AB PSY CHAPTER 6

Anxiety

Apprehension over an anticipated problem. Tends to be about a future threat.

Fear

A reaction to immediate danger. Tends to be about a threat that is happening now.

Arousal or Sympathetic Nervous System

Can involve both anxiety and fear.

Moderate arousal

Anxiety arousal level.

Higher arousal

Fear arousal level.

Low end symptoms of anxiety

Restless energy and physiological tension.

High end symptoms of anxiety

Sweat profusely, breathe rapidly, feel an overpowering urge to run.

Anxiety

Helps us notice and plan for future threats to increase our preparedness, to help us avoid potentially dangerous situations, and to think through potential problems before they happen.

Inverse u-shape curve

Anxiety when plotted against performance. Absence of anxiety is a problem, a little anxiety is adaptive, and a lot of anxiety is detrimental.

Fear

Fundamental for fight-or-flight reactions. Triggers rapid changes in the sympathetic nervous system to prepare the body for escape or fighting. Saves lives in the right circumstances.

Specific phobia

Fear of objects or situations that is out of proportion to any real danger.

Social anxiety disorder

Fear of unfamiliar people or social scrutiny.

Panic disorder

Anxiety about recurrent panic attacks.

Agoraphobia

Anxiety about being in places where escaping or getting help would be difficult if anxiety symptoms occurred.

Generalized anxiety disorder

Uncontrollable worry.

Anxiety disorders

Most common type of psychological disorder. Very costly to society and to people with the disorders. Ranked as the 9th leading cause of disability worldwide in 2015.

Anxiety disorder comorbidity

Elevated risk to marital discord, suicide attempt, and high risk of developing medical disorder.

Specific phobia

Consistent tendency to experience extreme fear of an object or situation, such as flying, snakes, or heights. The person recognizes that the fear is excessive but still goes to great lengths to avoid the feared object or situation.

Phobos

Greek God who frightened his enemies which the word phobia originated from.

Claustrophobia and acrophobia

Fear of closed spaces and fear of heights. 2 common phobias.

Specific phobia

Tends to cluster around a small number of feared objects and situations. Highly comorbid.

Animal phobia

Examples of the feared object: Snakes, insects. Associated characteristics: Generally begins during childhood.

Natural environment

Examples of the feared object: Storms, heights, water. Associated characteristics: Generally begins during childhood.

Blood, injection, injury

Examples of the feared object: Blood, injury, injections, or other invasive medical procedures. Associated characteristics: Runs in the families: profile of heart rate slowing and possible fainting when facing feared stimulus.

Situational

Examples of the feared object: Public transportation, tunnels, bridges, elevators, flying, driving, closed spaces. Associated characteristics: Tends to begin either in childhood or mid-20s.

Other

Examples of the feared object: Choking, contracting an illness, etc. Children’s fear of loud sounds, clowns, etc.

Symptoms of specific phobia

Specific objects or situations consistently trigger disproportionate fear. The object or situation is avoided or else provokes intense anxiety.

Social anxiety disorder

Persistent unrealistically intense fear of social situations that might involve being scrutinized by, or even just exposed to, unfamiliar people.

Common fears for those with social anxiety

Public speaking, speaking in meetings or group settings, meeting new people, and talking to people in authority.

Comorbidities of social anxiety disorder

Depression and alcohol abuse.

Avoidant personality disorder

Another disorder in which the symptoms of social anxiety disorder overlap with as well as the genetic vulnerability of the two conditions. However, this disorder is a more severe disorder with more pervasive symptoms.

Symptoms of Social Anxiety Disorder

Marked and disproportionate fear is consistently triggered by exposure to potential social scrutiny. Exposure to the trigger leads to intense anxiety about being evaluated negatively. Trigger situations are avoided or else endured with intense anxiety.

Symptoms of Panic Disorder

Recurrent unexpected panic attacks. At least 1 month of concern about the possibility that more attacks could occur or the possible consequences of an attack, or problematic behavioral changes to avoid attacks or their consequences.

Adolescence, childhood

The period in which social anxiety disorder generally begins when peer relationships become particularly important. For some, the symptoms may first emerge in this earlier time. Without treatment, social anxiety disorder tends to be chronic.

Panic Disorder

Characterized by recurrent panic attacks that are unrelated to specific situations and by worry about having more panic attacks.

Panic Attack

Sudden experience of intense apprehension, terror, or feelings of impending doom, accompanied by at least four other symptoms.

Physical symptoms of a panic attack

Shortness of breath, heart palpitations, nausea, upset stomach, chest pain, feelings of choking and smothering, dizziness, lightheadedness, faintness, sweating, chills, heat sensations, numbness or tingling sensations, and trembling.

Depersonalization

A symptom that occurs during a panic attack. Is a feeling of being outside one’s body.

Derealization

A symptom that occurs during a panic attack. Is a feeling of the world not being real.

Other symptoms of a panic attack

Depersonalization, derealization, fears of losing control, fears of going crazy, or dying.

Panic attack

Misfire of the fear system.

Presentation of a panic attack

Physiologically, the person experiences a level of sympathetic nervous system arousal matching what most people might experience when faced with an immediate threat to life.

Diagnostic criteria for panic disorder

Must experience recurrent, unexpected panic attacks. Must worry about the attacks or change his or her behavior because of the attacks for at least 1 month.

Adolescence

The period wherein the onset of the development of panic disorder typically occurs.

Agoraphobia

Anxiety about situations from which it would be embarrassing or difficult to escape if anxiety symptoms occurred.

Agora

Greek word for marketplace which the term agoraphobia comes from.

Commonly feared situations for agoraphobia

Crowds and crowded places such as grocery stores, malls, and theatres. Sometimes situations are those that are difficult to escape from such as trains, bridges, or long road trips.

Symptoms of Agoraphobia

Disproportionate and marked fear or anxiety about at least two situations where it would be difficult to escape or receive help in the event of incapacitation, embarrassing symptoms, or panic-like symptoms, such as being outside the home alone; traveling on public transportation; being in open spaces such as parking lots and marketplaces; being in enclosed spaces such as shops, theatres, or cinemas; or standing in line or being in a crowd. These situations consistently provoke fear or anxiety. These situations are avoided, require the presence of a companion, or are endured with intense fear or anxiety.

Generalized anxiety disorder

The central feature is worry. People with this anxiety disorder are persistently worried, often about minor things.

Worry

Refers to the cognitive tendency to chew on a problem and to be unable to let go of it. Continues because a person cannot settle on a solution to the problem.

Worries of people with GAD

Excessive, uncontrollable, and long-lasting.

Adolescence

Time in which GAD typically begins. Once developed, is often chronic.

Comorbidities of GAD

Marital distress and absence of friendships.

Symptoms of GAD

Excessive anxiety and worry at least 50% of days for at least 6 months about multiple events or activities (e.g. family, health, finances, work, and school). The person finds it hard to control the worry. The anxiety and worry are associated with at least three (one in children) of the following: Restlessness or feeling keyed up or on edge, tiring easily, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance.

Comorbidity in anxiety disorders

Major depression and OCD.

28%

The estimated lifetime prevalence of anxiety disorders in epidemiologic studies that conduct just one interview with people about whether they met diagnostic criteria for an anxiety disorder.

Kayak–angst

A disorder that is similar to panic disorder, occurs among the Inuit people of western Greenland; seal hunters who are alone at sea may experience intense fear, disorientation, and concerns about drowning.

Taijin Kyofusho

In Japan, this is called the fear of displeasing or embarrassing others...

Dhat syndrome

Anxiety or distress attributed to the loss of semen, reported in South Asia.

Susto

Fright-illness is the belief that a severe fright has caused the soul to leave the body. Reported in Latin America and among Latinos in the United States.

2:1

The size of the gender ratio in anxiety disorders.

The United States and European Countries

Countries that have the highest rates of anxiety disorders.

Influences that increase general risk for anxiety disorders

Cultural and cross-national influences: exposure to war, persecution, and income inequality. Behavioral conditioning (classical and operant conditioning). Genetic vulnerability. Disturbances in the activity of the amygdala, the medial prefrontal cortex, and other brain regions involved in processing fear and emotion. Decreased functioning of gamma-aminobutyric acid and serotonin; increased norepinephrine activity. Increased cortisol awakening response (CAR). Behavioral inhibition. Neuroticism. Cognitive influences, including sustained negative beliefs, perceived lack of control, over-attention to cues of threat, and intolerance of uncertainty.

Behavioral theory of anxiety disorders

Focuses on conditioning.

Mowrer’s two-factor model of anxiety disorders (1947)

Through classical conditioning, a person learns to fear a neutral (CS) stimulus that is paired with an intrinsically aversive stimulus (UCS). A person gains relief by avoiding the CS. Through operant conditioning, this avoidant response is maintained because it is reinforcing (it reduces fear).

Mineka & Zinbarg, 1998

Some people with anxiety disorders do not remember any conditioning experience because classical conditioning could occur in different ways: Direct experience, modeling, verbal instruction.

Classical conditioning

Most centrally, people with anxiety disorders seem to acquire fears more readily through this type of conditioning, and those fears are more persistent once conditioned.

Neutral predictable unpredictable (NPU) threat task

A neutral condition in which they do not experience an aversive stimulus. A predictable condition in which they experience an aversive stimulus and receive a warning beforehand. An unpredictable condition in which they experience an aversive stimulus without prior warning.

Unpredictable Threat condition

Anxiety disorders are specifically related to the increased affective and psychophysiological response to this threat condition.

50-60%

Percentage of genetic vulnerability that may explain risk for anxiety disorders in the population.

Fear circuit

A set of brain structures that are engaged when people feel anxious or fearful.

Amygdala

An important part of the fear circuit. A small almond-shaped structure in the temporal lobe that appears to be involved in assigning emotional significance to stimuli. Critical for the conditioning of fear in animals. It sends signals to a range of different brain structures involved in processing threat.

Medial prefrontal cortex

Helps to regulate amygdala activity. Involved in extinguishing fears, in conscious processing of anxiety and fear, and in regulation of emotions.

Bed nucleus of the stria terminalis

Brain area also engaged by cues of threat and particularly by unpredictable or diffuse threats.

Anterior cingulate cortex

Brain area involved in the anticipation of threat.

Insula

Brain area that appears related to awareness of and processing of bodily cues, such as the high arousal invoked by threat.

Hippocampus

Brain area that plays a role in encoding the context in which feared stimuli occur.

Locus Coeruleus

Brain area related to panic disorder.

Serotonin

Believed to help modulate emotions.

GABA

Is widely distributed throughout the brain and is involved in modulating activity in the amygdala and other regions involved in processing threats.

Norepinephrine

A key neurotransmitter in the activation of the sympathetic nervous system for fight-or-flight responses.

Cortisol

Has a strong diurnal rhythm with a large increase as people awaken.

Neuroticism and behavioral inhibition

Two closely related personality traits that appear to predict the onset of anxiety disorders.

Neuroticism

A personality trait defined by the tendency to experience frequent or intense negative affect.

Behavioral inhibition

A tendency to become agitated and cry when faced with novel toys, people, or other stimuli. A particularly strong predictor of social anxiety disorder.

Cognitive influences on anxiety disorders

Sustained negative beliefs about the future, perceived lack of control, intolerance of uncertainty, and attention to threat.

Safety Behaviors

The reason that beliefs might be sustained is that people think and act in ways that maintain these beliefs.

Watson & Rayner 1920

Little Albert experiment.

Memory gaps

The reason why people don’t remember a conditioning experience.

Prepared learning

Evolution may have biologically “prepared” us to learn the fear of certain stimuli very quickly and automatically.

Locus Coeruleus

Major source of the neurotransmitter norepinephrine in the brain.

Interoceptive conditioning

Classical conditioning of panic attacks in response to bodily sensations.

Anxiety sensitivity index

Measures the extent to which people respond fearfully to their bodily sensations.

Fear of fear hypothesis

Principal cognitive model for the etiology of agoraphobia. Driven by negative thoughts about the consequences of experiencing anxiety in public.

Contrast avoidance model

Helps explain why some people worry more than others do. Core to this model is the finding that people diagnosed with GAD find it highly aversive to experience rapid shifts in emotions. To ward off sudden shifts in emotion, people with GAD find it preferable to sustain a chronic state of worry and distress.

Benzodiazepines

In 2013, more than 5% of people in the United States filled at least one prescription for this class of antianxiety medications.

Exposure

Effective psychological treatments for anxiety disorders. A core component of CBT.

Exposure hierarchy

A graded list of the difficulty of these triggers.

70-90%

Exposure treatment is effective for this percentage of clients.

In vivo exposure

Real-life exposure.