Psychopathology 6: Anxiety disorders
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| is necessary for survival Elicited when: -Realistic threat to self -Strong/novel or fearful stimuli Anxiety is good for us in moderate amounts Helps us plan for the future | ||
| Too little stress Right amount of stress Too much stress | ||
| Bored •Restless •Tired •Prone to illness | ||
| •Productive •Creative •Energetic •Healthy | ||
| Burned out •Overwhelmed •Exhausted •Prone to Illness | ||
| Physical: Cognitive: Behavioural: | ||
| Fight/flight response mediated by sympathetic nervous system -Physiological symptoms | ||
| -Biased attention, hypervigilance, biased interpretations, "threat" cognitions | ||
| Avoidance, escape, aggression | ||
| Duration «Intensity of anxiety «Appropriateness of response (true versus false alarms) «Interference and Distress | ||
| Panic disorder (with or without agoraphobia) Specific phobia Social phobia Obsessive-compulsive disorder Posttraumatic stress disorder Generalized anxiety disorder | ||
| Presence of recurrent, unexpected Panic Attacks -Persistent concern about having another attack -Behavioural change related to attacks (e.g., agoraphobia) -Frequency and severity vary widely -"Out of the blue" or situational trigger | ||
| 1.Palpitations, pounding heart, accelerated heart rate 2.Sweating 3.Trembling, shaking 4.Sensations of shortness of breath or smothering 5.Feelings of choking 6.Chest pain or discomfort 7.Nausea or abdominal distress 8.Feeling dizzy, unsteady, lightheaded, faint 9.Derealization, depersonalization 10.Fear of losing control or going crazy 11.Fear of dying 12.Numbness or tingling sensations 13.Chills or hot flushes | ||
| Discrete period, sudden onset -Feelings, intense apprehension, fearfulness, terror, impending doom -Physical symptoms, shortness of breath, palpitations, chest pain, choking -Cognitions, "going crazy", "losing control | ||
| Anxiety or avoidance of places or situations from which escape might be difficult, embarrassing -Anxiety or avoidance of places or situations in which help may not be available in the event of having a Panic Attack or panic-like symptoms -Leads to pervasive avoidance of variety of situations | ||
| 1.5% to 3.5% -Women:men, 3:1 | ||
| Variable, but typically late adolescence to mid-30s (may be bimodal) ¡VChronic, but waxing and waning ƒÜ6-10 yrs posttreatment, ¡V30% well, 40-50% improved but symptomatic, 20-30% same or worse | ||
| Panic is fear of certain bodily sensations and their consequences Bodily sensations arise from many normal sources Panic disorder people (automatically) interpret these normal sensations in catastrophic ways Faulty interpretations leads to anxiety and more symptoms Don't correct mistaken interpretations because of safety behaviours and avoidance | ||
| Severe physiological response, incl. shortness of breath, palpitations, chest pain, choking | ||
| Hypervigilant to danger and symptoms -Catastrophic appraisal of symptoms | ||
| Avoid places and situations, safety behaviours | ||
| Marked and persistent fear of social or performance situations in which embarrassment may occur .Exposure often leads to Panic Attack .Adolescents and adults may recognise fear as excessive or unreasonable, but children may not .Most often, situation is avoided, but may be endured with dread .Must interfere significantly with person.s life or cause clinical distress | ||
| -eating or drinking in public -speaking in public -writing in the presence of others -using public toilets -being in a social situation in which the individual may say foolish things | ||
| 3% to 13% (public speaking most common) -Community studies suggest more common in women; clinical samples suggest equal or more common in men | ||
| Onset in mid-teens, sometimes in early childhood -May or may not follow a stressful or humiliating experience -Frequently lifelong, severity may fluctuate with life stressors and demands | ||
| Have you ever: -Returned home to check you locked the door? -Avoided throwing things away just in case? -Avoided cracks in the footpath? -Had a lucky number? -Been unable to get a song out of your head? | ||
| Recurrent obsessions or compulsions -Severe enough to be time consuming (> 1 hr/day) -Person recognises obsessions/compulsions are excessive or unreasonable, try to resist -Obsessions/compulsions cause marked distress or impairment | ||
| Persistent ideas, thoughts, impulses or images experienced as intrusive and inappropriate -Contamination, repeated doubts, need for order, aggressive or horrific impulses, sexual imagery | ||
| Repetitive behaviours or mental acts to reduce distress of obsessions or prevent dreaded event or situation -Hand washing, ordering, checking, praying, counting, repeating words silently | ||
| 2.5% -Equally common in women and men; adults and children show similar features | ||
| Onset usually in adolescence or early adulthood, but may begin in childhood; males earlier onset -Onset usually gradual -Chronic waxing and waning course, with symptoms exacerbated by stress | ||
| Physiological reaction (anxiety, distress) to intrusive obsessions | ||
| Recurrent and persistent obsessions; unsuccessful attempts to ignore or suppress | ||
| Repetitive behaviours in response to obsessions or to prevent/reduce distress/feared situations | ||
| Every anxiety disorder is characterised by intense anxiety But whereas phobias are characterised by intense specific anxiety, this particular type is generalised to the events of everyday life WORRYING about everything! | ||
| Excessive anxiety and worry (apprehensive expectation) more days than not for a period of 6 months ¡VIntensity, duration, frequency of anxiety and worry far out of proportion to actual likelihood or impact of feared event ¡VDifficult to control the worry ¡VAlso experience at least 3 of: ƒÜRestlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, disturbed sleep | ||
| 1 yr prevalence 3%, lifetime 5%, 12% of those presenting to anxiety clinics -Clinical settings 60% women, community samples, 67% women | ||
| Onset reported in childhood or adolescence ("all my life"), onset also 20+ -Course is chronic but fluctuating, worsens with stress | ||
| perceived as controllable and less likely to be accompanied by physical symptoms | ||
| difficult to control, pervasive, pronounced, distressing, of longer duration, occur for no reason | ||
| Majority occurs during evening or night Duration varies greatly / unknown Frequency unknown Contains verbal thought (vs imagery) Egosyntonic Only about 50% report worry control | ||
| No differences in worry process between normal and pathological worriers (Borkovec, 1994) The worriers initiate the worry process more frequently -because they perceive more threat in the environment : biased threat perception -possibly as a result of early trauma -frequency contributes to sense of uncontrollability | ||
| Normal and pathological worry involves problem solving attempts (Davey, 1994) Normal worry has an adaptive coping function Problem solving attempts of these worriers are prevented by -increased need for evidence before making a decision, intolerance of uncertainty -possibly associated with biased threat perception -each .solution. brings about a new "problem" -perceived uncontrollability: duration? | ||
| Marked and persistent fear that is excessive or unreasonable «Exposure to the feared stimulus provokes an immediate anxiety response «Phobic situation is avoided or endured with distress Avoidance interferes with person.s life «Lasts at least 6 months | ||
| -Common: affect 8% of the adult population but very few present for treatment, most people develop lifestyles that allow them to continue to avoid. -Female/Male ratio is >2:1 -Very common in younger children and maybe residual of innate protective fears. Remit with age | ||
| -Fears and anxieties are learned (expectancy model): -High threat appraisal combined with low coping appraisal leads to activation of anxiety -Overactive behavioural inhibition system | ||
| -Biological vulnerability to anxiety in general -Children born with low threshold for novelty -Excessive parental control | ||
| -Currently the preferred drugs -Relapse occurs when drug is discontinued | ||
| Fast acting, but addictive -90% relapse rate -Affects cognitive and motor functioning | ||
| Cognitive restructuring: identify and challenge catastrophic misinterpretations -Behavioural experiments: test validity of expectancies -Exposure to feared stimuli: bodily sensations -Importance of reducing safety seeking behaviours |