Lecture 7: Anxiety and Stressor related problems

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35 Terms

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normal worry

-limited to specific small number realistic events

-able to control worrying

-don’t cause significant distress

-doesn’t interfere with daily activities

-short period of time

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generalised anxiety disorder (GAD)

-worry about all sorts of things and expect the worst

-worry is uncontrollable

-worries are extremely upsetting and stressful

-significantly disrupts daily activities

-worrying almost everyday for at least 6 months

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GAD - diagnosis

-DSM-5

-disproportionate fear or anxiety relating different aspects of your life

-anxiety should be relating to at least two areas of activity

-feeling of anxiety will be accompanied by symptoms of restlessness, agitation and muscle tension

-feelings of anxiety and worry will be associated with behaviours such as avoidance, seeking reassurance, excessive preparing

-symptoms cannot be explained by other mental health disorders

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heritable influences (GAD)

-runs in families but heritability is low

-suggests a genetic or biological element

-may inherit a personality trait that makes you more vulnerable to anxiety

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biological theories (GAD)

-GAD sufferers show hyper-responsivity in the amygdala

-amygdala is larger in those with GAD

-amygdala shows greater activation in response to negative images

-observed more in female sufferers of GAD

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environmental factors (GAD)

  • attachment style

  • negative life events

  • modelling

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negative life events (GAD)

-typically happen during childhood

-can lead to people questioning the predictability and stability of the world

-things feel uncontrollable → worry and anxiety so they feel prepared

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attachment style (GAD)

-those with insecure attachment styles are more likely to develop anxiety disorders later in life

-secure attachment provides a sense of safety

-GAD sufferers recall having controlling, absent or cold parents

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modelling (GAD)

-child picks up on parent’s anxious behaviours and can copy these

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cognitive biases (GAD)

-biases in thinking and processing information

  • information → constantly looking for information that confirms anxiety, tend to focus on negative information and ignoring positive information

  • attention → focus on negative information

  • outcomes → always expect the worst outcomes, ignore positive side of things

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benzodiazepines (GAD interventions)

-anxiety relieving properties

-stimulate GABA activity in the brain

-dampens excitatory activity in the brain

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B-blockers (GAD interventions)

-dampen adrenaline activity

-reduce fight or flight response

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SSRIs (GAD interventions)

-used as anti-depressants but relieve anxiety symptoms

-increase amount of serotonin in the synaptic cleft to increase serotonin activity

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stimulus control treatment (GAD interventions)

-treatment recommends that sufferers limit their worry to a particular time of day in a specific location

-make list of what happened during the day and know they can worry about it later

-having a specific location + time makes associations to working through their worries

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CBT (GAD interventions)

-targets maladaptive cognition

-patients are exposed to their cognitions by imagining the worse possible outcome and working through with therapist

-self monitoring → patient made aware of their fixed patterns of behaviour and this helps understand what they need to target

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relaxation training (CBT)

-may have to consciously relax due to constant anxiety

-breathing exercises, visual imagery training

-not part of automatic behaviour for those with anxiety disorders

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cognitive restructuring (CBT)

-methods used to challenge biases and generate more accurate/realistic thoughts

-ask about worse case scenario and work backwards, challenging beliefs

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behavioural rehearsal (CBT)

-asked to imagine or rehearse a situation

-ask to think about how they would cope if something bad was to happen

-make individual think about their coping strategies

-help identify more healthy and positive coping strategies and build confidence

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panic disorder

-characterised by repeat panic attacks

-unexpected and spontaneous → essential for diagnosis

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panic attack

-discrete period of sudden and intense fearfulness

-rapid heart rate, breathing rate, trembling, dizziness, nausea, chest pains

-experience mental or physical breakdown

-situationally bound

-anticipation or immediately on exposure to the trigger

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panic disorder - diagnosis

-DSM-5

-panic attacks are spontaneous/unpredictable

-panic attacks should be recurrent

-worry about further panic attacks

-modify behaviours to avoid future attacks

-rule out other diagnoses

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biological theories (panic disorder)

-due to a failure to regulate fight or flight response

-much more easily triggered and overreactive fight or flight response

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hyperventilation (panic disorder)

-proposed that dysfunctional breathing may cause other physiological responses which leads to panic attacks

-hyperventilation is letting out more air than you are taking in

→ losing carbon dioxide, leads to a loss of Co2 pressure in the blood and this alter blood pH

→ so oxygen is not being delivered as effectively

→ so cardiovascular exchange (panic attack) compensates for lack of oxygen

→ cycle repeats

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cognitive model (panic disorder)

-trigger stimulus (not always aware of this) is perceived as a threat

-this causes apprehension

-bodily sensations are then interpreted as catastrophic → worsens sensations

-worsens sense of perceived threat

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pharmacological interventions (panic disorder)

-same as for GAD

-mechanisms of actions are the same

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CBT (panic disorder interventions)

-recognise what might cause the trigger

-restructure maladaptive beliefs

-teach the client about fight-flight response → natural and helps them feel less overwhelmed or misinterpret it

-prevent safety behaviours → reinforce anxiety in the long term

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social anxiety disorder - diagnosis

-DSM-5

-distinct fear of social interactions

-social interactions are avoided or experienced with intense fear or anxiety

-avoidance, fear/anxiety lasting more than 6 months and causes significant distress and difficulty in performing social or occupational activities

-other disorders are ruled out

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biological factors (SAD)

-more likely to have social anxiety disorder if a parent has it

-rather than inheriting the disorder, may inherit the vulnerability that makes them prone to developing any anxiety disorder

-children who show behaviourally limited temperament are more likely to develop social anxiety disorder

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before social interaction (cognitive model of social anxiety disorder)

  • engage in a lot of thinking

  • worry before

  • have negative beliefs about themselves from past experiences which reinforces fear around social situations

  • negative automatic thoughts lead to physical/visible symptoms of anxiety

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during social interaction (cognitive model of social anxiety disorder)

  • experience physiological and cognitive symptoms

  • can trigger further anxiety when worrying about the symptoms they are showing

  • look inwardly and focus on themselves

  • think other people are judging them in the same way

  • increases physiological symptoms

  • cannot enjoy event due to the amount of worry

  • embarrassment and humiliation

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after social interaction (cognitive model of social anxiety disorder)

  • negative thoughts

  • repeatedly going over event in head

  • reinforces negative beliefs

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cognitive bias (SAD)

-tend to focus on all the negative aspects of the social situation

-struggle to process and accept anything positive

-likely to maintain individual’s dysfunctional beliefs about the social situation and themselves

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pharmacological interventions (SAD)

-same as for GAD

-mechanisms of actions are the same

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CBT (SAD interventions)

  1. forming a rapport → brief the client that the therapy will target factors which are maintaining the disorder

  2. working with the client → engage in role play, identify safety behaviours and aim to remove these

  3. encourage client to focus on external situation rather than internal responses

  4. constructive feedback → for role play, social skills training

  5. exposure → behavioural experiment, test fears

  6. challenging cognitions → modify post event processing using cognitive restructuring

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anxiety and comorbidity

-core symptoms:

  • physiology

  • escape

  • avoidance

  • cognitive biases