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Chapter 5

PS280 Chapter 5 - Anxiety Disorders.docx

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Wilfrid Laurier University
Camie Condon

CHAPTER 5 ANXIETY DISORDERSCHARACTERISTICS OF ANXIETYDistinctive components of emotion that are interrelated and affect each othero Physiologicalinvolves changes in ANS that result in respiratory cardiovascular and muscular changes in the body eg heart rate o Cognitiveincludes alterations in consciousness and specific thoughts a person may have while experiencing a particular emotion o Behaviouralconsequences of certain emotionsAnxietyan affective state whereby an individual feels threatened by the potential occurrence of a future negative eventFearprimitive emotion and occurs in response to a real identified or perceived current threat o fight or flight responsefear prompts a person to either flee from a dangerous situation or stand and fight o It is important from an evolutionary perspective because of the behavioural response it elicitsPanicextreme fear reaction that is triggered even though there is nothing to be afraid of a false alarm HISTORICAL PERSPECTIVE1980disorders were classified together with the somatoform and dissociative disorders under the heading of neurosisPeople who were not psychotic but who still had emotional problems were labelled neurotica disturbance in the central nervous systemFreudtheorized that there was an important difference between objective fears and neurotic anxiety o Neurotic anxiety is a signal to the ego that an unacceptable drive mainly sexual in nature is pressing for conscious representation o Anxiety was thought to occur because defence mechanisms failed to repress painful memories impulses or thoughtsETIOLOGY 1 Biological FactorsGenetics o Genetic influence on anxiety disorders comes from studies of families and twins demonstrate that virtually all of anxiety disorders show at least a moderate level of concordance within family members o Individuals who have a family member who is diagnosed with an anxiety disorder are 46 times more likely to have an anxiety disorder than those without a family history o Environmental factors particular to specific individuals account for a greater degree of the nongenetic variation in risk for anxiety disorders than do shared family factors eg place of living o The genetic risk for anxiety disorders is more likely passed on in terms of broader temperamental andor dispositional traits such as behavioural inhibition and neuroticism Neuroanatomy and Neurotransmitters o The neural fear circuit as studied in animals is thought to begin with the registry of sensory info at the thalamus which is then sent to the amygdalaFrom the amygdalainfo is sent to areas in the hypothalamusmidbrain area periaqueductal greybrain stem and spinal cordThe latter areas connect with the various autonomic and behavioural output components that are involved in the expression of fearDirect electrical stimulation of this circuit at low levelssubjective anxiety in humansStimulation at high levelsfeelings of terror and flight behaviour o Higher cortical areas are not directly involved in the fear circuit o The fear system involves a subcortical network that can be aroused without influence of complex cortical input o Each of the neurotransmitter involved in fear anxiety and panic are involved in an assortment of general cognitive affective and behavioural functions o Many of the medications used in managing anxiety disorders have serotoninbased andor norepinephrinebased modes of action o Example GABAmost pervasive inhibitory neurotransmitter and receptors for this are distributed along the neural fear circuitBenzodiazepinesclass of antianxiety medication to operate GABAmediated inhibition 2 Psychological FactorsBehavioural Factors o Mowrertwofactor theory suggested that fears develop through the process of classical conditioning and are maintained through operant conditioningDoesnt do an adequate job in explaining the development of all phobias o Avoidance can be effective in reducing ones anxiety in the short term but can serve to increase anxiety over the long haul Avoidance feeds the belief that there is something to fear o It is possible to develop fears by observing the reaction of others vicarious learning or modelling o Some people also develop fears by hearing fearrelevant information Cognitive Factors o Dr Aaron T Beckpeople are afraid because of the biased perceptions that they have about the world the future and themselvesAnxious individuals often see the world as dangerous the future as uncertain and themselves as illequipped to cope with lifes threatsThey often believe they are helpless and vulnerableThey selectively attend to and recall info that is consistent with this threatening view of selfThey also filter out or ignore information that contradicts the presence of an objective dangerIndividuals with recurrent panic attacks often have fears that focus on the following when less threatening interpretations of their symptoms are far more likely o BodilyIm going to have a heart attack o MentalIm going to go crazy o InterpersonalIm going to embarrass myself o Anxious individuals tend to focus on information that is relevant to their fearsEg arachnophobias tend to orient toward words like crawl or hairy relative to positive or neutral words 3 Interpersonal FactorsParents who are anxious themselves tend to interact with their children in ways that are less warm and positive more critical and catastrophic and less granting of autonomy when compared to nonanxious parents o Such parents style ay foster beliefs of helplessness and uncontrollability in children that contribute to a general psychological vulnerability of anxiety Attachment theoristsearly parentchild interactions can lead to the development of general belief system or internal working models for how relationships operate in general o anxiousambivalent children learn to fear being abandoned by loved ones o These children have developed an attachment style from which parents are consistent in their emotional caregiving o Anxiousambivalent attachment style in infancy predicted anxiety problems when the children were 175 years oldBarlowtriple vulnerability etiological model of anxiety interact to increase riskgeneralized biologicaleg a genetic predisposition to being highstrung behaviourally inhibited and nervousnonspecific psychologicaleg diminished sense of control low selfesteemspecific psychological vulnerabilitieseg experiencing a real danger false alarm or vicarious exposure ANXIETY DISORDERSAnxiety disorders represent the most common of all mental disordersWithout treatment anxiety disorders tend to be chronic and recurrent and are associated with significant distress and sufferingIndividuals with this disorder are often impaired across multiple domains of functioningAnxiety disorders are also costly in treatment and lost productivity 1 Panic Disorder and AgoraphobiaDescription o Panic attacksinvolve a sudden rush of intense fear or discomfort during which an individual experiences a number of extreme psychological and physiological symptoms at least 4 of the 13 symptoms must be diagnosed o The attack must also develop suddenly reaching a peak within 10 minutes
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