Reading
- Describe the characteristics of anxiety.
- There are three distinctive components of emotion: physiology, cognition, and behaviour. When anxiety occurs, we might expect to see increased heart rate and breathing (physiology). The individual may also experience thoughts such as “Something terrible will happen” (cognition), and avoid the anxiety-provoking trigger (behaviour). Anxiety is distinct from panic and fear. Although these are all emotional states, in anxiety the individual feels threatened by a potential future event. In fear, the individual responds to a present or perceived threat. Panic is similar to fear but, in contrast to fear, which is often in response to an objective threat, panic is extreme and can be triggered in the absence of an actual threat.
- This chapter highlighted descriptions of the major anxiety disorders listed in DSM-5: panic disorder with and without agoraphobia, specific phobia, social anxiety disorder, GAD, OCD, BDD, and PTSD.
- Discuss various etiological factors involved in anxiety and related disorders.
- Three main etiological factors are known to be involved in anxiety disorders: biological, psychological, and interpersonal. Biological factors encompass genetic heritability and the role of brain systems, including the amygdala and neurochemicals such as GABA. Learning (a psychological factor) and attachment influences (interpersonal factors) are also contributing factors.
- Etiological models of anxiety disorders include the two-factor theory, the equipotientiality premise, and the nonassociative model. Concepts important to understanding anxiety disorders include panic attacks, compulsions, and obsessions.
- Identify and describe the methods involved in the assessment of anxiety and related disorders. Differentiate the anxiety and anxiety-related disorders from one another.
- Methods of assessment include the use of structured and semi-structured interviews to establish if the individual meets diagnostic criteria for a particular disorder. Behavioural and psychophysiological indices are sometimes used to measure severity and to determine how the disorder is manifested. For example, the clinician could measure heart and breathing rates in an individual who describes having panic attacks or behavioural avoidance in an individual with social phobia. Self-report measures are also an invaluable part of assessment. These reports can measure each individual’s self-reported behaviour, symptoms, and emotions.
- Summarize and discuss common treatments for anxiety and related disorders.
- Interventions include pharmacotherapy, cognitive restructuring, exposure techniques, problem solving, relaxation, and other techniques such as exercise and mindfulness strategies.
Lecture
Anxiety
->Fear->Panic (a “false alarm” that is triggered in the absence of a concrete, identifiable threat)
PDF:- What are the 3 factors of emotion?
- Subjective experience (focused on therapy)
- Physiological response
- Behavioural response
- Separation Anxiety Disorder
- Symptoms: What are the major symptoms of SAD? Diagnosis time and prognosis rate?
- Diagnostic: What are the 8 manifestation of SAD
- Prevalence:
- Childhood and adolescence: girls = boys; Adulthood: girl > boys
- In childhood: SAD (5%), GAD (3%), phobia (2.5%)
- Prognosis:
Heterotypic > Homotypic- Heterotypic: Comorbidity with Major Depressive Disorder
- Homotypic: can develop different kind of anxiety disorders
- Homotypic continuity of anxiety disorders
- will develop GAD + Depression + Substance Use Disorder problems
- Etiology:
- Temperament and Brain Structure/Function
- High stress reactivity may be heritable
- Behavioural inhibited (BI) children show avoidance of others and atypical autonomic nervous system responses
- BI may be due to abnormal functioning in the Amygdala
- Prenatal Risks
- Elevated levels of cortisol in the mother during pregnancy
- May be associated with lower socioeconomic status
- Makes baby over react for novel stimulus
- Elevated levels of cortisol in the mother during pregnancy
- Genetics
- Run in families (shared environmental factors?)
- Psychosocial risk factors
- Learn to fear by observing fear reactions in their parents
Conditioning experiences -> avoidant behavior -> fear + anxiety
- Gene-environmental interactions
- Behavioural inhibition, amygdala dysfunction (predisposition) combined with a conditioned fear experience (environment)
- Temperament and Brain Structure/Function
- Treatment: What are the 2 common treatment of SAD
- CBT
Reframe anxious thoughts -> assertive behaviours- Enhance self-efficacy, exposure to reduce avoidance + extinguish fear responses
- Pharmacological treatments
- SSRI + CBT
- Tricyclic antidepressants and benzodiazepines (common, but efficacy?)
- CBT
- Anxiety Disorders
- Historical Perspective
- Neurosis
- Until 1980, anxiety disorders were classified with dissociative and somatoform disorders
- Sigmund Freud focused on the difference between objective fears and neurotic anxiety
- Modern views: behavioural and cognitive-behavioural + biological factors
- Neurosis
- Etiology: What are the biological factors of anxiety disorders
- Genetics
- Heritability range from 30% to 50%
- Broad dispositional/temperamental traits
- High neuroticism
- Behavioural inhibition
- Neuroanatomy and neurotransmitters
- Neural fear circuit:
- Amygdala
->Hypothalamus->the Midbrain (periaquaductal grey)->Brainstem->Spine
- Amygdala
- GABA, norepinephrine and serotonin play a role (benzodiazepines)
- Anxiety medication that operate with GABA
- Helps to inhibit activity in the brain
- Exercise also increase GABA release
- Neural fear circuit:
- Genetics
- Etiology What are the psychological factors
- Behavioural
- Anxiety and fear are acquired through learning
- The Two-factor theory proposes that fears are acquired through classical conditioning but are maintained by operant conditioning
- Fears are sometimes acquired in the absence of classical conditioning
- Ex. vicarious learning or modeling
- Cognitive
- Emotions are influenced by the way people appraise the future, themselves, and the world
- Cognitive Model
- Interpersonal
- Parents who are exercising excessive control, fostering beliefs of helplessness, & failing to promote self-efficacy and independence
- Anxious Preoccupied Attachment
- Helicopter Parenting
- Interpersonal
- Behavioural
- Historical Perspective
- Panic Disorder
- Symptoms What are the 2 key features of panic disorder?
- Recurrent and unexpected panic attacks
- Diagnosis
- What is the difference between panic disorder vs other anxiety disorder
- Uncued/unexpected panic attacks VS in response to a specific situation
- Assessment: What are the 3 common assessments of panic disorders
- Interviews
- Behavioural assessment: behavioural avoidance test (BAT)
- Symptom induction test
- Etiology: What are the 3 Cognitive Perspective on the etiology of panic disorder?
- Catastrophic misinterpretation: quickly misinterpret bodily sensations as a sign that something must be wrong
- Elevated Anxiety sensitivity: the belief that the somatic symptoms related to anxiety will have negative consequences that extend beyond the panic episode itself
- Alarm theory
- True alarm: activation via real danger
- False alarm: activation via emotional cues
- Triggering panic attacks in neutral situations where there is an absence of threat
- Then, this neutral situation might become classically conditioned with fear
- Small changes in the body as ‘signal’
- Symptoms What are the 2 key features of panic disorder?
- Agoraphobia
- An active, persistent avoidance of situations
- The person is concerned that he/she will not be able to escape or get help in the event of a panic attack, or other incapacitating or embarrassing symptoms
- Panic disorder and agoraphobia are assigned as separate diagnoses
- They can be comorbid or exist on their own