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PSYCH257 Lecture Notes - Generalized Anxiety Disorder, Anxiety Disorder, Specific Phobia

Course Code
Uzma Rehman

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Anxiety Disorders
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
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

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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
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
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
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 base

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o 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
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
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 anxiety and pattern of attacks
Most common additional diagnosis for anxiety is major depression
Panic Disorder
12:09 PM
Panic disorder with agoraphobia (PDA): fear and avoidance of situations the person believes
might induce a panic attack
o Because they never know when an attack might occur, they experience agoraphobia:
anxiety about being in places or situations from which escape might be difficult
o Anxiety and panic combined with phobic avoidance
Panic disorder without agoraphobia (PD): panic attacks experience without the development of
Panic attack is not a disorder in itself, but is a quality of panic and anxiety disorders
o Recurrent unexpected panic attacks
o Concern about having additional attacks
o Worry about consequences of the attacks
o Change in behaviour related to the attacks.
ANS that occurs during panic attack doesn't last too long, but is very intense.
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
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