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128 Cards in this Set

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What is the difference between fear and anxiety?

Anxiety is a negative mood, with physical tension and apprehension of the future and fear that you cant control the upcoming event. Fear is the immediate alarm reaction to danger, negative affect and strong sympathetic nervous system activation

Panic attacks

it is an abrupt experience of intense fear or discomfort, accompanied by physical symptoms.

Two types: expected and unexpected

expected attacks is seen in specific phobias

unexpected panic attacks lead to panic disorder and agoraphobia

What is the difference between fear and panic?

Panic is fear occuring at an inappropriate time. Panic is a characteristic response to stress that runs in the family.

Jeffery Gray

He identified a brain circuit in the limbic system that is associated with anxiety. The behavioural inhibition system

State a psychological contributer to anxiety

Your belief about whether you have a sense of control over situations or not (this is inlfuenced by your upbringing)

What is the triple vulnerability theory?

It is an integrative psychological theory of the development of anxiety

generalized biological vulnerability

generalized psychological vulnerability

specific psychological vulnerability

a social stressor could activate your psychological and biological vulnerabilities

which would result in anxiety

What is the difference between different types of anxiety disorders?

the focus of the anxiety is different and the pattern of the panic attacks is different

Panic disorders are very comorbid together

What is the most common additional diagnostic for all anxiety disorders?

Depression (it occurs in 50% of cases)

Anxiety disorders often co-occur with physical disorders. But in most cases the anxiety disorder preceeds the physical disorder.


20% of patiets with panic disorder have attempted suicide


What characterizes Generalized anxiety disorder?

Muscle tension, fatigue, irritability, difficulty focusing because your mind switches from crisis to crisis. They focus on minor everyday life events.

What is the prevalence of GAD?


in the elderly it is as high as 10%

What is the sex ratio for GAD in Canada?

3 girls for 2 boys

What is the onset?

It is a gradual onset starting from a young age.

it is a chronic disorder

Causes of GAD:

It runs in the family - but what tends to be inherited is the tendency to become anxious, not GAD itself.

4 distinct cognitive processes of people with GAD:

intolerance of uncertainty

erroneous beliefs about worry (they think that it is helpful)

Poor problem orientation (they see roadblocks as insurmountable)

cognitive avoidance

Treatment of GAD

Benzodiazephines (they are good too relieve anxiety in the short term, but they lead to motor and cognitive impairments and to dependency)

Antidepressant drugs are better

- teaching patients how to relax to combat tension

- teaching them how to face and image their fear rather than avoid it through worrying

- CBT therapy (learning to use techniques to counteract the worry process)

-a psychological treatment is used to combat the 4 cognitive processes of ppl with GAD

- teaching patient how to accept distressing thoughts and feelings

- meditation

Panic disorder

when people experience severe unexpected panic attacks (and when they have them they feel like they are dying or losing control)

To meet criteria, the individual must have panic attakcs and develop susbtantial anxiety over the thought of haveing another one and its consequences


Is the fear or avoidance of a situation or people that a person sees as unsafe in the event that they have a panic attack

Where does the word agoraphobia come from?

It was coined by Karl Westphal and it refers to a fear of the marketplace

There is a high comorbidy between panic disorder and alcohol abuse


Agoraphobia is characterized by:

Either avoiding the situation, or experiencing intense dread and anxiety because of it

What is interoceptive avoidance of internal physical sensations?

Avoiding activities that lead to physical responses that remind someoneoe of a panic attack (ex; the gym.. heart racing)

Pervalence and gender of panic disorder

and onset

Prevalence 3.5%

Gender: 75% are women

onset is midteens to 40ies (peaks from 25 to 29)

Panic attacks begin after puberty

panic disorder is less common in the elderly

Stats for agoraphobia

Prevalence: 5.5%

more women than men

Reasons why women are more likely to be diagnosed with agoraphobia than men

- culture

- men are more likely to have it comorbid with alcohol abuse so harder to detect

- women fear anxeity symptoms mroe than men

Nocturnal Pain

Waking up from sleep because you experience a panic attack

this panic attack occurs during delta wave sleep

Causes of panic disorder and agoraphobia

Panic disorder has biological and psychological causes

agoraphobia is likely to happen after a person has an unexpected panic attack,. but whether the agoraphobia actually develops is influenced by social and cultural factors

the causes (vulnerabilities)

generalized biological vulnerability (some people have an emergency alarm reaction to stressful situation)

this first panic attack leads to a conditioning effect (the conditioning focuses either on internal or external cues) this learning process leads to a learned response to certain situations/experiences

what is the specific psychological vulnerbaility?

generalized psychological vulnerabilit?

the belief that unexpected bodily responses are dangerous

susceptible to developnig anxiety about having another panic attack

The cognitive theory of David Clark

- specific psychological tendency to interpret bodily responses in a catastrophic way

- this leads to the individual becoming anxious which creates even more bodily responses, and then more anxiety

vicious cycle

Treatment for panic disorder and agoraphobia


Exposure based treatments

relaxation and breathing exercises

in order to treat just panic disorder:

-relaxation and breathing retraining

cognitive therapy

- panic control treatment (expose the individual to the interoceptive responses invovled in a panic attack)

What does the drug D-cucloserine do?

It speeds up the extinction process of a conditioned stimuli and response

helpful for treating panic disorder and agoraphobia

What is a specific phobia?

A specific phobia is an irrational fear about something specific, which causes an avoidance response and interferes with that person's functioning

What are the 5 types of specific phobia?

1) animal phobia

2) blood injury phobia

3) natural environment phobia

4) situational phobia

5) other phobia

Characterstics of the blood injection phobia:

- it runs in the family

- it has a different physiological response than the other phobias

- people with this phobia have a vascular condition that reduces their blood pressure when they are exposed to blood, injury or injection, and this response causes them to faint. The phobia comes from the fear of experiencing this bodily response.

Age of onset: 9 years old

situational phobia

fear of public transportation and enclosed space

the difference between this and panic disroder is that here the bodily response will never occur in situations other than the feared one (expected attack)

situational phobia runs in families

age of onset: 20 to 25

Onset of natural environment phobia

average; 7 years

Onset of animal phobia

7 years

causes of specific phobia:

- direct experience of a traumatic event (true alarm, direct conditioning) OR they experience a panic attack (false alarm) and a phobia of that situation or state develops.

- vicarious experience: you see someone else who experienced a traumatic event

- information transmission (being told about a dangerous event)

Ex of a specific phobia

Illness phobia

Statistics for specific phobia

More women then men have it (apart for phobia of heights)

prevalence: 6.4%

people with situational phobias are more likely to come for treatment

Treatment for specific phobias

Exposure based exercises

Virtual reality exposure therapy

these treatments change brain functioning, by cahaing neural circuitry in areas of the brain such as the amygdala

Seperation anxiety disorder

- excessive worry that somethign will happen to important people in his life, or to one self that will prevent seeing each other again, while he is separted from them.

it occurs in 6.6 percent of the adult population

Social anxiety disorder

The individual is only anxious when others are present and watching (perhaps evaluating) their behaviour

Statistics of SAD:

13% of individuals experience it at some point in their lives (it is the most prevalent psychological disorder in the US)

the onset is in early adolescence, peak age is 15

the prevalence of SAD decreases with age

Oflactory reference syndrome

Culture bound syndrome in asia

it is the belief that you are embarrassing otheres with your odour

The more that attention avoidance behaviours are acceptable in a given culture, the greater the level of social anxiety


3 pathways to the development of social anxiety disorder:

- having a generalized biological vulnerability for shyness, socially inhibited and anxiety. And having a generalized psychological vulnerability (a belief that events are uncontrollable)

- experiencing a panic attack in a social situation which leads to conditioning and a fear of similar social situations (the panic attack becomes associated to social cues)

- experiencing a real life trauma in a social situation (ex: bullying)

In order to develop SAD, an individual must have also learned while growing up that social evaluation could be potentially dangerous

Lynn Alden's interpersonal transaction cycle

- people with SAD have a biased perception of social interactions. this influences them to behave in a certain way, which evokes negative responses from other peoplle and therefore confirms their beleifs about certain social situations.

Treatment of SAD

-CBT that involves role play of social situations

- intense cognitive therapy

- interpersonal psychotherapy

-family based therapy

- exposure to social mishaps therapy

self exposure

the drug D-cycloserine enhances the effects of CBT therapy (becauses it quickens the pace of extinction)

SSRIs, paxil, and zoloft drugs work

Selective mutism

a childhood disorder where a child does not speak in a social situation that he is expected to speak in (even though he is physically capable of speaking)

to meet criteria: the lack of speech must occur for 1 month

pervalence: 0.5%

treatment: CBT, BU brave camp buddies

Trauma and Stressor Related Disorders include:

Attachment disorder, adjustment disorder, post traumatic stress disorder, acute stress disorder

These disorders are seperate from anxiety disorders because they all have: an instigating stressful event followed by intense emotional responses (a broader range of responses than just fear or anxiety)

what is PTSD?

It is an emotioanl disorder that follows a trauma

the setting event for PTSD is exposure to a trauma that involves experiences or witness death or threatened death, injury or threatened injury, actual or trheatened sexual violance (close exposure to the trauma is necessary for PTSD to occur)

afterwards, the individual reexperiences the event through memories, flashbacks, and nightmares

victims sometimes experience emotional numbing and forget some of the details of the event afterwards

sometimes the individual will try to avoid the expeirence of intense emotions because these could trigger memories of the traumatic event

victims are often overaroused, quick to anger and easily startled

the DSM 5 added a dissociative subtype to PTSD

the dissociative subtype is characterised respoonses of less arousal and the experience of dissociative feelings of unreality

When can the diagnosis of PTSD be made?

It cannot the made until at least one month after the traumatic event has occured

When is PTSD considered to be chronic?

When it continues for more than 3 months after the traumatic event.

chronic PTSD is associated with avoidant behaviour, and it is more likely to be comorbid with other psychological disorders such as social phobia

What is delayed onset PTSD?

Individuals exhibit few symptoms directly after the trauma, but at least 6 months later or later they show full blown PTSD

What is acute stress disorder?

it is symptoms of PTSD that occur within the first month after the trauma has occured

Prevalence of PTSD

Looking at all types of trauma 18% experience PTSD

looking at the overall population, 8% experience PTSD

Causes of PTSD

the closer you are to the trauma and the more sever the trauma is the more likely you are to develop PTSD

ALSO the greater your psychological and biological vulnerability the more likely you are to develop PTSD

Biological vulnerabilities

genetic influence for the development of PTSD (sensitivity to anxiety and stress is passed down in the family, predisposed to being stressed and anxious)

having two short s alleles increase the probability of experiencing acute stress

also an individual's gene also influences whether someone is more likely to end up in a stressful situation, whic therefore influences the risk of developing PTSD (gene environment correlation)

Generalized psychological vulnerabilities

a sense that you cannot control things (this is most important for developing PTSD when the trauma is small)

anxiety sensitivity - having a fear of anxiety

Social contributions to PTSD

If you have a good support system you are less likely to develop PTSD because social support decreases stress hormones and stress levels

Talk about the HPA axis

PTSD creates chronic arousal which is associated with HPA axis activity (which produces stress). THis HPA axis activity damages the hippocampus over time, because the role of the hippocampus is to regulating the HPA axis. ANd seen the hippocampus is now damaged the person's body becomes even worse at regulating and managing stress

What is one main different between panic disorders and PTSD?

With panic disorders, the alarm response is usually false

with PTSD, the alarm response is usually a true alarm

Treatment of PTSD

Psychoanalytic therapy - relive the emotional experience in order to have an emotional release (catharsis)

Imaginal exposure (the content of the trauma and its emotions are worked through systematically)

a subtype of imaginal exposure -> constructivist narrative approach: forming a narrative of the experience with the help of the therapist, but changing the meaning of the experience, using adaptive coping, and instilling a positive sense of survivorship

forming a narrative of the traumatic event

Cognitive therapy -correct negative assumptions about the trauma (ex: self blame)

Eye movement desensitization and reprocessing

Relaxation training

Drugs that work - SSRIs

Which is the best type of therapy?

Imaginal exposure

What therapy techniques can be used for kids with PTSD?

- draw a picture of the event

- reinact the event in some way

Adjustment Disorders

It involves anxious or depressive reactions to life stress, which impairs the individual's life in some way

but the symtpoms are milder than for acute stress disorder or PTSD

When is the adjustment disorder considered chronic?

When the symptoms last for more than 6 months after the life stressor has stopped

Attachment Disorders

It refers to disturbed or developmentally inappropriate behaviours in children, emerging before 5 years old, where the child is unwilling or unable to form normal attachment relationships with adult caregivers

What causes attachment disorders?

Inadequate or abusive child rearing practises that fails to mee the child's emotional or physical needs

What are the two types of attachment disorders?

Reactive attachment disorder (avoidance of caregivers, and minimal response to caregivers)

Disinhibited social engagement disorder (the child shows no disinhibition whatsoever to approaching any adults

Obsessive compulsive and related disorders

This category of disorders is seperate from anxiety disorders

this category includes obsessive compulsive disorder, hoarding disorder, body dysmorphic disorder, trichotillomania and excoriation

What is OCD common to be comorbid with?

Debilitating avoidance, anxiety disorder, depression, and panic attacks

what is the different betwen OCD and other anxiety disorders?

In other anxiety disorders the feared thing is usually an external stimuli

In OCD the feared thing is an internal stimuli such as intrusive thoughts, image or impulse that the client wants to avoid

What are obsessions?

Intrusive, nonsensical thoughts, images, or impulses that the individual wants to avoid

what are compulsions?

They are the thoughts or actions that are used to surpress the obsessions and provide relief

What are the two types of compulsions?

Compulsions can either be behavioural or mental?

THe individual beleives that the compulsions work in surpressing the obsessions, and that they prevent a dreaded event

What are the four major types of obsessions?

(in order of highest prevalence to lowest)

symmetry obsessions

forbidden thoughts or actions

contamination and cleaning


Forbidden thoughts and actions are strongly associated with ___

checking rituals

Symmetry obsessions are associated with ____

ordering, arranging, and repeating rituals

Contamination obsessions lead to _____

washing rituals

In rare cases, especially with children, they will present with compulsions but no noticeable obsessions


What is tic disorder?

Tic disorder is characterized by involuntary movements

it is often comorbid with people who have OCD

the obsessions in tic related ocd are almost always related to symmetry

Somekids get tic OCD after having strep throat. This syndrome has been referred toas pediatric autoimmune neuropsychiatric syndrome (PANS).

What is tourette's disorder?

It is characterized by more complex involuntary movements accompanied by involuntary vocalizations

Prevalence of OCD

1 to 2 %

Obsesssions and compulsions are arranged along a continuum


WHat is the gender ratio of OCD?


What is the average age of onset for OCD?

13 to 15 for males

and 20 to 24 for females

Causes of OCD

in order for ocd to develop, the individual must develop anxiety about the possibility about having additional obsessive disturbing thoughts

repetitive intrusive thoughts may be regulated by a brain circuit

but the generalized biological vulnerability and generalized psychological vulnerability are the same as in other anxiety disorders (for the tendency to develop anxiety over having addition thoughts)

generalized biology: predisposed to be anxiou

generalzied psychology: anxious about things that will make you anxious. AND thought action fusion (which leads to the specific psychological vulnerability that some thoughts are unacceptabel to have)

the specifc psychological vulnerability is believing that some thoughts are unacceptable and must therefore be repressed (this can be taught through parents, school,and religion while growing up) - it is taught through misinformation that some thoughts are dangerous to have

What is thought action fusion?

Believing that thoughts of a specific action is just as bad as actually doing that action

What may cause thoguht action fusion?

attitudes of excessive responsibility and resulting guilt, that someone experienced during childhood

(peolpe with religious beliefs are more likely to have thought action fusion..

the severity of OCD is linked to religion beliefs.

People cant avoid terrifying thoughts and so they try to surpress them with various strategies, these strategies turn into compulsions, and the compulsions actually increase the amount of intrusive thoughts (obsessions) that the individual has


Drug treatment for OCD

The best drugs are the onces that inhibite serotonin reuptake (SSRIs)

but relapse frequently occurs when drugs are discontinued

Psychological treatments for OCD:

Exposure and ritual prevention (ERP): the individual is not allowed to perform is compulsion.. in order for him to experience what actually happens if he doesnt repress his obsessions.. and this will help him realize that his fear of his obsessions is unwarranted

- this allows for cognitive change in people with OCD

CBT therapy (focuses on the need for control, perfectionism, the consequence of the osbession, the sense of inflated responsibility..)

Psychosurgery - is surgical lesion to the cingulate bundle (it is used in extreme cases where no other therapies have worked)

deep brain stimulation

Body dysmorphic disorder

A preoccupation with some perceived bodily deficit of oneself, in an individual who actually looks relatively normal

BDD used to be considered a somatoform disorder but it was relocated under obsessive compulsive and related disorders


Similarities between BDD and OCD

Similar thoughts that lead to compulsions

Similar brain regions involved

approximately the same age of onset and the same course of the disorder

OCD often cooccurs with BDD

On average, how many body concerns does an individual with BDD have?

4 to 7

people with BDD engage in ____

checking, and compensating behaviours, and in various grooming techniques

they often become fixated on mirrors or avoid them

they have ideas of reference - they think that everything that goes on in the world around them is related to their perceived bodily deficit

People with sever cases, are scared to leave their houses for fear that they will run into people that they know and have their imagined deficit seen

Consequences of BDD:

Suicidal ideations and attempts

what is delusional BDD?

THey think that their imagined deficit is actually real

but htey dont respond to psychotic drugs, so it is still considered a type of BDD

pRevalence of BDD

1 to 2% of community people have BDD

and 2 to 13% of college students have BDD

Gender ratio of BDD

BDD is seen equally in men and women

men focus more on body build, genitals and thinning hair. women focus more on various aspects of their body and are also more likely to have an eating disroder with it


Age of onset for BDD

early teens to 20ies (peak is 16 to 17)

how many people with BDD attempt suicide?


depression and substance abuse are also common consequences of BDD

AND social anxiety disorder is commonly found in people with BDD


THe treatments for BDD are the same 2 that are used in OCD

exposure and response prevention

and drugs that block the reuptake of serotonin (prozac.. SSRIs)

do people with BDD benefit from surgery?

No, they often return for more surgery

the severity either stays the same or it increases

what are the 3 major characteristics of hoarding behaviour?

-excessive acquission of things

- difficulty getting rid of things

- living in a space that is unorganised and has intense clutter

the disorder often begins because the individual gets great pleasure out of collecting things

but has problem getting rid of things because they have potential, sentimental value, or they are an extension of her identity

Prevalence of hoarding disorder

2 to 5%

Gender ratio

an equal number of males and females have it

what is the average age that people with this disorder come in for treatment?


Does hoarding disorder get worse with age?


What are the cognitive and emotional abnormalities of hoarding?

-strong emotional attachment to objects

- exaggerated desire for control over posessions

- deficits in deciding whether an object is worth keeping or not

People who hoard animals

- they own a large amount of animals, but they show an inability to care for these animals

animal hoarders typically dont realize that they have a problem

they attribute human characteristics to their animals, have dysfunctional relatinships and greater mental health concerns

what is Trichotillomania?

It is a hair pulling disorder (the urge to pull one's own hair from anywhere on the body)


1 to 5% of college students

Gender ratio

Females have it more often than males


repetitive and compulsive picking of the skin which leads to tissue damage


1 to 5%

Gender ratio:

females have it more than males

these two disorders often cooccur with OCD and BDD


DIfferences between BDD and excoriation

BDD - they pick the skin only occasionaly and it is with the aim of improving their appearance

Treatments for excoriation and Trichotillomania

Habit reversal training (teach client to become aware of these maladaptive habits and replace them with adaptive habits)

SSRIs work for Trichotillomania only