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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
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
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
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
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
environmental factors (GAD)
attachment style
negative life events
modelling
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
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
modelling (GAD)
-child picks up on parent’s anxious behaviours and can copy these
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
benzodiazepines (GAD interventions)
-anxiety relieving properties
-stimulate GABA activity in the brain
-dampens excitatory activity in the brain
B-blockers (GAD interventions)
-dampen adrenaline activity
-reduce fight or flight response
SSRIs (GAD interventions)
-used as anti-depressants but relieve anxiety symptoms
-increase amount of serotonin in the synaptic cleft to increase serotonin activity
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
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
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
cognitive restructuring (CBT)
-methods used to challenge biases and generate more accurate/realistic thoughts
-ask about worse case scenario and work backwards, challenging beliefs
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
panic disorder
-characterised by repeat panic attacks
-unexpected and spontaneous → essential for diagnosis
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
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
biological theories (panic disorder)
-due to a failure to regulate fight or flight response
-much more easily triggered and overreactive fight or flight response
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
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
pharmacological interventions (panic disorder)
-same as for GAD
-mechanisms of actions are the same
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
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
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
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
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
after social interaction (cognitive model of social anxiety disorder)
negative thoughts
repeatedly going over event in head
reinforces negative beliefs
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
pharmacological interventions (SAD)
-same as for GAD
-mechanisms of actions are the same
CBT (SAD interventions)
forming a rapport → brief the client that the therapy will target factors which are maintaining the disorder
working with the client → engage in role play, identify safety behaviours and aim to remove these
encourage client to focus on external situation rather than internal responses
constructive feedback → for role play, social skills training
exposure → behavioural experiment, test fears
challenging cognitions → modify post event processing using cognitive restructuring
anxiety and comorbidity
-core symptoms:
physiology
escape
avoidance
cognitive biases