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Anxiety Disorders Lexture and textbook notes (chapter 5) detailing symptoms, statistics and treatments for anxiety disorders such as panic disorder, generalized anxiety disorder, specific phobias, social phobias, post traumatic stress disorder and obsessi

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Uzma Rehman

Anxiety Disorders January-19-11 5:24 PM Anxiety is a specific type of disorder but also an emotion Anxiety, Fear and Panic Anxiety: negative mood state characterised by bodily symptoms of physical tension and apprehension about the future Difficult to study: can be subjective sense of unease, set of behaviours, or physiological response originating in the brain Much of anxiety research has been done on animals Moderate amounts of anxiety is good for us; we perform better when we're anxious, physical and intellectual performances are driven and enhanced by anxiety Anxiety usually has no direct cause, and people usually know that they have no reason to be so anxious, but can't help it Fear: emotion of an immediate alarm reaction to present danger or life threatening emergencies o Can also be good for us, activating a massive response from the autonomic nervous system to react to danger Evidence to show that fear and anxiety reactions differ psychologically and physiologically o Anxiety is future oriented, characterised by apprehension because we can't predict or control upcoming events. Associated with negative cognition, worrying thoughts. o Fear is an immediate emotional reaction characterised by strong escapist action tendencies. Negative physical arousal. Present oriented o Panic when a fear response is activated in situations where it shouldn't be Fear and anxiety both adaptive and help. When they are in excess and impairing ability to function properly they become a problem. No fear and anxiety also an issue, psychopaths and sociopaths. Anxiety also improves performance Panic: sudden overwhelming fright or terror Panic attack: abrupt experience of intense fear or acute discomfort accompanied by physical symptoms that usually include heart palpitations, chest pain, shortness of breath and dizziness. 3 basic types of panic attacks: situationally bound, unexpected, and situationally predisposed o Situationally bound: a fear of heights might trigger a panic attack when driving on tall bridges or going to the top floors of a building. The panic is cued o Unexpected: not cued by anything, random o Situationally predisposed: more like to have an attack where you've had one before o Situationally predisposed and unexpected attacks are likely to occur in panic disorders. Situationally predisposed attacks are likely to occur in specific phobias or social phobias Characteristics: o Pervasive and persistent symptoms of anxiety and fear o Involve excessive avoidance and escapist tendencies, also true for OCD o Symptoms and avoidance causes clinically significant distress and impairment Biological Contributions Evidence shows we inherit a tendency to be tense or uptight No single gene causes anxiety, but many weak contributions from several areas on chromosomes collectively make us vulnerable to anxiety when the right psychological and social factors are in place Anxiety is associated with certain brain circuits and neurotransmitter systems: depleted levels of GABA indirectly associated with increased anxiety. Serotonergic system also involved and the noradrenergic system Corticotrophin releasing factor (CRF): activates hypothalamic-pituitary-adrenocortical (HPA) axis which is part of the CRF system and the CRF system affects areas of the brain implicated in anxiety. CRF also directly related to GABA-benzodiazepine system, serotonergic system and the noradrenergic neurotransmitter system o Also often associated with anxiety: limbic system. Acts as mediator between brain stem and cortex Jeffrey Gray: identified brain circuit in limbic system that seems heavily involved in anxiety. Leads from septal and hippocampal area in limbic system to frontal cortex (septal-hippocampal system activated by CRF, serotonergic and noradrenergic pathways) o Called it the behavioural inhibition system (BIS); brain circuit in limbic system that responds to threat signals by inhibiting activity and causing anxiety o Activated by signals from unexpected events , like major changes in body function that might signal danger o Danger signals descend from cortex to septal hippocampal system. BIS gets a boost from the amygdala. o When BIS is activated by signals that arise from brain stem or descend from cortex our tendency is to freeze, experience, anxiety, apprehensively evaluate the situation to determine that danger is present Jeffrey Gray also identified fight-flight system (FFS): brain circuit in animals, then when stimulated, causes an immediate alarm and escape response resembling human panic o Originates in brain stem, travels through several midbrain structures - including amygdala, ventromedial nucleus of the hypothalamus, and the central grey matter. o When stimulated, produces immediate alarm and escape response that looks like panic. o Suggested that it is activated in part by serotonin deficiencies. Environment can change sensitivity of the brain circuits, making someone more or less susceptible to anxiety disorders Possible that smoking as a teenager can increase risk of developing anxiety disorders as an adult, particularly panic disorder and generalised anxiety disorder o Possible explanation: nicotine increases anxiety, sensitises brain circuits associated with anxiety and increases biological vulnerability to develop severe anxiety disorders Psychological contributions Behaviour theorists see anxiety as a product of early classical conditioning, modelling or other forms of learning. Freud thought anxiety was a psychic reaction to danger surrounding reactivation of an infantile fearful situation Sense of control in childhood can grow into adulthood as a sense of control or a lack of control o Actions of parents do a lot to foster sense of control or uncontrollability o Parents who interact positively and predictably by responding to needs teach their children that they have control over their environment. Parents who allow children to explore their world and develop skills to cope with the unexpected enable children to develop a sense of control. Important to provide a secure baseo Parents who are overprotective, intrusive, never let their child experience adversity end up creating a child who never learned to cope with adversity. These children don't learn that they can control their environment Conditioning and cognitive explanations that are difficult to separate o Strong fear response occurs during real stress or actual danger. Emotional response becomes associated with internal and external cues. External cues beings things like places or situations. Internal cues being increases in heart rate or respiration (which can occur without fear) Social Contributions Stressful life events can trigger anxiety. Can be social, physical or interpersonal Integrated Perspective Psychological vulnerability: belief that the world is dangerous, life is out of your control, you do things wrong, can all lead to increased risk for anxiety Stressors can activate biological and psychological tendencies to anxious behaviour Learned alarms: panic attacks associated with internal or external cues Comorbidity Can often co-occur Rates of comorbidity among depression and anxiety disorders emphasises the fact that they share common features. Also share same vulnerabilities Differ in the focus of an
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