PBSI 306 Exam 2

panic attack

4 or more anxiety symptoms occurring at once within 10 minutes

mimics a heart attack

Adaptive

Anxiety is _______, the brain has a purpose for anxiety

uses it as an internal alarm system

helps prioritize

Inverted U theory

there is a perfect amount of anxiety needed for idea performance

too little - underprepared

too much - overwhelming, paralyzed 

Hypothalamus

activates the autonomic nervous systems and the endocrine system at the same time

Autonomic nervous system

controls unconscious, involuntary bodily functions like breathing, heart rate, and digestion to maintain internal homeostasis 

has two parts, the sympathetic and the parasympathetic

sympathetic nervous system 

fight or flight 

part of the autonomic nervous system

parasympathetic nervous system  

rest and digest 

part of the autonomic nervous system 

endocrine system

bodies hormone system, promotes release of adrenaline and cortisol

gives energy to systems that need it in the moment

HPA axis

main endocrine pathway involved in stress response

what is activated with fight or flight 

releases  ACTH → releases cortisol and adrenaline 

ACTH

body’s main stress hormone

this is released upon the activation of the HPA axis, then goes on to release cortisol and adrenaline 

adrenaline

boosts heart rate

controlled by the endocrine system

cortisol

raises blood sugar, temporarily suppresses non-essential systems

controlled by the endocrine system

Maladaptive anxiety

anxiety that goes beyond the helpful threshold and gets in the way of daily life 

Realistic, proportional, persistent without threat

questions to ask to figure out if anxiety is maladaptive or adaptive

Avoidance

lowers anxiety short-term, prevents natural decline in anxiety

negative reinforcing anxiety 

Exposure

helps habituate fear

Generalized Anxiety disorder (GAD)

type of anxiety disorder where worry is a key feature, leads to avoidance and other physical symptoms (restlessness, fatigue, sleep issues)

highly comorbid with other disorders

5-6 hours a day

how much to people with GAD worry?

GABA theory

biological theory of GAD, states that there is a deficiency in a key inhibitory neuron which leads to excessive firing, specifically in the limbic system

Glutamate rich

type of food that can lead to the production of GABA in the body

nutritional way of fighting off GAD (GABA theory of GAD)

Genetic theory

biological theory of GAD which states that a biological vulnerability to GAD is inherited

general trait anxiety may play a role 

Cognitive theory of GAD

constant focus on threat, overestimating threat and underestimating coping, worry preventing habituation to negative emotions and prevents obtaining coping skills 

constant low level worry

avoids sudden sharp increases in negative emotions

how worry can actually help people with GAD cope with their anxiety 

Benzodiazepines

allows for short-term relief in GAD, risk of dependence

SSRIs and SNRIs

effective for treatment of GAD and safer long term

CBT for GAD

cognitive restructuring, monitor and schedule worry time, relaxation, focus on tolerating uncertainty and reducing avoidance

Panic Disorder (PD)

recurrent, unexpected panic attacks followed by persistent worry about additional attacks, implications of attacks, or significant change in behavior to try to avoid attacks from happening 

mechanisms of PD

body’s alarm system if constantly misfiring

individuals become hypervigilant to bodily sensations 

agoraphobia

30-50% of those with PD also experience this

the avoidance of situations where escape/help is difficult

Biological explanations of PD

3-10x more likely with family history 

inherited vulnerability 

limbic system differences 

cognitive model of PD

hyperfocus on bodily sensations

catastrophic misinterpretation of symptoms 

snowball effect of fear 

anxiety sensitivity (AS)

Anxiety sensitivity (AS)

fear of anxiety-related physical sensations, risk factor for anxiety disorders

used in the cognitive model of PD 

safety behaviors

actions to avoid or reduce anxiety provoking situations

negatively reinforced 

Negative Reinforcement

removal of distress increases avoidant behavior, short-term relief leads to long term impairment

seen in all anxiety disorders (ex. avoidance)

if you constantly avoid the situation that makes you anxious, you never learn that you’re anxiety will naturally go down

CBT for PD

cognitive restructuring, challenging distorted thinking

Exposure therapy, altering maladaptive fear-anxiety, provides evidence against irrational thoughts and habituation to anxiety

progressive muscle relaxation (PMR) 

Progressive muscle relaxation (PMR)

key feature for CBT in PD patients

practicing relaxation because you can’t be both stressed and relaxed at the same time 

not effective as a stand alone treatment 

social anxiety disorder (SAD)

persistent fear of being humiliated or embarrassed in a social or performance setting

anxiety triggered by exposure, thus situations are actively avoided

person recognizes fear as excessive or unreasonable 

Generalized SAD

type of SAD that fears relate to most social situations

Performance SAD

type of SAD where fears are related to performance situations

most common non-clinical fear 

safety behaviors for SAD

over-preparing, avoiding eye contact, or alcohol/substance use

self-focused attentional bias

feature of SAD, thinking that everyone is going to be aware of the mistakes you make in a social situation

CBT for SAD

cognitive restructuring, identify and challenge negative, automatic thoughts

manualized therapy, structured and systematic (homework)

group therapy, observational learning and exposure 

Behavioral therapy for SAD

systematic desensitization (exposure), modeling, flooding

social skills training

another way of treating SAD

doesn’t involve therapy 

phobias

fear that is excessive or unreasonable, immediate anxiety cued by the presence of a specific object or situation

object or situation is avoided or endured with intense anxiety and distress 

animal, natural environment, situational, BII

the four main categories of phobias

all but one increase heart rate 

animal type 

specific phobia category triggered by specific animals or insects

most common is snakes 

natural environment type

specific phobia category triggered by events or situations in the natural environment

i.e. thunderstorms, natural disasters, etc 

Situational type

specific phobia category triggered by specific situations

i.e. transportation, encloses spaces, etc 

often begins in childhood 

Blood-injection-injury (BII) type

specific phobia category that is triggered by seeing blood, receiving an injection, or witnessing/experiencing and injury

the only category that results in a drop in blood pressure and heart rate (as opposed to fight or flight) 

vasovagal response (fainting) 

vasovagal response

seen in those who have a BII type phobia

categorized by fainting

lifetime fear

percent of people who experience of something at any point in their life

lifetime phobia 

percent of people who meet clinical criteria for a phobia of that a specific long-term fear 

11.3%

phobias are the most common psychological disorder, what percent is it?

diathesis stress model

theory for the cause of phobias, person has biological/psychological vulnerabilities combined with an aversive experience to create the specific phobia

Evolutionary theory of phobias

theory for the cause of phobias, humans are biologically prepared to fear things that posed a danger to them in ancestral past 

prepared classical conditioning 

fear learning happens more easily with evolutionary relevant threats, and it’s harder to develop phobias to non-threatening stimuli 

part of the evolutionary theory of phobias 

classical conditioning for phobias

fear can develop when a neutral object of paired with a frightening experience

Ex. the little albert experiment

operant conditioning for phobias

avoidance → immediate anxiety relief → negatively reinforces the act of avoiding

mechanism for phobia development 

systematic desensitization

big part of exposure therapy (can work for phobias or other psychological disorders)

client will gradually be exposed to feared stimuli while practicing relaxation 

modeling

therapist demonstrates calm behavior with feared object before client tries, paired with desensitization based on observational learning 

part of exposure therapy 

flooding

client is immediately exposed to the most intense fear until anxiety fades, works quickly but rarely used due to high dropout rates 

SUDs scale

subjective unit of distress, 0 (no distress)-100 (extreme panic/fear) scale

obsessions

unwanted, recurrent, persistent thoughts, images, or impulses coming from one’s own mind (not being inserted)

key fear in OCD

ex: dirt & contamination, aggressive impulses, sexual thoughts, immoral behavior, doubting 

compulsions 

repetitive behaviors that occur after obsession or based on rigid rules 

key feature of OCD, designed to reduce/prevent distress and is maintained through negative reinforcement