PSY 350 - Anxiety Disorders

What are the 3 channels fear and anxiety are expressed?

1. Cognitive distress (stressed thinking)

- distortions and ruminations

2. Physiological arousal

3. Behavioral disruptions and avoidance

What is fear?

A set of emotional, behavioral and physical responses to danger

- PRESENT-oriented mood state

- requires an actual perceived danger

- immediate fight-or-flight response to danger or threat

- involves abrupt activation of the sympathetic NS

- strong avoidance/escapist tendencies

- marked negative affect

- normal emotional states

What is panic?

Fear when no actual danger is present

What is anxiety?

A diffuse or vague sense of apprehension accompanied by fearful behavior and physiological arousal

- future-based

- physical symptoms of tension (feel it in their body, headaches, stomach ache)

- characterized by marked negative affect

- may lead to avoidance of situations likely to provoke fear

- normal emotional state

What are the characteristics of anxiety disorders? (4)

1. Pervasive and persistent symptoms of anxiety and fear

2. Excessive avoidance and escape

3. Cause clinically significant distress and impairment

4. Comorbidity across anxiety disorders

Why do anxiety disorders develop? (etiology) (3)

1. Probably some biological and genetic predispositions

2. Early childhood

- Experiences with uncontrollability and unpredictability lead to more anxiety

- stressful life events trigger vulnerabilities

3. Behavioral and cognitive views

- Conditioning and cognitive explanations

- anxiety and fear are learned responses

- catastrophic thinking and appraisals play a role

What is comorbidity?

Having more than one diagnosis at once

- common across anxiety disorders

- major depression is the most secondary diagnosis

- about half of patients have 2 or more secondary diagnosis

implications:

- common factors create and maintain disorders

- relation between anxiety and depression

What is a specific phobia?

An extreme, irrational fear of a specific object or situation

- People will go to great lengths to avoid phobic objects

- Egodystonic --> recognizes that it's irrational, but still greatly interferes with one's ability to function

- Markedly interferes with one's ability to function

- females are over-represented

- phobias tend to run a chronic course

What % of the general population is affected by specific phobias?

Affects about 12.5% of the general population

What are some common examples of specific phobias?

1. Animals (bees, dogs, and snakes)

2. Natural environment (heights, storms)

3. Situational (flying, driving)

- elevators

- John Madden with flying

4. blood-injection-injury

- blood draws, getting injections, seeing blood from a minor cut; watching others get blood drawn or injections

- sometimes associated with unusual vasovagal response > fainting

What are the causes of phobias? (4)

1. Direct experience

2. Biological and evolutionary vulnerability

3. Traumatic conditioning

4. Preparedness

What are the psychological treatments of specific phobias? (3)

1. Cognitive-behavioral therapies (CBT) are highly effective; exposure is critical

2. Systematic desensitization

- desensitizing at different levels

- feared stimulus hierarchy

3. Flooding

- prolonged exposure to feared stimulus

Cultural factors

- certain objects feared more in different cultures

What are the defining features of social anxiety disorder (SAD)? (4)

1. Extreme or discomfort in social or performance situations

2. Markedly interferes with one's ability to function

3. Often avoids social situations or endures them with great distress

4. Performance-only subtype:

- anxiety only occurs in performance sitatuions (like public speaking) without anxiety in everyday interactions

What % of the general population is affected by SAD?

affects about 12.1% of the general population, 6.8% in 1-year period

Is SAD prevalence higher in females or males?

Slightly greater in females

At what age does SAD onset occur?

Usually during adolescence

- Peak age of onset is about 13 years

Is SAD more common than specific phobias in terms of anxiety disorders?

Specific phobias has more, SAD is second

What are the 2 causes of social anxiety disorder?

1. Biological and evolutionary vulnerability

- adaptive to fear of rejection from peers

2. Conditioning of fear response with stimulus

- traumatic experience and/or self-generated thoughts associating fear w/ stimulus

- Similar learning pathways as specific phobias

What are the 2 psychological treatments for social anxiety disorder?

1. Cognitive-behavioral treatment (CBT)

2. Cognitive-behavioral group treatment (CBGT)

- most effective in a group

- modeling

- exposure

- social skills training

*Cognitive-behavioral therapies are highly effective

What are the 2 medicinal treatment for social anxiety disorder?

1. General social anxiety often treated with SSRIs

- increases serotonin in the brain

2. Performance anxiety may be treated with beta-blockers or benzodiazepines

- used for hypertension bc it slows the HR down

*Relapse rates are high following medication discontinuation with pharmacology-only treatment

What are Diatheseses?

1. Possible genetic risks for phobias

2. Tendency to overreact physiologically to stimuli

3. Biological preparedness to associate fear with the stimulus

4. Early adverse experiences such as overcontrolling parents

5. Tendency to shift to cognitive self-focus in social situations

What are Stressors?

1. Traumatic conditioning of fear response

2. Vicarious conditioning of fear response

3. Vivid (and/or self-generated) information associating fear with the stimulus

What do diatheses contribute to the diathesis-stress model of phobias?

A predisposition to learn to fear certain stimuli

What do stressors contribute to the diathesis-stress model of phobias?

Frightening experiences w/ a stimuli

When the diatheses and stressors are put togther, what happens?

Can lead to a specific phobia or social anxiety disorder

What are the defining features of panic disorder?

Experience of unexpected panic attacks

1. Develop anxiety, worry, or fear about another attack

2. Behavioral changes such as avoidance

3. Often comorbid w agoraphobia

What is agoraphobia?

A fear of open spaces or being separated from a safe place ("fear of the marketplace")

1. Individuals typically fear leaving home alone, being in public, traveling

- for many, the concern is having a panic attack while being away from a place they consider safe

OR

- fear the place they could have an attack --> develop agoraphobia

How does the DSM-5 diagnose panic disorder?

When a person has recurrent panic attacks and reacts w/ either:

1. Worry about having another attack

or what the attack means

and/or

2. With behavior changes such as avoidance

What is panic attack?

Involves intense fear and 4+ of the following 13 symptoms:

Racing heart, sweating, shaking, difficulty breathing, choking sensations, pain in chest, pain or nausea in the stomach, dizziness, heat or chills, numbness, feeling things that are not real, thinking that you are going crazy, worrying that you are going to die

How much of the general population is affected by panic disorder?

2.7%

At what age does panic disorder onset often occur?

Mean onset is between 20 to 24 years of age

Is panic disorder onset acute or insidious?

Acute - many feel like it comes out of nowhere as they are not consciously aware of how stressors affect them

- many go to ER first as it feels like a heart attack and they are unfamiliar with panic attacks

--> worry abt the heart attack makes it worse

What % of individuals with agoraphobia are female?

66%

Are panic attacks universally interpreted the same across cultures?

No

What are causes of panic disorder and agoraphobia? (3)

1. A biological predisposition to overreact physically to stressors

- genetic

2. A tendency to misinterpret bodily sensations as signs of danger

3. Low perceived control over negative events and emotional experiences

*Together, these factors lead to constant apprehension about further attacks

What is the genetic relation of panic disorder?

1. Panic disorder and agoraphobia tend to run in families

2. Identical twins have higher concordance rates than fraternal twins

3. There is a HIGH GENETIC CORRELATION between panic disorder and agoraphobia

4. Hypersensitivity of the locus coerleus may be involved in panic disorder

Why does the tendency to misinterpret bodily sensations as a sign of danger cause panic disorder/agoraphobia?

1. Misperceptions escalate into repetitive thoughts about potentially catastrophic events

2. Panic attacks begin as false alarms exacerbated by distorted thinking

What is the medical treatment for panic disorder?

1. SSRIs

2. Benzodiazepines

- not the greatest

- addictive and sedative

- can be helpful as a sense of security --> placebo

- used in ER in acute phase

- Withdrawals bring attack symptoms leading to more addiction

What is cognitive-behavioral therapy for panic disorder? (3) Is it effective?

Highly effective

1. Breathing retraining to combat panic disorder

- Reducing breathing rate to promote relaxation and combat hyperventilation

- Increase sense of control

2. Cognitive restructuring

- Correct chronic misinterpretations of harmless bodily sensations

3. Interoceptive exposure to somatic cues that often trigger an attack

What are the defining features of generalized anxiety disorder (GAD)? (3)

1. Excessive, uncontrollable anxious apprehension and worry abt multiple areas of life (work, health, etc)

- Nondescriptive worry, not specifically worry abt smthing

2. Persists for 6 months or more

3. Accompanied by associated symptoms

- 3+

What are the symptoms of GAD? (6)

1. muscle tension

2. restlessness

3. fatigue

4. irritability

5. concentration difficulties

6. sleep disturbance

What % of the general poluation is affected by GAD?

3.1%

- limited by 6 month minimum

How many females, compared to males, have GAD? Is it common in the elderly?

1. 2 females to 1 male

Biological? Social?

2. Very prevalent among the elderly

Is GAD onset acute or insidious? When does it usually occur?

1. Onset is often insidious (starts slow, gets worse

2. Beginning in early adulthood

Does GAD run in families?

Yes, tends to run in families!

What are the potential causes of GAD? (2)

1. Biological vulnerability

2. Cognitive avoidance theory

What is the biological vulnerability for GAD? (3)

1. Abnormal amygdala

- strong! alarmy system

2. Abnormal prefrontal cortex activation (also found in other anxiety disorders)

3. Abnormal frontal lobe circuits

What is the Cognitive avoidance theory?

A cause for GAD

1. Worry is an attempt to avoid the emotional or physical feelings of anxiety

- verbal thought predominates during worry and may serve to distract from more emotional topics

Feedback loop:

1. Rumination --> Physical symptoms

What are psychological treatments for GAD? (5)

1. Cognitive behavioral therapy (CBT)

2. Relaxation training

3. MBSR (mindfulness-based stress reduction)

4. Biofeedback

- measuring bodily cues of anxiety

5. Combined treatment

How does CBT treat GAD?

Cognitive restructuring

- Identify and challenge irrational anxiety-generating thoughts and replace them w more rational beliefs

(breaking down the worry)

How does relaxation training treat GAD?

1. Structuring worry; scheduling

- Designed to reduce excessive physiological arousal

- working on breathing

What is the pharmacotherapy treatment for GAD? (2)

1. Benzodiazepines

- often prescribed

- robust efficacy in short term managemnet but not long term effective in long term studies

2. Antidepressants --> SSRI