond more to anxiously - Negative affect
o Tendency to experience things as negative (situations, people etc.) - Life stressors
o Unique familial and interpersonal stressors
o Stressful life events
o Vicarious learning
o Events may trigger existing or create new biological/psychological vulnerabilities
o Magnify existing or create new sensitivities
9
Q
- General complexity
A
o Existence of concurrent psychological disorders
o Common across anxiety disorders
o ~50% have 2+ secondary diagnoses
o Major depression is the most common
10
Q
Specific phobia
A
- 11% of general population
- 9% of women 4% of men
- Extreme and irrational fear in presence of a phobic stimulus
- Extreme avoidance
- Triggers:
o Confronting in person, reading about it, hearing about it
o Common to have more than 1
o Unexpected panic attack in presence of phobic stimulis
o Informational transmission - If kid you express distress as crying, tantrum
- Typical onset btwn 7-11y
- Must have fear and be struggling for at least 6mo
- Make sure that nothing else is going on
- Clinically significant distress of cause impairment
- Onset is young, anywhere from childhood to adolescence
11
Q
- Blood injection injury
A
o Fear of needles, invasive medical procedures, blood, injury
o May or may not be about seeing blood/injury
o Inherited vasovagal response
o More about being frightened
o Most inherited phobia
12
Q
- Natural environment
A
o Heights, storms, water etc.
13
Q
situational
A
o Particular places and situations
o Airplanes elevators, enclosed spaces
14
Q
animal
A
o Fear of specific animals
o Spiders, dogs, insects, snakes etc.
15
Q
other
A
o Fear of situations that may lead to choking, vomiting
o In kids: costumed characters, loud noises
16
Q
treatment -SP
A
- Cognitive behavior therapies
- Systematic desensitization
o Discovered that responses can exist at the same time
o If you can get people into a physical and mental state of relaxation
o You cant also experience panic
o Person can tolerate higher and higher levels on higharchy - Exposure based therapy
o Similar, use imagination
o Graduated
o Consistent
o Structures
o Relaxation - Virtual reality
17
Q
social anxiety disorders
A
- Fear in social situations
- On a stage, using a urinal, at a party
- Fear of humiliation or being judged
- Avoid social situations or endure with great distress
- Associate experience wit emotion and get anxiety so avoid
- Peak around age 13, can develop in 20s
- People aren’t usually evaluating us to the degree that we think they are
- Rate higher in Canada than US
18
Q
biological -SAD
A
- Prepared learning: prepped to feel anxious and avoid angry and threatening people, evolution
- Inherited
o Behavioral inhibition: extreme shyness
o Genetic predisposition for anxiety - Neurobiological
o Multiple neurotransmitters implicated
19
Q
psychological -SAD
A
- Generalized vulnerability
- Anxiety sensitivity
- Negative beliefs including anxious apprehension
o Looks → anxiety that your sensitive to depends on you, but get anxious about it and it can get worse
o Reading catastrophic meaning into cues
o Focusing on negative self talk
o All anxiety disorders have uncontrollability aspect
• If have high need for control when out can feel more anxious - Vicarious experience
o Way we socialize can be learned from parents (way they act affects)
o People with SAD don’t have a lot of the same social cues as others
• Selectively attend to negative cues, lots of comparisons with others - Specific vulnerability
o Traumatic exposure : something we’re involved in that becomes traumatic, most obvious way for disorder to start
o True alarm or false: something you judge as bad and assume others are but people pay less attention than thought
o Uncued or unexpected panic attack or intense fear
20
Q
treatment -SAD
A
- Medications
o SSRIs
o Only does so much, once you stop disorder may come back - Psychological
o Cognitive behavior treatment
• Exposure
• Rehearsal
• Role play
• Group therapy → hard for SAD but important, reality testing
• Doesn’t let you avoid
o Highly effective, good with long term results
21
Q
panic disorder
A
- Experience of recurrent, unexpected panic attacks
- Develop persistent anxiety worry or fear about having another panic attack or its implications
- Engage in behaviors designed to prevent or avoid future panic attacks
- Seems to happen in all kinds of situations
- Associated features
o Agoraphobia
o Interoceptive/exteroceptive
• Intro: symptoms and associate with panic attack symptoms feel like panic so avoid
• Extero: actual avoidance
o Nocturnal panic attacks – when asleep
o High rates of suicide and attempts
22
Q
agoraphobia
A
- Variation of panic disorder
- In places where person feels like they cant escape becomes part of disorder
- Avoid any situation where panic disorder occurs and escape is an issue
- Ex. public transit, enclosed place
- Begin to limit life and don’t go where you cant escape
- Severe: may become homebound
- High rates of comorbidity and impairment
- Without treatment remission = 10%
- Some people endure with intense dread
23
Q
biological -PD
A
- Inherited, strong genetic predisposition → have gene and 5x more likely
o Inherit anxiety and over reactiveness
o Stress vulnerability
24
Q
psychological -PD
A
- Anxiety and sensitivity
- Negative beliefs, self evaluation more aware of every change
- Worry about it → make more likely to have PA – anxious apprehension
- Hyper vigilance → sensitivity to threatening things
- Negative attributions
- Conditioning resulting in a learned alarm reaction
25
treatment -PD
```
Medications
- Target serotonergenic, noradrenergetic, benzodiazepine GABA systems
- SSRIs: currently preferred
- High relapse when discontinue
- Benzos are highly addictive
Psychological
- Cog behave therapy effective
- Learn to manage anxiety
- Gradual exposure – based exericeses
- Relaxation and breathing
- Psych treatment should be offered initially and then meds offered for those who the meds don’t work for
Panic control
- Exposure to interoceptive cues
- Cog therapy
- Therapist creates mini panic attack
```
26
gad
- Excessive, uncontrollable apprehension and worry about numerous life events
o Cant stop worry anxiety
- Strong pronounced persistant anxiety
- Somatic symptoms
- Sleeping problems
- Chronic course
- No panic attacks, just constant worry
- Muscle tensions → chronic aches and pains
- Feel restless, overwhelmed bc of worries
27
biological -GAD
- High genetic predisposition
- Anxiety sensitivity → think the worst is going to happen and get stressed
o Become distressed in response to arousal related sensations
o Anxiety related sensations have harmful consequences
- Unique physiological patterns
o Chronic muscle tension
o Reduces responsiveness to most anxiety measures
- Risk higher for identical twins when one already had GAD
- Inherit tendency to be anxious, not disorder itself
28
psychological -GAD
- Unique cog characterisitcs
o Intolerance of uncertainty → cant calm themselves, less tolerant of uncertainty situations
o Erroneous beliefs → think worrying will help them
• Effective in avoiding negative outcomes
o Poor problem orientation → don’t focus on problem solving
o Cog avoidance → avoid, never able to work through problems
29
treatments -GAD
- meds
o Benzodiazepines – short term relief but high risk
• Impair cognitive and motor functioning
• Produce dependence, hard to stop taking
• Best for short term relief of a temporary crisis
o Antidepressants
o SSRIs promising
- Psychological
o Cog behave treat
• Exposure to worry process
• Confronting anxiety provoking images
o Coping strategies
o Mindful based treatments
30
Trauma and stressor related disorders
- DSM5 created a new diagnostic category
- Includes
o Reactive attachment disorder
o Disinhibited social engagement disorder
o Adjustment disorders
• With: depressed mood, anxiety, conduct disturbance, mixed emotion/conduct disturbance
o Acute stress disorder
o Post traumatic stress disorder
31
ptsd
- Trauma exposure: actual or threatened death, serious injury or sexual violence
- May be thought direct experience, witnessing or learning that a traumatic even has occurred to significant other
- Experiencing repeated or extreme exposure to aversive details of the trauma (ex. first responders, child service workers)
- Typically experience extreme fear, helplessness or horror, although not required
- Most common: sexual assault, domestic violence, accidents, natural disasters, combat
- Symptoms:
o Avoidance
o Intrusive symptoms
o Negative cognitions and mood states
o Emotional numbing
o Altered physiological arousal and reactivity
- 3 core features
o Persistent re-experiencing of event
o Avoidance of associated stimuli and numbing of general responsiveness
o Symptoms of extreme arousal
32
causes -ptsd
- Biological and psychological vulnerabilities
o Genetics
o Neurobiological impact of traumatic event
o Emotional and cognitive reactions (pre and post trauma)
o Social support (pre and post)
o Psychiatric history (includes previous trauma)
- Event related factors
o Dosage related
o Natural vs man made trauma
o Nature of threat
33
treatment -ptsd
```
- Medications
o SSRIs
- Cognitive behavioral therapy
o Exposure
o Imaginal
- Increasing positive coping skill s
- Increase social support
- Highly effective
```
34
ocd and related disorders
- Obsessive compulsive disorder
- Body dysmorphic disorder
- Hoarding disorder
- Trichotillomania
- Excoriation
- Substance-induced obsessive-compulsive and related disorders
- Obsessive-compulsive and related disorder due to another medical condition
35
ocd
- Presence of obsessions, compulsions, or both
- Obsessions
o Repetitive and persistent thoughts
• Intrusive and unwanted thoughts, images, urges
o Attempts to resist or eliminate
- Compulsions
o Repetitive behaviors or mental acts
• Driven to perform in response to an obsession, r according to rules which must be rigidly followed
o Temporarily suppresses obsessions
o 4 major categories
• Checking, ordering, arranging, washing/clearning
36
biological -ocd
o Genetics
• A moderate genetic risk identified for OCD related dysfunctional beliefs and symptoms
o Neurobiological
• Research implicated the basal ganglia and frontal cortex
• Hypothesized: structureal and/or functional abnormalities in the basal ganglia and frontal cortex may be responsible for obsessions and compulsions
• Neurochemical hypotheses: abnormalities in serotonin system have been implicated
37
psychological -ocd
o Early life experiences may result developing maladaptive beliefs about oneself, one’s thoughts (dangerous), leading to dysfunctional behaviors
• Catastrophic misinterpretations of thoughts including anxious apprehension
• Thought/action fusion
• Thought suppression and rebound effect
• Compulsions (thoughts or behaviors) may develop as maladaptive coping mechanism
38
treatment -ocd
```
- Medications
o Clomipramine and SSRIs
• 50-50% benefit
• High relapse when discontinued
- Cognitive-behavioral therapy
o Exposure and ritual prevention (ERP)
o Reality testing
o Highly effective
• 85% benefit from ERP
- Psychosurgery (cingulotomy)
o Extreme cases: 30% benefit
```
39
body dismorphic disorder
- Preoccupation with perceived defects or flaws in physical appearance
- Typical unobservable or slight flaws
- Strong beleifs regarding unattractiveness or physical abnormalities
- Characterized by intrusive thoughts (pops up all the time), time consuming activities related to appearance
o Checking mirrors, comparison to others
o Efforts to improve appearance (grooming, exercise, cosmetic surgery, skin picking)
- Usually no one else is able to tell what they’re obsessing about
- May be ore focused on appearance than others
- Don’t want to confuse with eating disorders – diff = that people with anorexia have a fear of becoming obese and have a disturbed body image
- Can confuse with excoriation – in this case skin picking is about trying to improve appearance
- Causes largely unknown
o Similarities with ocd: symptomology, etiology, treatment
40
treatment -bdd
o Ssris
| o Exposure and response prevention therapy
Abnormal Behavior
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