Psyb32: Anxiety Disorders
Most common mental disorder
Anxiety disorder
Component of anxiety disorder
Physiological: heightened sense of arousal and activation with symtoms like high heart rate, short breath, dry mouth, sweating, etc.
Cognitive: subjective perception of anxious arousal and associated cognitive process like worry and rumination.
Potential third component: behaviours resulting from the first 2 component to avoid anxiety.
What time period does anxiety focus on and how does that relate to what it is reinforced by?
Future focused and fixated on possible consequences and things that never even happen, reinforced by avoidance of those feared outcomes.
Why might anxiety be good and what should you do because of it?
Adaptive when serving as motivation to do some.
Why you shouldn't overpathologize and take situational factors into consideration. There are situations where it is normal for those to feel anxious.
Chronically anxious people
Those that percieve threat and are worried in situations where there is no objective threat/when situations are ambiguous.
Specific phobia and it's criteria
Unwarrented fears caused by the presence/anticipation of a specific object or situation.
Criteria:
- Recognized as groundless
- Debalitating and stops regular function
- Out of proportion fear/avoidance to the actual danger
What is a phobia if it doesn't disrupt your life?
Just a fear.
Other name for specific phobia
Simple phobia
Subtypes of phobia
Injections/blood/body, situations, animals, objects, natural enviornment
What could be a phobia?
Anything and everything.
Social anxiety disorder
Persistent, obsessive and irrational fear and apprehension of being judged negatively bu others
Other name for social anxiety disorder
Social phobia
3 types of feared situations of those with social anxiety disorder
Preformances and public speaking (both or else it is a phobia), social interactions, situations of observation
What behaviours do those with social anxiety fear exhibiting and other's usual reactions
Signs of anxiousness or behaving embarrassingly, avoids showing physical signs of nervousness. Usually others will not even notice.
Symptoms of social anxiety disorder
Fear of embarrassment, nausea. sweating, excessive worrying, difficulty speaking, avoiding social situations, etc.
How many social situations do those with social anxiety fear?
Multiple. If not, it is only a fear.
Prevelence of social anxiety disorder
Chronic, lasting 20 years. More likely in women and those that are single, no secondary education, lower income, unemployed, no social support.
Panic disorder
Characterized by panic attacks.
Onset of SAD
Late adolescence, when social interactions and awareness becomes important.
Panic attacks and symptoms
Jarring symptoms of laboured breath, nausea, chest pain, choking, terror, feelings of doom, literally feeling like you are going to die, depersonalization, derealisation
Criteria for panic disorders
4/13 symptoms, and attacks must be cued and uncued, or uncued in general, constant worry about panic attacks, changes in behaviour as a result of those attacks.
Cues/expected panic attacks
Those that are linked to be a specific situation/trigger. A phobia.
Uncued/unexpected panic attacks
Those that are out of the blue
Time for panic attacks
Could happen frequency lasting for a couple of seconds.
Nocturnal panic disorder
Waking up from sleeping with a panic attack, not due to a nightmare or some other reason.
Agoraphobia
Cluster of fear of public places/situations you can't escape from
Agoraphobia diagnoses criteria
Fear of 2/5 situations: lines/crowds, open spaces, closed spaces, public transportation, being out of the house alone.
Agoraphobia diagnosed with?
Other disorders, it is not really diagnosed by itself. Ex: panic disorder with/without agoraphobia"
Generalized personality disorder
Persistently anxious often about all things
What is generalised personality disorder ofter worried about?
Health and life daily hassles.
Generalised personality disorders worrying traits
Groundless, unexpected, chronicc, uncontroable.
What does generalised anxiety disorder effect?
Concentration, fatigue, restless, sleeping
Systemation desensitisation
make a hierarchy about what you are anxious about, teach relaxation techniques and pair techniques and anxieties and slowly move up the hierarchy until you are relaxed for all levels of the hierarchy
Flooding
Person exposed to phobia at full intensity
Gestalt
physical, biological, psychological or symbolic configuration or pattern of elements so unified that its properties can’t be derived from a simple summation of its parts.
When is gestalt therapy focused on and why?
The present moment, becaise anxiety can exist in the future.
What does gestalt therapy bring awareness to?
The discrepanies in someone's presentation. Ex: firefighter pretends he can continue to do his job despite being traumatised from an event.
Gestalk therapy and resistance and how does this help.
Focuses on how they resist contact and resources where interventions are drawn from.
Helps them with different ways to meet their needs.
That views do gestalt therapy come from?
Humanistic streams
Anxiety and excitment
Their physiological responses are similar and could be confused with eachother depending on how you interpret responses.
Cycle of needs
Sensation, awareness, use of energy, excitment/anxiety to figure out how to fix a problem, action, contact for connecting with yourself and the enviornment to meet the need, withdrawal.
Gestalt therapy and needs
Needs sometimes need to be disrupted, especially if there are multiple and they are conflicting. tehrapy is finding a better way to meet those needs.
Field theory and conclusion
Everything is already around you, youre just not aware of it because you subconciously choose to focus on something else.
You need to focus on what you want instead of what you don't want.
Phenomenology
Someone's experience of the moment.
Existentialism
We're all individuals
Eastern thoughts
Some things just are.
Working with anxiety
Getting to the here and now, re-experiening in a safe enviornment so they know that nothing eill happen.
Getting friently with anxiety and discovering your relationship with it.
Recognizing and addressing resistance where they teach themselves to say no when they feel like they have no choice.
Awareness of attitude around taking support when anxiety is a lack of suppoer because when you have someone watching your basck, you feel safer.
Hot seat
Group therapy when you are doing personal work in front of a group.
Psychodrama
Playing the roles of the trauma to help you process and analyze it.
Empty chair/2 chairs
One chair for unfinished business and you finish those emotions.
Dialogical relating
Having a conversation and dialogue with others while not telling them directly what to do.
Exaggerating
Asking someone to do more so they are aware of it.
Language of responsibility
Making someone take ownership of their words.
Dreamwork
Tells dreas as it is now, representing who you are.
Disowned parts
Group therapy where others see an aspect of you that you yourself don't see. You have a party where you play that rile and you own that part and integrate it in your life.
Anxiety
Drive that mediates between threatening situation and avoidance behaviour.
Root of anxiety
Feelings of powerlessness and deficitless
Text anxiety
Feeling of tension, apprehension and worry when facing/anticipating tests.
Seperation anxiety
Fear when they are away from someone they are dependent on.
Changing society and phobias
New phobias can emerge with societal changes.
Nomophobia
Fear of being out of touch with tech
Where does new phobias come from
Inability to communicate
No access to information
Inconvience
Being disconnested
Phobia variation
Varies cross-culturally, some are more prevelant somewhere else.
Psychoanalytic perspective and phobia
Phobia as a symbol of an important, unconcious fear.
Behavioural perspective of phobias
Function of phobias and how they are acquired and reduced.
Classification of SAD before the DSM-5
Generalised if they fear many differenter interpersonal situations
Specific if they fear only one, mainly public speaking
What was SAD called before the DSM-5
Social phobia
What did they not take into account/evaluate before the DSM-5
Degree to which the fear is excessive, and the socio-cultural contect.
High cormorbidity with SAD and why (also in children)
Alcohal and marijuana to cope with SAD, or other types of anxiety in children.
Selective mutism
Pattern of refusing to speak when you could, found in children with social anxiety
Social media anxiety and their actions
Fear of being judged by others related to social media use.
Misinterpreting texts, FOMO, not having likes.
2 factor theory of avoidance conditioning formulation
2 sets of learning for phobias:
Classical conditiong where people fear a neutral stimulus when it is paired with a unconditioned negative stimulus.
Operate condition where consequence reinforce the fear avoidance.
How to exteinguish a phobia with the learning theory
Present it without UCS
Why there might be other learning other than conditiong
Phobias might still exist without prior frightening experience or expose to feardul models.
Modelling
Watching and intimating others
Vicarious learning
Learning of fear by observing ans listening to others. So people can fear stuff through verbal instructions.
Anxious-rearing model
Anxiety disorders appear in children due to constant parental warnings.
Prepared learning
Certain stuff are more likely to become phobias than others
Prepared stimuli and how they are extinguished, and evolutionary implications
Stimuli more likely to be classically conditioned to be feared. They are the ones that are not extinguished easily and indicate biological prepardness shaped by natural selection.
Behavioural models of social anxiety and why.
Social anxiety is caused by innapropriate behaviour and lack of social skills. They never learned to behave so they feel uncomfortable or they are often critisised by others.
Where so social skill deficits come from
People being scared of interacting with others so no experience.
Cognitive views on the diathesis of phobias or anxiety
Diathesis on how thoughts can maintain phobias/anxiety
Thoughts processes that can maintain phobias/anxiety
Thinking negative things are going to happen, interpretating stimuli as threatening, focusing on negative information.
Cognitive processes implicated in the etiology and maintenence of SAD
Concerns of the evaluations of others, exaggerations of the cost of social blunders, preoccupied in siutations they are treated negatively by others, hypersensitive to social cues, excessive self-criticism, worried about discomfort to others PEP
Post-event processing (PEP)
Ruminative cognitive processing on previous experiences and responses to these situations, thinking about how things could have been done differently.
Cognitive models of SAD treatment tried to facilitate
External focus on others, realisation that they are not really judgemental
Techniques for cognitive models of treatment
Behavioural experiments, role-plays, widening the bandwith
Widening the bandwith
Acting in ways previously thought to be unacceptable and watching for the lack of negative reactions to ass to the list of stuff safe to do.
Biological diathesis for phobias
Brain aread, automative nervous systems, genetic temperment
Brain areas for phobias and proof of their involvement
Amygdala, insula, therapy reducing phobias leads to decrease in brain activity there.
Role of automatic nervous system in phobias
More easily aroused
Genes in phobias
Temperment is related to phobias later on and it is genetic. Phobias run in a family, but there are no genes related to any phobias.
Psychoanalytic perspectives of phobia
Defences against anxiety produced by repressed Id impulsis. The anxiety is moved to another with symbolic connections to it.
What disorders are panic attacks part of and how would they impact them?
Many different anxiety disorders, makes them more severe.
How panic attacks are diagnosed with other disorders
(other disorder) with panick attacks
Agoraphobia
Cluster of fears of being unable to run if needed
Panic disorders and agoraphobia
Often diagnosed together, agoraphobia preceded with panic disorders
Possible physical causes and panic attacks
Physical sensations could lead to panic attacks
Genetic component to panic attacks
Overactivity of the noradrenergic system
Sensitivity to cholecystokinin (CCK)
Panic attacjs and noradrenergic system and drugs
Problem with GABA neurons that inhibit noraderenergic activity, and theraputic interventions often change GABA receptions. Drugs that stimulate locu coeruleus elicits panic attacks but drigs that block it do not treat.
Panic attacks and sensitivity to cholecystokinin (CCK)
2 possibilities:
Effects neurons in the noradrenergic systen
Reacting strongly to physical sensations caused by CCK.
Fear of fear hypothesis
Agoraphobia is not a fear of publis places, but having panic-like symptoms in public
How fear-of-fear hypothesis works
ANS predisposed to be overly active combined with tendency to be very upset by these sensations.
People experience it once, they are upset. fear makes them panic more, leading to more activity, activity interpreted in catastrophic ways and raises anxiety level
Anxiety disposition
Anxiety sensitiveity as a innate characteristic for anxiety disorders and a risk factor.
Behavioural models of GAD
People are classically conditioned to fear a braid range of stimuli
Cognitive-behavioural therapy model of GAD
Anciety results from when people face pain that they have no control over. Control is key. More control means less anxiety. The control does not actually have to exist, it could be imagined.
Intolerance of uncertainty
Inability to tolerate uncertain outcomes. The more uncertainty, the more anxeity.
2-factor model linking GAD with classic aprroach-avoidance conflict
2 factors include intollerance of uncertainty that promotes appraoch behaviour to reduce it and fear of anxiety that promotes avoidance behaviour to get tf out.
Brain parts in GADA
Amygdala activation, anterior cingulate cortex activation for reduction in anxiety and more white matter abnormailities for GAD people
Benzodiazepines
Drugs treating that increases GABA that inhibits activity to reduce anxiety
In vivo exposure
Exercise at home requiring patients to be exposed to deared stimuli or situations
Virtual reality exposure
Treating phobias using computer generated graphics and sounds
What is virtual reality exposure good for
Treating phobias for flying
Augmented reality exposure
Treatment with a combonation of VR and the physical world
What is augmented reality exposure good for
Phobia of small animals
3 challenges for exposure based treatments
Need for information on the specific mechanism for change
Incorgorating research knowledge into clinical practice, underused in community setting that are flexible to clients
Social effectivemess therapy
combines exposure and social training
Modelling therapy
Clients exposed to others interacting with scary stimuli fearlessly
Flooding
Exposed to scary stimuli at full intensity
Operate conditiong techniques for interventions, what it ignores and focuses on
Encourage more exposure to a stmuli with awards, avoids underlying fear and focus on overt behaviour
Barlow's panic control therapy
3 components:
relaxation training
Combination of ellis and Beck types CBT where you self-monitor cognitions during panic episode
Introceptive exposure
Introceptive exposure
Exposure to internal panic cues, like increased heartbeat. previously learned strategies are applied so sensations are not threatening.
Minfulness and acceptance-based approaches
More open to anxiou thoughts and feelings inctead of avoiding/changing them, decentering, longkindness
Decentering
ability to view thoughts and emotions locailly without getting caught in them
Longkindness
being kind to yourself and others
Drugs for anxiety
Sedative, anxiolytes, tranquillisers
First drig more anxiety
barbiturates
What anxiety are benzodiazpines for
Not for any specific phobias
What other medication other can be used for anixeyt
antidepressants
Dcycloserine (DCS)
drug that facilitate extenction of fear and exhences exposure treatment for phobiuas
downsides to Dcycloserin
Makes the good great but the bad worse
Psychoanalytic methods
Uncover repressed conflicts, focused on insight, trying to confront phobia.