Anxiety Disorders - SAD, specific phobia, panic disorder

What are similarities between fear and anxiety? What are differences?

• Both involve negative affect

• Fear = sympathetic NS arousal; Anxiety = somatic symptoms of tension

• Fear = urge to escape/act in response to present danger; anxiety = future orientated

• Anxiety has a sense of unpredictability or uncontrollability of upcoming events

What is panic?

A sudden episode of intense fear that triggers severe physical rxns, when there is no real danger or apparent cause

What is worry? What does it represent?

A chain of thoughts + images, negatively affect-laden and relatively uncontrollable

Represents an attempt to engage in mental problem-solving on an issue whose outcome is uncertain but contains possibility of negative outcomes

What is the psychodynamic theory of anxiety?

Anxiety is a conflict between id and ego. Repressed drives break through repression and cause danger, with anxiety as the signal.

Triangle - three points are defense, anxiety, and hidden feelings

According to Freud, anxiety is a psychic rxn to danger

What is the cognitive theory of anxiety?

Feelings, thoughts, behaviours

Anxiety caused by tendency to overestimate the potential for danger + cognitive misinterpretations

What is the behavioural model of anxiety?

Classical conditioning, operant learning, and modelling cause anxiety disorders

A dog bite + contiguous pairings lead to a classically conditioned fear of dogs. A strong fear response acts as a stimulus or drive and results in an overt avoidance response, acting as operant conditioning

What is the prevalence and sequelae of anxiety disorders? (2)

Highly prevalent - up to one third of people will have at least one

Sequelae - poor educational outcomes; underemployment/social welfare

What are the two themes across anxiety disorders?

Over-estimation of threat - feared outcomes as highly likely to happen

Underestimation of ability to cope - thoughts = “I will not be able to cope” and “I will fall apart”

DSM criteria for Specific Phobia (A-G)

A. Marked fear or anxiety about a specific object or situation

The object or situation

B. Almost always provokes immediate fear or anxiety

C. is actively avoided or endured with intense fear or anxiety

The fear or anxiety

D. Is out of proportion to the actual danger posed and to the sociocultural context

E. Is persistent (>6 mth)

F. Causes clinically significant distress or impairment

G. not better explained

Specific Phobia Specifiers (5)

Animal (spiders, insects, dogs)

Natural environment (e.g., heights, storms, water)

Blood-injection injury (e.g., needles, invasive medical procedures)

Situational (e.g., airplanes, lifts, enclosed places)

Other (e.g., situations that might lead to choking or vomiting)

How do fears differ from phobias?

Development of fears are normal but transient at various developmental stages

• Separation from caregivers (6-22m)

• Animals/darkness/imaginary creatures (2-6y)

Common fears in adulthood - illness/injury/death, animals, environmental hazards

In phobias, fear is intense/severe, immediate, response is excessive; more likely to be chronic and causes significant distress or impairment

Epidemiology of Specific Phobia

12-m prevalence 6-9% in US, Europe; 2-24% in Asia, Afria, S America

2:1 females:males except BII

Peak in teenagers (5% in children, 16% in teens, 3-5% in older adults)

Multiple common (75% fear more than one, on average 3)

High comorbidity and severe role impairment

What are risk factors for specific phobia?

Genetic (including to category — BII Higher)

Physiological

Temperamental

Environmental

What are physiological risk factors for specific phobia?

• Amygdala hyperactivity to feared stimuli

• Unique propensity to fainting in BII

What are temperamental risk factors for specific phobia?

• Negative affectivity (neuroticism)

• Anxiety sensitivity (fear of fear)

• Behavioural inhibition

• Emotional regulation and distress tolerance

What are environmental risk factors for specific phobia?

Parental overprotectiveness

Parental loss and separation

Physical/sexual abuse

Traumatic encounters (with feared object or situations)

What is Mowrer’s two factor model for specific phobia?

1. Fear acquired via classical conditioning

2. Fear maintained via operant conditioning

Stimulus generalisation also implicated

Avoidance and escape negatively reinforced by removing aversive affective states

What’s Rachman’s revised two-factor model?

1. Direct conditioning

2. Modeling/vicarious acquisition due to observational learning

3. Informational and instructional acquisition (i.e., receiving mis information from others)

What is Seligman’s preparedness theory of specific phobia?

Evolution predisposed organisms to learn easily associations that facilitate survival

When compared to lab-conditioned fears, phobias are:

1. Rapidly acquired

2. Resistant to extinction

3. Non-cognitive/irrational

4. Differentially associated with stimuli of evolutionary significance

What is Reiss’s Expectancy Model’s three types of sensitivity/fundamental fears?

Three types of sensitivity/fundamental fears

1. Anxiety sensitivity - the fear of anxiety-related sensations, arising from belief sensations have averisve somatic, psychological, or social consequences

2. Fear of illness, injury, or death

3. Fear of negative evaluation

According to Reiss’s expectancy model, human motivation to avoid a feared stimulus is a function of what two classes of variables?

1. Expectation (what you think will happen)

2. Sensitivity (the reasons you fear that happening)

Phobic fear + motivation to avoid feared stimulus = involves BOTH

What is the expectancy model formula?

1. Total danger expectancy in relation to all objective disasters that could be associated with stimulus x sensitivity to injury/death

2. Total anxiety expectancy in relation to all components of anxiety reaction associated with stimulus x sensitivity to anxiety

3. Total expectancy of social disaster in relation to all that could be associated with the stimulus x their sensitivity to negative evaluation by others

What maintains phobias?

Anxious predictions (based on exaggerated estimates of harm/danger)

Physiological arousal (focus for further anxious predictions)

Hypervigilance for cues (scanning, attention to physiology)

Safety behaviours