Anxiety Disorders
What is the role of the amygdala is anxiety
"fight - flight - freeze" response Plays central role in anxiety disorders Part of the limbic system that warns us of danger
What are the neurophysiological factors associated with anxiety? What are some brain areas identified in Anxiety Disorders and OCD
-thalamus-amygdala circuit Early traumatic experience changes the way the brain develops = the amygdala becomes hyperactive; makes individual unable to learn well and cope well In OCD: caudate nucleus/orbital prefrontal cortex/anterior cingulate cortex Caudate involved in physiological responses Cingulate involved in emotion and is connected to the amygdala If the amygdala is removed one experiences Kluver-Bucy Syndrome
How can anxiety be beneficial ? What is the normal function of anxiety?
A certain amount of anxiety, however, is normal and serves to improve performance, focus energy, motivate, prioritize tasks Anxiety also rouses you to action, it gears you up to face a threatening situation by activating the fight-flight response
What are panic attacks? How are they described
A panic attack is a sudden surge of overwhelming and high intensity anxiety and fear. May occur out of the blue or can be triggered by a specific situation- tests, public speaking etc. Usually results in increased heart beat, pupil dilation, difficulty breathing and in extreme cases Depersonalization-don't know where or who you are
Epidemiology Age?
Lower prevalence in the elderly As one gets older the anxiety one experiences decreases
What are some physiological reactions associated with fear and anxiety?
Activation of the fight-flight response Heart-rate increased Pupils dilate
Describe relaxation training
Activity that helps a person to relax and reduce levels of anxiety Often involves meditation and training the brain how to relax Can be done through slow breathing, Isometric relaxation
What is the role of the hippocampus in anxiety
Also part of limbic system that encodes information Anxiety/phobias are generated by memories of painful experiences
Anxiety Disorders are considered to be a group of disorders- not just one disorder but they are all similar with slightly different manifestations.
Anxiety Disorders are considered to be a group of disorders- not just one disorder but they are all similar with slightly different manifestations.
When does anxiety become maladaptive
Anxiety becomes a problem when the anxiety and fear is too much and persistent, causing distress and it interferes with daily life Anxiety becomes pathological when it is heightened for extended periods
What are anxiety disorders usually comorbid with?
Anxiety disorders are frequently comorbid- with mood disorders such as depression - Anxiety and depression frequently occur together most of the time suggesting a biological component may be involved comorbid- the presence of one or more additional diseases or disorders co-occurring with a primary disease or disorder;
Compare and contrast anxiety and fear. How is anxiety different from fear?
Anxiety is different from fear Fear is a basic emotion that involves activation of the "fight-or-flight" response when there is a direct threat or a real perceived threat Fear, is a similar state to anxiety, both psychologically and physiologically. Anxiety is a general feeling of apprehension about possible danger- feeling threatened either directly or indirectly (can be real or imagined) ** Some people have anxiety about things that are a perceived to be a direct threat but are not really a direct threat Example phobias
What are some symptoms associated with panic attacks
At least 4 of 13 symptoms: Palpitations sweating trembling/shaking shortness of breath/smothering feelings of choking chest pain/discomfort nausea feeling dizzy/light-headed derealization or depersonalization fear of losing control/going crazy fear of dying tingling/numbness of extremities chills/hot flushes
How is systematic desensitization described? Provide an example
Behavioral technique commonly used to treat fear, anxiety disorders and phobias. Using this method, the person is engaged in some type of relaxation exercise and is exposed to a series of increasingly frightening scenes/stimuli Example- In treating a phobia of snakes Whilst engaging in a relaxation exercise - Asked to imagine a snake -Asked to hold a photo of a snake -Then presented with a toy snake -Presented with a real snake
How is the nervous system implicated in anxiety disorders
Brain alters the body's physiology by activating the Autonomic Nervous System -ANS is control automatic body functions also regulates metabolism and homeostasis Neurons from ANS proceed to smooth muscle cells - heart, sweat glands etc. Two divisions of ANS: sympathetic and parasympathetic
How are social phobias/social anxiety disorders normally treated
CBT - restructure negative thoughts CBT for social anxiety disorder may include exposure therapy which involves direct or imagined controlled exposure to objects or situations that cause anxiety.
Generalized Anxiety Disorders How is GAD normally treated
Can be treated using medication (short-term treatment) that target the GABA system or psychological intervention (long-term treatment) Problem with medication - addiction, persons develop tolerance and need a higher dosage of the drug to achieve the same effect CBT - cognitive restructuring, relaxation
What are the different components of Anxiety Disorders- Test Question
Cognitive ( Most common and measurable component of an anxiety disorder) Physiological (somatic) Behavioral
Cognitive Behavioural Therapy (CBT) Provide an example
Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. o Works just as well as medications but the process is more expensive and lengthy is involves two main components: Cognitive therapy examines how negative thoughts, or cognitions, contribute to anxiety. Behavior therapy examines how you behave and react in situations that trigger anxiety The basic premise of cognitive behavioral therapy is that our thoughts—not external events—affect the way we feel. Thought #1: The party sounds like a lot of fun. I love going out and meeting new people! Emotions: Happy, excited Thought #2: Parties aren't my thing. I'd much rather stay in and watch a movie. Emotions: Neutral Thought #3: I never know what to say or do at parties. I'll make a fool of myself if I go. Example- example, imagine that you've just been invited to a big party. Consider three different ways of thinking about the invitation, and how those thoughts would affect your emotions.
What is the treatment for PTSD
Difficult to diagnose because it is hard to discover PTSD as most persons suppress memories It is also difficult to treat it is the leading anxiety disorder that is resistant to treatment
How are panic attacjks treated ?
Difficult to treat once it has started because the individual is not responding psychologically and persons may be unresponsive Drugs that treat anxiety don't work well with panic attacks
Provide a difference between fears and phobias using an example- Test Question
Example- An individual has a phobia of spiders may refuse to come out at night because they cannot see where they are- this is clearly an excessive and unrealistic response to an object which poses little or no actual danger However, Fear of someone chasing you with a knife is rational and adaptive as it activates the flight or fight response allowing one to protect themselves
Provide an example of a specific phobia
Example-Fear of flying Persons think "This plane will crash." "We are all going to die." Because of such a phobia, persons often avoid air travel
What are some symptoms associated with anxiety?
Excessive Worry uncontrollable sequence of negative thoughts of danger pathological worry- high quantity and negative, unrealistic content (irrational) causes impairment and marked distress
How can one train the autonomic nervous system to remain calm
Exercise Sleep Music meditation breathing exercises
Why is anxiety described as innate
anxiety is seen cross-culturally present in birth however decreases as one gets older
What is the role of the amygdala is it relates to anxiety?- Test Question
Fear and anxiety are generated in the amygdala Anxiety and panic attacks occur when environmental or emotional stressors (perceived or real) convince your amygdala that you are in danger resulting in activation of the fight-flight system Activation of the amygdala results in increased activation of the frontal lobe characterized by excessive thinking Early traumatic experience changes the way the brain develops = the amygdala becomes hyperactive; makes individual unable to learn well and cope well When the amygdala is lesioned in primates - they no longer experience fear and anxiety
What is the difference between fear and phobia- Test Question
Fear is a basic, adaptive emotion that involves activation of the "fight-or-flight" response accompanied by physiological changes when there is a direct or immediate threat Phobias however are characterized by persistent, excessive and unrealistic/irrational (with awareness) fear towards a perceived threat or specific objects or situations that pose little to no danger
Interventions and Treatment What are 4 types of behavioral therapy used to treat anxiety disorders-Test Q
Flooding Implosion Therapy/Exposure and response prevention Systematic Desensitization Modelling
How is flooding described? Provide an example
Flooding is a therapeutic technique in which the client is exposed to the source of the phobia at full intensity for a particular amount of time. Example-placing the patient in a room filled with spiders
What is one neurotransmitter involved in anxiety- Test Question
GABA an inhibitory neurotransmitter is often associated with anxiety disorders Anxiety is caused when there is insufficient/low GABA levels (inhibitory neurotransmitter) As a result, thoughts and actions associated with anxiety become excessive due to lack of inhibition receptors for GABA are the targets for medications used to relieve short-term anxiety symptoms, the benzodiazepines.
What are the categories of anxiety disorders listed in the DSM-V
Generalized Anxiety Disorder Phobias Panic Attack Panic Disorder and Agoraphobia Specific Phobias Social Anxiety Disorder OCD, PTSD, and ASD are no longer under anxiety disorders
Which two disorders are genetic factors identified in?
Generalized Anxiety Disorder (most common forms of anxiety disorders-can be intense or not very intense -feel anxious all the time) Major Depression
What are some things associated with maladaptive anxiety
High levels of anxiety diffuse negative emotion Sense of uncontrollability Shift in attention to state of self-preoccupation
How is Implosion Therapy/Exposure and response prevention described? Provide an example
Implosion is a therapeutic technique in which clients imagine and re-live aversive scenes associated with their anxiety in an attempt to develop more appropriate responses to similar situations in the future. Example- Asking an individual to imagine giving a speech in front a huge crowd
How are panic disorders treated
Medications - SSRIs, benzodiazepines CBT Address the avoidance of internal and external cues using behavioural and cognitive techniques
How do Stressful /dangerous life events contribute to anxiety disorders
Minor stresses added up can lead to significant anxiety Temporal and spatial component to stress •Significant stress over a long period of time •Lots of little stresses that accumulate
What is modelling
Modelling- the client learns new skills by imitating another person, Often watch persons in the presence of the phobic stimulus who are responding with relaxation rather than fear Example- an individual holding a spider
How are specific phobias often treated
Not well treated with drugs- psychological interventions more helpful Treatment exposure based therapies are most effective also CBT -Reconditioning person to associate stimuli with something pleasant versus unpleasant Challenge one's expectations and increase one's sense of control and self-efficacy
What are the two most common phobias
Number 1 irrational fear- public speaking,(usually comfortable speaking in front 3 or less persons) Number 2- I'm getting older- I'm going to die
OCD- No longer listed as an anxiety disorder -has it's own section in the DSM-V How is OCD described
Obsessive Compulsive Disorder (OCD) is characterized by repetitive thoughts, images, impulses (obsessions) that cause a significant amount of anxiety or discomfort. The individual tries to reduce anxiety and discomfort associated with the obsessions by engaging in repetitive, ritualistic behaviors and mental acts (compulsions). basal ganglia
What brain areas are activated in an individual suffering from social anxiety
PET image (uses radiation) The anxiety is focused in the frontal lobes (midline).
Generalized Anxiety Disorders How is GAD described?
Persistent, excessive and uncontrollable worry for minor things But people with GAD are extremely worried about health, money, or family problems etc., even when there is little or no reason to worry about them. Most common anxiety disorder
What is social phobia/social anxiety disorder? What it is it often characterized by
Persistent, irrational fears linked generally to the presence of other people, social situations, performance anxiety and interpersonal interactions Rotted in fear of negative evaluations-"I'll look anxious and stupid." "People will think I'm weird." Usually starts in childhood- not exposed to other people, anxious about interacting with other persons- some psychologists believe home-schooling not a good idea
PTSD- Trauma- and Stressor-Related Disorders under DSM-V How is PTSD described
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after experiencing or witnessing a traumatic event- persons often fearful that what they experienced will happen again he thoughts or memories of the traumatic experience are often triggers
What is the most common traumatic event causing PTSD
Sexual assault 1/3 chance that men and women will be assaulted
Epidemiology Cross-cultural studies?
Similar prevalence rates suggesting genetic/biological component) but Different symptom patterns Different causes/triggers cross-culturally
Etiology What are some possible factors that contribute to anxiety disorders
Social factors Biological factors Neuroanatomy/neurophysiological
Social Pain vs Real Pain
Social pain is real pain. It activates the same areas of the brain as for real pain. The brain cannot distinguish the different types of pain.
What are some social factors that may contribute to anxiety disorders
Stressful (dangerous) life events Childhood abuse/neglect -Physical or psychological abuse Insecure attachment
What brain areas are implicated in anxiety disorders
The perception of threatening stimuli is registered in the frontal lobes of the brain after limbic system processing. -since those with frontal lesions often don't experience anxiety amygdala is important in adding emotional significance to stimuli-humans with amygdalae lesions often don't understand which stimuli are anxiety provoking
How is OCD normally treated
Treatment: CBT - exposure and response prevention Cognitive restructuring
How does attachment style contribute to anxiety disorders?
Unable to form social attachments it can lead to a number of different psychopathologies Research shows that we all require attachments (friends, family etc.) to other humans, if we are unable to do so it can lead to psychopathology insecure attachment patterns may elevate the risk for the development of anxiety symptoms
How is anxiety described
Unpleasant emotional state ranging from mild unease to intense fear- referred to as a negative emotion
What are the behavioral components of anxiety? Provide an example
actions we take when we become anxious or what behaviors can be seen in the individual who is experiencing fear or anxiety Example-avoidance of air travel, avoidance of social gatherings, deep-breathing Behavior can be controlled and misinterpreted therefore not a good measure
Anti-anxiety medications What are some anti-anxiety medications that are commonly used
benzodiazapines (Valium, Xanax) often target GABA system serious side effect: addiction Advantages- works quickly and less expensive CBT and Medication together seem to be the most effective
What are the cognitive components of anxiety ? Provide an example
characterized by excessive, irrational thoughts and worries Example-"I'll look anxious and stupid.", "This plane will crash." Usually ask persons to rate how anxious they feel on a scale of 1-10 Most common and measurable component of an anxiety disorder Convenient- all you need to do is ask the patient how he/she feels
What brain areas are activated during a panic attack
fMRI shows activation of limbic and basal ganglionic structures in a patient suffering a panic attack.
What is agoraphobia
fear of public spaces Can accompany panic disorder
Epidemiology Gender?
higher prevalence in females biological component- If immediate relative suffers from an anxiety disorder there is a strong likelihood one will experience an anxiety disorder as well
What are the physiological/somatic components of anxiety ? Provide an example
involves physical symptoms and sensations one experiences and natural changes that take place in the body in response to the perception of some sort of danger. Example-increased heart rate, increased breathing, sweating etc. Not reliable- many emotions have the same physiological component
How common are anxiety disorders
most common psychopathologies- most common form of abnormal disorders 25-30% of population have experienced an anxiety disorder Stress is one of the main triggers
Antidepressant medications? Which is preferred
o Anxiety and depression often comorbid o SSRIs (Prozac, Zoloft, Paxil) preferred o Tricyclics OK but serious side effects o Clomipramine for OCD
What are some other types of treatments and interventions
relaxation training - breathing/meditation CBT anti-anxiety medications Antidepressant medications
How do Biological factors contribute to anxiety disorders?
strong genetic component based on family and twin studies If immediate relative suffers from an anxiety disorder there is a strong likelihood one will experience an anxiety disorder as well
What are the common themes associated with OCD? What are the common compulsions
themes of sex, violence, contamination hand-washing, checking, counting
Specific Phobias How are specific phobias described- Test Question
persistent, excessive and unrealistic fear of a specific object/situation that that usually poses little or no actual danger Fears are usually unrealistic (with awareness) and often cause significant life impairments and avoidance behaviors
What are some concerns associated with flooding as a technique
problem with this - unethical - replacing phobia with trauma Used commonly in OCD especially if related to cleanliness - works well with OCD
How are panic disorders described
recurrent unexpected panic attacks, persistent concern about additional attacks Most individuals with panic disorders develop agoraphobia