Exam 2 Study Guide PDF

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Abnormal Psych 26 February 2021 Chapter 6: Anxiety Disorders Module 5

Learning Objectives 1. Describe the flight-or-fight response and its relation to anxiety disorders 2. Explain the components of the tripartite model of anxiety and depression 3. Describe the interactions among neuropsychosocial factors and treatments for generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, specific phobia, and separation anxiety disorder. Guiding Questions 1. What influences do you think contribute to the fact that anxiety disorders are such common and enduring disorders? Discussion Prompt Watch the three assigned videos on LaunchPad: Anxiety Disorders, Agoraphobia, Exposure treatment for an Elevator Phobia. Observe the differences in the varieties of anxiety discussed in these videos, and differences in the treatment approaches. Do therapists adjust their treatment approaches based on the type of anxiety they are treating? Do they use more than one type of treatment and if so, do they use these treatments successively or in combination? Explain your answer. An anxiety disorder is one in which a stimuli (object, event, etc.) triggers extreme fear or anxiety. Generalized Anxiety Disorder is explained the be the most common form of anxiety disorder. A panic attack is a symptom of an anxiety disorder, which leads to shortness of breath, increased heart beat, sweating, etc. In the video about Shawn, who suffers from agoraphobia, we learn that he has an irrational fear of being outside he safety zones. His father had many phobias, agoraphobia included, and his sister had autism— he believes that seeing her be banished is what triggered his phobia. He is treated with psychotherapy, which targets his cognitive and behavioral factors, and medication, which targets his neurological factors. Aside from his treatments, he explains that he uses music as an outlet. In the video about Bill, who suffers from a phobia of elevators, we learn about another type of treatment irrational fears and anxieties, which his exposure treatment. They “expose” him to his fear by making him ride in an elevator, to prove to him that his response is out of proportion to the stimulus, which will hopefully decrease his fear. Aside from this exposure treatment, Bill is shown in a group setting, which implies he is also getting group therapy to help manage his disorder.

READING Chapter 6 - Anxiety Disorders • Earl Campbell, NFL player, suffered from anxiety disorders — became unable to work effectively • 6 types of anxiety disorders describes in DSM-5: GAD, panic disorder, agoraphobia, social anxiety disorder, specific phobia, and separation anxiety disorder anxiety - a sense of agitation or nervousness, which is often focused on an upcoming possible danger anxiety disorder - a category of psychological disorders in which the primary symptoms involve fear, extreme anxiety, intense arousal, and/or extreme attempts to avoid stimuli that lead to fear and anxiety fight or flight response (stress response) - the automatic neurological and bodily response to a perceived threat • prepares your body to exert physical energy for an action, either fighting threat or running away from it • your body automatically responds because you perceive a threat • your body responds in a number of ways, most notably by • increasing heart rate and breathing rate • increasing the sweat on your palms • dilating your pupils panic - an extreme sense (or fear) of imminent doom, together with an extreme stress response phobia - an exaggerated fear of an object or a situation, together with an extreme avoidance of the object or situation • people with phobias, such as musicians with performance anxiety, may use alcohol to relieve anxiety symptoms • using alcohol this way can lead to alcoholism • in the US, anxiety disorders are the most common type of mental disorder— approximately 15% of people will have some type of anxiety disorder • women are 2x as likely as men— hormonal shifts during childbearing years, men tend to be reluctant to acknowledge symptoms • clinicians determine whether the anxiety is primary cause of disturbance or a by-product of another problem— anorexia: gets anxious about high-calories, so anxiety is secondary to food concerns

• Tripartite Model of Anxiety and Depression • anxiety and depression have in common a high level of negative emotions, but each has a unique elements: anxiety generally involves a very high level of physiological arousal, whereas depression involves a low level of positive emotions • anxiety — physiological hyperarousal • depression— lack of enjoyment (low level of positive emotions) • comorbid — general distress (high level of negative emotions) general anxiety disorder (GAD) - an anxiety disorder characterized by uncontrollable worry and anxiety about a number of events or activities, which are not solely the result of another disorder DSM-5 Diagnostic Criteria for GAD A. excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities B. individual finds it difficult to control to worry C. the anxiety and worry are associated with 3+ of the following 6 symptoms (with at least some symptoms having been present for more days than not the past 6 months) 1. restlessness or feeling keyed up on edge 2. being easily fatigued 3. difficulty concentrating or mind going blank 4. irritability 5. muscle tension 6. sleep disturbance D. the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning E. the disturbance is not attributable to the physiological effects of a substance or another medical condition F. the disturbance is not better explained by another mental disorder • for people suffering from GAD, the worry and anxiety focus primarily on family, finances, work, and illness • people with GAD worry even when things are going well • their worries intrude into their awareness when they are trying to focus on other thoughts, and they lead people to feel on edge or have muscle tension • because symptoms are chronic and many people with GAD can function adequately, they see their worrying and anxiety as a part of themselves, not a disorder

• Generalized Anxiety Disorders Facts at a Glance • prevalence • approximately 9% of people will develop GAD in their lifetimes • comorbidity • GAD occurs very frequently with depression, with up to 80% of those having GAD also experiencing depression at some point • onset • approximately half the people with GAD develop the disorder before the age of 30 • course • people diagnosed with GAD report that they have felt nervous and anxious all their lives ; once someone has GAD • its course is likely to be chronic, with symptoms fluctuating in response to stress • gender difference • twice a many women as men • cultural difference • the content of the worries of people with GAD is shared by their culture, their personal experiences, and the environment where they live. some people worry about catastrophic events and others worry about human-caused calamities • brain systems • decreased arousal that arises from unusually responsive parasympathetic nervous system • slows HR, stimulates digestion and bladder, causes pupils to contract • when person with GAD perceives threat, their worry reduces arousal, suppresses negative emotions, and produces muscle tension • neural communication • frontal lobes are normal in size; dopamine in frontal lobes does not function normally • GABA, serotonin, and norepi may not function properly— effects response to reward, their motivation, and how effectively they can pay attention • genetics • solid evidence of genetic component; equally heritable for men and women • psychological factors contributing to GAD generally have 3 characteristic modes of thinking/behaving 1. people with GAD pay a lot of attention to stimuli in their environment, searching for possible threats (hyper vigilance)

2. people with GAD typically feel that their worries are out of control and that they cannot stop or alter the pattern of their thoughts, no matter what they do 3. the mere act of worrying prevents anxiety from becoming panic, and thus the act of worrying is negatively reinforcing. the worrying doesn’t help the person to cope with the problems at hand, but it does give him or her the illusion of coping, which temporarily decreases anxiety about the perceived threat. some people think that if they worry, they are actively addressing a problem. but they are not — worrying is not the same thing as effective problem solving; the original concern isn’t reduced by worrying, and it remains a problem, along with the additional problem of chronic worrying hyper vigilance - a heightened search for threats biofeedback - a technique where a person is trained to bring normally involuntary or unconscious bodily activity, such as heart rate or muscle tension, under voluntary control habituation - the process by which the emotional response to a stimulus that elicits fear or anxiety is reduce by exposing the patient to the stimulus repeatedly exposure - a behavioral technique that involves repeated contact with a feared or arousing stimulus in a controlled setting, bringing about habituation • social factors • stressful life events can trigger symptoms fo GAD in someone neurologically and psychologically vulnerable • for people who develop after 40 y/o, typically because of significant stressor • appears to be related to relationships • targeting neurological factors — medication • anti anxiety meds (busiprone) reduce symptoms of GAD, probably by decreasing serotonin release • serotonin facilitates changes in amygdala that underlie learning to fear objects or situations, thus reducing it would impair learning to fear or worry • most people with GAD are also depressed, but busiprone only helps anxiety • SNRI venlafaxine (effexor) and certain SSRIs paroxetine (PAxil) and escitalopram (Lexapro) appear to relieve anxiety and depression symptoms • SNRI is considered first-line medication for GAD • psychological treatments for GAD generally have several aims

• to increase the person’s sense of control over thoughts and worries • to allow the person to assess more accurately how likely and dangerous perceived threats actually are • to decrease muscle tension • behavioral methods to treat GAD focus on • awareness and control of breathing • awareness and control of muscle tension and relaxation • elimination, reduction, or prevention of worries and behaviors associated with worries breathing retraining - requires patients to become aware of breathing and to try to control it by taking deep, relaxing breaths; can help induce relaxation and provide sense of coping muscle relaxation training - requires patients to become aware of early signs of muscle tension, and then to relax those muscles • patients in therapy can experience exposure in three ways • imaginal exposure, which relies on forming mental images of the stimulus • virtual reality exposure, which consists of exposure to a computer-generated representation of the stimulus • in vivo exposure, which is direct exposure to the actual stimulus • people with GAD do not naturally habituate to anxiety, as they worry about one set of concerns, they get increasingly anxious until they shift focus to another set of concerns, never becoming habituated • cognitive treatment methods • focus on helping patients identify thought patterns associated wit hworries and anxieties and then helping them to use cognitive restructuring adn other methods to prevent these thought patterns from spiraling out of control • the methods can also decrease the intensity of patients’ responses to their thought patterns, so they are less likely to develop symptoms • specific cognitive methods for treating GAD include: • psychoeducation • meditation • helps patients “let go” of thoughts and reduce time spent worrying • self-monitoring • become aware of cues that lead to anxiety and worry

• problem solving • teaching patient to think about worries in specific terms so they can be addressed through cognitive restructuring • cognitive restructuring • learn to identify and shift automatic, irrational thoughts related to worries in vivo exposure - behavioral therapy method that consists of direct exposure to a feared or avoid situation or stimulus psychoeducation - the process of educating patients about research findings and therapy procedures relevant to their situation • targeting social factors • very few treatments for GAD that specifically target social factors, and none have been successful panic attack - a specific period of intense fear or discomfort, accompanied by physical symptoms, such as a pending heart, shortness of breath shakiness, and sweating, or cognitive symptoms, such as a fear of losing control • during a panic attack, symptoms tend to begin quickly, peak after a few minutes and disappear within an hour • cued - associated with particular objects, situations or sensation • uncured - spontaneous and feel as though they come out of the blue ad are not associated with specific situation or object • nocturnal - while sleeping • infrequent panic attacks affect 30% of adults DSM-5 Criteria for a Panic Attack • a discrete period of intense fear or discomfort, in which at least 4 of the following symptoms develop abruptly and reach a peak within minutes • palpitations, pounding heart, or accelerated heart rate • sweating / trembling or shaking • sensations oof shortness of breath or smothering / feeling of choking • chest pain or discomfort / nausea or abdominal distress / feeling dizzy, unsteady, lightheaded or faint • chills or heat sensation / paresthesias / derealization or depersonalization • fear of losing control or going crazy / fear of dying

panic disorder - an anxiety disorder characterized by frequent, unexpected panic attacks, along with fear of further attacks and possible destruction of behavior in order to prevent such attacks • having panic attacks doesn't necessarily indicate panic disorder; panic attacks are distinguished based on frequency and unpredictability • research shows that those with panic disorder don’t experience attacks as out of the blue as they feel ; changes in breathing and HR occur over 30 minutes before onset • ataque de nervios - common symptoms include uncontrollable screaming and crying attacks, with palpitations, shaking, and numbness • differs from panic attack not only because symptoms but because it is usually triggered by specific upsetting vent • usually not worried about recurrences DSM-5 Criteria for Panic Disorder A. recurrent unexpected panic attacks B. at least on of the attacks has been followed by 1 months or more fo one or both of the following • persistent concern or worry about additional panic attacks or their consequences • a significant maladaptive change in behavior related to the attacks C. the disturbance is not attributable to the physiological effects of a substance or another medical condition D. the disturbance is not better explained by another mental disorder Panic Disorder Facts at a Glance • prevalence • up to 3% of people worldwide will experience panic disorder at some point in their lives. however, 30% of people will experience at least on panic attack in their lives. up to 60% of people seen by cardiologists have panic disorder • comorbidity • about 80% of people with panic disorder will have an additional disorder. the 3 disorders most commonly associated with panic disorder are depression, agoraphobia, and substance abuse • approximately 15-30% of those with panic disorder also have social anxiety dsorder of GAD, and 2-20% have some other type of anxiety disorder • onset • panic disorder is most likely to arise during young adulthood • course

• the frequency of panic attacks varies from person to person: some people get panic attacks once a week for months, others have them every day for a week • gender difference • women are 2x as likely • cultural differences • symptoms of panic disorder are generally similar across cultures, although people in some cultures may experience or explain the symptoms differently, such as “wind overload” among the Khmer agoraphobia - an anxiety disorder characterized by persistent avoidance of situations that might trigger panic symptoms or from which help would be difficult to obtain DSM-5 Criteria for Agoraphobia A. marked fear or anxiety about 2+ of the following 5 situations • (1) using public transportation (2) being in open spaces (3) being in enclosed spaces (4) standing in line or being in a crowd (5) being outside of the home alone B. the individual fears or avoids these situations because of thoughts that except might be difficult or help might not be available in the event of or developing panic-like symptoms or other incapacitating or embarrassing symptoms C. the agoraphobia itatuons almost always provoke fear or anxiety D. the agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intesenf ear or anxiety E. the fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context F. the fear, anxiety, or avoidance is persistent, typically lasting 6+ months G. the fear, anxiety, or avoidance cause clinically significant distress or impairment in social, occupational, or other important areas of functioning H. if another medial condition is present, the fear, anxiety, or avoidance is clearly excessive I.

the fear, anxiety, or avoidance isn’t better explains by the symptoms fo a mental disorder— for example, the symptoms are not confined to a specific phobia, situational type; do not involve only social situations; and are not related exclusively to obsessions; perceived defects or flaws in physical appearance, reminders of traumatic events, or fear of separation

Agoraphobia Facts at a Glance • prevalence • up to 2% of people worldwide will develop at some point in their lives • comorbidity

• about1/2 people with it will also have another anxiety disorder, the symptoms of which predate the agoraphobia • depression and substance abuse disorders are also common comorbid disorders, but unlike with other anxiety disorders, these tend to emerge after • onset • 2/3 people with it develop it before 35 • about 1/2 people with it report having had panic attacks or panic disorder before developing agoraphobia • course • chronic medical disorder, persisting over time unless treated • more than 1/3 of people with it are completely housebound • gender difference • women are 2x as likely • cultural difference • people with it in Hong Kong also have a fear of being a burden to others or making others worry • brain systems • hyperventilating triggers panic attacks • in people with panic disorder, injecting sodium or caffeine triggered panic attacks • why? brains of people who get panic attacks have low threshold for detecting oxygen in blood, which triggers brain mechanism that warns us when we are suffocating • patients with panic disorder cannot hold breath for as long as people without • neural communication • norepi — too much produced in people with anxiety disorders • locus coeruleus is small structure in brainstem that produces norepi, and some think it is too sensitive in people with panic disorder, and therefore produces too much norepi • SSRIs can reduce frequency and intensity of panic attacks— they reduce effects of serotonin, which affects locus in complex ways • genetics • first degree relatives of people with panic disorder are up to 8x as likely and up to 20x as likely if the relative developed it before 20 y/o concordance rate - the probability that both twins will have a characteristic or disorder, given that one of them has it

• psychological factors • learning theory — person may have had a true alarm, which then produces conditioning where the initial bodily sensations of panic become false alarms associated with panic attacks; normal sensations come to be associated with panic attacks, the bodily sensations of arousal come to elicit panic attacks (learned alarms). the per...