Chapter 6 – Panic, Anxiety, And Their Disorders Flashcards Preview

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1
Q

Distinguish between fear and anxiety

A

Anxiety involves a general feeling of apprehension about possible future danger, and fear is an alarm reaction that occurs in response to immediate danger.

The most common way of distinguishing between the fear and anxiety response patterns has been whether there is a clear and obvious source of danger that would be regarded as real by most people. When the source of danger is obvious, the experienced emotion has been called fear. With anxiety, however, we frequently cannot specify clearly what the danger is.

Recently, researchers have proposed a more fundamental distinction between the fear and anxiety responses saying that fear is a basic emotion shared by many animals that involves activation of the fight-or-flight response of the autonomic nervous system.
The anxiety response pattern is a complex blend of unpleasant emotions and cognitions that is both more oriented to the future and much more diffuse than fear. Like fear, it has not only cognitive/subject of components but also physiological and behavioural components. Although there is no activation of the fight or flight response as there is with fear, anxiety does prepare or prime a person for the fight or flight response should be anticipated danger occur. May also create a strong tendency to avoid situations where danger might be encountered, but there’s not the immediate behavioural urge to flee with anxiety as there is with fear

2
Q

What are the seven primary types of anxiety disorders?

A

Specific phobia; social phobia; panic disorder with or without agoraphobia; generalized anxiety disorder; obsessive-compulsive disorder; acute stress disorder; post dramatic stress disorder

3
Q

Describe the various causal factor theories of phobias

A

Psychoanalytic: phobias represent a defense against anxiety that stems from repressed impulses from the ID which are displaced onto some external object or situation that has some symbolic relationship to the real object of the anxiety

Learning theory: phobic behaviour is developed through classical conditioning. The response can readily be conditioned to previously neutral stimuli when the stimuli are paired with traumatic or painful events and these phobic fears would generalize to other, similar objects or situations
Can also be developed through vicarious conditioning by simply watching a phobic person behaving fearfully with his or her phobic object. vicarious or observational classical conditioning.
Individual differences in learning me also play apart, for example, having exposure to a non-fearful parent behaving on fearfully with the phobic object may serve as a protective factor and immunize a child against the effects of later seeing the phobic parent behaving fearfully with the phobic object.

Evolutionary preparedness for learning certain fears and phobias: over the course of evolution, those primates and human to rapidly acquired fears certain objects or situations that post real threats to our early ancestors may have enjoyed a selective advantage. Prepared fears are not inborn or innate but rather are easily acquired or specially resistant to extinction

Biological causal factors: genetic and temperamental variables affect the speed and strength of conditioning of fear

4
Q

What are some of the most effective treatment approaches for phobias?

A

Exposure therapy – involves controlled exposure to the stimuli or situations that elicit phobic fear. Clients are gradually placed – symbolically or increasingly under real life conditions – in those situations they find the most frightening so that their fear begins to subside.

5
Q

What is an effective treatment approach for social phobias?

A

Cognitive restructuring him where the therapist attempts to help clients with social phobia identify their underlying negative, automatic thoughts and to change these inner thoughts and beliefs through logical reanalysis

6
Q

List the diagnostic criteria for panic attacks

A

A discrete period of intense fear or discomfort, in which four or more of the following symptoms developed abruptly and reached a peak within 10 minutes:

  1. Palpitations, pounding heart, or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath or smothering
  5. Feeling of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling dizzy, unsteady, lightheaded, or faint
  9. Derealization or feelings of unreality or depersonalization or being detached from oneself
  10. Fear of losing control or going crazy
  11. Fear of dying
  12. Paresthesias- numbness or tingling sensations
  13. Chills or hot flushes
7
Q

Describe the diagnostic criteria for panic disorder

A
  1. recurrent unexpected panic attacks
  2. And persistent concern about having additional attacks; worry about the implications of the attack or its consequences; a significant change in behaviour related to the attacks

Panic disorder can be with Agoraphobia, without Agoraphobia, and there can be agoraphobia without history of panic disorder

8
Q

Contrast panic attacks and other types of anxiety

A

Panic attacks are fairly brief but intense, with symptoms developing abruptly and usually reaching peak intensity within 10 minutes. The attacks usually subside in 20 to 30 minutes and rarely last more than an hour. Periods of anxiety, by contrast, do not usually have such an abrupt onset and are more long-lasting

9
Q

Summarize the prevalence, age of onset, and comorbidity for panic disorder

A

The national comorbidity survey – replication study found that approximately 4.7% of the adult population has had panic disorder with or without agoraphobia at sometime in their lives, with panic disorder without agoraphobia being more common.

Often starts in the late teenage years, but the average age of onset is 23 to 34 years. It can begin, especially for women, when in a persons 30s or 40s however.

About twice as prevalent in women as in men. Most common explanation of this gender difference is a socio-cultural one where it is more acceptable for women who experience panic to avoid the situations they fear and to need a trusted companion to accompany them when they enter feared situations.

83% of people with panic disorder have at least one comorbid disorder. Most commonly these include generalized anxiety disorder, social phobia, specific phobia, PTSD, depression, and substance-use disorders

10
Q

Describe recent findings on biological, behavioral, and cognitive influences for anxiety proneness

A

Biological:
Genetic factors – panic disorder has a moderate heritable component, it is estimated that 33 to 43% of the variance in liability to panic disorder is due to genetic factors.
Panic and the brain: increased activity in the amygdala plays a more central role in panic attacks. The amygdala is the central area involved in what has been called a “fear network”, and panic attacks occur when the fear network is activated, either by cortical inputs or by inputs from lower brain areas. According to this influential theory, panic disorder is likely to develop in people who have abnormally sensitive fear networks that get activated too readily to be adaptive.
Biochemical abnormalities- people with panic disorder are much more likely to experience panic attacks when they are exposed to various biological challenge procedures that are normal people or people with other psychiatric disorders. Such procedures produce panic attacks and panic disorder clients at a much higher rate than in normal subjects and they are called panic provocation procedures. Two primary neurotransmitter systems are most indicated – and noradrenergic and the serotonergic systems

Psychological:
Comprehensive learning theory – initial internal bodily sensations of anxiety or arousal effectively become interoceptive conditioned stimuli associated with higher levels of anxiety or arousal. Initial panic attacks become associated with initially neutral internal and external cues through an interoceptive conditioning process.
Cognitive theory – proposed that individuals with panic disorder are hypersensitive to their bodily sensations and are very prone to giving them the direst possible interpretation. It is a tendency to catastrophize about the meaning of their bodily sensations.
Anxiety sensitivity and perceived control – people who have high levels of anxiety sensitivity are more prone to developing panic attacks and perhaps panic disorder. Anxiety sensitivity is a trait-like belief that certain bodily symptoms may have harmful consequences. Studies have shown that simply having a sense of perceived control reduces anxiety and even blocks panic.

11
Q

Describe how safety behaviours and cognitive biases help to maintain panic

A

Safety behaviours and the persistence of panic – disconfirmation where the person is proved wrong that a catastrophic event is going to happen does not occur because people with panic disorder frequently engage in safety behaviours such as breathing slowly or carrying a bottle of medication before or during an attack. They then mistakenly tend to attribute the lack of catastrophe to their having engaged in the safety behaviour rather then to the idea that panic attacks actually do not lead to heart attacks.

Cognitive biases and the maintenance of panic- people with panic disorder are biased in the way they processed threatening information bite interpreting ambiguous bodily sensations as threatening and also interpreting other ambiguous situations as more threatening than do controls. These people seem to have their attention automatically drawn to threatening information in their environment such as words that represent things they fear.

12
Q

Compare and contrast the major treatment approaches for panic disorder and Agoraphobia

A

Medications: many people with panic disorder are prescribed anti-anxiety medications or anxiolytics from the benzodiazepine category such as alprazolam (Xanax) or clonazepam (Klonopin). These people frequently show symptom relief from these medications, and many can function more effectively. One major advantage is that they act quickly and so can be useful in a cute situations of intense panic or anxiety, but they also have quite undesirable side effects such as drowsiness and sedation, which can lead to impaired cognitive and motor performance. With prolonged use, people may develop physiological dependence which results in withdrawal symptoms when the drug is discontinued and relapse can be high.
The other category of medication is the antidepressants. One major advantage is that antidepressants do not create physiological dependence in the way benzodiazepines Ken, and they also can alleviate any comorbid depressive symptoms or disorders. A disadvantage is that it takes about four weeks before they have any beneficial effects, so they are not useful in an acute situation where a person is having a panic attack. Side effects such as dry mouth, constipation, and blurred vision and interference with sexual arousal mean that large numbers of people refuse to take the medications were discontinued their use and relapse rates when discontinued are high.

Behavioural and cognitive-behavioral treatments: exposure based treatments to feared situations has been shown to help about 60 to 75% of people with Agoura phobia show clinically significant improvement. The idea was to make people gradually face the situations they feared and learned that there was nothing to fear. When limitation of these original treatments was that they did not specifically target panic attacks, so in the 1980s to new techniques were developed, interoceptive exposure – deliberate exposure to feared internal sensations, and cognitive restructuring techniques in recognition that catastrophic automatic thoughts may help maintain panic attacks. Panic control treatment targets both Agoura phobic avoidance and panic attacks. Overall, the magnitude of improvement is often greater with these cognitive and behavioural treatments than with medications. A combination of medication and cognitive-behavioral therapy sometimes produces a slightly superior results compared to either type of treatment alone.

13
Q

What are the Central features of generalized anxiety disorder?

A

Excessive anxiety and worry occurring more days than not for at least six months, about a number of events or activities such as work or school performance.
The person finds it difficult to control the worry.
The anxiety and worry are associated with three or more of the following six symptoms – restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating or mind going blank; irritability; muscle tension; sleep disturbance.
The worry content cannot be exclusively related to the worry associated with another concurrent axis I disorder, or do to the direct physiological effects of a substance or a general medical condition.
Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

14
Q

Describe the psychological and biological causal factors of generalized anxiety disorder

A

Psychological:
Psychoanalytic viewpoint – results from an unconscious conflicts between ego and ID impulses that is not adequately dealt with because the person’s defence mechanisms have either broken down or have never developed.
Perceptions of uncontrollability and unpredictability – people with GAD may have a history of experiencing many important invents in their lives as unpredictable or uncontrollable and are more likely to have had a history of trauma in childhood.
A sense of mastery the possibility of immunizing against anxiety – a person’s history of control over important aspects of his or her environment is another important experiential variable strongly affecting reactions to anxiety provoking situations.
The central role of worry and it’s positive functions – the worry process is now considered the central feature of GAD. Several of the benefits that people with GAD most commonly think derive from worrying are superstitious avoidance of catastrophe, avoidance of deeper emotional topics, and coping and preparation. Because worry suppresses physiological responding, it also insulates the person from fully experiencing or processing the topics that she or he is worrying about, and it is known that such full processing is necessary if extinction of that anxiety is to occur.
The negative consequences of worry – where he is not an enjoyable activity and can lead to a greater sense of danger and anxiety and lower positive mood. People tend to have more negative intrusive thoughts. Attempts to control thoughts and where he may paradoxically lead to increased experience of intrusive thoughts and enhanced perception of being unable to control them.
Cognitive biases for threatening information – people with GAD process threatening information in a biased way, perhaps because they have prominent danger schemas. They preferentially allocate their attention toward threatening cues when both red and non-threat cues are present in the environment.

Biological causal factors:
Genetic factors – there does seem to be a modest heritability, although perhaps smaller than that for most other anxiety disorders except phobias. Estimate that 15 to 20% of the variance is due to genetic factors. At least part of this common genetic predisposition for GED and major depression is best conceptualized as the basic personality trait commonly known as neuroticism.
Neurotransmitter and neurohormonal abnormalities- A functional deficiency in GABA which ordinarily plays an important role in the way our brain inhibits anxiety in stressful situations.
And anxiety-producing hormone called corticotropin releasing hormone or CRH has also been strongly implicated as playing an important role in GAD.

15
Q

Evaluate the treatments for generalized anxiety disorder

A

Medications: medications from the benzodiazepine (anxiolytics) category such as Xanax or Klonopin are used and miss used for tension relief, reduction of other somatic symptoms, and relaxation. Their effects on worry and other psychological symptoms are not as great and can create physiological and psychological dependence and withdrawal. Several categories of antidepressant medications are also used and they seem to have a greater effect on the psychological symptoms, however they take several weeks before their effects are realized

Cognitive behavioural treatment – usually involves a combination of behavioural techniques, such as training in applied muscle relaxation, and cognitive restructuring techniques aimed at reducing distorted cognitions and information-processing vices associated with GAD as well as reducing catastrophizing about minor events.

16
Q

Describe the defining features of obsessive-compulsive disorder

A

Defined by the occurrence of unwanted and intrusive abscess of thoughts or distress and images; these are usually accompanied by compulsive behaviours performed to neutralize the obsessive thoughts or images or to prevent some dreaded event or situation.

Obsessions involve persistent and recurrent intrusive thoughts, images, or impulses that are experienced as disturbing, inappropriate, and uncontrollable. People who have such of sessions actively try to resist or suppress them or to neutralize them with some other thought or action.

Compulsions can involve either over to repetitive behaviours that are performed as lengthy rituals such as handwashing, checking, or ordering over and over again, or more covert mental rituals such as counting, praying, or saying certain words silently over and over again.

A person with OCD usually feels driven to perform this compulsive, ritualistic behaviour in response to an upset Chin, and there are often very rigid rules regarding how the compulsive behaviour should be performed. These compulsive behaviours are performed with the gold preventing or reducing distress or preventing some dreaded event or situation.

17
Q

What are the five primary types of compulsive rituals?

A

Cleaning such as handwashing and showering, repeated checking, repeating, ordering or arranging, and counting

Some compulsions are to perform various every day activities extremely slowly, this is called primary obsessional slowness

18
Q

Summarize theories of etiology of obsessive-compulsive disorder along with supporting evidence or the lack thereof

A

Psychological causal factors:
OCD as learned behaviour – the dominant behaviour or learning view is derived from Mowrer’s two-process theory of avoidance learning. According to this theory, neutral stimuli become associated with frightening thoughts or experiences to classical conditioning and come to elicit anxiety. Once learned, such avoidance responses are extremely resistant to extinction. Several classic experiments have supported this theory, which predicts that exposure to feared objects or situations should be useful in treating OCD if the exposure is followed by prevention of the ritual, enabling the person to see that the anxiety will subside naturally in time without the ritual. Not being so helpful in explaining why it develops in the first place.

OCD and preparedness – can be looked at in an evolutionary context where humans obsessions about dirt and contamination and certain other potentially dangerous situations did not arise out of a vacuum but rather have deep evolutionary roots.

Cognitive causal factors – the effects of attempting to suppress abscess of thoughts may sometimes cause a paradoxical increase in those thoughts later. One factor contributing to the frequency of obsessive thoughts, and the negative moods with which they are often associated, may be these attempts to suppress them.
Appraisals of responsibility for intrusive thoughts – people with OCD often seem to have an inflated sense of responsibility which can be associated with belief that simply having a thought about doing something is morally equivalent to actually having done it, or that thinking about committing a sin increases the chances of actually doing so. This is known as thought-action Fusion.
Cognitive biases and distortions – people with OCD’s attention is drawn to disturbing material relevant to their abscess of concerns and seem to have difficulty walking out negative, irrelevant input or distracting information, so they may attempt to suppress negative thoughts stimulated by this information. May also have low confidence in their memory ability, which may contribute to their repeating their ritualistic behaviours over and over again.

Biological causal factors: the evidence suggests that biological causal factors are perhaps more strongly implicated in the causes of OCD then if any of the other anxiety disorders.

Genetic factors – moderately high concordance rate for monozygotic twins and a lower rate for dizygotic twins.

OCD and the brain – research has found that abnormalities occur primarily in certain cortical structures as well as in certain subcortical structures known as the basal ganglia which are in turn linked at the amygdala to the limbic system, which controls emotional behaviors. People with OCD have abnormally high levels of activity into parts of the frontal cortex, which are also link to the limbic area. Also had abnormally high levels of activity in the sub cortical caudate nucleus, which is part of the basal ganglia. These primitive brain circuits are involved in executing primitive patterns of behaviour such as those involved in sex, aggression, and hygiene concerns.
The cortical-basil-ganglionic-thalamic Circuit which is normally involved in the preparation of complex sets of interrelated behavioural responses used in specific situations such as those involved in territorial or social concerns may not be functioning properly and people with OCD. The over activation of the orbital frontal cortex, which stimulates “the stuff of obsessions”, combined with a dysfunctional interaction among the orbital frontal cortex, the corpus Stratham or caudate nucleus, and the thalamus may be the central component of the brain disfunction in OCD. The dysfunctions in this circuit intern prevent people with OCD from showing the normal innovation of sensations, thoughts, and behaviours that would occur if the circuit were functioning properly.
Neurotransmitter abnormalities – with the discovery in the 1970s that a tricyclic drug called Anafranil is often effective in the treatment of OCD highlighted the fact that this drug has greater effect on the neurotransmitter serotonin, which is now strongly indicated in OCD. It’s exact nature is unclear but evidence suggests that increased serotonin activity and increased sensitivity of some brain structures to serotonin are involved in OCD symptoms. Drugs that stimulate serotonergic Systems lead to a worsening of symptoms.

19
Q

Outline treatments for OCD

A

Behavioural and cognitive-behavioral treatments: a behavioural treatment that combines exposure and response prevention seems to be the most effective approach. This treatment involves having the OCD clients develop a hierarchy of upsetting stimuli and rate them on a 0 to 100 scale according to their capacity to evoke anxiety, distress, or disgust. Then the clients are asked to expose themselves repeatedly to stimuli that will provoke there obsession. Following each exposure, they are asked to not engage in the rituals that the ordinarily would engage in to reduce the anxiety or distress provoked by there of session. Preventing the rituals is essential so that they can see that if they allow enough time to pass, the anxiety created by the up session will dissipate naturally down to at least 40 to 50 on the 100 point scale, even if this takes several hours. Although some people refuse such treatment or drop out early, it does help a majority of clients who stick with the treatment, most of whom show a 50 to 70% reduction in symptoms as well as improvement in quality of life.

Medications: medications that affect the neurotransmitter serotonin seem to be the primary class that has recently good effects. The other anxiety and mood disorders respond to a wider range of drugs. These medications, such as clomipramine or Anfranil and fluoxetine or Prozac, which alter functioning of the serotonin system, appear to reduce the intensity of the systems of the this disorder. A major disadvantage is that when the medication is discontinued relapse rates are generally very high. Studies have found that combining medication with exposure and response prevention is much more effective than behaviour therapy alone.
Psychiatrists have also begun to re-examine the usefulness of certain neurosurgical techniques for the treatment of severe, intractable OCD
20
Q

Provide several examples of socio-cultural effects on anxiety disorders

A

The lifetime risk for social phobia, generalized anxiety disorder, and panic disorder is somewhat lower among it to my Nordie groups then among the non-Hispanic whites. These differences were slightly larger for people under age 45 and from lower socioeconomic classes.

Latin Americans from the Caribbean, and other people from the Caribbean, do show higher rates of a variant of panic disorder called ataque de nervios then do other groups. Most of the symptoms are the same as in panic attack, but they may also include bursting into tears, anger, and uncontrollable shouting. Other symptoms can include shakiness, verbal or physical aggression, dissociative experiences, and seizure-like or fainting episodes. Such attacks are often associated with a stressful events relating to the family.

Koro occurs in places like China and other Southeast Asian countries which involves an intense, acute fear that the penis is retracting into the body and that when this process is complete the sufferer will die.

Taijin Kyofusho: The Japanese disorder which is related to the western diagnosis of social phobia. It is a fear of interpersonal relations or of Social Security shins but these people are concerned about doing something that will embarrass or offend others for example by blushing, emitting an offensive odor, staring inappropriately into the eyes of another person, or through their perceived physical defects or imagined deformities. These pattern of symptoms have clearly been shaped by cultural factors. Japanese children are raised to be highly dependent on their mothers and to have a few of the outside world, especially strangers. They are praised for being obedient and DOS Tsaile and there is a great deal of emphasis on increasing communication. People who make too much iContact are likely to be considered aggressive and insensitive, and children are taught to look at the throat of people with whom they are conversing rather than into their eyes.

21
Q

Compare and evaluate the merits of Freud’s use of the concept of anxiety in the aetiology of the neuroses versus the descriptive approach used in DSM since 1980

A

For Freud, neurotic disorders developed when intrapsychic conflict produced significant anxiety. Anxiety was a sign of an inner battle or conflict between some primitive desire (from the id) and prohibitions against its expression (from the ego and superego). Sometimes this anxiety was overly expressed as in those disorders known today as the anxiety disorders. In certain other neurotic disorders, the anxiety might not be obvious either to the person involved or to others, it’s psychological defence mechanisms were able to deflect or mask it.

In 1980 the DSM dropped the term neurosis and reclassified most of these disorders that did not involve obvious anxiety symptoms as either dissociative or somatoform disorder’s. DSM made this change in order to group together smaller sets of disorders that share more obvious symptoms and features