Ch 5: Anxiety, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders

Stats of SAD

anxiety

A mood state characterized by marked negative affect and bodily symptoms of tension in which a person apprehensively anticipates future danger or misfortune. Anxiety may involve feelings, behaviors, and physiological responses.

fear

The emotion of an immediate alarm reaction to present danger or life-threatening emergencies.

panic

Sudden, overwhelming fright or terror.

panic attack

Abrupt experience of intense fear or discomfort accompanied by a number of physical symptoms, such as dizziness or heart palpitations.

behavioral inhibition system (BIS)

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

fight/flight system (FFS)

Brain circuit in animals that when stimulated causes an immediate alarm and escape response resembling human panic.

generalized anxiety disorder (GAD)

Anxiety disorder characterized by intense, uncontrollable, unfocused, chronic, and continuous worry that is distressing and unproductive, accompanied by physical symptoms of tenseness, irritability, and restlessness.

panic disorder (PD)

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

agoraphobia

Anxiety disorder characterized by anxiety about being in places or situations from which escape might be difficult in the event of panic symptoms or other unpleasant physical symptoms (e.g., incontinence).

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

Unreasonable fear of a specific object or situation that markedly interferes with daily life functioning.

blood–injection–injury phobias

Unreasonable fear and avoidance of exposure to blood, injury, or the possibility of an injection. Victims experience fainting and a drop in blood pressure.

situational phobias

An anxiety involving enclosed places (for example, claustrophobia) or public transportation (for example, fear of flying).

natural environment phobias

Fear of situations or events in nature, especially heights, storms, and water.

animal phobias

Unreasonable, enduring fear of animals or insects that usually develops early in life.

separation anxiety disorder

Excessive, enduring fear in some individuals that harm will come to them or their loved ones when they are apart.

social anxiety disorder (SAD)

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

posttraumatic stress disorder (PTSD)

Enduring, distressing emotional disorder that follows exposure to severe helplessness or a fear-inducing threat. The victim reexperiences the trauma, avoids stimuli associated with it, and develops a numbing of responsiveness and an increased vigilance and arousal.

acute stress disorder

Severe reaction immediately following a terrifying event, often including amnesia about the event, emotional numbing, and derealization. If symptoms persist beyond one month, victims are diagnosed with posttraumatic stress disorder.

prolonged grief disorder

Prolonged adaptation to loss associated with intense longing for and preoccupation with the deceased, leading to difficulty moving on with life even after a year or more has passed.

adjustment disorders

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

attachment disorders

Developmentally inappropriate behaviors in which a child is unable or unwilling to form normal attachment relationships with caregiving adults.

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 are often evident.

disinhibited social engagement disorder

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

obsessive-compulsive disorder (OCD)

A disorder involving unwanted, persistent, intrusive thoughts and impulses, as well as repetitive actions intended to suppress them.

obsessions

Recurrent intrusive thoughts or impulses the client seeks to suppress or neutralize while recognizing they are not imposed by outside forces.

compulsions

Repetitive, ritualistic, time- consuming behaviors or mental acts a person feels driven to perform to suppress obsessions.

body dysmorphic disorder (BDD)

Disorder featuring a disruptive preoccupation with some imagined defect in appearance (“imagined ugliness”). Now classified among obsessive-compulsive and related disorders; previously grouped with DSM-IV somatoform disorders.

trichotillomania

People’s urge to pull out their own hair from anywhere on the body, including the scalp, eyebrows, and arm.

excoriation

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

Is anxiety a naturally occuring emotion?

yes

Anxiety vs. Fear

anxiety = future-oriented

fear = immediate reaction to perceived danger

Two basic types of panic attacks are described in DSM-5:

expected and unexpected

How do genes play a roll in anxiety?

We inherit tendencies or increased sensitivity to anxiety

“…depleted levels of …, are associated with increased anxiety…”

gamma-aminobutyric acid (GABA)

who identified BIS and FFS?

Jeffrey Gray

The area of the brain most often associated with anxiety is …

the limbic system

“…corticotropin-releasing factor (CRF) system as central to the expression of anxiety (and depression) and the groups of genes that increase the likelihood that this system will be turned on… This is because CRF activates the ??…”

hypothalamic–pituitary–adrenocortical (HPA) axis

“…there is now general agreement that in people with anxiety disorders, the limbic system, including the amygdala, is …”

overly responsive to stimulation or new information (abnormal bottom-up processing)

“…there is now general agreement that in people with anxiety disorders…, controlling functions of the cortex that would down-regulate the hyperexcitable amygdala are ….”

deficient (abnormal top-down processing)

psychological factors in childhood that may contribute to anxiety

• “In childhood, we may acquire an awareness that events are not always in our control…”

• helicopter/over-protective parents who clear way → children who can’t face adversity?

  • “…these children don’t learn that they can control their environment.”

the triple vulnerability theory of anxiety

“The first vulnerability (or diathesis) is a generalized biological vulnerability. We can see that a tendency to be uptight or high-strung might be inherited. … The second vulnerability is a generalized psychological vulnerability. That is, you might also grow up believing the world is dangerous and out of control, and you might not be able to cope when things go wrong based on your early experiences. … The third vulnerability is a specific psychological vulnerability in which you learn from early experience, such as being taught by your parents, that some situations or objects are fraught with danger (even if they really aren’t)”

“…the co-occurrence of two or more disorders in a single individual is referred to as ??.”

comorbidity

“…??is that for therapy to be effective, it needs to target the underlying processes of change rather than the DSM-defined psychiatric syndromes…”

process-based therapy

unified protocol (UP)

“…a transdiagnostic treatment applicable to all anxiety and related disorders…”

what % of patients with panic disorder had attempted suicide?

20%

What disorder is this?

“The DSM-5 criteria specify that at least 6 months of excessive anxiety and worry (apprehensive expectation) must be ongoing more days than not. Furthermore, it must be difficult to turn off or control the worry process.”

“… characterized by muscle tension, mental agitation, susceptibility to fatigue (probably the result of chronic excessive muscle tension), some irritability, and difficulty sleeping (…). Focusing one’s attention is difficult, as the mind quickly switches from crisis to crisis.”

GAD

“…??, which is the tendency to become distressed in response to arousal-related sensations, arising from beliefs that these anxiety-related sensations have harmful consequences…’’’

anxiety sensitivity

“Several studies have found that individuals with GAD show ??? on most physiological measures…”

less responsiveness

“…GAD patients often show a comparatively ??? …”

low cardiac vagal tone

“…GAD patients often show a comparatively low cardiac vagal tone (the vagus nerve is the largest parasympathetic nerve innervating the heart and decreasing its activity), leading to ??? because the heart is less responsive to certain tasks …”

autonomic inflexibility

“… people with GAD have been called ???…”

autonomic restrictors

Which disorder does this match

“…intense cognitive processing in the frontal lobes as indicated by EEG activity, particularly in the left hemisphere. This finding would suggest frantic, intense thought processes or worry without accompanying images (which would be reflected by activity in the right hemisphere of the brain rather than the left)…”

GAD

common treatments for GAD

antidepressents and cognitive-behavioral treatment (CBT)

T/F: Panic Disorder and Agoraphobia are linked

True

What disorder is this?

“… a person must experience an unexpected panic attack and develop substantial anxiety over the possibility of having another attack or about the implications of the attack or its consequences.”

panic disorder

what condition? “…?? may be characterized either by avoiding the situations or by enduring them with intense fear and anxiety.”

agoraphobia

interoceptive avoidance

avoidance of internal physical sensations

“Among Asian Americans, Hispanic Americans, and Blacks in the United States, panic disorder is associated with ???, even after accounting for the effect of demographic factors…”

reports of racial/ethnic discrimination

“…nocturnal panic attacks occur during ???, which typically occurs several hours after we fall asleep and is the deepest stage of sleep.”

delta wave or slow-wave sleep

Causes for Panic Disorder and Agoraphobia

unexpected panic attacks + social/cultural factors + inherited “…tendency to believe that unexpected bodily sensations are dangerous…”

“…seem to be related most strongly to biological and psychological factors and their interaction.”

Treatments for PD

Medication: Benzos (bad), serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs)

Psychological Intervention: exposure-based treatments, PCT, CBT

A ?? attack is an abrupt experience of intense fear or acute discomfort accompanied by physical symptoms, such as chest pain and shortness of breath.

panic

An ?? panic attack often occurs in certain situations but not anywhere else.

expected

Anxiety is associated with specific ?? (for example, behavioral inhibition system or fight/flight system) and neurotransmitter systems (for example, noradrenergic).

brain circuits

The rates of ?? among anxiety and related disorders are high because they share the common features of anxiety and panic.

comorbidity

?? life events can trigger biological and psychological vulnerabilities to anxiety.

stressful

GAD is characterized by muscle tension, mental agitation, irritability, sleeping difficulties, and susceptibility to fatigue. T/F?

true

Most studies show that in the majority of cases of GAD, onset is early in adulthood as an immediate response to a life stressor. T/F

false

GAD is prevalent in older adults and in females in our society. T/F?

true

GAD has no genetic basis. T/F

false

Cognitive-behavioral treatment and other psychological treatments for GAD are probably better than drug therapies in the long run. T/F

true

Panic disorder is a disorder in which an individual experiences anxiety and panic triggered by being in an “unsafe” situation. T/F

false

About 40% of the population meets the criteria for panic disorder at some point in life. T/F

false

Some individuals with panic disorder are suicidal, have nocturnal panic, and/or are agoraphobic. T/F

true

Psychological treatments like PCT or CBT are highly effective for treating panic disorder. T/F

true

“A ?? is an irrational fear of a specific object or situation that markedly interferes with an individual’s ability to function”

specific phobia

“Four major subtypes of specific phobia have been identified: ???”

blood–injection–injury type, situational type (such as planes, elevators, or enclosed places), natural environment type (for example, heights, storms, and water), and animal type.

“Phobias characterized by fear of public transportation or enclosed places are called ??.”

situational phobias

“Notice also that the sex ratio among common fears is overwhelmingly ?? with a couple of exceptions”

female

“?A?, where real danger or pain results in an alarm response (a true alarm). This is one way of developing a phobia, and there are at least three others: ?B? a false alarm (panic attack) in a specific situation, ?C? someone else experiencing severe fear (vicarious experience), or, under the right conditions, ?D?.”

direct experience ; experiencing ; observing ; being told about danger

“…several things have to occur for a person to develop a phobia. First, … Second, …, … Third, …”

1. a traumatic conditioning experience often plays a role (even hearing about a frightening event is sufficient for some individuals).

2. fear is more likely to develop if we are “prepared”; that is, we seem to carry an inherited tendency to fear situations that have always been dangerous to the human race

3. we also have to be susceptible to developing anxiety about the possibility that the event will happen again

treatment for phobias

“…specific phobias require structured and consistent exposure-based exercises…”

social anxiety disorder (SAD) was formerly known as ??

social phobia

what disorder is this:

“…marked fear or anxiety focused on one or more social or performance situations.”

“…the individual is very anxious only while others are present, maybe watching, and, to some extent, evaluating their behavior.”

social anxiety disorder (SAD)