1
Q
Anxiety def
A
Apprehension over an anticipated problem
2
Q
Fear def
A
A reaction to immediate danger
3
Q
Both ____ and ____ involve physiological arousal
A
- Both anxiety and fear involve physiological arousal
- Anxiety – moderate arousal (e.g., restless energy, tension)
- Fear – higher arousal (e.g., overpowering urge to run)
4
Q
Anxiety
A
- Anxiety increases preparedness
- “U-shaped” curve
- Absence of anxiety interferes with performance
- Moderate levels of anxiety improve performance
- High levels of anxiety are detrimental to performance
5
Q
What does anxiety increase?
A
preparedness
6
Q
Fear
A
- Fear triggers “fight or flight” response
- In the right circumstance, fear saves lives
- Fear system seems to misfire in some anxiety disorders
7
Q
describe anxiety on a graph:
A
- “U-shaped” curve (really looks more bell curve)
- Absence of anxiety interferes with performance
- Moderate levels of anxiety improve performance
- High levels of anxiety are detrimental to performance
8
Q
Anxiety Disorders
A
- DSM-5 Anxiety Disorders
- Specific phobias
- Social anxiety disorder
- Panic disorder
- Agoraphobia
- Generalized anxiety disorder
- Most common psychological disorders
- 28% of people report anxiety symptoms
- 10th leading cause of disability worldwide in 2015
9
Q
*DSM-5 Anxiety Disorders
A
- DSM-5 Anxiety Disorders
- Specific phobias
- Social anxiety disorder
- Panic disorder
- Agoraphobia
- Generalized anxiety disorder
10
Q
what is the most common psychological disorders
A
anxiety disorders (Specific phobias Social anxiety disorder Panic disorder Agoraphobia Generalized anxiety disorder)
11
Q
10th leading cause of disability worldwide in 2015
A
Anxiety Disorders
12
Q
DSM-5 Criteria: Panic Disorder
A
- Recurrent unexpected panic attacks
- At least 1 month of concern about the possibility of more attacks occurring or the consequences of an attack, or maladaptive behavioral changes because of the attacks
13
Q
Criteria for Anxiety Disorders: DSM-5 criteria for each disorder:
A
- Symptoms interfere with important areas of functioning or cause marked distress (clinically significant)
- Symptoms are not caused by a drug or a medical condition
- Symptoms persist for at least 6 months or at least 1 month for panic disorder
- The fears and anxieties are distinct from the symptoms of another anxiety disorder
14
Q
Panic disorder: how many month(s)
A
1
15
Q
how to distinguish panic disorder (from other anxiety disorders)
A
panic disorder is for at least 1 month, the others are for at least 6 months
16
Q
Specific Phobias
A
- Disproportionate fear caused by a specific object or situation
- Great lengths taken to avoid feared object or situation
- Most specific phobias cluster around a few feared objects and situations
- High comorbidity among specific phobias
17
Q
DSM-5 Criteria: Specific Phobia
A
- Marked and disproportionate fear consistently triggered by specific objects or situations
- The object or situation is avoided or else endured with intense anxiety
18
Q
Social Anxiety Disorder
-has overlap with…
A
- Persistent, unrealistically intense fear of social situations that might involve being scrutinized by or exposed to unfamiliar people
- *Fear of negative evaluation or scrutiny leads to avoidance of social situations
- Common fears include: public speaking, meeting new people, talking to people in authority
- 33% also diagnosed with Avoidant Personality Disorder
- Overlap in genetic vulnerability for both disorders
19
Q
Common fears of Social Anxiety Disorder
A
Common fears include: public speaking, meeting new people, talking to people in authority
20
Q
DSM-5 Criteria: Social Anxiety Disorder
A
- Marked and disproportionate fear consistently triggered by exposure to potential social scrutiny
- Exposure to the trigger leads to intense anxiety about being evaluated negatively
- Trigger situations are avoided or else endured with intense anxiety
21
Q
Panic attacks
A
*Sudden attack of intense apprehension, terror, and feelings of impending doom
*Accompanied by at least four other symptoms:
Physical symptoms can include:
-Shortness of breath, heart palpitations, nausea, upset stomach, chest pain, feelings of choking and smothering, dizziness, lightheadedness, faintness, sweating, chills, heat sensations, numbness or tingling sensations, and trembling
*Depersonalization - feeling of being outside one’s body
*Derealization - feeling of the world not being real
*Fears of going crazy, losing control, or dying
- Symptoms come on rapidly and peak in intensity within 10 minutes
- Many people interpret symptoms as having a heart attack
- Misfiring of the fear system
- Physiological response similar to what most experience when faced with immediate threat
22
Q
how do people describe panic attacks
A
Many people interpret symptoms as having a heart attack
23
Q
panic attacks vs panic disorder
A
Panic attacks triggered by specific situations (e.g., phobia) should not be considered in diagnosing panic disorder
-panic disorder def: recurrent and unexpected panic attacks (except those caused by phobias)
24
Q
panic disorder
A
- Recurrent panic attacks unrelated to specific situations
- Worry about having more panic attacks
- Panic attacks triggered by specific situations (e.g., phobia) should not be considered in diagnosing panic disorder
- 25% of the general population of people will experience a single panic attack
- -Not the same as panic disorder
25
DSM-5 Criteria: Panic Disorder
Recurrent unexpected panic attacks
At least 1 month of concern about the possibility of more attacks occurring or the consequences of an attack, or maladaptive behavioral changes because of the attacks
26
Agoraphobia
| -how many people with agoraphobia will experience panic attacks
*Anxiety about situations in which it would be embarrassing or difficult to escape if anxiety symptoms occurred
E.g., crowds, stores, malls, churches, trains, bridges, tunnels, etc.
*Causes significant impairment
-Unable to leave house or leaves house with great distress
*About half of people with agoraphobia experience panic attacks
27
DSM-5 Criteria: Agoraphobia
* Disproportionate and marked fear or anxiety about at least 2 situations where it would be difficult to escape or receive help in the event of incapacitation, embarrassing symptoms, or panic-like symptoms
* These situations consistently provoke fear or anxiety
* These situations are avoided, require the presence of a companion, or are endured with intense fear or anxiety
28
Generalized Anxiety Disorder (GAD)
| -Def
DSM def: Uncontrollable worry
* Excessive, uncontrollable, and long-lasting worry about minor things
* Worry : Cognitive tendency to chew on a problem and to be unable to let go of it
* Common worries: Relationships, health, finances, daily hassles
* Also includes: difficulty concentrating, tiring easily, restlessness, irritability, and muscle tension
* Typically begins in adolescence
29
DSM-5 Criteria: Generalized Anxiety Disorder
* Excessive anxiety and worry at least 50% of days about a number of events or activities (e.g., family, health, finances, work, and school)
* The person finds it hard to control the worry
* The anxiety and worry are associated with at least three (or one in children) of the following:
- Restlessness or feeling keyed up or on edge
- Easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance
30
Comorbidity of anxiety disorder
- among anxiety disorders
- with other disorders... specifically
* More than 50% of those with anxiety disorder meet criteria for another anxiety disorder
* 75% of those with anxiety disorder meet criteria for another psychological disorder
* Disorders commonly comorbid with anxiety:
- 60% also have depression
- Obsessive compulsive disorder also common
* Comorbidity is associated with greater severity and poorer outcomes of the anxiety disorders
31
what percent of people will experience a panic attack
25% of people will experience a single panic attack
| Not the same as panic disorder
32
Treatment of the Anxiety Disorders: Commonalities Across Psychological Treatments
* Exposure: Face the situation or object that triggers anxiety
* Virtual reality vs. in vivo (real-life) exposure are equally effective
* Mindfulness and acceptance treatments also show promise
33
Exposure as a treatment as Anxiety disorder
(how effective?)
(behavioral vs cognitive view)
* Exposure: Face the situation or object that triggers anxiety
- E.g., exposure hierarchy: graded exposure to a list of triggers
- Effective for 70-90% of clients
- Behavioral view: Newly learned associations inhibit fear
- Cognitive view: Corrects mistaken beliefs
34
Psychological Treatment of Phobias
*Exposure
-In vivo (real-life) exposure
-For phobias involving fear of animals, injections, or dental work:
Very brief treatments lasting only a couple of hours have been found to be highly effective
-Most people experience relief from phobic symptoms
35
Exposure as a treatment as Anxiety disorder
| behavioral vs cognitive view
*Exposure: Face the situation or object that triggers anxiety
-E.g., exposure hierarchy: graded exposure to a list of triggers
Effective for 70-90% of clients
Behavioral view: Newly learned associations inhibit fear
Cognitive view: Corrects mistaken beliefs
36
Psychological Treatment of Phobias
*Exposure
In vivo (real-life) exposure
For phobias involving fear of animals, injections, or dental work:
Very brief treatments lasting only a couple of hours have been found to be highly effective
Most people experience relief from phobic symptoms
37
Social skills training
| as a psychological treatment of Social Anxiety Disorder
Provides extensive modeling of behaviors
| Reduces use of safety behaviors (e.g., poor eye contact)
38
Clarks’ cognitive therapy for social anxiety
Reduce internal focus of attention
Reduce the idea that people are looking at you
Challenge negative images of how others will react
39
Psychological Treatment of Agoraphobia
* CBT for agoraphobia
- Systematic exposure to feared situations
- Coached to gradually leave home and engage in community activities for short periods of time
- Enhanced by involving patient’s partner
40
Clarks’ cognitive therapy for social anxiety
* Reduce internal focus of attention
* Reduce the idea that people are looking at you
* Challenge negative images of how others will react
41
Professor thinks this is the best approach to GAD
Cognitive behavioral methods
42
Medications
*Anxiolytics: drugs that reduce anxiety
-Benzodiazepines (e.g., Valium, Xanax)
Can be addictive and cause severe withdrawal symptoms
Side effects: cognitive and motor difficulties
-Antidepressants (e.g., Tricyclics, SSRIs, SNRIs)
Side effects: jitteriness, weight gain, elevated heart rate
* Most people relapse once they stop taking medications
- Psychological treatments are considered the preferred treatment of most anxiety disorders
43
Benzodiazepines as a means to reduce anxiety
-a type of...
Benzodiazepines (e.g., Valium, Xanax)
Can be addictive and cause severe withdrawal symptoms
Side effects: cognitive and motor difficulties
-a type of Anxiolytics
44
Benzodiazepines as a means to reduce anxiety
Benzodiazepines (e.g., Valium, Xanax)
Can be addictive and cause severe withdrawal symptoms
Side effects: cognitive and motor difficulties
45
```
Gender Factors (for anxiety)
*Possible explanations for gender differences:
```
* Women are twice as likely as men to have an anxiety disorder
- And experience greater functional impairment
* Possible explanations for gender differences:
- Women may be more likely to report symptoms
- Men more likely to be encouraged to face fears
- Women more likely to experience sexual assault : May interfere with sense of control
- Women show more biological reactivity to stress
46
Cultural Factors (in regards to anxiety)
Culture and environment influence what people fear
* Culturally specific syndromes
- Kayak-angst: Inuit disorder in seal hunters at sea similar to panic disorder
- Taijin kyofusho: Japanese fear of displeasing or embarrassing others similar to social anxiety disorder
* Rate of anxiety disorders varies by culture
- Prevalence is highest in Europe and US than other countries
47
Kayak-angst
Inuit disorder in seal hunters at sea similar to panic disorder
-example of cultural factors
48
*Culturally specific syndromes (examples)
Kayak-angst
Inuit disorder in seal hunters at sea similar to panic disorder
Taijin kyofusho
Japanese fear of displeasing or embarrassing others similar to social anxiety disorder
49
Fear Conditioning
* Mowrer’s two-factor model (pure behaviorism)
- Classical Conditioning (to start)
- Operant Conditioning (keeps it going)
50
-Classical Conditioning (in regards to fear conditiniong)
A person learns to fear a neutral stimulus (CS) that is paired with an intrinsically aversive stimulus (UCS)
51
-Operant Conditioning : in regards to fear conditioning - (keeps it going)
A person gains relief by avoiding the CS
| Avoidance maintained though negative reinforcement
52
Extensions to Mowrer’s Model
*Classical conditioning can occur in different ways:
-Direct experience
-Modeling
Seeing someone else experience feared situation
-Verbal instruction
E.G., hearing a parent say dogs are dangerous
*People with anxiety disorders:
-Acquire fears more readily through classical conditioning
-Experience more persistent fears once conditioned
-Are sensitive to unpredictable treats
Neutral predictable unpredictable (NPU) threat task
People with anxiety disorders show high physiological arousal to unpredictable threat conditions compared to health controls
53
Genetic Factors for anxiety
| -percent
*Twin studies suggest heritability of about 50 to 60%
*Some genes may elevate risk for several anxiety disorders
E.g., a family member with a phobia is associated with increased risk of developing a phobia and other anxiety disorders
54
bipolar heritability
= 90%
55
Neurobiological Factors for anxiety
* Fear circuit: Amygdala, Medial prefrontal
| * Neurotransmitters
56
Amygdala : role in anxiety
*part of the fear circuit
Assigns emotional significance
Involved in the conditioning of fear
57
Personality Factors
* Behavioral inhibition
| * Neuroticism
58
*Behavioral inhibition
-a Personality Factor for anxiety
*Tendency to become agitated, distressed, and cry in unfamiliar or novel settings
Observed in infants as young as 4 months
May be inherited
*Predicts social anxiety in adolescence
59
*Neuroticism
- a Personality Factor for anxiety
* Tendency to experience frequent or intense negative affect
* Predicts onset of anxiety disorder and depression
* People with high levels are twice as likely to develop anxiety disorders than those with low levels
60
Cognitive Factors in regards to anxiety
* Sustained negative beliefs about future
* Belief that one lacks control over environment
* Attention to threat
61
Cognitive Factors in regards to anxiety : Sustained negative beliefs about future
*Sustained negative beliefs about future
Bad things are likely to happen
Engage in safety behaviors, which maintain negative cognitions
62
* Belief that one lacks control over environment
| - how is this fostered
Negative childhood experiences (e.g., abuse) and severe life events may foster the belief that life is uncontrollable
63
Etiology of Specific Phobias (3)
* Two-factor model (the mowrer’s model) of behavioral conditioning
* Risk factors act as diatheses
- Vulnerabilities influence development of phobias
* Prepared learning
- Evolutionary preparation to fear certain stimuli
- Potentially life-threatening (heights, snakes, etc.)
64
*Attention to threat as a
| Cognitive Factors in regards to anxiety
Tendency to notice negative environmental cues
Selective attention to signs of threat
*Attention training interventions show promise for reducing anxiety
65
Etiology of Specific Phobias: Two-factor model of behavioral conditioning
*Two-factor model (the mowrer’s model) of behavioral conditioning
- Phobias are a conditioned response to threat : Classical conditioning
- Sustained by avoidant behaviors : Operant conditioning
66
Etiology of Social Anxiety Disorder
* Behavioral factors
| * Cognitive factors
67
*Behavioral factors as Etiology of Social Anxiety Disorder
*Factors similar to specific phobia: Classical and operant conditioning
*Safety behaviors maintain and intensify social difficulties
E.g., avoiding eye contact, disengaging from conversation, standing apart from others
68
*Cognitive factors as Etiology of Social Anxiety Disorder
*Overly negative in evaluating their social performance
E.g., consequences of their behaviors
*Excessive attention to internal ( e.g., heart rate) vs. external (e.g., social) cues
69
Etiology of Panic Disorder: Neurobiological Factors
Locus coeruleus
70
Locus coeruleus as Etiology of Panic Disorder: Neurobiological Factors
* Major source of norepinephrine
| * People with panic disorder are more sensitive to drugs that trigger the release of norepinephrine
71
Etiology of Panic Disorder: Behavioral factors
* Interoceptive conditioning
- Classical conditioning of panic in response to internal bodily sensations
- -A person experiences somatic signs of anxiety
- -Followed by a panic attack
- -Panic attacks become a conditioned response to somatic changes
72
Etiology of Panic Disorder: Cognitive Factors
* Catastrophic misinterpretations of somatic changes
| * Anxiety Sensitivity Index
73
*Catastrophic misinterpretations of somatic changes as Etiology of Panic Disorder:
- a Cognitive Factor
* Catastrophic misinterpretations of somatic changes
- Interpreted as impending doom
- I must be having a heart attack!
- Beliefs increase anxiety and arousal
- Creates vicious cycle
74
*Anxiety Sensitivity Index as Etiology of Panic Disorder:
-a Cognitive Factor
* Measures intensity of fear in response to bodily sensations
* High scores predict onset of panic attacks and anxiety disorders
- “Unusual body sensations scare me.”
75
Etiology of Agoraphobia
* Risk related to genetic vulnerability and life events
| * Fear-of-fear hypothesis
76
*Fear-of-fear hypothesis as Etiology of Agoraphobia
* Negative thoughts about the consequences of experiencing anxiety in public
* Catastrophic beliefs that anxiety will lead to socially unacceptable consequences
77
Etiology of GAD
* Contrast Avoidance Model
- People with GAD find it highly aversive to experience shifts in emotions
- To avoid shifts, they prefer a constant state of worry
- Helps them feel as if they are preparing for the worst
- Worry can help a person keep a more stable emotional, albeit uncomfortable, state
78
Yerkes-Dodson
performance vs level of stress
* calm
* eustress
* distress
79
Types of Specific Phobias
```
animal
natural environemnt
blood, injecection, injury
situational
other:
```
80
Which of the anxiety disorders involves fear of objects of situations that is out of proportion to any real danger?
specific phobia
81
If someone has social anxiety disorder, what other disorder are they likely to also be diagnosed with?
33% also diagnosed with Avoidant Personality Disorder
82
25% of people will experience a single panic attack
| -does this mean that 25% of people have panic disorder?
NO
83
About _____ of people with agoraphobia experience panic attacks
About half of people with agoraphobia experience panic attacks
84
* 75% of those with anxiety disorder meet criteria for another psychological disorder
* Disorders commonly comorbid with anxiety: (2)
- 60% also have depression
| - Obsessive compulsive disorder also common
85
* Rate of anxiety disorders varies by culture
| - the US in comparison....
-Prevalence is highest in Europe and US than other countries
86
Factors that Increase General Risk for Anxiety Disorder (8) see slide 31
- behavioral conditinioning
- genetic vuluberablity
- distrubrance in the fear curtuit of the brain
- decreased functioning of gamma-aminobutyirc acid (GABA) and serotoning; increased norpephrine acvtitiy
- increased cortisol awakening response (CAR)
- behavioral inhibition
- neurotiscism
- cognitive factors, including sustained negative beliefs, perceived lack of control, oer-attention to cues of threat, and intolerance of uncertainty
87
Anxiety often involves __________ arousal, and fear involves __________ arousal.
moderate; high
88
The central feature of Generalized Anxiety Disorder in children is ________.
uncontrollable worry
89
Figure 6.1 Two Factor Model of Conditioning as Applied to Dog Phobia
Step 1) Classical conditiniong
-UCS: dog bite
-CS: dog
-CR: classiclaly conditioned fear of dogs
Step 2) operant conditioning: strong fear motivates the person to avoid dogs, avoidance is reinforced because it relieves the fear
90
n Japan, taijin kyofusho involves
the fear of embarrassing others.
91
Medial prefrontal cortex
| in regards to neurobiological factors for anxiety
-part of the fear circuit
Regulates amygdala activity
Involved in extinguishing fears
Processes anxiety and fear
92
Neurotransmitters in regards to neurobiological factors for anxiety
Disruptions in serotonin and GABA
Norepinephrine
Increased levels and changes in sensitivity of receptors
93
T/F Success rates are generally lower for GAD treatment than they are for other anxiety disorders.
TRUE
| Success rates are generally lower for GAD treatment than they are for other anxiety disorders.
94
Fear Circuit Associated with Anxiety Disorders
-see image slide 38
Fear and anxiety appear to be related to a set of structures in the brain called the fear circuit. The amygdala and the medial prefrontal cortex are particularly involved in anxiety disorders.
95
Cognitive Factors for anxiety : Attention to threat
Tendency to notice negative environmental cues
Selective attention to signs of threat
Attention training interventions show promise for reducing anxiety
96
Psychological Treatment of Social Anxiety Disorder
*CBT for Social Anxiety
Graded hierarchy of exposure
Involves role playing or practicing with a small group
*Social skills training
Provides extensive modeling of behaviors
Reduces use of safety behaviors (e.g., poor eye contact)
*Clarks’ cognitive therapy for social anxiety
Reduce internal focus of attention
Reduce the idea that people are looking at you
Challenge negative images of how others will react
97
Psychological Treatment of GAD
*Relaxation training to promote calmness (deep breathing, 5 senses: connecting to the presence)
*Cognitive behavioral methods
Improve problem-solving
-Challenge and modify negative thoughts
-Increase ability to tolerate uncertainty
Worry only during “scheduled” times
Focus on present moment
He thinks that cognitive is a better approach
98
Medications
Anxiolytics: drugs that reduce anxiety
Benzodiazepines (e.g., Valium, Xanax)
Can be addictive and cause severe withdrawal symptoms
Side effects: cognitive and motor difficulties
Antidepressants (e.g., Tricyclics, SSRIs, SNRIs)
Side effects: jitteriness, weight gain, elevated heart rate
Tends to work pretty well
Most people relapse once they stop taking medications
Psychological treatments are considered the preferred treatment of most anxiety disorders
99
T/F All of the anxiety disorders are associated with decrements in quality of life.
TRUE
100
T/F all anxiety disorders must be present for 6 months
FALSE
| -panic disorder must be present for 1 month
101
*____% of people report anxiety symptoms vs _____% of the general population of people will experience a single panic attack
* 25% of the general population of people will experience a single panic attack vs
* 28% of people report anxiety symptoms
102
More than ____% of those with anxiety disorder meet criteria for another anxiety disorder
* ___% of those with anxiety disorder meet criteria for another psychological disorder
* Disorders commonly comorbid with anxiety:
- __% also have depression
- Obsessive compulsive disorder also common
More than 50% of those with anxiety disorder meet criteria for another anxiety disorder
* 75% of those with anxiety disorder meet criteria for another psychological disorder
* Disorders commonly comorbid with anxiety:
- 60% also have depression
- Obsessive compulsive disorder also common
103
T/F when treating phobias- people should use exposure therapy for a long time over many sessions
FALSE
| Very brief treatments lasting only a couple of hours have been found to be highly effective
104
People with high levels of ______ are twice as likely to develop anxiety disorders than those with low levels
People with high levels of neuroticism are twice as likely to develop anxiety disorders than those with low levels
105
Some of the most commonly prescribed medications for social anxiety disorder are __________, which are proposed to work by ____________.
beta blockers; diminishing the effects of adrenaline on the body
106
Classical conditioning of panic attacks in response to bodily sensations is called
interoceptive conditioning.
107
Researchers training those with GAD to focus on a positive set of words over a long period of time using the dot probe task have found that participants
report less anxiety in both interview and self-report measures following the trainings.
108
While a therapist might consider adding cognitive therapy to treatment of _________, research suggests that outcomes are no better when cognitive therapy is added in the treatment of ________
social anxiety disorder; specific phobias.
109
Exposure treatment is effective in __________ of clients.
70-90%
