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What is the difference between fear and anxiety?
Fear → Emotional response to a real, present threat
Reaction to experienced danger
Builds quickly
Adaptive (helps respond to threats)
Anxiety → Focus on future concerns (linked to sadness/fear)
Disproportionate response to the situation
Anticipatory (worry about what might happen)
Generalized emotional reactions
What are the five major anxiety disorders?
Specific Phobia (Animals/natural disasters/needles/situation/other)
Social Phobia (social situations/interactions: Fear of feeling embarrassed)
Panic Disorder & Agoraphobia (fear of public spaces)
Generalized Anxiety Disorder (GAD)
Obsessive-Compulsive Disorder (OCD)
Specific phobia
Social Phobia (SAD)
Panic Disorder & Agoraphobia
Generalized Anxiety Disorder (GAD)
Obsessive- Compulsion Disorder (OCD)
What is a key commonality across anxiety disorders?
Failure to habituate (reduced ability to adapt to repeated anxiety-provoking stimuli)
How does habituation work in non-anxious individuals?
With repeated exposure to an anxiety-provoking stimulus (e.g., public speaking, spiders, social situations), anxiety gradually decreases over time
→ habituation (decrease in response to a repeated stimulus)
How does failure to habituate contribute to anxiety disorders?
People with anxiety do not experience a decrease in fear with repeated exposure
Instead, their anxiety remains high or worsens over time
Leads to avoidance behaviors, reinforcing the anxiety
What types of stressful life events often precede the development of anxiety?
Events involving danger, insecurity, and family discord.
What type of life events are associated with the onset of depression?
Loss events
How can childhood adversity contribute to anxiety disorders?
Experiences of abuse or neglect increase the risk of developing anxiety.
How does parental anxiety exposure influence a child's risk of anxiety?
Children exposed to more anxiety in parents are at higher risk of developing anxiety themselves.
How do genetics contribute to anxiety disorders?
Genetic influences are nonspecific and overlap with mood and anxiety disorders.
What is behavioral inhibition (BI) in infants?
A temperament characterized by stereotyped responses to novel stimuli, such as freezing behavior, increased arousal, and heightened attention
What is "freezing behavior" in the context of behavioral inhibition?
When infants or children stop their activity and become still in response to new stimuli.
What physiological responses are increased in infants with behavioral inhibition?
Heightened arousal, increased heart rate, and physical tension.
How does behavioral inhibition affect attention in infants?
Infants with BI focus intensely on unfamiliar stimuli, scanning their environment with heightened awareness.
What is the strongest known risk factor for later development of anxiety disorders?
Behavioral Inhibition
→ “Freezing”
How does behavioral inhibition contribute to long-term anxiety disorders?
Leads to AVOIDANCE of new stimuli, reinforcing fear and anxiety patterns over time.
At what age is behavioral inhibition reliably measured?
14 months
What measures are used to assess reactivity in younger infants?
Reactivity measures at 4 months.
How does VAN connectivity at birth predict behavioral inhibition (BI) at age 2?
Higher VAN connectivity is linked to increased attentional control and sensory processing, which may contribute to heightened vigilance in children with BI.
What role does the Ventral Attention Network (VAN) play in attentional control?
It directs attention to important or novel stimuli, helping individuals respond to environmental changes.
How does the VAN help process emotionally significant stimuli?
It enhances detection and processing of emotionally relevant stimuli, such as threats or rewards.
How do children with anxiety process potential threats differently?
They have heightened attention to potential threats or emotional stimuli, making them more reactive to unexpected changes.
What is the role of the amygdala
Processes and regulates emotions, especially fear, and triggers the fight-or-flight response when detecting potential threats.
What is the amygdala's response to phobic stimuli?
Has a stronger response to phobic stimuli, such as a spider phobic response, where one side of the amygdala is more active when the specific stimulus is present
→ One side of the amygdala responds more to certain stimuli
What are the key functions of the insula?
connected to the autonomic nervous system (sympathetic & parasympathetic)
Critical for interoception (understanding internal bodily sensations)
involved in bodily perception and shows increased activity in anxiety.
How does the insula's activity relate to anxiety?
heightened awareness of bodily sensations (e.g., heart rate, breathing), which can amplify anxiety symptoms
What are the characteristics of phobias?
Persistent, irrational, narrowly defined fears associated with a specific object or situation
Avoidance is key
Individual is aware that their response is irrational
PERSISTENT + IRRATIONAL
What is the role of avoidance in phobias?
→ FAILURE TO HABITUATE
The person actively avoids the phobic stimulus or endures it with intense anxiety
Anxiety —> Phobias
How do anxieties develop into phobias?
when the fear response becomes excessive, persistent, and linked to a specific object or situation.
Excessive + Persistent + Unreasonable/ SPECIFIC
What are the DSM-5 criteria for Specific Phobia?
Marked and persistent fear that is excessive or unreasonable, cued by a specific object or situation.
Immediate anxiety response to exposure.
Avoidance of the phobic stimulus or intense distress.
Persistent for 6 months or more and interferes with daily life.
Excessive (occur automatically with exposure) + Persistent (6 months) + irrational → Leads to AVOIDANCE
What are the subtypes of specific phobia according to DSM-5? (Total: 5)
Animal
Natural Environment
Blood-injection-injury
Situational (fear of flying)
Other (fear of clowns)
What are the key statistics for the prevalence of phobias?
Lifetime prevalence: 12%
More common in women (3x more than men).
Blood-injection-injury phobia affects about 3-4% of the population.
Onset age varies by phobia type.
What are some causes of phobias? (natural causes)
Evolutionary adaptations (biologically prepared for certain fears).
Classical conditioning (e.g., pairing a stimulus with a negative event).
Preparedness theory (humans are more likely to develop fear of certain stimuli like snakes and spiders)
What does the Preparedness Theory suggest about phobias?
Humans are biologically predisposed to fear certain stimuli, such as snakes or spiders, due to evolutionary pressures. These fears are easily conditioned and hard to extinguish.
What is the most common treatment for phobias?
Exposure therapy is the most common treatment
Involves systematic desensitization, where fear is addressed through gradual exposure, either through imagination, observation, virtual reality, or direct experience
What is the Fear-Avoidance Hierarchy in phobia treatment?
gradually exposing a person to feared situations, starting with the least anxiety-provoking and working up to more intense ones, helping to reduce avoidance behavior
What is Flooding in phobia treatment?
behavioral exposure technique where a person is exposed to the most frightening stimulus all at once in a controlled setting to overwhelm their fear and reduce it
→ Goal: experience habituation
What is Systematic Desensitization?
gradually exposes the person to less intense versions of the feared stimulus while pairing it with relaxation techniques to reduce anxiety
→ Soft approach
What is the difference between shyness and Social Anxiety Disorder (SAD)?
Shyness: related but non-disorder construct
SAD: high level of fear in social situations, leading to impairment in daily life (e.g., work, relationships).
What are the hallmark features of Social Anxiety Disorder (SAD)?
Marked and persistent fear of social or performance situations, especially fear of being scrutinized or embarrassing oneself.
Feared situations are avoided or endured with distress.
Fear interferes significantly with functioning.
Persistent + fear of being embarrassed + Avoidance + Impairment in daily life
What are the subtypes of Social Anxiety Disorder (SAD)? → 2
Specific: 1-3 feared situations (e.g., public speaking).
Generalized: 4 or more feared situations (e.g., eating in public, using restrooms, conversations).
What is the prevalence of Social Anxiety Disorder (SAD)?
Lifetime prevalence: 12.1%.
12-month prevalence: 6.8%.
More common in women (11% vs 15.5%).
Early onset (childhood to mid-adolescence), with high comorbidity with other anxiety disorders and depression.
Women
Children (you become shy at an early age
What are environmental risk factors for developing Social Anxiety Disorder (SAD)?
Bullying in childhood (directionality is unknown).
Childhood neglect or abuse, often linked to being victims of bullying.
Maternal overprotection in parenting.
SAD = Shy
bullying
childhood neglect
Codling by mother
What is the Cognitive Behavioral Theory of SAD?
Beliefs: Individuals with SAD believe negative evaluation is likely and that being liked is fundamental.
Hyper-vigilance: They show heightened attention to social threats and negative cues, even interpreting ambiguous stimuli as threatening.
Hyperfixation: Constant second-guessing and assuming the worst outcomes.
Interpretation of the situation
Decrease Hyper-vigilance
Decrease hyper fixation (second-guessing)
What are the common treatments for Social Anxiety Disorder (SAD)?
Medication: SSRIs and sometimes benzodiazepines to reduce physiological arousal.
Psychotherapy: CBT (Cognitive Behavioral Therapy) is most supported, focusing on changing negative thought patterns and gradually facing feared social situations.
Attention Bias Retraining: Helps the person focus away from negative cues.
CBT + SSRIs + Attention Bias Retraining (focus away from negative cues)
What does CBT for SAD focus on?
Changing negative thought patterns and gradually facing social situations
includes cognitive restructuring and social exposures, using a fear hierarchy to reduce avoidance
→ Based on INTERPRETATION
What is a Panic Attack, and how is it defined?
symptoms like palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, and must peak within 10 minutes.
→ PEAKS AT 10 MIN
How does the first panic attack typically occur?
follows a distressing or stressful life event
Many adults who experience a single panic attack do not develop panic disorder
How common are panic attacks in college students?
20%
How one responds to the attack that determines whether panic disorder develops
What is the DSM-5 criteria for Panic Disorder?
Recurrent unexpected panic attacks (sudden, overwhelming terror or fright).
At least one attack followed by 1 month (or more) of:
Persistent concern about future attacks.
Worry about the implications of the attack.
Significant behavior change due to the attacks (e.g., avoiding driving).
Recurrent (more than one per moth) + Persistent + behavior changes
What is Agoraphobia according to the DSM-5?
anxiety about being in situations where escape might be difficult, or help may not be available if panic-like symptoms develop
Such situations are avoided or endured with distress (e.g., restricted travel)
→ CROWDED TRAIN
What is the difference between Panic Disorder and Agoraphobia?
Panic Disorder: Repeated panic attacks + fear of future attacks.
Agoraphobia: Fear of being in places where escape or help is difficult, often due to past panic attacks.
What is the prevalence of Panic Disorder?
Lifetime prevalence: 3.5% of adults.
Twice as prevalent in females.
Chronic course: 50% recover in 12 years.
Average onset: 23-34 years.
Post-college development often leads to agoraphobia
What is the Cognitive Model for Panic Disorder?
Catastrophic Misinterpretation (Clark): People exaggerate the meaning of bodily sensations (e.g., "My heart is racing → I'm having a heart attack!").
Panic attacks are often triggered by internal stimuli (e.g., dizziness or rapid heartbeat).
Anxious mood increases awareness of bodily sensations, leading to misinterpretation as a catastrophic event.
This creates a Fear of Fear cycle, where fear of bodily sensations leads to panic, reinforcing the cycle.
What is the treatment for Panic Disorder?
Interoceptive Exposure: Deliberate exposure to feared bodily sensations (e.g., rapid heartbeat).
Cognitive Therapy: Targets catastrophic thoughts, teaching realistic interpretations of bodily sensations.
Psychoeducation: Educates individuals about panic attacks, symptoms, and self-monitoring strategies.
What is the difference between Interoception-Based Therapy and Mindfulness-Based Therapy?
Interoception-Based Therapy: Helps individuals become aware of bodily sensations without misinterpreting them as dangerous (e.g., racing heart).
Mindfulness-Based Therapy: Teaches individuals to observe anxious thoughts and feelings without judgment, helping reduce reactivity to anxiety triggers.
What are the DSM-5 criteria for Generalized Anxiety Disorder (GAD)?
Excessive anxiety and worry occurring more days than not for at least 6 months, about various events or activities.
Difficulty controlling the worry.
Three (or more) of the following symptoms:
Restlessness or being on edge.
Easily fatigued.
Difficulty concentrating.
Irritability.
Muscle tension.
Sleep disturbance.
Symptoms cause significant distress or impairment in daily functioning.
General Anxiety Disorder = WORRY
“ Worry switch” that is always on and hard to turn off
What is worry?
Uncontrollable, negative emotional thoughts.
Concerned with potential future threats or dangers.
Usually verbal rather than visual.
A normal thought process that doesn’t significantly interfere with daily life unless excessive.
How does worry become generalized anxiety disorder (GAD)?
Worry becomes GAD when:
Frequency: Worry occurs more days than not.
Control: Worry is uncontrollable.
Range of topics: Worry spans multiple areas of life.
Valence: Worry is excessive and causes distress, physical symptoms like muscle tension and fatigue.
What is the difference between worry and rumination?
Worry: Focused on future events.
Rumination: Focused on past events (cause, consequences), often present in both internalizing (anxiety/depression) and externalizing (anger) syndromes.
What is the lifetime prevalence of Generalized Anxiety Disorder (GAD)?
Lifetime prevalence: 5.7%.
Age of onset: Median age of 31-33 years
What is the correlation between GAD and Major Depressive Disorder (MDD)?
correlated with a coefficient of .57-.70, indicating a strong relationship.
How can you differentiate between GAD and MDD?
there must be evidence that GAD exists outside of depressive disorders.
What is the Tri-partite Model of Mood and Anxiety Disorders?
The model relates mood and anxiety disorders to three broad traits:
Negative affect: Shared by both mood and anxiety disorders (e.g., distress, fear, sadness).
Low positive affect: Specific to MDD (e.g., lack of pleasure, motivation, or enthusiasm).
Physiological hyper-arousal: Specific to anxiety (e.g., racing heart, restlessness).
What are the GAD-specific symptoms compared to MDD?
GAD Symptoms:
Persistent, uncontrollable worry about multiple areas of life.
Cognitive biases (overestimating threats, underestimating coping abilities).
Intolerance of uncertainty.
GABA/benzodiazepine receptor dysfunction.
MDD Symptoms:
Lack of positive affect (low motivation, pleasure, energy).
→ “What if I perform poorly??” “What if they don’t like me at the party??” “What if I don’t have enough money to pay bills”
What treatments are used for Generalized Anxiety Disorder (GAD)?
Medications: SSRIs, benzodiazepines.
CBT (Cognitive Behavioral Therapy): Addresses cognitive distortions and excessive worry.
New treatments:
Interpersonal & emotional processing therapy.
Mindfulness-based CBT for GAD.
Emotion regulation therapy.
What are the broad underlying traits of mood and anxiety disorders according to the Tri-Partite Model?
(LOW) Positive affect:
Lack of pleasure, motivation, enthusiasm
Negative affect:
excessive distress, fear, sadness
Autonomic arousal:
racing heart/excessive nervousness
MDD = Lack of positive affect (low motivation, pleasure, and energy).
GAD = Hyperarousal, excessive worry, and cognitive distortions related to uncertainty
Q: What is the negative affect shared by both mood and anxiety disorders?
Negative affect
→ Fear + Sadness
What is a key characteristic of Major Depressive Disorder (MDD) in the Tri-Partite Model?
Low positive effect
What is a specific characteristic of anxiety disorders in the Tri-Partite Model?
psychological hyper-aroussal
What are the specific symptoms of Generalized Anxiety Disorder (GAD) compared to Major Depressive Disorder (MDD)?
GAD symptoms include worry, cognitive biases, intolerance of uncertainty, and GABA/Benzodiazepine receptor dysfunction.
What medications are commonly used to treat GAD?
SSRIs and Benzodiazepines.
What therapies are used to treat GAD?
CBT
Interpersonal and emotional processing therapy
mindfulness-based CBT
emotion regulation therapy
What is a key focus of CBT for Generalized Anxiety Disorder (GAD)?
Focusing on automatic negative thoughts and cognitive biases
(overestimating negative events and underestimating coping abilities)
What is "emotion regulation therapy" used for in GAD treatment?
Helps individuals manage and regulate their emotions effectively
What is "self-monitoring" in CBT?
Tracking thoughts and behaviors to identify patterns and triggers of anxiety or depression.
What is "antecedent cognitive reappraisal" in CBT?
Changing how a person thinks about events before they become distressing.
What commonality exists across all anxiety disorders?
Failure to habituate (not getting used to distressing situations over time).
What is the DSM-5 criterion for obsessions in Obsessive-Compulsive Disorder (OCD)?
Recurrent, intrusive thoughts that cause anxiety, are recognized as the person’s own, and cause distress.
→ RECURRENT + INTRUSIVE thoughts
What is the DSM-5 criterion for compulsions in OCD?
Repetitive behaviors or mental acts performed to reduce distress
often excessive or unrealistic in relation to their goal.
→ RECURRENT + INTRUSIVE thoughts
What are common obsessions in OCD?
Cleaning, checking, repeating, ordering/arranging, and counting.
What is the definition of OCD according to the DSM-5?
Presence of obsessions or compulsions, recognized as excessive, causing significant distress or impairment in functioning.
What is the lifetime prevalence rate of OCD?
What is the one-year prevalence rate of OCD?
2.3%
1%
How does OCD commonly co-occur with other disorders?
It frequently co-occurs with other mood and anxiety disorders, and with body dysmorphic disorder (12%).
What is the role of avoidance learning in OCD?
Neutral stimuli become associated with anxiety, and compulsive behaviors are used to reduce that anxiety, making these avoidance responses hard to extinguish.
What is the role of cognitive factors in OCD, such as thought suppression?
Trying to suppress thoughts can make them more frequent, increasing anxiety and compulsive behaviors
What is the primary treatment for OCD?
Exposure and response prevention (ERP), where individuals are exposed to distressing stimuli but prevented from engaging in compulsive behaviors
What is the effectiveness of ERP in treating OCD?
50-70% of people show positive responses, with 76% maintaining gains after years.
How effective are SSRIs in treating OCD?
40-60% show a reduction in symptoms, but relapse rates are high.
What is psychoeducation’s role in preventing OCD?
It helps individuals learn how to manage their thoughts and behaviors, understand dangerous vs. non-dangerous situations, and practice coping skills.
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