Abnormal Psychology - CHAPTER 5

Anxiety, Trauma-and Stressor-Related, and Obsessive-Compulsive and Related Disorders

Anxiety

Future-oriented negative mood state characterized by bodily symptoms of physical tension and by apprehension about the future

True

True or False: Anxiety is good for us in moderate amount

True

True or False: Social, physical, and intellectual performances are driven and enhanced by anxiety

Howard Liddell

He called anxiety the “shadow of intelligence”

Anxiety

A future oriented mood state characterized by apprehension because we cannot predict or control upcoming events.

True

True or False: Severe anxiety usually doesn’t go away

Fear

An immediate emotional reaction to current danger characterized by strong escapist action tendencies and, often, a surge in the sympathetic branch of the autonomic nervous system

Fear

It protects us by activating a massive response from the autonomic nervous system

Fear

Motivates us to escape or possibly attack

Flight or Fight Response

Emergency reaction that motivates us to escape or possibly to attack

Panic

Alarm response of fear when there is nothing to be afraid of

Panic attack

It is defined as an abrupt experience of intense fear or acute discomfort, accompanied by physical symptoms that usually include heart palpitations, chest pain, shortness of breath, and, possibly, dizziness.

Expected and Unexpected (Cued and Uncued)

The two basic types of panic attacks described in the DSM-5

Expected (cued) attacks

More common in specific phobias or social anxiety disorder

True

True or False: The experience of panic attacks is an important severity marker and predictor of persistence of any anxiety disorder across the life span

True

True or False: We inherit a tendency to be tense, uptight, and anxious

False

True or False: The tendency to panic does not run in the family

True

True or False: No single gene seems to cause anxiety or panic or any other psychiatric disorder

False

True or False: A genetic vulnerability cause anxiety and/or panic directly

True

True or False: Stress or other factors in the environment can “turn on” or “turn off” certain genes

GABA (gamma-aminobutyric acid)

Depleted levels of this neurotransmitter are associated with increased anxiety (the relationship is not quite direct)

Noradrenergic system (norepinephrine/noradrenaline) and Serotonergic neurotransmitter system

Two neurotransmitter that are also implicated in anxiety

Corticotropin-releasing factor (CRF) system

This is central to the expression of anxiety (depression)

Limbic system

The area of the brain is most often associated with anxiety. It also acts as a mediator between the brain stem and cortex.

Behavioral Inhibition System (BIS)

This is activated by signals from the brain stem of unexpected events, such as major changes in body functioning that might signal danger.

Fight/Flight System (FFS)

Produces an immediate alarm-and-escape response that looks very much like panic in humans.

True

True or False: Cigarette smoking as a teenager is associated with greatly increased risk for developing anxiety disorders as an adult.

Distress tolerance

The amount of distress a person can tolerate

Anhedonia

This is the inability to feel pleasure

True

True or False: A sense of control (or lack of it) that develops from early experiences is the psychological factor that makes us more or less vulnerable to anxiety in later life.

Anxiety sensitivity

The tendency to respond fearfully to anxiety symptoms

External cues

Places or situations similar to the one where the initial panic attack occurred.

Internal cues

These are increases in heart rate or respiration that were associated with the initial panic attack, even if they are merely the result of exercise or other routine activities

True

True or False: You may not be aware of the cues or triggers of severe fear (unconscious)

Triple Vulnerability Theory

Theory of the development of anxiety

Generalized biological vulnerability

• The first vulnerability

• This is not sufficient enough to produce anxiety itself

• “Glass is half empty”

• Irritable

• Driven

Generalized psychological vulnerability

• The second vulnerability

• Sense that events are uncontrollable/unpredictable

• You might not be able to cope when things go wrong based on your early experiences

• Tendency toward lack of self-confidence

• Low self-esteem

• Inability to cope

Specific psychological vulnerability

• The third vulnerability

• You learn from early experience that some situations or objects are fraught with danger

• Ex: physical sensations are potentially dangerous

• Anxiety about health?

• Nonclinical panic?

True

True or False: Anxiety is usually focused on one area

True

True or False: Anxiety increases the likelihood of panic

Comorbidity

The co-occurrence of two or more disorders in a single individual

Process-based therapy

This is for therapy to be effective, it needs to target the underlying processes of change rather than the DSM-defined psychiatric syndromes.

Major depression

The most common additional diagnosis for all anxiety disorders

True

True or False: Additional diagnosis of depression or alcohol use disorder or drug use or misuse makes it less likely that you will recover from an anxiety disorder and more likely that you will relapse if you do recover

True

True or False: Any anxiety or related disorder uniquely increases the chances of having thought about suicide or making suicidal attempts.

Suicidal Ideation

Described as having thoughts about suicide

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder (GAD)

Worrying never stops meaning turning to the next crisis as soon as the current one was over

Generalized Anxiety Disorder (GAD)

People with this disorder mostly worry about minor everyday life events

Panic Attack

False

True or False: About twice as many individuals with GAD are male than female in epidemiological studies

True

True or False: Once it develops, GAD is chronic

Benzodiazepines

This is the most prescribed for GAD. They give short term relief for a temporary crisis or stressful event

Antidepressant: Paroxetine (Paxil) and Venlafaxine (Effexor)

There is stronger evidence for the usefulness of these drugs in the treatment of GAD. Better choice than Benzodiazepines

False

True or False: Psychological treatments are less effective in the long run

Panic Disorder (PD)

People with this disorder experience severe, unexpected panic attacks. They may think they are dying or losing control.

Panic Disorder (PD)

Agoraphobia

Fear and avoidance of situations in which a person feels unsafe or unable to escape to get home or to a hospital in the event of a developing panic, panic-like symptoms, such as loss of bladder control.

Agoraphobia

Severe cases of this disorder include not being being able to leave the house, sometimes for years on end.

Unexpected panic attack

To meet the criteria for Panic Disorder (PD) a person must experience an ________ and develop substantial anxiety over the possibility of having another attack or about the implications of the attack or its consequences

Karl Westphal

Agoraphobia was coined in 1871 by whom

True

True or False: people with agoraphobia always plan for rapid escape

True

True or False: People with agoraphobia may either avoid situations or endure them with intense fear and anxiety

Interoceptive avoidance

The avoidance of internal physical sensations; removing oneself from situations or activities that might produce the physiological arousal that somehow resembles the beginnings of a panic attack

False

True or False: Most of those who suffer from agoraphobia are men

Agoraphobia

Nocturnal attacks

Panic attacks that occur more often between 1:30am and 3:30am. This also occurs during delta wave or slow-wave sleep (deepest stage of sleep)

Learned alarms

Cues become associated with a number of different internal and external stimuli through a learning process

Medication for panic disorders

High-potency benzodiazepines such as alprazolam (Xanax), the newer selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Paxil, and the closely related serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine

Psychological Intervention for Agoraphobia

Exposure therapy combined with anxiety-reducing coping mechanisms such as relaxation or breathing retraining

Panic Control treatment (PCT)

Exposing patients with panic disorder to the cluster of interoceptive (physical) sensations that remind them of their panic attacks.

True

True or False: Psychological treatments seemed to perform better in the long run