Abnormal Psychology Chapter 6 Lesson 6

cognitive approaches to treatment of anxiety disorders:

1. focuses on a person's beliefs about the likelihood of negative outcomes if he or she faces an anxiety - provoking object or situation 2. The expectation that he or she will be unable to cope. Thus cognitive treatments typically involve exposure in order to help people learn that they can cope with these situations

List 2 reasons psychological treatment is a better option than medication for anxiety disorders.

1. the moment the patient stops taking the medications they shall relapse if they are not undergoing therapy. 2. the person may become dependent on their medication or go through withdrawal if they stop taking their medication. 3. medication has side - effects

lifetime prevalence of social anxiety disorder

13%

lifetime prevalence of specific phobia

14%

lifetime prevalence of agoraphobia

2.6%

Research suggests that genes can explain ___% of the variance in anxiety disorders other than panic disorder.

20-40%

what % of US adults have experienced symptoms of anxiety at some point in their life that met criteria for diagnosis of an anxiety disorder?

28%

lifetime prevalence of panic disorder

5.2%

lifetime prevalence of generalized anxiety disorder

6.2%

According to Borkovec and colleagues, worry Question 14 options: a) serves as an avoidance mechanism. b) is adaptive. c) increases psychophysiological signs of arousal. d) helps people remember traumatic images.

A

Edna does not currently have panic disorder. However, she cannot leave her house and had required home sessions when she began therapy. It is likely that Question 10 options: a) Edna has agoraphobia, but does not meet criteria for panic disorder. b) Edna does not have agoraphobia. c) Edna is faking her symptoms. d) Edna has more severe panic but is able to cope with the symptoms.

A

In vivo exposure to feared objects simulates Question 15 options: a) real life. b) memories of trauma. c) social anxiety disorder. d) anxiety developed in the womb.

A

NPSR1 gene

A gene that influences neurobiological and psychological risk factors for panic disorder. The presence of a polymorphism in a gene guiding neuropeptide S function, the NPSR1 gene, has been tied to an increased risk of panic disorder. In humans, this gene has been related to increased amygdala response to threat stimuli, larger cortisol response to a laboratory stressor, and higher anxiety sensitivity scores.

Neuroticism

A personality trait defined by the tendency to experience frequent or intense negative affect.

amygdala

A small, almond-shaped structure in the temporal lobe that appears to be involved in assigning emotional significance to stimuli.

behavioral inhibition

A tendency to become agitated and cry when faced with novel toys, people, or other stimuli. This behavior pattern may be inherited and may set the stage for later development of anxiety disorders. 45% of children showed symptoms of anxiety at 7.5 years old compared to only 15% of those who had shown low BI levels.

phobia

An excessive fear of a specific object or situation that causes distress or impairment

According to the text, which of the following is NOT a theory as to why women are more likely to develop anxiety disorders than men? Question 11 options: a) Women may show more biological reactivity to stress than men. b) Women tend to be more nervous than men in general. c) Men may be raised to believe more in personal control over situations. d) Men may experience more social pressure than women to face fears.

B

In terms of the social environment's role in the development of anxiety disorders, which of the following statements is true? Question 8 options: a) negative life events often buffer against the development of anxiety disorders. b) negative life events often precede the onset of anxiety disorders. c) negative life events are unrelated to the onset of anxiety disorders. d) none of the above. Save

B

Lola is low in neuroticism. Compared with people who have high levels of neuroticism, Lola Question 6 options: a) is more likely to experience anxiety and depression. b) is less likely to develop an anxiety disorder. c) is probably characterized by a tendency to react to events with negative effect. d) is more likely to have OCD. Save

B

etiology of specific phobias

Behavioral theory suggests that phobias could be conditioned by direct trauma, modeling, or verbal instruction. Risk factors; genetic vulnerability, neuroticism, negative cognition, and propensity toward fear conditioning, probably operate as a diatheses

what do anxiety and fear have in common?

Both involve arousal or the sympathetic nervous system. Fear is a higher version of anxiety. These trigger the fight or flight reactions.

Factors that may increase risk for more than one anxiety disorder include all of the following EXCEPT Question 13 options: a) behavioral conditioning. b) genetic vulnerability. c) culture of origin. d) neuroticism.

C

John is persistently and excessively afraid of snakes. Whenever he sees one, he feels intense anxiety and thus avoids snakes at all costs. John realizes, however, that this fear is unrealistic. John most likely has Question 4 options: a) obsessive-compulsive disorder. b) social anxiety disorder. c) specific phobia. d) panic disorder.

C

Laboratory studies, like the ones using the dot probe task, have provided evidence for the theory that Question 12 options: a) chronic anxiety creates negative cognitions. b) fixating on dots for long periods of time may create anxiety. c) the way we focus our attention can influence anxious mood. d) none of the above. Save

C

Social anxiety disorder generally begins during: Question 1 options: a) early childhood b) middle childhood c) adolescence d) early adulthood

C

Which of the following is NOT an anxiety disorder? Question 9 options: a) panic disorder b) phobic disorder c) generalized fear disorder d) posttraumatic stress disorder

C

An individual diagnosed with social anxiety disorder Question 5 options: a) exhibits paranoid symptoms, believing others are plotting to hurt him or her. b) exhibits anxiety about having panic attacks in public. c) is terrified of being in public places and may become housebound. d) becomes extremely anxious when in certain situations that involve activities done in the presence of other people.

D

As a group, anxiety disorders Question 3 options: a) are unlikely to be comorbid. b) are one of the least costly psychiatric disorders to society. c) cause little interpersonal problems. d) are the most common type of psychiatric diagnosis.

D

Which of the following might buffer someone against developing an anxiety disorder? Question 7 options: a) repeated early life experiences of having control. b) previous experiences of control during highly threatening circumstances. c) being controlled by an understanding parent. d) both a and b.

D

etiology of GAD

Evidence has been gathered that worry is actually reinforcing because it distracts people from more powerful negative emotions and images. By worrying, people with GAD may avoid emotions that are more unpleasant and powerful than worry, but as a consequence of this avoidance, their underlying anxiety about these images does not extinguish.

Prepared learning

Evolution may have 'prepared' our fear circuit to learn fear of certain stimuli very quickly and automatically. EX: monkeys can be conditioned to fear snakes and crocodiles but not flowers and rabbits.

What are the most common strategy used in CBT for anxiety disorders?

Exposure therapy sometimes supplemented with cognitive approaches.

GABA

Findings of PET research link anxiety disorders to disruptions in serotonin and GABA receptors. GABA is widely distributed throughout the brain and is believed to help inhibit anxiety.

Medial Prefrontal Cortex

Helps to regulate amygdala activity - it is involved in extinguishing fears and also appears to be engaged when people are regulating their emotions. Researchers have found that adults who meet diagnostic criteria for anxiety disorders display less activity in the medial prefrontal cortex when viewing and appraising threatening stimuli.

comorbidity in anxiety disorders

More than 1/2 the people with 1 anxiety disorder meet the criteria for another anxiety disorder during their life. 3/4 of people with an anxiety disorder meet the diagnostic criteria for 1 or more psychological disorders. 60% of people in treatment for anxiety disorders meet the diagnostic criteria for major depression. substance abuse is common personality disorders are common

Attention to threat

People with anxiety disorders pay more attention to negative cues in their environment than people without anxiety disorders. Ex: People with SAD attend to angry faces, people with snake phobias attend to cues related to snakes Once a threatening object captures their attention, anxious people have a difficult time pulling their attention away from that object; they tend to stay focused on a threatening object longer than others do.

Other neurotransmitters and their link to anxiety disorders

Researchers have also used drug manipulation studies to show that anxiety disorders are related to increased levels of epinephrine and changes in the sensitivity of norepinephrine receptors.

anxiety disorders and fear conditioning

Researchers have shown that people with anxiety disorders seem to acquire fears more readily through classical conditioning and show a slower extinction of fears once they are acquired.

what anti-depressants are used to treat anxiety disorders?

SSRIs, tricyclic antidepressants, SNRIs

fear of fear hypothesis

Suggests that agoraphobia is driven by negative thoughts about the consequences of experiencing anxiety in public. There is evidence that people with agoraphobia think the consequences of public anxiety would be horrible. They seem to have catastrophic beliefs that their anxiety will lead to socially unacceptable consequences.

locus coeruleus (etiology of panic disorder - neurobiological factors)

The major source of the neurotransmitter norepinephrine in the brain. Surges in Norepinephrine are a natural response to stress, and when these surges occur, they are associate with increased activity in the sympathetic nervous system, reflected in a faster heart rate and other psychophysiological responses that support the fight or flight response

Etiology of Social anxiety disorders: Behavioral factors; conditioning of SAD

The person could have a negative social experience, directly, through modeling, or verbal instruction, and become classically conditioned to fear similar situations. operant conditioning: the avoidance behavior is reinforced because it reduces the fear the person experiences. There are few opportunities for the conditioned fear to be extinguished because the person tends to avoid social situations, and when the person does interact they may show avoidant behaviors in other ways (safety behaviors - avoiding eye contact, disengaging from conversation, standing apart from others) People tend to disapprove of these behaviors which intensifies the problem

Anxiety Sensitivity Index

The propensity toward catastrophic interpretations can be detected before panic disorder develops. Many researchers have tested this idea using a scale called the Anxiety sensitivity index, which measures the extent to which people respond fearfully to their body sensations.

Positive bias

The way we focus our attention can foster an anxious mood, or improve our mood. Participants in the positive- bias training condition obtained lower anxiety scores on self-report and interview measures post-training; 50% of the people who received positive - bias training no longer met the diagnostic criteria for GAD. This type of training also has been shown to help reduce cortisol responses when people encounter daily stressors.

safety behaviors

To protect against feared consequences, people engage in safety behaviors. For example, people fearing they will die from a fast heart rate stop all physical activity the minute they feel their heart race.

Genetic factors and anxiety disorders

Twin studies suggest a heritablity of 20-40% for specific phobias, social anxiety disorder, and GAD, and about 50% for panic disorders

Gender and anxiety disorders.

Women are more vulnerable to anxiety disorders than men at a ratio of 2 to 1 Reasons: 1. women are more likely to report their symptoms 2. social factors such as gender roles are likely to play a part 3. Men may face more social pressure than women to face fears, the basis for most treatments. 4. women experience different life circumstances; sexual assualt etc, leading to a sense of lack of control

D-cycloserine (DCS)

a drug that enhances learning. Those treated with DCS while undergoing their exposure therapy were less afraid at the end of therapy than those who took a placebo. This learning - enhancement medication appears to bolster the effects of a psychotherapy based on conditioning principles.

depersonalization

a feeling of being outside one's body, a feeling of being robotic, lacking emotions.

derealization

a feeling of the world not being real; fears of losing control, of going crazy, or even of dying. people tend to report having an intense urge to flee whatever situations they are in when a panic attack occurs. Symptoms tend to come on very rapidly and reach a peak of intensity within 10 minutes

social anxiety disorder

a persistent, unrealistically intense fear of unfamiliar people or social scrutiny. exposure to the trigger leads to intense anxiety about being evaluated negatively. trigger situations are avoided or else endured with intense anxiety

fear

a reaction to immediate danger

fear circuit

a set of brain structures engaged when people feel anxious or fearful. Key components are the amygdala, the medial prefrontal cortex, and the hippocampus (and also the locus coeruleus, which is not discussed in this chapter)

panic attack

a sudden attack of intense apprehension, terror, and feelings of impending doom, accompanied by at least four other symptoms. physical symptoms can include shortness of breather, heart palpitations, nausea, upset stomach, chest pain, feelings of choking and smothering, dizziness, lightheadedness, faintness, sweating, chills, heat sensations, numbness or tingling sensations, and trembling.

serotonin - norepinephrine reuptake inhibitors SNRIs

a type of antidepressant used to treat anxiety disorders.

Panic control therapy (PCT)

a well-documented behavioral treatment approach that is based on the tendency of people with panic disorder to over react to bodily sensations. In PCT, the therapist uses exposure techniques - that is , he or she persuades the client to deliberately elicit the bodily sensations associated with panic. When the sensations of panic begin, the person experiences them under safe conditions. in addition, the person practices coping tactics for dealing with somatic symptoms

A key structure in the fear circuit is the

amygdala

agoraphobia

anxiety about being in places where escaping or getting help would be difficult if anxiety symptoms occurred (Greek agora means marketplace) disproportionate and marked fear or anxiety about at least two situations where it would be difficult to escape or receive help in the event of an incapacitation, embarrassing symptoms, or panic-like symptoms, such as being outside of the home alone. These situations consistently provoke fear or anxiety

panic disorder

anxiety about recurrent panic attacks that are unrelated to specific situations and worry about having more panic attacks. at least 1 month of concern or worry about the possibility of more attacks occurring or the consequences of an attack, or the maladaptive behavioral changes because of the attacks

anxiety

apprehension over an anticipated problem

what fraction of people with social anxiety disorder also meet the criteria for avoidant personality disorder?

at least 1/3

Cognitive factors found to correlate with anxiety disorders include:

attention to signs of threat lack of perceived control

What are anti-anxiety medications that more than 80 million prescriptions were written for in 2011?

benzodiazepines

Which of the following are valid treatment approaches to anxiety disorders?

benzodiazepines antidepressants exposure

After viewing tapes of monkeys apparently showing fear of snakes, lambs, and flowers, monkeys who viewed these tapes were only fearful of snakes. This provides only partial support for __________ but better support for __________. Question 2 options: a) modeling; classical conditioning b) vicarious learning; avoidance learning c) modeling; prepared learning d) prepared learning; diathesis

c

interoceptive conditioning

classical conditioning of panic attacks in response to bodily sensations has been called interoceptive conditioning: a person experiences somatic signs of anxiety, which are followed by the person's first panic attack; panic attacks then become a conditioned response to somatic changes According to this model, panic attacks develop when a person interprets bodily sensations as signs of impending doom. Pattern: panic attacks are often triggered by internal bodily sensations of arousal.

The first step in Mowrer's 2 - factor model includes ___ conditioning, and the second step involves ____ conditioning

classical, operant

how is agoraphobia treated?

cognitive behavioral treatments also focus on exposure, specifically, on systematic exposure to feared situations. The person may be coached gradually to tackle leaving home, driving a few miles, sitting in a theater for five minutes, then staying for the full duration of the movie in a crowded theater

What is a common comorbidity of social anxiety disorder?

depression and alcohol abuse.

anxiolytics

drugs that reduce anxiety. 2 common types of medications are most commonly used for anxiety disorders: benzodiazepines *valium, xanax*

When does social anxiety typically begin?

during adolescence when peer relationships become particularly important. sometimes does emerge during childhood. without treatment tends to be chronic.

how effective (%) is exposure treatment?

exposure treatment is effective for 70-90% of clients

What is the most effective psychological treatment for anxiety disorders?

exposure treatments

in vivo (real life) exposure

exposure treatments using virtual reality appear to provide substantial relief from anxiety disorders. Highly effective with phobias involving fear of animals, injections, or dental work.

specific phobia

fear of objects or situations that is out of proportion to any real danger. DSM: Marked and disproportionate fear consistently triggered by specific objects or situations. The object or situation is avoided or else endured with intense anxiety.

Factors that increase general risk for anxiety disorders

genetic vulnerability disturbances in the activity in the fear circuit of the brain behavioral conditioning decreased functioning of gama - aminobutyric acid (GABA) and serotonin; increased norepinephrine activity behavioral inhibition neuroticism cognitive factors, including sustained negative beliefs, perceived lack of control, and attention to cues of threat.

psychodynamic treatment for panic disorder

involves 24 sessions focused on identifying the emotions and meanings surrounding panic attacks. Therapists help clients gain insight into areas believed to relate to panic attacks, such as issues involving separation, anger, and autonomy.

how is anxiety helpful ?

it is adaptive in helping us notice and plan for future threats - that is, to increase our preparedness, to help people avoid potentially dangerous situations, and to think through potential problems before they happen.

what % of us people report experiencing a panic attack during their lifetime?

more than 25%

____ is a personality trait characterized by a tendency to experience frequent and intense negative affect

neuroticism

how is social anxiety differentiated from shyness?

people with social anxiety disorder avoid more social situations, feel more social discomfort, and experience symptoms for longer periods of their lifetime than do people who are shy.

Mowrer's 2 - factor model

published in 1947. 2 steps; 1. Through classical conditioning, a person learns to fear a neutral stimulus (the conditioned stimulus or CS) that is paired with an intrinsically aversive stimulus (The unconditioned stimulus or UCS) 2. A person gains relief by avoiding the CS. Through operant conditioning, this avoidant response is maintained because it is reinforcing (it reduces fear).

triggers

situations and activities that might elicit anxiety and fear.

Common types of specific phobias

snakes, insects, begins during childhood storms, heights, water - begins during childhood blood, injection, injury, medical procedures - runs in families public transportation, tunnels, bridges, elevators, flying, driving, closed spaces - begins in childhood or mid 20s choking, contracting an illness, loud sounds, clowns - misc

cognitive factors of anxiety disorders

sustained negative beliefs about the future perceived lack of control attention to threat

Comorbidities of GAD

tends to co-occur with other anxiety disorders. people with GAD are more likely to experience MDD than those with other anxiety disorders.

how is GAD treated?

the most widely used behavioral technique involves relaxation training to promote calmness. Involve relaxing muscle groups one by one or generating calming mental images. With practice, clients learn to relax rapidly.

exposure treatments

the person must face what he or she deems too terrifying to face.

worry

thinking about potential problems, often without settling on a solution

Etiology of Social anxiety disorders: cognitive factors

too much focus on negative self-evaluations. 1st - People with anxiety disorders appear to have unrealistically negative beliefs about the consequences of their social behaviors - they may believe others will reject them if they blush or pause while speaking. 2nd - they attend more to how they are doing in social situations and their own internal sensations than other people do. Instead of attending to their conversation partner, they are often thinking about how others might perceive them.

What can cause perceived lack of control?

traumatic events, punitive and restrictive parenting, or abuse.

Anxiety disorders as a group are the most common type of psychological disorder true or false

true

Which type of medication is preferred to treat anxiety disorders and why?

typically antidepressants are preferred over benzodiazepines. This is because people may experience severe withdrawal symptoms when they try to stop using benzodiazepines

Generalized anxiety disorder

uncontrollable worry. DSM: Excessive anxiety and worry at least 50% of days about a number of events or activities (family, health, finances, work, and school). The person finds it hard to control the worry. The anxiety and worry are associated with at least 3 (or 1 in children) of the following: restlessness or feeling keyed up or on edge easily fatigued difficulty concentrating or mind going blank irritability muscle tension sleep disturbance Typically begins in adolescence. Often chronic once deveoped