fear and anxiety

Fear: emotional response to a real or perceived imminent threat

• Surges of physical response: flight or fight
  Anxiety: Anticipation of a future threat
• Conceptually different
• Muscle tension and vigilance
• avoidance behaviors
• 

Anxiety Disorders

• Most common mental health condition in the U.S.
  • 22% women 14% men
• Differ in types of objects or sutiations that induce fear, anciety, or avoidance behavior, and the associated cognitive ideation
• Tend to be highly comorbid with one another
  • CoMorbid
  • denoting or relating to diseases or medical conditions that are simultaneously present in a patient.
  • You can have more than 1 anxiety disorder
• Many develop in childhood and tend to persist if not treated
• Most occur more frequently in females than in males (approx. 2:1 ratio)
• Symptoms persist for 6 months or more, we start looking at it as more of a disorder, rather than phase in life
• Prevalence and Lifetime Morbidity Risk of Anxiety Disorders in the United States
  • 
• Ruling out medical or physical causes of anci4ty symptoms is important
  • Medication side effects
  • Excessive caffeine intake
  • Hyperthyroidism
  • Cardiac arrhythmias
  • Withdrawal from alcohol
    • Any substance use lmao
    • People self medicate, which leads to more anxiety

Biological Dimension

Fear Circuitry in the Brain

• Centered in the amygdala, interacting with Prefrontal cortext and Hippocampus

Amygdala

Plays a central role in triggering state of fear or anxiety

• HPA activity triggers “fight-or-flight” response and in some cases a
  “freeze” response
• Primitive survival responses may take over and interfere with rational
  thinking
• starts the emotional ball rolling, what strats it

Sensory signals travel to hippocampus and prefrontal cortex

• Prefrontal cortex is slower, but is better at thinking things through
  • Disables when in fear
• Process sensory input and evaluate danger
• Higher-level mental processing may result in signals to stop the HPA response
• Some studies have linked anxiety and fear with a reduction in GABA activity
• Neuroimaging techniques suggest that certain medications and certain therapies produce a reduction in limbic activity
  • PET scans n stuff
  • compares both anxiety people and non anxiety people, seeing how brains respond
  • found overactivity in anxiety people
  • Insufficent neurotransmitters
  • Meds decrease oversensisitivty than therapy gets rid of thoughts

Genetic Influences

Serotonin

• Research focused on variation in serotonin transporter gene, 5-HTTLPR
• Result: short alleles of the 5-HTTLPR gene are associated with a reduction in serotonin activity and increased anxiety-related behaviors
• Anxiety can run in families
• Stressful environments help develop anxiety disorders

Numerous genes affect vulnerability

• Only influence an individual's predispositon

Psychological Dimension

• Psychological characteristics can interact with biological predispositions and produce anxiety symptoms
  • Drinking way too much, then next day feeling anxious.
  • Too much caffeine
• Anxiety sensitivity
  • Common in those with disorders
• Negative appraisal
  • Interpreting events as threatening
  • Neutral situations can be interpreted negatively
• Skill of reappraisal
  • Can evaluate other options, they can step back
• A sense of self-control and mastery also appears to reduce susceptibility to anxiety in humans
  • Confidents that we can control ourselves and our actions can help reduce anxiety

Social and Sociocultural Dimensions

Daily environmental stress can produce anxiety

• People with biological or psychological vulnerabilities are most likely to be affected
• Predisposition and lack of psychological dimension skills
• Limited social support can cause anxiety

Factors

• Poverty, traumatic events, adverse working conditions, and limited social support
• Emergence of the COVID-19 illness significantly increased anxiety throughout the world

Gender plays a role in the development of anxiety disorders

• Women more frequently experience anxiety disorders compared to men

Culture can influence how anxiety is expressed

• Exposure to discrimination and prejudice can increase anxiety
• Internalized racism has been linked to increases in anxiety symptoms
• Acculturation conflicts also contribute to anxiety disorders
• In Western countries social anxiety involves fear of embarrassing oneself
• In some Asian countries social anxiety involves worries about being offensive to others

Phobias

Strong, persistent, unwarranted fear of a specific object or situation

• Extreme anxiety or panic is expressed when phobic stimulus is encountered
• Most adults recognize fear is excessive, but children may not
• Most common mental disorder in the United States

Categories of phobias

• social anxiety disorder
• specific phobias
• agoraphobia

Social Anxiety Disorder

• Intense fear of being scrutinized or doing something embarrassing or humiliating in the presence of others
• Women twice as likely as men to have social anxiety disorder
• Can be chronic and disabling
• Often comorbid with major depressive disorder, substance-use disorders, and suicidal thoughts or attempts
  • Someone may be scared of eating infront of others
• This is the person who would drop out of school because they cannot do a presentation
• Very irrational thinking
• Cognitive process: being evaluated by others, judged

Specific Phobia

Extreme fear of a specific object or situation

• Exposure to stimulus nearly always produces intense anxiety or panic attack
• Immediate, dont need cognitive thought process
  • Someone afraid of snakes doesnt think "im afraid of that snake" it is purely an irrational fear
• Common for one to have more than one specific phobia
  • Average of 3 fears
• 75% have more than one phobia

Primary Types

• Living creatures (example: spiders)
• Environmental conditions (example: heights)
• Blood/injection or injury (example: needles)
• Situational factors (example: flying)

Agoraphobia

• Intense fear of at least two of the following:
  • Being outside of the home alone
  • Traveling via public transportation
  • Being in open spaces
  • Being in stores or theatres
  • Standing in line or being in a crowd
• Situations are feared because escape or help may not be readily available
• In some cases, people refuse to leave their homes due to concern they might have a panic attack
• Older adults might fall
• Always cause panic, so they avoid or go with companion

Social Dimension

• Parental behaviors influence development of social anxiety in children
  • Over protection
  • Lack of support for independence/ learning how to be independent
• Negative family interaction patterns and family stress
  • Associated with social anxiety in middle childhood
  • Punitive maternal parenting style
• Victimization by peers during childhood
  • Ongoing ostracism and bullying maintain and exacerbate social anxiety symptoms
  • Kids can have intense fear of going to school

Sociocultural Dimension

• Women and girls are more likely to have phobias
  • Some objects of phobia trigger both fear and disgust responses
  • Disgust response stronger in females
• Gender differences may be due to a combination of biological and temperamental factors
  • Social norms and socialization experiences
  • There are fewer gender differences for ear of bodily injury and enclosed spaces
• Sad is more common in collectivistic cultures
  • Individual behaviors seen to reflect on entire family or group
  • Use of shame as a method of parental control
  • Discrepancies between traditional cultural behavioral norms and mainstream culture
• Other Cultural Factors
• A strong sense of personal responsibility for social behaviors
• A perceived need to follow a set of rigid moral codes and rituals
• The threat of being ostracized for deviations from social norms
• Prejudice and discrimination from the mainstream culture

Biological Treatment of Phobias

Medications with efficacy for SAD

• SSRI (antidepressants)
• Often prescribed for chronic forms of anxiety
• SNRIs and MAOIs
• Beta-blockers
• Benzodiazepines increase GABA activity
  • Examples: Ativan, Xanax, Valium
    • Can produce dependence
    • Cognitive deterioration or fall-related injury in older adults

Cognitive-Behavioral Treatments

• Exposure Therapy
  • Systematic desensitization
    • Imagine situation
  • Flooding
    • Repeatedly placed in feared situation
    • No relaxation
    • Gradual buildup or just thrown in the depend
  • Modeling
    • Individual watches another confront object or situation
  • Gradual introduction to the feared situation
  • Applied tension
  • Smartphone apps and virtual reality therapy
• Cognitive Restructuring
  • Identifying and changing irrational thoughts
  • Therapist challenges false thoughts, "Is that really whats happeing?"
• Systematic desensitization
  • Exposure techniques with relaxation
• Modeling therapy
  • Viewing another person’s successful interactions with the subject of the phobia

Panic Disorder

Panic Attacks

• Prominent feature of anxiety disorders as type of fear response, but is also in other mental disorders
• Quick, Immiediate, physical, reaches peak fast
• Can be expected
• Recurrent, unexpected panic attacks
  • Combined with apprehension about having another attack or behavior changes designed to avoid having another
  • Reactions present for 1 month or more to be considered disorder
• Most diagnosed with Panic Disorder also have Agoraphobia
• Cultural variations in how symptoms are expressed
  • Caucasians generally report cardiac and respiratory symptoms
  • Cambodian refugees may have somatic symptoms
  • African Americans may experience numbing sensations in their extremities and fears of dying
  • Indigenous/American Indians may report a pounding heart, dizziness, and altered perceptions of time
• Past-year prevalence rate in the United States is 2.7 percent
  • Twice as common in women as in men

Psychological Dimension

• Individuals show heightened fear responses to bodily sensations
• Cognitive-Behavorial perspective
  • Unpleasant bodily sensations are misinterpreted
  • Inaccurate cognitions and symptoms create a feedback loop that increases anxiety
  • A decrease in panic-related cognitions and anxiety sensitivity is associated with a subsequent reduction in panic symptoms

Role of Cognitions in Panic Attacks

Biological Treatment of Panic Disorders

SSRI Antidepressants
Tricyclic antidepressants
Benzodiazepines (risk of dependency)

• 45% of people dont respond to medication

Cognitive-Behavioral Treatment of Panic Disorder

• Educating the client about panic disorder
• Identifying and correcting catastrophic thinking
• Teaching client to self-induce physiological symptoms in order to extinguish the conditioning
• Encouraging client to face the symptoms
• Reviewing the skills acquired and making a plan to prevent relapse

Generalized Anxiety Disorder (GAD)

Persistent, high levels of anxiety and excessive, difficult-to-control worry over life circumstances
- Work, school, interpersonal relaitonships
- Sooo difficuilt to stop worrying

• DSM-5 diagnostic criteria
  • Symptoms must be present on the majority of days for 6 months
  • Causes significant impairment in life activities
• About 2.7 percent of the U.S. adult population is affected
  • Lifetime prevalence among adolescents is 2.2 percent
  • Women and girls are nearly twice as likely to receive this diagnosis compared to men and boys

Treatment of GAD

• Drug Therapy
  • Benzodiazepines—Issues with dependence
  • Antidepressants—Lower less risk of dependence
• Cognitive-behavorial therapy
  • Effective psychological treatment
  • Mindfulness practice
    • very important, teach relax

Obsessive-Compulsive and Related Disorders

• More common in boys as children
• More common in women and girls in adolescents and adulthood
  Obsession:
• consistent, anxiety producing thoughts or images
  Compulsion:
• overwhelming need to engage in activities or mental acts to counteract anxiety or prevent occurrence of dreaded event
• In response to obsession

Hoarding Disorder

• Inability to discard items regardless of their value
• Perceived need for items and distress over the thought of giving or throwing them away
• An accumulation of items that produces congestion and clutter
• More common among women and in older adults

Other Types of OCD-Related Disorders

Body dysmorphic disorder

• Preoccupation with a perceived physical defect, repetitive behaviors, and distress or impairment in life activities
• Up to 60 percent of individuals with BDD undergo unnecessary cosmetic surgeries
• Muscle dysmorphia
  Trichotillomania
• Hair ripping
• Despite trying to stop, pull and rub their hair
  Excoriation
• mental health condition where you compulsively pick at your skin

OCD vs TIC Disorder

Compulsion = ritualized, overt, or covert behaviors
OCD = Compulsions (thoughts or actions) may be performed to neutralize obsessions or reduce distress/anxiety
Tic = sudden, repetitive, stereotyped motor movements or phonic productions that are often perceived as involuntary but that are sometimes accompanied by premonitory sensory urges

• occur in bouts, vary in intensity, and wax and wane in severity

Suicidal Obsession

Suicidal ideation = range of contemplations, wishes, and preoccupations with death and suicide

• Other things along with this, lke depressive and sad mood
  Suicidal Obsession (Self-Harm OCD) = intrusive thoughts about losing control and committing suicide
• Part of OCD, persons thoughts are incongruent with mood. (Dont want to kill self but think bout it)

Etiology of Obsessive-Compulsive and Related Disorders

• Heredity is involved
• Non-shared environmental influences are equally important
• Endophenotype (bio or psych phenomenon of disorder) characteristics for OCD
  • Impairment in:
    • Decision making, planning, and mental flexibility
    • Associated with less volume in certain regions of the prefrontal cortex (Parietal lobe)
    • Dysregulation of the orbitofrontal-caudate circuit (orbitofrontal-striatal circuit)

Psychological Dimension of OCD

• Behavioral Perspective
  • Obsessive-compulsive behaviors develop because they reduce anxiety
• Cognitive Characteristics
  • Exaggerated estimates of probability of harm
  • Control
  • Intolerance of uncertainty
  • Thought fusion
  • Disconfirmatory bias
  • thinking about bad act is just as bad as doing it

Social and Sociocultural Dimensions

Family variables

• Controlling, overly critical parenting styles
• Low parental warmth
• Discouragement of autonomy
• Overprotective parents with rigid rules
• Perceiving relatives to be critical or hostile can increase symptom severity
• On rare occasions, living with a partner or family member with OCD can produce a shared psychopathology

Treatment of Obsessive-Compulsive and Related Disorders

Biological Treatments

• SSRI
• Deep Brain Stimulation

Behavorial Treatments

• Exposure therapy
  • Gradual exposure or flooding
  • Response preventiony

Cognitive behavioral treatments appear to induce neuroplasticity that results in more functional connectivity