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Chapter 5

Chapter 5 and Lecture 5- Anxiety Disorders- 2310.pdf

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Psychology 2310A/B
Rod Martin

CHAPTER #5:ANXIETY DISORDERS ▯ ▯ CHARACTERISTICS OFANXIETY -Physiological component involves changes in the automatic nervous system that result in respiratory, cardiovascular, and muscle changes in the body (e.g., changes in breathing rate, heart rate, and muscle tone) -Cognitive component involves alterations in consciousness, and specific thoughts -Specific behavioral responses tend to be consequences of certain emotions -Anxiety: Affective state whereby an individual feels threatened by the potential occurrence of a future negative event —> future oriented -Fear: More primitive emotion and occurs in response to a current threat (real or perceived) —> present oriented -Fight or flight response: Fear prompts a person or organism to either flee from a dangerous situation or stand and fight (due to increased heart rate, muscle tension, and breathing rate) -Panic: Whereas fear is an emotional response to an objective, current, and identifiable threat, panic is an extreme fear reaction that is triggered even though there is nothing to be afraid of (false alarm) ▯ HISTORICALPERSPECTIVE -Hippocrates described a man terrified of flute music (that old) -Until 1980, anxiety disorders were classified together with somatoform and dissociative disorders under neurosis (neurotic used to refer to a disturbance in the central nervous system) -Freud was one of the oldest theorists to focus on anxiety —> proposed that neurotic anxiety is a signal to the ego that an unacceptable drive is pressing for conscious representation ▯ ETIOLOGY ▯ Biological Factors -Genetics: -Evidence of genetics came from studies of families and twins and demonstrates that almost all anxiety disorders show some concordance within family members -4-6 times more likely to develop anxiety when a family member has it -Heritabilities range from 23 to 40% -Environmental factors account for a greater degree of the non-genetic variation than do shared family factors -The genetic risk for anxiety is more likely passed on in terms of broader temperamental and/or dispositional traits such as behavioral inhibition or neuroticism -Neuroanatomy and neurotransmitters: -The neural fear circuit as studied in animals is thought to begin with the registry of sensory info at the thalamus; this info is then sent to the amygdala —> then sent to areas in the hypothalamus —> then through the midbrain area to the brain stem and spinal cord -The brain stem and spinal cord con nest with various automatic (heart rate, blood pressure, body temp) and behavioral (freezing, flight) output components that are involved in the expression of fear -Direct electrical stimulation of this circuit at low levels causes subjective anxiety in humans and freezing in rats, whereas stimulations at high levels provokes feelings of terror and flight behavior -The higher cortical areas are necessary for extinguishing fear -Info transfers between the neuroanatomical structures involved in fear, anxiety and panic is mediated by a complex and interacting number of neurotransmitter systems ▯ Psychological Factors -Behavioral factors: -Anxiety and fear are acquired through learning -2 factor theory: Fears develop through the process of classical conditioning and are maintained through operant conditioning (doesn’t explain all phobias) - Vicarious learning/modelling: It is possible to develop fears by observing the reactions of others -Cognitive factors: -Beck proposed that people are afraid because of the biased perceptions they have about the world, the future, and themselves - Anxious individuals often see the world as dangerous, the future as uncertain, and themselves as ill-equipped, helpless and vulnerable -Selectively attend to and recall info that is consistent with their views ▯ Interpersonal Factors -Parents who are anxious themselves tend to interact with their kids in ways that are less warm and positive, more critical and less granting of autonomy —> may foster beliefs of helplessness and uncontrollability in kids which may contribute to anxiety -Children who develop an “anxious-ambivalent” attachment style learn to fear being abandoned by loved ones ▯ Comment on Etiology -There is an interplay between all factors -Triple vulnerability model: Generalized biological, nonspecific psychological, and specific psychological vulnerabilities interact to create risk ▯ THEANXIETY DISORDERS -Most common of all mental disorders -Without treatment they are chronic and recurrent and impair multiple domains ▯ Panic Disorder andAgoraphobia -Panic attacks: Sudden rush of intense fear and discomfort during which an individual experiences a number of physiological and psychological symptoms -At least 4 symptoms must occur of the 13 symptoms (pounding heart, sweating, trembling or shaking, sensations of shortness of breath, feeling of choking, chest pain, nausea, dizziness, derealization (unreality) or depersonalization (feeling detached from self), fear of losing control, fear of dying, parenthesis (numbness, tingling), chills or hot flashes -Attack must develop suddenly and reaching a peak within 10 minutes -At least 2 attacks are required for diagnosis -21% experience a panic attack in lifetime -At least one panic attack myst be followed by persistent concerns (lasting at least a month) about having additional attacks -Agoraphobia: Anxiety about being in places or situations where an individual might find it difficult to escape (in crowds, a car, etc.) or in which he or she would not have help readily available should a panic attack occur (you can be diagnosed without agoraphobia too) -Most people develop panic disorder in teenage years but don’t adress it til around 34 -Women are twice as likely as men -Comorbid with depression, substance abuse, and other anxiety disorders -Diagnosis and assessment: -Clinical interview, behavioral measurement, psychophysiological tests, and self- report indices -Structural Clinical Interview: Semi structures interview that covers theAxis I disorders -Behavioral avoidance test: Patients are asked to enter situations that they would typically avoid to assess their agoraphobic avoidance naturally -They provide a rating of their degree of anticipatory anxiety and the level of anxiety that they experience -Psychophysiological assessment may include monitoring heart rate, blood pressure, and galvanic skin response while a patient is approaching a feared situation or having a panic attack -Self report questionnaires -Etiology: -Tends to run in families (5x more likely) -Biological challenges (presentation of a stimulus intended to induce physiological changes associated with anxiety) induce panic attacks in individuals with panic disorder -Nocturnal panic: Attacks that occur while sleeping or attempting to relax (71%) —> leads to cognitive theories -Cognitive theories focus on how individuals with anxiety catastrophically misinterpret bodily sensations —> sign that something is wrong -Anxiety sensitivity: There is a trait-like tendency to be anxiety sensitive —> belief that the somatic symptoms related to anxiety will have negative consequences that extend beyond the panic episode itself -Alarm theory: When a real danger is present, a true alarm occurs and our bodies kick in an incredibly adaptive physiological response that allows us to face the feared object or flee -Can be activated by emotional cues but this leads to “false-alarm” ▯ Specific Phobia -Phobia: When a fear is extreme and excessive —> unreasoned fear reaction -8.7 % of population, more prevalent in females (15.7%) -Women have greater fears of animals and situational fear (greater fear in total too) -Men and women are equally as afraid of injections and dental procedures -Diagnosis and assessment: -There must be a marked persistent fear and exposure to the feared object/ situation must produce an excessive anxiety reaction -5 subtypes of specific phobia: -Animal type -Natural environment type (thunderstorm, water, heights) -Blood injection-injury type (fears seeing blood or injury or fears injection or any other invasive medical procedure) -Situational type (specific situations like bridges, buses, enclosed space) -Other type (any other fears like choking, clowns, etc. and also includes illness phobia: intense fear of developing an illness) -Having a phobia from one subtype increases likelihood of developing another phobia within that same category -Etiology: -Main criticism of classical conditioning in phobias is the idea that all neutral stimuli have equal potential of becoming phobias —> Equipotentiality premise (The chances of being afraid of a lamp and a snake are presumed to be equal but it is not the case that people have phobias for everything; rather a select number of stimuli seem to be consistently related) -Non-associative model: Runs counter to classical/associative conditioning and proposes that the process of evolution has endowed humans to respond fearfully to a select group of stimulus and thus no learning is necessary to develop these -Babies seem to be born with prewired fears (stranger anxiety) -The failure to habituate to phobias may occur because they did not have the appropriate opportunities for exposure during development -Genetic component supports this -Biological preparedness: The process of natural selection has equipped humans with the predisposition to fear objects/situations that represented threats - Associative learning is still necessary to develop a phobia though -Disgust sensitivity: Degree to which people are susceptible to being disgusted by a variety of stimuli such as certain bugs, food, and small animals —> we think they are gross and contaminated - Women have higher degrees - Phobia may not always involve fear of danger but also disgust ▯ Social Phobia/SocialAnxiety Disorder -Social anxiety: Marked and persistent fear of social or performance related situations (humiliation and embarrassment) -Fear of being evaluated negatively -Fear of being the centre of attention -Non-generalized social phobia patients fear specific situations like casual speaking, eating or writing in public, giving speeches -General social phobia: Most social settings and interactions -May lead to their isolation and loneliness —> low self esteem, depression -Duration must be for more than 6 months -3% with more women -Diagnosis and assessment: -Structured or semi-structured interview combined with self-report measures -Fear that characterizes social anxiety involves fear of negative evaluation -Etiology: -Genetic, biology, environmental, and cognitive factors -Genetic factors account for one half or more of the variance in risk -What seems to be inherited is a predisposition to develop social anxiety rather than the disorder itself, and vulnerability is determined by environmental factors -Behavioral inhibition is an early marker of risk for social phobia (2x) -Reduced synaptic re-uptake and receptor binding of dopamine-2, and dysregulation of the interplay between serotonin, norepinephrine, and corticotropin releasing factors during stress responses are associated -Most people have been bullied or teased in childhood, exposed to critical parenting, overprotection, and control as a child —> lack of confidence -Abnormal processing of social information -Greater concern of making mistakes -Judge self as inferior and think negatively about self -Tend to avoid looking directly in eyes of other people and appear threatened -High in public self-consciousness —> awareness of self as an object of attention, or the tendency to see one’s actions from the perspective of an outsider than through their own eyes -Interpersonal disorder: commonly associated with marked disruption in the ability to relate with other people -Difficulty in experiencing positive emotions ▯ Obsessive-Compulsive Disorder -OCD: Recurrent obsessions and compulsions that cause marked distress -1% with typical age of onset being during adolescence and early adulthood -Obsessions: Recurrent and uncontrollable thoughts, impulses, or idea that the individual finds disturbing and anxiety provoking -Uncertainty (door unlocked), sexuality (homosexual imagery), violence (harming a child), contamination (believing one is dirty) -Try to conceal these from other people - Compulsions: Repetitive behaviors or cognitive acts that are intended to reduce anxiety -Repetitive behaviors —> Hand washing, organization, checking, etc. -Cognitive acts —> Counting numbers, praying, repeating phrases over and over -Neutralizations: Behavioral or mental acts that are used by individuals to try to prevent, cancel, or “undo” the feared consequences and distress caused by an obsession -Excessive belief about personal responsibility and feelings of guilt -Thought-action fusion (TAF): 2 types of irrational thinking (1) the belief that having a particular thought increases the probability that the thought will come true —> likelihood TAF (self and others) (2) belief that having a particular thought is the moral equivalent of a particular action —> moral TAF -Hoarding: Difficulty disposing of possessions by overestimating their importance -Diagnosis and assessment: -Presence of either obsessions or compulsions -Obsessions tend to be more bizarre and involve more imagery than worries - Etiology: -Mild genetic risk factor (32-40% heritability) -Most neuropsychology models implicate the basal ganglia (controls motor behaviors) and frontal cortex (abstract reasoning, inhibition, planning, and decision making) —> connected and form a loop system -OCD patients more likely affected by poor memory confidence as opposed to poor memory accuracy —> people with OCD are more likely to recheck the door because they do not have much confidence in their memory -Neuro-chemical theories include the serotonin hypothesis: abnormalities in the serotonin system are responsible for OCD -Cognitive-behavioral conceptualization posits that problematic obsessions are caused by the person’s reaction to intrusive thoughts -Obsessions are believed to persist because of the person’s maladaptive attempts to cope with them —> suppression of thoughts, avoidance behaviourism and neutralizations -Rebound effect: Trying to suppress intrusive thoughts can actually increase their frequency -Compulsions are believed to persist because they tend to (1) lower the severity of anxiety (2) lower the frequency of obsessions (3) “prevent” obsessions from coming true -This short term relief comes at the expense of failing to learn that the feared illness likely would not occur anyways and their anxiety would eventually decrease on its own ▯ Post-Traumatic Stress Disorder -PTSD: Psychological condition that may ensue following exposure to a traumatic event (serious accident, natural disaster, assault, military, etc.) -The event must have involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and have been experienced with intense fear, helplessness, or horror -Symptoms for longer than a month after the event (if not, may just be acute stress) -Re-experiencing the event in some way after being reminded of it through recollections (images, thoughts, perceptions, dreams) or psychological and physiological distress upo
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