Ch4 Terms: Anxiety, Trauma, Stress, and Obsessive-Compulsive Disorders

Anxiety Disorder

• Future-oriented state. When experiencing danger/threat, you experience future/anticipated anxiety.

• Mood state characterized by marked negative affect & bodily symptoms of tension in which a person apprehensively anticipates future danger of misfortune. 

• Anxiety involves feelings, behaviors, and physiological responses. 

Panic Attack

• Abrupt experience of intense fear or discomfort accompanied by several physical symptoms, like dizziness or heart palpitations. 

• Sudden, intense attack of fear and discomfort. Feels like a heart attack! 

• Symptoms must be greater than or equal to 4 of 13. 

  • Physical: increased heart rate, shortness of breath 📈

  • Cognitive and emotional: sense of losing control, going crazy 🥴

Expected panic attack 🌎

directly triggered by environmental stimulus 

Unexpected panic attack 🟦

unpredictable, out of the blue 

Behavioral inhibition system (BIS) 🧊

• Brain circuit in the limbic system that responds to threat signals by inhibiting activity and causing anxiety. 

• Limbic and septal-hippocampus systems used 

• Causes “freezing” when scared. When we hear a loud noise, we stop to figure out where that noise is coming from, and be quiet. 😱 🥶

Fight-or-flight system (FFS)

• Increased alarm of escape when afraid

• Brain circuit in animals; when stimulated, causes immediate alarm-and-escape response resembling human panic.

Triple vulnerability model

• Biological, specific psychological, and generalized psychological vulnerabilities contribute to the development of anxiety disorders

• If you possess all three, you’ll likely develop an anxiety disorder after experiencing a stressful situation.  

Biological vulnerability

• heritable contribution to negative affect

• “Glass is half empty”, irritable, driven

• A person's genetic predisposition or tendency to develop a medical condition

Specific psychological vulnerability

• Physical sensations are potentially dangerous

• Anxiety about health, nonclinical panic

• A predisposition or susceptibility to developing a particular mental health disorder or experiencing specific psychological distress

Generalized psychological vulnerability

• Sense that events are uncontrollable/unpredictable

• Tendency toward lack of self-confidence, low self-esteem, inability to cope.  

Generalized anxiety disorder (GAD)

• Anxiety disorder characterized by intense, uncontrollable, unfocused, chronic, and continuous worry that’s distressing and unproductive

• Accompanied by physical symptoms of tenseness, irritability, and restlessness. 

Autonomic Restrictors ❤ ⬇

• Natural responses that are designed to improve the bodily situation in times of stress

• People with generalized anxiety disorder (GAD), who have a lower heart rate, blood pressure, skin conductance, and respiration rate than do people with other more general anxiety symptoms. 

Panic disorder (PD)

• Recurrent unexpected panic attacks accompanied by concern about future attacks and/or a lifestyle change to avoid future attacks

• Panic is a sudden, overwhelming fright or terror.  

Agoraphobia 🏠

Anxiety about being in places or situations from which escape may be difficult

Interoceptive avoidance

• Avoidance of internal physical sensations. 

• Behaviors: removing oneself from situations or activities that might produce the physiological arousal that somehow resembles the beginnings of a panic attack

• Some patients may avoid exercise because it produces increased cardiovascular activity or faster respiration, which reminds them of panic attacks and makes them think one might be beginning. 

Panic control treatment (PCT)

Cognitive-behavioral treatment for panic attacks, involving gradual exposure to feared somatic sensations and modification of perceptions and attitudes about them

Specific Phobia

• Extreme fear of a specific object or situation, which most view as unreasonable. 

• Unreasonable fear of a specific object or situation that interferes with daily life function

Separation anxiety disorder

excessive, enduring fear in some children that harm will come to them or their parents while they’re apart. 

Social anxiety disorder

extreme, enduring, irrational fear and avoidance of social or performance situations.

Selective mutism (SM)

Rare childhood disorder characterized by lack of speech in 1 or more settings in which speaking is socially expected  

Acute stress disorder

Severe reaction immediately following a terrifying event, often including amnesia about the event, emotional numbing, and derealization. Many victims later get PTSD. 

Post-traumatic stress disorder (PTSD)

• Enduring, distressing emotional disorder that follows exposure to a severe helplessness-or-fear-inducing threat

• The victim re-experiences the trauma, avoids stimuli associated with it, and develops a numbing of responsiveness and an increased vigilance and arousal. 

Adjustment Disorders

Clinically significant emotional and behavioral symptoms in response to 1 or more specific stressors. 

Reactive attachment disorder

Attachment disorder in which a child with disturbed behavior neither seeks out a caregiver, nor responds to offers of help from one; fearfulness and sadness often evident

Disinhibited social engagement disorder

Condition in which a child shows no inhibitions whatsoever in approaching adults. 

Disorder

A clinically significant disturbance in an individual's cognition, emotional regulation, or behavior

Obsessive compulsive disorder (OCD)

Disorder characterized by intrusive, unwanted thoughts and the attempt to resist them 

Obsessions

Re-current intrusive thought or impulse the client seeks to suppress or neutralize while recognizing it’s not imposed by outside forces. 

Compulsions

Repetitive, ritualistic, time-consuming behavior or mental act a person feels driven to perform. 

Thought action fusion

• psychological process that equates merely thinking about an action with performing that action

• Ex: “Thinking about eating a forbidden food can actually make me gain weight”

Hoarding Disorder

• obsession: fear of throwing anything away 

• compulsion: collecting/saving objects with little or no actual or sentimental value, like food wrappings 

Trichotillomania 💇‍♀

urge to pull out own hair from anywhere on body, including scalp, eyebrows, arm 

Excoriation 🏻

Recurrent, difficult to control picking of one’s skin leading to significant impairment or distress 

Body dysmorphic disorder (BDD) 👺

• Preoccupation with some imagined defect in appearance by someone who actually looks reasonably normal

• Imagined ugliness.

Behavioral habit reversal

• Patients taught to be more aware of their repetitive behavior as it’s just about to begin, and to then substitute a different behavior, such as chewing gum, or some other reasonably pleasurable but harmless behavior. 

• Results may be evident in 4 sessions 

• Process requires teamwork between the patient and therapist, close monitoring of the behavior throughout the day 

• Drug treatments, mostly serotonin-specific re-uptake inhibitors, hold some promise, particularly for trichotillomania, but results have been mixed with excoriation 

• This treatment has the most evidence for success with trichotillomania (hair pulling disorder) and excoriation (skin picking disorder) 

For anxiety disorders, ____ is the present-orientated emotional state that causes an ____ response.

fear; immediate

Low levels of ____ are related to increased anxiety.

GABA

A fear of interviews would be classified as?

Situational phobia

_______ report the highest rate of social anxiety disorder.

White Americans

For social anxiety disorder (SAD), what’s the treatment of choice?

CBT