Lecture 3.1: Anxiety Overview, Generalized Anxiety Disorder, and Phobias

What do all Anxiety disorders involve?

A preoccupation with, or persistent avoidance of, thoughts and situations that provoke fear or anxiety.

What is the difference between fear and anxiety?

Fear:

• present focused (the “threat” is really happening right now)

• Brief in duration (Once the feared stimuli is removed, the feelings of fear are also removed)

• Specific threat (like a seeing a question on an exam that you don’t know how to answer)

• Generally adaptive (helps survival, doesn’t inhibit life)

Anxiety:

• Future focused (the “threat” might happen in the future)

• Sustained in duration

• Diffuse threat (not always specific)

• Can be adaptive in moderation

Associative networks

How our brains make connections between stimuli or concepts

3 parts of Fear Networks

• Stimuli (various kinds of snakes, how they sound)

• Meaning of the stimuli (snakes: SCARY and they will kill me)

• Physiological response (heart racing, sweating)

Anxiety Prevalence

• Anxiety disorders are more common than any other form of mental disorder.

What are anxiety disorders often comorbid with?

• Between different anxiety disorders

• Between anxiety and substance abuse

• Between anxiety and depression

What do anxiety and depression have in common?

• Both are defined in terms of negative emotional experience.

• Both are triggered by stressful experiences.

Clark and Watsons Tripartite Model of Depression and Anxiety

Low positive Affect= pure depression

High somatic arousal = pure anxiety

High negative affect = both depression and anxiety = general distress

How is generalized anxiety disorder diagnosed?

• A. Excessive Worry: Chronic anxiety and worry about at least 2 events or activities (e.g., work, health, school), occurring more days than not for at least six months.

• B. Uncontrollable: The individual finds it very challenging to stop or control the worry.

• C. Associated Symptoms: The anxiety is linked to three or more of the following physical or cognitive symptoms (Note: Children only require one symptom):

  • Restlessness, feeling keyed up, or on edge

  • Easily fatigued or tiring easily

  • Difficulty concentrating or mind going blank

  • Irritability

  • Muscle tension

  • Sleep disturbance (trouble falling or staying asleep, or restless/unsatisfying sleep)

• D. Impairment: The symptoms cause significant distress or impair social, occupational, or other important areas of functioning.

• E. Rule-Outs: The disturbance is not caused by the physiological effects of a substance (e.g., medication, drug abuse) or another medical condition (e.g., hyperthyroidism).

• F. Exclusions: The anxiety is not better explained by another mental disorder (e.g., panic attacks in panic disorder, fear of contamination in OCD, or weight concerns in eating disorders).

 

Does anxiety as a trait seem to run in families?

Yes. Anxiety as a trait does seem to run in families (MZ = .28; DZ = .17)

Hypothesized etiology (causes) of Generalized Anxiety Disorder

• Intolerance of uncertainty

• Belief that worry is adaptive/healthy (e.g., prevents panic)

• Avoidance of threatening information

Prevalence of Generalized Anxiety Disorder

• twice as likely for women compared to men.

• Approximately 5% of the population meets criteria for GAD

• Onset usually develops in adolescence (10-19), as well as among people over 40 (particularly women), often in response to life stressors.

Specific phobia definition

Excessive or unreasonable fear related to a specific object/situation that interferes with functioning (e.g., fear of snakes):

• The event/object almost always causes immediate fear/anxiety.

• The individual avoids the event/object.

• The fear/anxiety is out of proportion to the actual threat.

Specific Phobia Subtypes

• Animal (e.g. spiders, insects, dogs)

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

• Blood/injury (e.g. needles, invasive medical procedures)

• Situational (e.g. airplanes, elevators, enclosed spaces)

• Other (e.g. situations that may lead to choking, costumed characters, etc)

Specific Phobia prevalence rates

• Specific phobia is the most common form of anxiety disorder.

• Women are 3x more likely to experience specific phobias than men.

• 11% One year prevalence for any specific phobia (higher lifetime prevalence)

  • 5% animal phobia

  • 1.3% environmental

  • 2.4% blood/injury

  • 2.6% situational

Etiology/Causes of specific phobias: Preparedness Model

• There are some things that we are naturally afraid of because fear confers an evolutionary advantage. (ex. Fear of heights is an evolutionary advantage to avoid falling to ones death)

Etiology/Causes of specific phobias: Conditioning

Classical conditioning

• Phobias are learned from repeated pairing of a particular stimulus and an aversive response of the self or witnessed others

Operant conditioning

• Phobias are learned through reduction of anxiety (eg. I learn that I can avoid the anxiety of seeing a tiger at the zoo by not going to the zoo at all)

Social Phobia

Marked and persistent fear of one or more social or performance situations in which a person is exposed to unfamiliar people or possible scrutiny by others.

• Exposure to the feared social situation invariably provokes anxiety.

• The feared situation is avoided or endured with great distress.

• The fear is out of proportion to the actual threat.

Social Phobia Prevalence

• Lifetime prevalence = 12%

  • Somewhat more common in women

    • Could be due to reporting bias, women more likely to seek help

  • Most commonly starts in childhood or adolescence

Social Phobia Etiology/causes

• Classical conditioning

  • People have negative experiences in social and/or performance situations (e.g., teasing).

• Preparedness model doesn’t make sense.

  • Evolutionarily speaking, people need social bonds to survive.

Cognitive Biases of Social Phobia

Attention:

• Selective attention to cues of poor social interaction (e.g., lack of eye contact).

Memory:

• Biased memory of social interactions (e.g., have an easy time remembering when presentations went poorly, but a hard time remembering times when they went well).

• Judgment:

  • Biases in the expected occurrence and cost or negative social interactions

  Occurrence example: a client believes that 90% of their social interactions are negative.

  • In reality, only about 5% are

  Cost example: The same client claims that they will never connect with anyone again if they lose their best friend.