Ch. 5 - Anxiety

What is it?

fear → operant (escape/avoidance) + respondent (bodily responses involved in autonomic arousal) behavior


Causes

  • biological - may run genetically

    • e.g. specific brain circuits, neurotransmitter systems, corticotropin-releasing factor system

  • psychological & behavioral

    • e.g. temperament (how sensitive are you to anxiety?) & reactivity

    • conditioning (classical/operant)

  • social

    • e.g. stressful life events → physical reactions

all causes can affect each other (multidimensional model!)


Statistics

  • comorbidity - 2 or more disorders occurring (e.g. anxiety & depression often diagnosed together)

    • with physical disorders, symptoms may fit with anxiety disorders


Specific Phobia

→ irrational fear of a specific object/situation that interferes with an individual’s ability to function in everyday life (e.g. emetophobia)

  • statistics:

    • women > men experience this

    • goes untreated often (only 6% receive diagnosis)

    • can be culture specific

  • causes:

    • traumatic experiences/conditioning

    • vicarious experience (observed someone else)

    • social & cultural factors

  • treatment:

    • systematic desensitization (in vitro/vivo)

      • relaxation training

      • anxiety hierarchy (rank the fears)

      • graded exposure (confront each rank relaxed)


Generalized Anxiety Disorder

→ uncontrollable, unproductive worrying about everyday events, impending catastrophe after successes, inability to stop the worry-anxiety cycle

  • statistics:

    • more common among girls/women

    • 5% of canadian population meets the GAD criteria

  • treatments:

    • drugs → antidepressants, benzodiazepines (short-term)

    • CBT (cognitive-behavioral treatment)

    • ACT (acceptance & commitment therapy)


Panic Disorder & Agoraphobia

→ recurring events of an abrupt surge of intense fear/discomfort that reaches peak within minutes (often accompanied by agoraphobia; fear & avoidance* of situations that feel unsafe/inescapable)

*interoceptive avoidance: tendency to avoid bodily sensations (e.g. elevated heart rate)

  • statistics:

    • PD - women > men experience it more

    • mean age of onset is 25-29, with initial attacks beginning at/after puberty

    • has cultural influences (e.g. highest in white americans, lowest in asian americans)

  • causes:

    • biological/psychological/social

    • agoraphobia can develop after someone has unexpected panic attacks (learned alarms → stimulus associated w/ prev. panic attack becomes trigger)

  • treatments:

    • medication → benzodiazepines (can affect cognitive/motor functions), SSRIs, SNRIs (relapse closer to 90% if stopped)

    • systematic desensitization

      • relaxation training

      • anxiety hierarchy (rank the fears)

      • graded exposure (confront each rank relaxed)

    • CBT (cognitive-behavioral treatment)

→ medication & behavioral intervention can be combined

Social Anxiety Disorder

→ more than exaggerated shyness (fear of being watched, judged, humiliated by others in social situations)

  • statistics:

    • usually begins during adolescence

    • affects young, less educated, single, economically disadvantaged

    • distributes relatively equally among different ethnic groups (rates depends on cultural norms!)

  • causes:

    • biological vulnerability to developing anxiety

    • conditioned panic attack in social situation

    • real social trauma experience

  • treatments:

    • CBGT (cognitive-behavioral group therapy)

    • systematic desensitization

      • relaxation training

      • anxiety hierarchy (rank the fears)

      • graded exposure (confront each rank relaxed)

    • SSRIs


Selective Mutism

→ rare childhood disorder characterized by lack of speech in settings where its expected

  • treatments:

    • systematic desensitization

      • relaxation training

      • anxiety hierarchy (rank the fears)

      • graded exposure (confront each rank relaxed)

    • self monitoring

    • micro-shaping


Separation Anxiety Disorder

→ excessive/unrealistic/persistent worry over being apart from someone a person is closely attached to (typically a child’s behavior)

  • statistics:

    • 35% in childhood can extend to adulthood (if untreated)


  • treatments:

    • systematic desensitization

      • relaxation training

      • anxiety hierarchy (rank the fears)

      • graded exposure (confront each rank relaxed)

    • self monitoring

    • micro-shaping