Week 6 lecture 2 (Anxiety disorders)

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41 Terms

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depression and insulin resistance

What conditions are associated with loss of negative feedback in the HPA axis

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The hippocampus

-in encoding contextual info→ feeds it to the amygdala

-high in glucocortoid receptors and CRH levels in some parts

-in associative memory

-in memory involving fear (extinction and consolidation)

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Fear v anxiety

-anxiety involves uncontrollability of future events

-Anxiety responds to a future threat

-Fear involves noncognitive processes

-anxiety involves cognitive processes

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integrated model of anxiety

-biological vulnerability (heritibal contributions to negative effects)

-specific psychological vulnerability (physical sensations are potentially dangerous)

-generalized psychological vulnerability (sensing events are uncontrollable/ unpredictable)

-all three enhance the chance of somone having an anxiety disorder

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Biological vulnerability

-multiple genes add to risk

-difference in brain circuits

  • HPA

  • limbic systems

  • fight or flight

-different reactivity to stressfull events

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Psychological vulnerability

-pay select attention to the threat

-misinterpreting something neutral as threatening

-overestimation of future bad events

-personalization of neg events

-thinking world is uncontrollable

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Panick attack

intense fear eithout reason to be afraid

-peaks within 10 minutes

-four or more autonomic symptoms

-can be unexptected or expected

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panic disorder

-reacurring panick attacks

-1 attack followed by a month of…

  • continual concern of panic attack and its consequences

  • maladaptive change as a result of panic attacks (agoraphobia)

-no better explained by another disorder

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Agoraphobia

-dread/avoidance of 2+ situations where environments are unfamiliar or theres a perceived lack of control

-fear of public panic attacks

-situations provoke fear/anxiety

-avoidance is persistent

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conditioning and panic

US: uncued panick attacks (by coincidence at grocery store)→UR: anxiety

CS: grocery store →CR: anxiety

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interoceptive conditioning

-small changes in physical sensation induce a panick attack

-low levels of physical sensations of arousal or anxiety become conditional stimuli→early somatic components of an anxious responce elicits panic

-for example: CO2 make make somone with panic disorder have a panic attack

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Introceptive avoidance

-avoiding activities that may produce physiological arousal reminiscent of panic

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Cognitive contributions to panic disorder

-seeing bodily functions as dangerous (eg: feeling faint or about to have a heart attack)

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Causes for panick disorder

-anxiety and sensitivity

  • percieve anxiety as harmful

-biological vulnerability: more sensitivity to stress

-general psychological vulnerability

  • anxiety on future events

  • hypervigilience

  • more introspectively aware

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Panic disorder treatment

-psychoeducation

-exposure

-cognitive restructuring

-relaxation

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GAD

-worrying about # of activities or events

-difficulties controlling worry

  • restless or on edge

  • easily fatigue/ sleep disturbance

  • mind going blank/cant concentrate

  • irritable

  • muscle tention

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GAD biases

-inderited tendency for anxiousness

-cognitive

  • overstimation of bad outcomes

  • catastrophic thinking

-attentional/judgmental

  • allocate more attention to ‘threat’ sources

-stressful life events

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GAD medical treatments

-Benzodiazepines (short term)

-antidepressants (side effects)

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GAD psychological treatments

-cognitive behavioral treatments

  • exposure to worry process

  • confronting anxiety provoking images

  • coping stratagies

  • relaxation techniques

  • attentional bias modification

-acceptance

-meditation

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Specific phobia

extreme fear of an object or situation

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Blood injection phobia

-early onset (9 years old)

-less heart rate and blood pressure

-fainting

-more of a genetic component

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situational phobia

fear of specific situations

-onset at 20

-no uncued panic attacks

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Animal phobia

-onset at 7

-may associate with real danger

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Natural enviorment phobia

-onset at 7

-assoc with real danger

-must last 6 months minimum

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causes of specific phobia

-inherited vulnerability to anxiety

-some objects are more readily associated with danger/aversion (preparedness)

-trauma

  • conditioning

-observational learning

-info transmission (being told of danger)

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Extinction of classical conditioning

CR is gradually diminished over time since CS is shown without US

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Treatment for specific phobia

-systemic desensitization (gradually giving exposure in a relaxed enviorment)

-cognitive behavior therapy

  • exposure

  • hieractchy of exposure

  • structured

  • consistant

  • within a therapy setting

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Social anxiety disorder

-fear social situations will result in scrutiny by others or some loss of status

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Cognitive factors in social anxeity disorder

-social situations are dangerous (so perfect performance is needed)

-predict

  • some social situations are bound to lead to humiliation/status loss

-problematic comparisons

  • rate self lowly

  • believe others have high expectations of them

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Social anxiety psychological treatment

-group therapy

-cognitive behavioral therapy

  • exposure

  • rehearsal

  • roleplay

  • group settings

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Social anxiety medical treatment

-norepinephrine (beta blockers)

  • dampens physiological cues (heart medication)

  • Seratonin reuptake inhibitors

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PTSD

-NOT an anxiety disorder but a trauma/stress disorder

-needs trauma exposure and its continual experience

-avoidance (emotional numbing)

-neg cognition/mood (low opinion on self and others)

-1 month post trauma

-intrapersonal problems/dysfunction

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PTSD statistics

-affects women on a greater scale

-prevalance varies

-comorbidy with MDD, GAD, and alchohol use disorder

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PTSD causes

-intense/severe trauma with little social support and additional life stress

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Why may people with the same trauma not all get PTSD?

generalized biological vulnerability

-family hostory of anxirrty

-gene enviorment interactions: kids acting out→ more likely to encounter trauma

-high norepinephrine activity

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PTSD and hippocampus

reduced hippocampal volume (but may not be due to the disorder itseld acc to studies)

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PTSD treatment

-meds (SSRI’s) seratonin reuptake inhibitors

-cognitive behavioral treatment

  • exposure

  • more positive coping skills

  • more social support

  • very effective

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OCD

-obsessive, compulsive or both

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OCD obsession

reacurent and persistent thoughts +impulses that are intrusive + innapropriate → causes distress

-attempts to supress thoughts, impulses, images with other thoughts and actions

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OCD compulsion

-repetitive behaviors or mental acts that a person feels driven to perform due to rules or obsession

-usually aimed at reducing/ impairing distress (but are not realistically connected)

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OCD treatment

-SSRI’s (60% benifit)

-psychosurgery (cingulate bundle lesion, 30% benefit)

-cognitive behavioral treatment

  • exposure

  • response prevention

  • reality testing (most effective)

-NO BENIFIT for combined treatment