Chapter 6. Anxiety Disorders

Front 1

Anxiety disorder

Back 1

A category of psychological disorders in which the primary symptoms involve fear, extreme anxiety, intense arousal, and/or extreme attempts to avoid stimuli that lead to fear and anxiety.

Front 2

Fight-or-flight response
also called what?

Back 2

The automatic neurological and bodily response to a perceived threat; also called the stress response.

primarily by activating the sympathetic branch of the autonomic nervous system.

-increasing your heart rate and breathing rate

-increasing the sweat on your palms

-dilating your pupils

Front 3

Panic

Back 3

An extreme sense (or fear) of imminent doom, together with an extreme stress response.

Front 4

Phobia

Back 4

An exaggerated fear of an object or a situation, together with an extreme avoidance of the object or situation.

Front 5

Clinicians must determine whether the anxiety and avoidance symptoms are the primary cause, explain an example of primary vs. secondary

Back 5

for example, when someone with anorexia gets anxious about eating high-calorie foods, the anxiety is secondary to larger concerns about food, weight, and appearance.

Front 6

Anxiety and depression often occur together; approximately __% of people with an anxiety disorder are also depressed

and approximately __-__% of people who have anxiety disorders also abuse alcohol

Back 6

50%
10-25%

Front 7

FIGURE 6.1 • Tripartite Model of Anxiety and Depression

Back 7

Anxiety generally involves a very high level of physiological arousal, whereas depression involves a low level of positive emotions.

Front 8

Generalized anxiety disorder (GAD)
Anxiety focuses on what?

DSM5 Criteria?

idk about memorizing dsm, wasn't on last exam.

Back 8

An anxiety disorder characterized by uncontrollable worry and anxiety about a number of events or activities, which are not solely the result of another disorder.

For people suffering from GAD, the worry and anxiety focus primarily on family, finances, work, and illness

A Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months

BThe individual finds it difficult to control the worry.

C The anxiety and worry are associated with three (or more) of the following six symptoms

Note: Only one item is required in children.

Front 9

________________ nervous system appears to play a special role in GAD

STUDY**** im confused.

Back 9

parasympathetic GAD isn’t associated with the cranked-up sympathetic nervous system activity that underlies the fight-or-flight response

GAD is associated with decreased arousal that arises from an unusually responsive parasympathetic nervous system.

for instance, heightened parasympathetic activity slows heart rate, stimulates digestion and the bladder, and causes pupils to contract

When a person with GAD perceives a threatening stimulus, his or her subsequent worry temporarily reduces arousal (Borkovec & Hu, 1990), suppresses negative emotions (see Figure 6.1), and produces muscle tension. Worrying=less arousal

Front 10

GAD=what neurotransmitter

Back 10

dopamine.

In fact, numerous studies suggest that a wide range of neurotransmitters, including gamma-aminobutyric acid (GABA), serotonin, and norepinephrine, may not function properly in people with GAD

Front 11

Psychological factors that contribute to GAD generally involve three characteristic modes of thinking and behaving:

Back 11

1. People with GAD pay a lot of attention to stimuli in their environment, searching for possible threats. This heightened search for threats is called hypervigilance.

2. Helplessness
3. the mere act of worrying prevents anxiety from becoming panic (Craske, 1999), and thus the act of worrying is negatively reinforcing (Borkovec, 1994a; Borkovec et al., 1999). The worrying does not help the person to cope with the problem at hand, but it does give him or her the illusion of coping

Front 12

Moreover, people who develop GAD often report that they were_______ ________ ________as children

Back 12

afraid and avoidant

Front 13

The antianxiety medication buspirone (Buspar) effectively reduces the symptoms of GAD, probably ??? by decreasing _________ release. _

How does it work? What substructure?

Back 13

Serotonin

________ facilitates changes in the amygdala that underlie learning to fear objects or situations (Huang & Kandel, 2007); thus, reducing serotonin may impair learning to fear or worry about specific objects or situations.

Only helps symptoms*****

Front 14

Psychological treatments for GAD generally have several aims:

Back 14

to allow the person to assess more accurately how likely and dangerous perceived threats actually are,

to increase the person’s sense of control over thoughts and worries,

and to decrease muscle tension.

Front 15

Behavioral methods to treat GAD focus on three main areas (Barlow, 2002a):

Back 15

awareness and control of breathing,

awareness and control of muscle tension and relaxation, and

elimination, reduction, or prevention of worries and behaviors associated with worries.

Front 16

Biofeedback

Back 16

technique in which a person is trained to bring normally involuntary or unconscious bodily activity, such as breathing or muscle tension, under voluntary control.

Front 17

Habituation & Exposure

Back 17

The process by which the emotional response to a stimulus that elicits fear or anxiety is reduced by exposing the patient to the stimulus repeatedly.

A behavioral technique that involves repeated contact with a feared or arousing stimulus in a controlled setting, bringing about habituation.

Front 18

Patients in therapy can experience exposure in three ways: ******

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imaginal exposure, which relies on forming mental images of the stimulus;

virtual reality exposure, which consists of exposure to a computer-generated (often very realistic) representation of the stimulus; and

in vivo exposure, which is direct exposure to the actual stimulus. "within the living"

Front 19

Specific cognitive methods include the following:

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Psychoeducation, which is the process of educating patients about research findings and therapy procedures relevant to their situation. For patients with GAD, this means educating them about the nature of worrying and GAD symptoms and about available treatment options and their possible advantages and disadvantages.

Meditation, which helps patients learn to “let go” of thoughts and reduce the time spent thinking about worries (Evans et al., 2008; Lehrer & Woolfolk, 1994; Miller et al., 1995).

Self-monitoring, which helps patients become aware of cues that lead to anxiety and worry. For instance, patients may be asked to complete a daily log about their worries, identifying events or stimuli that lead them to worry more or worry less.

Problem solving, which involves teaching the patient to think about worries in very specific terms—rather than global ones—so that they can be addressed through cognitive restructuring.

Cognitive restructuring, which involves helping patients learn to identify and shift automatic, irrational thoughts related to worries (see the third panel in

Front 20

Panic attack

Back 20

A specific period of intense fear or discomfort, accompanied by physical symptoms, such as a pounding heart, shortness of breath, shakiness, and sweating, or cognitive symptoms, such as a fear of losing control.

During a panic attack, the symptoms generally begin quickly, peak after a few minutes, and disappear within an hour.

Front 21

cued & uncued

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Although panic attacks are occasionally cued by a particular external stimulus (such as seeing a snake), they are more frequently cued by situations that are associated with internal sensations similar to panic, such as breaking out into a sweat (when overheated).

Front 22

Panic disorder

Back 22

An anxiety disorder characterized by frequent, unexpected panic attacks, along with fear of further attacks and possible restrictions of behavior in order to prevent such attacks.

-lasting at least 1 month

Panic attacks are distinguished from panic disorder by the frequency and unpredictability of the attacks and the person’s reaction to the attacks.

Front 23

Onset age?

Back 23

Panic disorder is most likely to arise during young adulthood.

Front 24

Gender diff?

Back 24

Women are two times more likely than men to be diagnosed with panic disorder.

Front 25

wind overload

Back 25

among Cambodian refugees, symptoms of panic disorder include a fear that “wind-and-blood pressure” (referred to as wind overload) may increase to the point of bursting the neck area, and patients may complain of a sore neck, along with headache, blurry vision, and dizziness

Front 26

ataque de nervios

Back 26

Latin America, an anxiety-related problem called ataque de nervios can occur, usually in women. The most common symptoms are uncontrollable screaming and crying attacks, together with palpitations, shaking, and numbness. An ataque de nervios differs from a panic attack not only in the specific symptoms experienced but also because it usually is triggered by a specific upsetting event, such as a funeral or a family conflict

Panic attacks that are part of panic disorder tend not to have such an obvious situational trigger. Furthermore, people who have had anataque de nervios are usually not worried about recurrences

Front 27

agoraphobia

Back 27

(which literally means “fear of the marketplace”) refers to the persistent avoidance of situations that might trigger panic symptoms or from which escape would be difficult or help would not be available.

About half of the people with agoraphobia also have panic disorder,

people who only avoid particular kinds of stimuli (only bridges or only parties) are not diagnosed with agoraphobia, which is a more general pattern of avoiding many kinds of environments or situations.

Front 28

onset of agoraphobia +gender?

Back 28

Two-thirds of people with agoraphobia develop it before age 35.About half of people with agoraphobia report having had panic attacks or panic disorder before developing agoraphobia.
Women are twice as likely as men to be diagnosed with agoraphobia.

Front 29

Why does hyperventilating, injecting sweat salt or caffeine trigger a panic attack???

Back 29

One possibility is that the brains of people who experience panic attacks have a low threshold for detecting decreased oxygen in the blood, which triggers a brain mechanism that warns us when we are suffocating

Front 30

too much of which neurotransmitter is apparently produced in people who have anxiety disorders

Back 30

norepinephrine

Front 31

locus coeruleus

Back 31

small structure in the brainstem that produces norepinephrine, and some researchers have theorized that it is too sensitive in people with panic disorder

Front 32

what medication would you use?

Back 32

Finally, we note that SSRIs can reduce the frequency and intensity of panic attacks (DeVane, 1997); SSRIs reduce the effects of serotonin, which affects the locus coeruleus in complex ways

Front 33

concordance rate

Back 33

The probability that both twins will have a characteristic or disorder, given that one of them has it

Front 34

a true alarm & false alarms & learned alarms

Back 34

person may have had a first panic attack in response to a stressful or dangerous life event true alarm,... This experience produces conditioning, whereby the initial bodily sensations of panic (such as increased heart rate or sweaty palms) become false alarms associated with panic attacks. the bodily sensations of arousal themselves come toelicit panic attacks (learned alarms). The person then develops a fear of fear—a fear that the arousal symptoms of fear will lead to a panic attack

Front 35

catastrophic thinking, caused by what

Back 35

People with panic disorder may misinterpret normal bodily sensations as indicating catastrophic effects

Catastrophic thinking can arise in part from anxiety sensitivity, which is a tendency to fear bodily sensations that are related to anxiety along with the belief that such sensations indicate that harmful consequences will follow

Front 36

medication to treat panic disorder?
side deffects? purpose? first line?

Back 36

To treat panic disorder, a psychiatrist or another type of health care provider licensed to prescribe medication may recommend an antidepressant or a benzodiazepine

Benzodiazepines are prescribed as a short-term remedy; affect the targeted symptoms within 36 hours, and they need not be taken regularly.

Side effects of benzodiazepines include drowsiness and slowed reaction times, and patients can suffer withdrawal or need to take increasingly larger doses (tolerance) when these drugs are taken for an extended period of time.

For these reasons, antidepressants such as an SNRI, an SSRI, or TCAs are better long-term medications and are now considered “first-line” medications for panic disorder

-medications can take up to 10 days to have an effect

Front 37

first line treatment of panic disorder?

Back 37

CBT is the first-line treatment for panic disorder because it has the most enduring beneficial effects of any treatment

Front 38

interoceptive exposure

Back 38

A behavioral therapy method in which patients intentionally elicit the bodily sensations associated with panic so that they can habituate to those sensations and not respond with fear.

Front 39

psychoeducation involves what?

Back 39

psychoeducation for people with panic disorder involves helping them understand both how their physical sensations are symptoms of panic—not of a heart attack or some other harmful medical situation—and the role of catastrophic thinking

Front 40

Social anxiety disorder

social situations 3types:

Back 40

An anxiety disorder characterized by intense fear of public humiliation or embarrassment; also called social phobia.

-- social interactions (such as a conversation); being observed (such as when eating or using public restrooms); and performing (such as giving a speech)

Front 41

social anxiety vs. agoraphobia

Back 41

People with social anxiety disorder fear other people’s scrutiny.

People with social anxiety disorder rarely have panic attacks when alone.

agoraphobia do not have these features

Front 42

evolutionary psychologist etiology perspective

Back 42

Less powerful animals fear aggressive action from those more dominant and therefore behave submissively toward them. It is possible that social phobias arise when this innate mechanism becomes too sensitive or otherwise responds improperly

Front 43

neurotransmitters involved w/ social anxiety?

Back 43

patients with social anxiety disorder show less activation in brain areas that rely on dopamine than do control participants.

Furthermore, people with social anxiety disorder have too little serotonin, which may suggest why SSRIs have sometimes helped these patients

Front 44

Three types of psychological factors influence the emergence and maintenance of social anxiety disorder:

Back 44

cognitive biases and distortions, (law of attraction)

classical conditioning,

operant conditioning.

Front 45

emotional reasoning

Back 45

distorted emotional reasoning as proof that they will be judged negatively: They evaluate the impression they made on others based on how anxious they became during the interaction, regardless of what actually transpired.

i.e. rachel ,,misattribution error

Front 46

medication for temporary event, what medication would you use?

For those whose social anxiety arises in a wider and more frequent set of circumstances, ???

Back 46

beta-blocker, such as propranolol (Inderal), is the medication of choice

Beta-blockers bind to some of the brain’s receptors for epinephrine and norepinephrine and hence make these receptors less sensitive.

SSRI=wider range These medications affect the amygdala and the locus coeruleus, decreasing their activation

Front 47

preferred exposure method?

Back 47

Because the anxiety symptoms relate to social interactions, group therapy is the preferred mode of exposure treatment

Cognitive-behavioral group therapy uses exposure and cognitive restructuring in a group setting

Cognitive-behavioral group therapy is as effective as medication

Front 48

specific phobia

DSM-5 lists five types or categories of specific phobia:

Back 48

An anxiety disorder characterized by excessive or unreasonable anxiety about or fear related to a specific situation or object.

animal, natural environment-heights,blood-injection-injury=-surgery, situational i.e. airplane , and “other”

Front 49

neurotransmitter?

Back 49

specific phobia is associated with too little of the inhibitory neurotransmitter GABA (File et al., 1999). When a benzodiazepine (such as diazepam, or Valium) binds to the appropriate receptors, it facilitates the functioning of GABA—and the drug thereby ultimately produces a calming effect.

Front 50

Three primary psychological factors contribute to a specific phobia

Back 50

a tendency to overestimate the probability of a negative event’s occurring based on contact with the feared stimuli,

classical conditioning, and operant conditioning.

Front 51

Which phobias were not contributed by conditioning?

Back 51

In studies of people with a phobia of water, heights, or spiders, researchers usually have not found evidence that classical conditioning played the role that had been predicted

Front 52

Treating specific phobia, meds or CBT?

first line ?

fear of flying?

Back 52

Medication is usually unnecessary because CBT treatment—even a single session—is highly effective in treating a specific phobia

1st line-graded exposure-therapist progress through an individualized hierarchy of anxiety-producing stimuli or events as fast as the patient can tolerate

-flying=virtual reality, even heights

Front 53

Separation anxiety disorder

Back 53

A disorder that typically arises in childhood and is characterized by excessive anxiety about separation from home or from someone to whom the person is strongly attached.

Front 54

Anxiety Disorder or Developmental Difference?

Back 54

Treatment for this disorder is similar to treatment for other anxiety disorders. Separation anxiety does not share the types of symptoms related to executive and intellectual functioning that are found in neurodevelopmental disorders.

Separation anxiety itself is a normal developmental process; what makes this a disorder is the range and severity of symptoms and the appearance of symptoms at a later age than would be expected.