WEEK 7 - Anxiety Disorders 3 FLASHCARDS

worry

An internal representation of future aversive events that cause anxiety in the absence of existing threat. It is the cognition component of anxiety (Clark & Beck, 2011).

ego-dystonic

A term for a disordered state that is experienced as non-characteristic of the self

ego-syntonic

A term for a disordered state that is experienced as a characteristic of the self and consistent with their desires and values

generalized anxiety disorder

Occurs when individuals chronically worry about two or more life circumstances, and this constant worry is experienced as excessive and distressing

• This generates chronic symptoms of motor tension and hypervigilance, fatigue, poor concentration and sleep

• defining feature is the perceived inability to stop worrying (or at least control / influence it) and this adds to the anxious distress

gad comorbidity

50% onset under age 31, 85% of those with gad also had a comorbid condition alongside it.

• GAD is chronic and unremitting, and is a social economic burden (Newman. 2000; Newman et al., 2016)

gad risk factors

heritability 15-20%, a lot lower than other conditions like bipolar disorder or schizophrenia (Hettema et al., 2001)

for older adults, caused by poverty, separation, low child emotional support, parental mental illness

for women, caused by middle-aged, widowed, separated, divorced, low income

gad worries

ego-syntonic, the content of the thoughts are distressing because they do not want these feared future consequences to occur. It is something that would consider important to think about

differences between ocd worries and gad worries: obsessions are shorter-lived and image laden. worry is more chronic and verbal (Wells & Morrison, 1994)

gad experiential avoidance approach

a theoretical mechanism of GAD; The mental and verbal focus on worry is an attempt to avoid more emotionally distressing concerns, where thought-focused activity serves to inhibit vivid mental imagery and associated emotions. (Borkovec & Newman, 1999)

gad metacognition

a theoretical mechanism of gad; the meaning of worry processes themselves can begin to perpetuate worry (Wells, 1997; 2009)

gad intolerance of uncertainty approach

a theoretical mechanism of gad: an anxious disposition that emerges from beliefs about the negative consequences of being uncertain. may set the conditions for worry but there is no guarantee that something will happen

positive beliefs about worry

a cognitive process from the intolerance of uncertainty approach to GAD: facilitates the pursuit of certainty, rather than supporting cognitive problem solving

negative problem orientation

a cognitive process from the intolerance of uncertainty approach to GAD: a state where one’s attitude to problems ultimately prohibits their resolution. Common beliefs such as problems “are threatening,” “should be easily solved” and “I can’t solve problems” underpin the failure to accurately define worries well enough to solve them, reinforcing the negative problem orientation

cognitive avoidance

a cognitive process from the intolerance of uncertainty approach to GAD: a range of strategies to reduce anxious arousal ranging from suppression, distraction, thought replacement, to constantly thinking verbally to suppress anxious imagery.

limitations to the gad intolerance of uncertainty approach

• cannot explain when worry is adaptive and when it is not (Gustavsson, 2021)

• does not demonstrate specificity to GAD when compared to depression and OCD (Gentes & Ruscio, 2011)

gad worry type 1

a type of worry: occurs with everyday concerns about concrete events such as bills, work, deadlines, conflicts (Hjemdal et al., 2013) worry used as a strategy for anticipating, avoiding, or dealing with potential future threats.

• underpinned and sustained by positive worry beliefs such as “worry helps me avoid problems”

• worry continued until ability to cope, hence feeling compelled to worry

• resolvable, controllable and does not cause significant distress

gad worry type 2

a type of worry: negative evaluations of the worry process such as “I am making myself sick,” “I am losing control.” Underpinned and sustained by negative beliefs that worry is uncontrollable and dangerous

developed from the t1 worry when this worry type becomes activated. unhelpful coping mechanisms then exacerbate anxiety, worry, and reinforce negative beliefs about uncontrollability and danger

positive empirical evidence for the metacognitive model of gad

• No difference between GAD and non-GAD samples (Davis & Valentiner, 2000)

• But positive beliefs predicts GAD severity when capacity for top-down cognitive control is high (Fishback et al., 2020)

negative empirical evidence for the metacognitive model of gad

• GAD samples endorse negative beliefs and engage in type 2 worry (Cartwright-Hatton & Wells, 1997; Wells & Carter, 2001)

metacognition empirical evidence to the metacognitive model of gad

• Good statistical fit for explaining GAD in clinical samples compared to poorly-fitting competing models (Nordahl et al., 2022)

• Evidence supports Metacognitive Therapy is superior in retaining patients, recovery rates and duration effect compared to other recommendations

common criticisms of the metacognitive model of gad

• Meta beliefs in GAD are transdiagnostic

• Assumes temporal precedence of main characteristics over cognitive avoidance - evidence insufficient

• Metacognition model assumes a causal, not concomitant, relationships between t1 and t2 worry

social anxiety disorder

Occurs when individuals develop a persistent fear of situations that are social or performance-focused and believe that they will behave in an anxious and embarrassing manner. Exposure to social situations provokes anxiety, the individual knows this fear is generally unwarranted, but they avoid these situations or endure them with distress. This results in a negative impact on their life, which endures for at least six months

• A defining feature of SAD is the struggle to develop realistic perceptions of themselves in the eyes of others, or in the case of “social slip-ups” a balanced appraisal of the consequences

sad comorbidity

• Has comorbidity rates between 61-81% (Fehm and Wittchen, 2004)

  • Of those who present with SAD, 61% also meet the criteria for Avoidant Personality Disorder (APD; Sanderson et al., 1994)

  • SAD more likely to occur alongside substance use, odds of using alcohol and cannabis 4-6x higher for SAD sufferers (Buckner et al., 2008)

  • Level of co-morbidity also predicts degree of socio-occupational impairment

sad risk factors

familial psychopathology, maternal stress, behavioural inhibition, memories of social trauma, repetitive negative thinking, contrast avoidance

contrast avoidance

a sensitivity to sharp changes in emotion, particularly increase in negative and decrease in positive emotion. Worry increases anxiety but inhibits surges of negative affect when during stressful events

sad psychological impact

functional impact of sad. untreated SAD is a powerful risk factor for subsequent substance use and MDD episodes (Buckner et al., 2008) Shame and stigma were the main reason for not presenting for treatment (Goetter et al., 2020)

sad educational impact

functional impact of sad. Earlier onset of social anxiety can undermine scholastic achievement, heightening the risk of dropping out early and leaving with poorer qualifications. Sadly, this factor would put sufferers in the strata for higher prevalence of SAD due to socio-economic status (Kessler et al., 2005)

sad economic impact

People with SAD were earning 10% less than the normal, non-clinical population (Katzelnick et al., 2001)

sad occupational impact

associated with increased volume of sick leave and decreased productivity when in employment

sad social impact

Those suffering have fewer friends and struggle to maintain these relationships. Compared to the normal population, they are less likely to have children, less likely to get married and more likely to get divorced

sad cognitive model

• There is a preoccupation with the threat of being revealed as socially unacceptable, either through behaviour or anxious presentation, leading to negative evaluation and rejection

• doubt their ability to make positive impressions amplifying the distressing event of social unacceptability

• Negative bias for ambiguous social situations, catastrophic interpretations of mildly negatives, and neutral interpretation of positive ones

sad stressful event

a part of the cognitive model: when a socially anxious person enters a social situation, this activates core beliefs, assumptions and rules for social performance

sad beliefs and biases

These set the conditions for perceiving a social danger, which takes the form of negative automatic thoughts

sad cognition of safety behaviours

• cognition activates safety behaviours to protect oneself from the perceived threats

• These behaviours are also experienced as socially threatening since they may be visible and odd to others, increasing anxiety further

sad self-focused attention

• a part of the cognitive model: increases belief in anxiety visibility, motivating safety behaviours which generate the reactions they wish to avoid

• This reinforcing self focused attention decreasing attention to social cues and disrupts social performance

• Confirmatory experience is internally-generated and disconfirming experience from the social element remains unnoticed, resulting in significant anxiety-reinforcing distortions in perception

how sad self-focused attention functions

• create distorted self-referent images from the perceptive of their observers. this increases anxiety and impairs judgement of anxiety visibility and social performance (Clark & Ahmad, 1998; Hackmann et al., 1998)

• process social cues less but biased toward detecting negative facial cues in observers, neglecting other cues (Winton, Clark & Edelmann, 1995)

• Hirch et al, 2003

  • SAD patients conversed with a stranger, once while maintaining negative self-imagery, and then counterbalanced with a neutral image

  • Negative Image Condition: greater anxiety, anxiety rated as more visible, and performance underrated compared to observer

sad pre-event processing

a cognitive factor: Often worry for long periods in anticipation of stressful and problematic social encounters

• involves planning safety behaviours in the face of predicted catastrophes

• this pre-event worry and processing activates the negative self image

sad post-event processing

a cognitive factor: after the event is endured with distress, the individual ruminates about their performance and the social context

• but, they were focused on themselves and their own self-image during the event, so nothing new is learned, and the beliefs are inadvertently confirmed

• this reinforces negative self-image, catastrophe predictions, and the anticipated need for the safety-behaviours and self-focus

sad exposure therapy

sad cbt treatment: Early studies show poorer outcomes of exposure alone for SAD (Butler et al., 1984)

sad meta-analysis of cognitive therapy

Cognitive Therapy with exposure for SAD was superior to control and placebo at both port-treatment and follow-up (Taylor, 1996)