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Flashcards in Task 3 Anxiety disorders Deck (40)
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1

Social anxiety disorder

people become so anxious in social situations that they are so preoccupied with their worries that they may focus on avoiding social situations

2

Prevalence SAD

lifetime prevalence in USA 12% and 3-7% internationally
o Women are more likely to develop it
o Decreases with higher age

3

Point of onset (SAD)

develops in either the early preschool years or adolescence, when many people become self-conscious and concerned about others opinions of them

4

Cormobidity (SAD)

SAD often co-occurs with mood disorders and other anxiety disorders (70%)

5

DSM-5 SAD

o A Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech)
o B The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated
o C The social situation almost always provoke fear or anxiety
o D The social situations are avoided or endured with intense dear or anxiety
o E The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context
o F The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
o G The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
o H The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition
o I The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder
o J If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive

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SAD specify if

 Performance only: If the fear is restricted to speaking or performing in public

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Cognitive perspective SAD

people with social anxiety disorder have excessively high standards for their social performance (e.g. they believe that they should be liked by everyone)
o Also focus on negative aspects of social interactions and evaluate their own behaviour harshly
o Safety behaviour:
 Avoid eye contact
 Or social interactions altogether

8

Biological treatment for SAD

o SSRIs and SNRIs (selective serotonin-norepinephrine reuptake inhibitors) reduce symptoms of social anxiety but only for the time of intake

9

CBT for SAD

exposing people to situations that make them anxious starting with the least anxiety causing situation
 Relaxation techniques, role plays,

10

Mindfulness based interventions

 Teaches: being less judgemental about their own thoughts and reactions and more focused on, and relaxed in, the present moment.

11

Enhanced CBT

 Specifically target underlying processes proposed to maintain social anxiety & exposure tasks that make use of a hypothesis-testing approach
 Greater treatment effect

12

Panic attacks

short but intense periods during which she experiences many symptoms of anxiety: heart palpitations, trembling a feeling of choking and so on
o Might sometimes have no environmental triggers
o Prevalence: 28% of adults have occasionally panic attacks, esp. during time of stress

13

Panic disorder

o when panic attacks are not usually provoked by any particular situations but are unexpected
o when a person starts to worry about having them and changes behaviours as a result of this

14

Episodes of PD

Might occur in PD e.g. having it one week every day and then not for one week

15

Prevalence PD

3-5 % of people will develop panic disorders
 Usually between late adolescence and the mid thirties
 More common in women and tends to be chronic

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DSM-5 PD

 A Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensation of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, light-headed or faint
9. Chills or heat sensations
10. Paresthesias (numbness or tingling sensations)
11. Derealization (feeling of unreality) or depersonalization (being detached from oneself)
12. Fear of losing control or going crazy
13. Fear of dying
 Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms
 B At least one of the attacks has been followed by 1 month or more of one of both following
• Persistent concern or worry about additional panic attacks or their consequences (e.g. losing control. Having a heart attack)
• A significant maladaptive change in behaviour related to the attacks (trying to avoid panic attacks)
 C The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders)
 D The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder)

17

Genetic factor PD

 Runs in families (heritability 43-48%)

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Fight or flight response (PD factor)

 Fight or flight response is poorly regulated in PD patients
• Might be due to poor regulation of several neurotransmitter (nor-epinephrine, serotonin, GABA)

19

Locus ceruleus (factor PD)

well connected to limbic systems and causes it to lowering the threshold for activation of diffuse and chronic anxiety

20

Women factor PD

 Women might get attacks before or while their period caused by unbalanced neurotransmitter

21

Biological challenge test

Giving the participant a substance that elicits a panic attack

22

Body view (factor PD)

 People are more fine-tuned in view of body responses so even minimal changes can cause hyperreaction

23

Suffercation around theory (PD)

• Combination of CO2 and O2 intake triggers oversensitive alarm system

24

Cognitive factors (PD)

 1 Pay very close attention to their bodily sensation
 2 Misinterpret these sensations in a negative way (Egg or chicken)
 3 engage in snowballing catastrophic thinking, exaggerating symptoms and their consequences
• Increases subjective sense of anxiety
• This constant arousal makes further attacks more likely

25

Anxiety sensitivity (PD)

the unfounded belief that bodily symptoms have harmful consequences
• Increases likeliness of developing PD and increases the frequency of attacks

26

Interoceptive awareness (PD)

a heightened awareness of bodily cues (such as slight sensations of arousal and anxiety) that may signal a coming panic attack

27

Interoceptive conditioning (PD)

bodily cues that have occurred at the beginning of previous panic attacks and have become conditioned stimuli signalling new attacks
• Slight increase in anxiety might already trigger a panic attack (person does not recognize this process)

28

Cognitive mediators (Clark) (PD)

• Expected effect: Subjects expectation about distress and anxiety they might experience during the procedure
• Interpretation: the explanations that were readily available for sensations experienced during the procedure (most critical probably even more than perceived control)
• Perceived control: subjects perceived control over sensations that might be experienced during procedure (critical)

29

An integrated model (PD)

 People often have hypersensitive fight or flight response, when combined with catastrophic thinking about physiological symptoms can lead to panic attacks
 It also leads to hypervigilance for signs which leads to mild to moderate levels of anxiety all the time which increases the likelihood of panic attacks
 Conditioned avoidance response: When situations get associated with panic attacks people try to avoid these situations
• Leads to Agoraphobia

30

Biological treatment (PD)

• Mostly affecting nor-epinephrine or serotonin systems (SSRI and SNRI)
• Benzodiazepines: supresses CNS and influence GABA serotonin and nor-epinephrine functioning
o Helps to quickly reduce panic attacks and general symptoms of anxiety in most patients