1
Q
Anxiety
A
- general feeling of apprehension ab possible future danger
- response pattern is a blend unpleasant emotions and cognitions
2
Q
Fear
A
- alarm reaction that occurs as result of immediate danger
3
Q
Anxiety disorders
A
- unrealistic, irrational fears or anxieties that cause significant distress/impairments
- eg Specific phobia, Social anxiety disorder, Panic disorder, Agoraphobia, Generalized anxiety disorder
4
Q
Commonalities (causes of anxiety disorders)
A
- neuroticism
- involves limbic system
- neurotransmitters: GABA, norepinephrine, serotonin
- ppl who feel out of control over emotions/environment are more vulnerable
- sociocultural environment
5
Q
Commonalities (effective treatment of anxiety disorders)
A
- graduated exposure to fears is best
- cognitive restructuring
- medications effective for all except phobias
6
Q
Phobia
A
- persistent and disproportionate fear of some specific object/situation that presents little to no actual danger
- great deal of avoidance of feared situations
7
Q
Ablutophobia
A
- fear of bathing
8
Q
Achluophobia
A
- fear of darkness
9
Q
Acrophobia
A
- fear of heights
10
Q
Aerophobia
A
- fear of flying
11
Q
Algophobia
A
- fear of pain
12
Q
Agoraphobia
A
- fear of open spaces or crowds
13
Q
Aichmophobia
A
- fear of needles or pointy objects
14
Q
Amaxophobia
A
- fear of riding in a car
15
Q
Androphobia
A
- fear of men
16
Q
5 types of phobias in DSM
A
- animal
- natural environment (storms, heights, water)
- blood-injection-injury
- situational (public transit, tunnels, flying, driving)
- other (choking, vomiting, falling down)
17
Q
DSM-5 Criteria for Specific Phobias
A
- marked fear/anxiety of specific situation
- situation almost always provokes anxiety
- avoidance
- fear/anxiety out of proportion
- lasting at least 6 months
- clinically significant distress or impairment
- not better explained by another disorder
18
Q
Blood-injection-injury phobia
A
- presents differently from other phobias
- typically experience as much disgust as fear
- drop in heart rate and blood pressure
19
Q
Prevalence of specific phobias
A
- 12% during lifetime
- more common in women, 90% of animal phobias are women
- high prevalence of comorbidity
20
Q
Age of onset of specific phobias
A
- animal, dental, blood-injection-injury phobias start in childhood
- other phobias start in early adolescence or early adulthood
21
Q
Psychoanalytic viewpoint on phobias
A
- defense against anxiety that stems from repressed impulses from the id
- too dangerous to “know” repressed id impulse
- anxiety displaced to external object/situation that has some symbolic relationship to real object of anxiety (young hans scared of horses but actually his father?)
- defense mechanism is displacement
22
Q
Phobias as cognitive distortions
A
- ‘possible’ becomes ‘probable’
23
Q
Phobias as learned behavior
A
- classical conditioning: fear response can be conditioned to previously neutral stimuli when paired with traumatic events
- vicarious conditioning: learn from seeing fear response from someone else (ie parental modeling)
24
Q
Prepared learning
A
- when primates and humans are evolutionarily prepared to associate certain objects w frightening events
- why we are more likely to have phobia of animals
25
Biological causal factors of phobias
- genetic/temperamental variables affect speed and strength of conditioning of fear
- identical twins more likely to share animal phobias than situational phobias
26
Treatments of phobias
- exposure therapy is best bet!
- participant modelling: watching someone else have contact w feared object
- medication ineffective on its own
27
Social Anxiety Disorder
- social phobia
- disabling fear of 1 or more specific social situations
- underlying fear of scrutiny/negative evaluation of others
- 2 subtypes: performance (eg public speaking) and nonperformance (eg eating in publlic)
28
Prevalence of social anxiety
- about 12% of population meets diagnostic criteria in lifetime
- typically begins early adolescence/adulthood
- more common in women
- often present (2/3) w other anxiety disorders (anxiety disorders as causally connected network of symptoms)
- 1/3 abuse alcohol to manage symptoms
- lower employment rate and SES
- very persistent (1/3 spontaneous recovery in 12 years)
29
Psychological causal factors of social anxiety
- learned behavior (direct or vicarious conditioning -- 56-58% can identify direct traumatic exp as origin)
- evolutionarily based predisposition to acquire fears of social stimuli that signal dominance/aggression from others
30
Diminished sense of personal control in social anxiety
- perceptions of uncontrollability and unpredictability
- esp. when person has experienced actual social defeat
- developed in part due to overprotective parents
31
Cognitive biases in social anxiety
- tend to expect other ppl will reject or negatively evaluate them
- expect that they will be awkward
- vicious cycle
- tendency to interpret ambiguous social info as negative
32
Biological causal factors of social anxiety
- most important temperamental variable is behavioral inhibition
- children high on behavioral inhibition ages 2-6 were 3x more likely to be diagnosed w social phobia
- modest genetic contribution (12-30%)
- larger part of variance due to nonshared environmental factors (twin studies)
33
Treatments of social anxiety
- CBT: prolonged and graduated exposure is very effective; cognitive restructuring (identify and change underlying negative thoughts)
- Medications: sometimes effective, mostly antidepressants; CBT is better
34
Panic Disorder
- occurrence of panic attacks that often come 'out of the blue' (not provoked by identifiable aspects of immediate situation)
- most symptoms are physical (at least 4 of 13 symptoms for panic attack)
- palpitations, sweating, shaking, shortness of breath, choking, chest pain, nausea, dizzy, chills/heat, numbness, derealization, fear of losing control, fear of dying
- at least one attack followed by 1mo+ of worry ab another and/or maladaptive change in behavior
35
Agoraphobia
- fear of 'open gathering places' (places that it would be hard to escape or where immediate help would be unavailable)
- may involve inability to leave home
- frequent complication of panic disorder
36
Prevalence of panic disorder and agoraphobia
- panic disorder with or without agoraphobia: begins 20s-40s, about 4.7% of population
- both twice as prevalent in women vs men (more agoraphobic avoidance=higher percentage of women)
37
Odds ratio
- represents increase in odds of disorder associated with female vs male gender (looks like 2.1)
38
Odds ratio of agoraphobia
2.0
39
Odds ratio of specific phobia
2.0
40
Odds ratio of panic disorder
1.9
41
Odds ratio of generalized anxiety disorder
1.7
42
Odds ratio of social anxiety disorder
1.3
43
Comorbidity of panic disorder
- majority have at least 1 comorbid disorder (usually GAD, social A, specific phobia, PTSD, depression, substance-use
- increased risk for suicidal ideation
44
Biological causal factors of panic disorder
- moderate heritable component (30-34% of variance in liability to panic symptoms)
- amygdala (nuclei in front of hippocampus) critically involved in fear -- central area for 'fear network'
- theory that panic disorder likely to develop in those with abnormally sensitive fear networks
- noradrenergic and serotonergic systems most implicated in panic attacks
- GABA implicated in anticipatory anxiety
45
Cognitive Theory of Panic
- proposes that people w panic disorder are hypersensitive to bodily sensations
- tendency to catastrophize ab meaning of bodily sensations
46
Panic circle
(trigger stimulus -->) perceived threat -- apprehension or worry -- (Trigger stimulus -->) body sensations --interpretation of sensations as catastrophic -- perceived threat...
47
Comprehensive Learning Theory of Panic Disorder
- initial panic attacks become associated w initially neutral internal (interoceptive) and external (exteroceptive) cues through conditioning
- more intense panic attack = more robust conditioning
48
Anxiety sensitivity
- trait-like belief that certain bodily symptoms may have harmful consequences
- predicts dev. of panic attacks and onset of other anx. disorders
49
Behavioral and Cognitive-Behavioral Treatments for Panic Disorders and Agoraphobia
- prolonged exposure effective in 60-75% of ppl with agoraphobia
- Panic Control Treatment (PCT) targets agoraphobic avoidance and panic attacks
- PCT is combo of cognitive and behavioral components (incl. education, cog. restructuring, breathing retraining, interoceptive exposure)
- greater magnitude of improvement w these than meds
50
Medications for panic and agoraphobia
- anxiolytics from benzodiazepine category (eg Xanax or Klonopin) -- act very fast but cause drowsiness
- sometimes use antidepressants (SSRIs) -- take at least 4 weeks, can alleviate comorbid depressive symptoms, can have troublesome side effects
51
Generalized Anxiety Disorder
- chronic, excessive, and unreasonable worry about many different aspects of life
- future-oriented mood state of anxious apprehension
- frequently engage in subtle avoidance like checking and procrastination
52
DSM-5 Criteria for GAD
- excessive anxiety and worry, more days than not for 6mo+, ab number of events or activities
- difficult to control worry
- associated w at least 3/6 of: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances
- anxiety or symptoms cause clinically significant distress or impairment
53
Prevalence of GAD
- 3% of population
- tends to be chronic
- about 2x as common in women
- most ppl can still function
54
Comorbidity of GAD
- often co-occurs w other disorders, esp. anxiety/mood
- many people experience occasional panic attacks (might qualify for panic disorder diagnosis)
55
Psychoanalytic viewpoint and GAD
- anxiety results from unconscious conflict between ego and id impulses
- defense mechanisms do not work w GAD
- this theory is not testable
56
Perceptions of uncontrollability in ppl with GAD
- may have history of experiencing important events in their lives as unpredictable or uncontrollable
- may be more likely to have history of trauma in childhood
- less tolerance for uncertainty!
57
Sense of mastery
- parent responsiveness to child needs influences dev. of sense of mastery
- history of control over important aspects of environment also significant variable
58
Reinforcing properties of worry (GAD)
- think benefits of worrying are: superstitious avoidance of catastrophe, avoidance of deeper emotional topics, coping and preparation
59
Negative consequences of worry
- greater sense of danger and anxiety
- more negative and intrusive thoughts
- cognitive bias for threatening information (likely due to prominent danger schemas)
60
Biological causal factors of GAD
- heritability: approx 30%
- neuroticism is part of genetic predisposition
- GABA (inhibits anxiety) is functionally deficient
- corticotropin-releasing hormone (CRH) plays role
61
Treatment of GAD (Cognitive-Behavioral)
- combination of behavioral techniques
- often exposure-based techniques
- magnitude of changes with CBT comparable to those w benzodiazepines
- benzodiazepines do not have much effect of worry/psyc symptoms, can lead to dependence
- buspirone works better w less side effects (after 2-4w)
62
Thought reaction record
- part of CBT treatment of anxiety
- The Situation, Your Thoughts, What You Did, What You Could Have Done Differently
- think of alternate ways to interpret things that might reduce anxiety
63
Obsessive-Compulsive Disorder
- formerly anxiety disorder in DSM, now own group
- occurrence of obsessive thoughts and compulsive behaviors in attempt to neutralize such thoughts
- obsessions: persistent, recurrent intrusive thoughts, images, impulses, etc
- compulsions: overt repetitive behaviors (rituals)
- learned behavior!
64
DSM5 criteria for OCD
- presence of obsessions (tries to ignore or suppress), compulsions, or both
- obsessions or compulsions for more than 1h/day OR cause clinically significant distress/impairment
- not attributable to or better explained by smt else
65
Prevalence of OCD
- 2-3% meet criteria in lifetime
- over 90% of those seeking treatment have both obsessions and compulsions
- little-no gender differences in adults
- usually gradual onset, becomes chronic
66
Comorbidity and OCD
- most frequent w other anxiety disorders (social phobia, panic disorder, GAD, PTSD)
- 25-50% of ppl w OCD experience major depression in lifetime
67
Mowrer's Two-Process Theory of avoidance learning
- neutral stimulus becomes associated w frightening thoughts/experiences through classical cond.
- stimuli come to elicit anxiety -- compulsive behavior reduces anxiety
68
Cognitive Biases and Distortions in OCD
- attentional bias toward relevant disturbing material
- difficulty blocking out negative/irrelevant input of distracting info
- low confidence in memory ability may contribute to repeating ritualistic behaviors
69
Biological Causal Factors of OCD
- moderately high concordance rate in mz twins
- increased metabolic activity in orbital frontal cortex, cingulate gyrus/cortex, and basal ganglia
- serotonin is strongly implicated
70
Treatment of OCD
- CBT: exposure and response prevention
- medications that affect serotonin system are best (clomipramine and fluoxetine)
- high relapse rates when meds discontinued
- combination treatment better for kids + teens
71
Body Dysmorphic Disorder
- preoccupation w certain aspects of body (perceived or imagined flaws)
- causes clinically significant impairment or distress
- most have compulsive checking behavior
- avoidance of usual activities (social functioning and work)
- 94% of ppl w BDD felt depressed at some point bc of it
- SSRIs can often help (higher doses than OCD)
- exposure and response prevention work well!
72
Prevalence of BDD
- 2% of people meet diagnostic criteria (20% of those seeking rhinoplasty!)
- equal in men and women
- onset usually in adolescence
- often also have depression diagnosis
73
Hoarding Disorder
- acquire and fail to discard many possessions that seem useless or of very limited value
- significantly more disabled than those w OCD without hoarding symptoms
- 3-5% of adults (10-40% w OCD)
- diff. brain activation patterns than OCD w/o hoarding
- OCD meds not effective for hoarding
- behavior therapy also less effective
74
Trichotillomania
- compulsive hair pulling, resulting in noticeable hair loss
- usually preceded by increasing sense of tension, pulling hair out brings relief
- onset post-puberty is more severe course
- research still in early stages
PSYC 337
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Decks in class (15)
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