PSYC 2810 Test 2: Anxiety, OCD, PTSD

cognitive (internal) symptoms of anxiety (5)

• anticipating harm

• exaggerating danger

• concentrating

• hypervigilance

• rumination

emotional symptoms of anxiety (4)

• dread

• terror

• restlessness

• irritability

behavioral symptoms of anxiety (4)

• escape

• avoidance

• aggression

• freezing

physical symptoms of anxiety (8)

• goosebumps

• tense muscles

• heart rate

• respiration

• dilated pupils

• sweating

• adrenaline

• bladder activity

adaptive fear

• more realistic concerns

• fear experienced is in proportion to the reality of the threat

• fear response ends when threat goes away

maladaptive anxiety

• unrealistic concerns

• fear is out of proportion to harm associated with perceived threat

• fear persists after threat goes away

prevalence rate of anxiety in the US

31.1%

average age of onset for anxiety disorders

11 years old

prevalence rates of anxiety in children & adolescents

• adolescents (13-18): 31.9%

• children (3-17): 9.4%

comorbidity rates of anxiety (3)

• 57% with another anxiety disorder or depression

• 54% have two or more diagnoses

• 60% had multiple diagnoses of mood, anxiety, and substance use

panic attacks

discrete period of intense fear and physical arousal

physical symptoms of panic attacks (6)

• shortness of breath

• heart palpitations

• trembling

• chills

• chest pain

• nausea

emotional symptoms of panic attacks

overwhelmed with intense apprehension, terror, depersonalization

cognitive symptoms of panic attacks

• fear of dying or losing control

• thinks panic attack is a heart attack

panic disorder Criteria A

recurrent, unexpected panic disorders with at least FOUR panic symptoms

panic disorder criteria B

either symptom for at least one month:

• persistent worry about future panic attacks

• maladaptive change in behavior to avoid panic attacks

agoraphobia

• “fear of the marketplace”

• fear of embarrassment of physical symptoms of panic attacks

• fear of open spaces, crowds, and streets because help may not be available

situations where agoraphobia is triggered (2 out of 5):

• public transportation

• open space

• enclosed spaces

• standing in line/crowd

• being outside the home alone

duration of agoraphobia

at least 6 months

prevalence of panic disorder

• children and adolescents: 0.4%

• adults: 3.7%

• 55+: 1.2%

prevalence of agoraphobia

adults: 0.7%

are women or men more likely to have panic disorders?

women

prevalence of panic disorder + agoraphobia comorbidity

adults: 1%

generalized anxiety disorder duration

at least 6 months

generalized anxiety disorder

persistent, uncontrollable worry about multiple everyday activities

how many symptoms must be present in order for it to be generalized anxiety disorder?

3 out of 6

generalized anxiety disorder symptoms (6):

• restlessness

• easily fatigued

• difficulty concentrating

• irritability

• muscle tension

• sleep disturbance

social anxiety disorder (social phobia)

• fear of being evaluated or observed in social situations

• worry that they will be ridiculed by others

what does social phobia result from?

distorted beliefs: “people will think i’m stupid”, “they’ll notice how nervous i am”

how is social phobia maintained?

• avoidance of social situations

• safety behaviors like drinking and rehearsing conversations

average onset age of social phobia

between 11 and 13 (middle school years)

specific phobia

• marked fear or anxiety about a specific object or situation

• fear response must be immediate and cause impairment (avoidance, anticipation)

two criteria of specific phobia

• significant emotional distress

• impairs an aspect of life functioning

five types of phobias

• animals

• natural environment

• blood/injection/injury

• situational

• others

risk factors of generalized anxiety disorders

• lower socioeconomic status

• past trauma

• negative life events

is generalized anxiety disorder episodic or chronic?

chronic

specifier for social phobia

performance-only: fear is only in response to public speaking or performing

top 3 phobias in adults

animals, heights, closed spaces

separation anxiety

inappropriate fear/anxiety about being separated from attachment figure, usually found in children

selective mutism

• refusal to speak in situations where speaking is expected

• associated with high negative affect, social inhibition, over controlling parents

duration and onset of selective mutism

duration: at least one month

onset: before 5 years old

object permanence

• idea that attachment figure is still there even when out of sight

• weak in those with separation anxiety

age of onset for generalized anxiety disorder

late teens - late 20s

prevalence of any anxiety disorder

28.8%

social anxiety age of onset

11-13, can be as early as 8

specific phobia age of onset

7 years old

obsessive compulsive disorder (OCD) symptoms

presence of obsessions or compulsions that cause significant clinical/daily impairment

obsessions in OCD

persistent thoughts, urges, or images that are unwanted and provoke anxiety/distress that the person tries to ignore/suppress

compulsions in OCD

excessive, repetitive behaviors or mental acts in response to an obsession that relieve short-term anxiety

true or false: degree of insight for people with OCD can vary

true

common obsessions in OCD

• contamination

• mistakes

• impulses

• order

common compulsions in OCD (6)

• checking

• cleaning/washing

• repeating

• ordering/arranging

• hoarding

• counting

insight specifiers for OCD

• good/fair insight

• poor insight

• absent insight

tic-related specifier for OCD

• if individual has current/past history of tic disorder

• tics are a counter for obsession

• more common in men

• may be more heritable

prevalence of OCD

1.6%-2.7%

mean age of onset of OCD in USA

19.5 years old

OCD manifestation in adults & children

adults: obsessions and compulsions

children: rituals that they may not notice or eventually grow out of

older people: more hand washing & fear of wrongness

OCD comorbidity

• mood disorders: up to 50% of people with depression also have OCD

• anxiety disorder: specifically social phobia or panic disorder

Cycle of OCD

obsession —> anxious feelings —> physical sensations —> compulsion —> negative thinking —> repeat

biological treatments of OCD

• selective SSRIs

• SSRIs are usually beneficial with children, otherwise behavioral treatment is considered a better first option

cognitive behavioral model of OCD (5 steps)

normally occurring intrusive thought —> faulty appraisal —> obsessional anxiety —> resistance or avoidance —> short-term anxiety reduction

cognitive therapy for OCD

• education about normalcy of intrusive unpleasant thoughts

• cognitive restructuring that helps reduce thought misappraisals

• behavioral experiments (CBT)

• retraining from rituals/safety behaviors

behavioral therapy for OCD

• procedures that evoke obsessional anxiety

• procedures that replace harmful association with rituals with a more neutral association

• increased exposure to obsessions to reduce anxiety

treatment of fear

• exposure to fear-eliciting stimuli or situations

• prevention of avoidant behaviors

• anxiety increases initially, followed by habituation

• provide corrective information

positive reinforcement

adding a stimulus to encourage a behavior

positive punishment

adding a stimulus to discourage behavior

negative reinforcement

removing stimulus to encourage a behavior

negative punishment

removing stimulus to discourage a behavior

genetic studies of anxiety

• anxiety disorders run in families

• heritability is varied across anxiety disorders

neurotransmitters involved in anxiety

low levels of serotonin

areas of the brain involved in anxiety

• amygdala (fear behavior)

• hippocampus (storing memories)

• anterior cingulate cortex (connection between limbic system and prefrontal cortex)

family risk factors

• attachment styles

• expression of emotions

• family conflict

• parent anxiety (excessive parental control, modeling of anxious behaviors/thoughts)

tripartite model

anxiety symptoms: anxious arousal

depressive symptoms: low positive affect

anxiety & depressive symptoms: negative affect

used to explain manifest symptoms of anxiety and depression

negative affect (6)

• interpersonal sensitivity

• poor self-concept

• sadness

• guilt

• fear

• anger

two sub-factor method

• distress and fear

• distress: depression and GAD

• fear: specific & social phobia, panic

• underlying factor is negative affect

unconscious conflicts in psychodynamic theory

• lack of balance between id and superego

• ego tries and fails to maintain balance

• desire to express unconscious thoughts that conflict with conscious values

three parts of the unconscious theory

id: pleasure/what you want to do

ego: rational/what you can do

superego: morality/what you should do

defense mechanisms example (8)

• repression

• regression

• displacement

• sublimation

• reaction formation

• projection

• rationalization

• denial

corrective emotional therapy

• techniques used to reduce defense mechanisms and expose ourselves to more healthy behaviors

classical conditioning

• acquisition of fears

• introceptive conditioning: when body’s anxiety response becomes the conditioned response

• introceptive avoidance: avoiding situations that mimic physiological symptoms of anxiety

operant conditioning

• behaviors are rewarded or punished, which predicts whether they are repeated

• vicarious conditioning: instilling fear by seeing someone else get punished for doing something

cognitive theory of anxiety (5)

• information is processed with a bias to threat

• memory is primed to recall negative events

• worry is reinforced through a cycle

• poor problem-solving skills limit sense of control/self-efficacy

• treatment involves revising estimates of likelihood of terrible events

anxiety sensitivity

introceptive conditioning: tendency to catastrophically misinterpret arousal-related physical sensations as dangerous —> more anxiety

cognitive-behavioral model of panic disorder

• beliefs about dangerousness of physical sensations —> hypervigilance —> perception —> catastrophic misinterpretation of threat —> fight-or-flight response —> safety seeking behaviors

fear of fear model

panic attack —> increased physical arousal and worry —> vigilance of bodily symptoms —> catastrophic misinterpretation of physical sensations —> cycle repeat

behavioral treatment of anxiety (4)

• systematic desensitization

• exposure therapy

• flooding

• habituate anxious response

cognitive treatment of anxiety (3)

• identify and challenge negative, catastrophic thoughts

• break cycle of rumination

• improve problem solving

cognitive-behavioral treatment of anxiety

• recalibrating false alarms

psychodynamic treatment of anxiety (2)

• identify conflicts causing anxiety and resolve them

• identify internal conflicts - work through them and resolve underlying conflict

cognitive behavioral group therapy (CBGT) (6)

• built-in exposure

• vicarious learning

• make a public commitment to change

• see others with similar problems

• availability of multiple role-play partners

• range of people to provide evidence to counter distorted cognitions

exposure procedures (5)

• assessment of obsessional triggers

• discuss rationale for exposure

• develop fear hierarchy

• systematic prolonged and repeated confrontation

• all this leads to habituation

response prevention technique (3)

• helps patient to resist engaging in rituals and avoidance behaviors

• helps to prolong exposure

• helps patient recognize rituals are redundant

body dysmorphic disorder (BDD) symptoms

1) preoccupation with one or more specific part in physical appearance which the person believes is ugly

2) repetitive behaviors or mental acts regarding specific body part at some point

BDD prevalence

USA: 2.4%

women: 2.5%

men: 2.2%

examples of BDD concerns

• lines in the skin/acne

• facial deformities

• hair

muscle dysmorphia and comorbidity

• form of BDD consisting of preoccupation with the idea that one’s body is too small

• comorbidity: substance disorder in men, eating disorder in women

how is insight in people with BDD?

poor

associated features in BDD

• depression is common

• suicide risk is elevated

• delusions of reference

• many attempts to receive cosmetic treatment

onset and course of BDD

• average age of onset: 16-17 years old

• usually during school transitions

• earlier onset: more impairment, higher suicide risk

risk factors (4)

• 4X higher prevalence in first degree relatives of BDD patients

• history of childhood abuse or neglect

• past history of appearance related teasing/bullying

• early childhood shyness, perfectionism, anxiety & depression