Anxiety Disorders

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Anxiety Disorders by Mind Map: Anxiety Disorders

1. Issues and Debates

1.1. Application to real life

1.1.1. Applied tension (Öst et al.)

1.1.2. Behavioural

1.2. Individual vs. Situational explanations

1.2.1. Individual Biomedical-genetic Cognitive

1.2.2. Situational Behavioural Psychoanalytic

1.3. Use of children in psychological research

1.3.1. Psychoanalytics

1.3.2. Behavioural

1.4. Reductionist vs. Holistic

1.4.1. Reductionist Behavioural Biomedical-genetic

1.4.2. Holistic Psychoanalytics Cognitive

1.5. Deterministic vs. Free will

1.5.1. Determinism Behavioural

1.5.2. Free will Cognitive

1.6. Cultural bias

1.6.1. Psychoanalytics

1.7. Nature vs. Nurture

1.7.1. Nature Biomedical-genetic

1.7.2. Nurture Behavioural Cognitive CBT (Öst and Westling) Systematic desensitization (Wolpe,1958)

1.8. Longitudinal research

1.8.1. Psychoanalytics

1.8.2. Applied tension (Öst et al.)

2. Characteristics

2.1. Key aspect

2.1.1. Threat posed is minor or non-existent Individuals perceive it as threatening Creates a pattern of frequent, persistent worry and apprehension

2.2. Symptoms

2.2.1. Restlessness Low concentration Individuals are preoccupied by their worries

2.2.2. Muscle tension

2.2.3. Feeling 'on edge'

2.3. Common features

2.3.1. Panic attacks Last minutes or even hours Frightening for both the individual and third-parties

2.4. Types

2.4.1. Phobias Response to a unique stimulus; specific Case study Kimya (female aged 39) - afraid of birds, avoiding paces which she could be exposed to birds and limits her social life Types and examples Agoraphobia - fear of public places Haemophobia - fear of blood Animal phobias Other specific phobias Measures Generalised Anxiety Disorder 7 (GAD-7) Blood-Injury Phobia Inventory (BIPI)

2.4.2. General Occurs in response to many different stimulus The individual's own way of processing things GAD (Generalised Anxiety Disorders) Not linked to certain situations

3. Explanations

3.1. Cognitive (Di Nardo et al., 1988)

3.1.1. Hypotheses Origin of phobia involves individual thought process Based in reasoning about what is harmful Perceive ambiguous stimuli as more threatening than other people Having negative self beliefs, not coping with exposed phobic stimulus

3.1.2. Aim Examine the origin of cynophobia, the fear of dogs Investigate whether particular unpleasant events, known as conditioning events, involving dogs were more common in cynophobes or non-cynophobes Compare fearful and non-fearful participants' expectation of physical harm and fear on encountering a dog

3.1.3. Sample Sample technique: Opportunity sampling Sample size: 37 Sample age: 18-21 Demographic: All female psychology students

3.1.4. Research Method Quasi/Natural Experiment Design: Independent Measures /Matched Pairs Data collecting technique Self-report and observation (behavioural test) Structured interview

3.1.5. Procedure 1. Describe frightening and fearful experience involving dogs 2. Expectation of fear or harm coming to them in such encounter 3. Estimating the likelihood associated with the expectation of such harm

3.1.6. Results 56% of fearful reported conditioning events (painful encounters with dogs) 66% non-fearful reported similar conditioning events (bites & scratches) 100% of fearful expected to experience fear/harm during an encounter of a dog

3.1.7. Conclusion Factors other than conditioning events affect whether or not painful experiences develop into dog phobia, such as the individua's own interpretation and rationalisation of events

3.2. Behavioural (Classical Conditioning, Watson & Raynor, 1920)

3.2.1. Suggestion Individual may develop phobia of harmless stimulus if it’s paired with a frightening stimulus

3.2.2. Sample Little Albert 11-month-old infant

3.2.3. Procedure Before conditioning Shown different stimuli Reacted normally without signs of fear Placed metal bar above and behind Albert’s head (Unconditioned stimulus) During conditioning Albert was shown the rat As his hand touched animal, researched made the US of loud noise Repeatedly paired loud noise with presentation of white rat over trials one week after

3.2.4. Results Albert showed fearful response to rat (crying, moving away) His fear generalized to other animals, like rabbit

3.2.5. Conclusion Feat could be learned through classical conditioning

3.3. Psychoanalytic (Freud, 1909)

3.3.1. Suggestion Anxiety and fear can result from impulses of the id, when denied or repressed

3.3.2. Sample Hans 5-year old Austrian boy Father is Freud’s friend Has phobia of horses and other symptoms illustrating Oedipus complex

3.3.3. History of phobia 1. Hans frequently played with himself which angered his mother 2. His mother threatened to cut his penis off He developed fear of castration 3. Around this time, Hans’ sister was born and he witnessed a horse falling down and dying in the street 4. Horse phobia emerged, specifically getting bitten by a white horse 5. Father denied chance of him getting into parents bed to be with his mom 6. Phobia messed as he reached age 5 Experienced two fantasies

3.3.4. Freud’s theory The object of fear, the horse, was Hans’ father White horses with black noseband is similar to father’s mustached look Anxiety he experienced was related to fear of castration and banishment from parents bed Oedipus comped came from the two fantasies, representing the dynamics of their three way relationship

3.4. Biomedical/genetic (Ost, 1992)

3.4.1. Hypotheses We are born prepared to fear certain objects There are particular stimuli in the environment posing a threat to survival Transmitted in our DNA through generations

3.4.2. Sample Experimental group 81 blood phobic 59 injection phobic Control group Diagnosed with different specific phobias (animal, dental and claustrophobia)

3.4.3. Procedure 1. A screening interview with a clinician Discussing the impact of the phobia had on their normal lives 2. Self-report questionnaire on the history and nature of their phobia Giving ratings to particular situations which may trigger fearful response 3. Behavioural test Blood-phobics Injection-phobics

3.4.4. Measures A score relating to the percentage of maximal performance Experimenter's rating of the patient's fainting behaviour (0-4 : no fainting-fainting) Self-rating of anxiety (0-10 : not at all to-extremely anxious) Questionnaire on their thoughts during the test Blood pressure and heart rate measurement Fainting associated with these phobias has been found to be related to changes in blood pressure and heart rate

3.4.5. Result 50% blood phobics and 27% injection phobics had one or more parents with same fear 21% blood phobics reported to have at least one sibling with same disorder 70% blood phobics and 56% injection phobics had a history of fainting when exposed to respective phobic stimuli Much higher than participants with other specific phobias Mean number of fainting instances Blood phobics: 10.8 Injection phobics: 7.7

3.4.6. Conclusion Seemed to be a strong genetic link for these phobias, more likely than other phobias to produce a strong physiological response (fainting)

4. Treatment and Management

4.1. Systematic desensitisation

4.1.1. Explanation Principles based within behavioural psychology: all behaviour is a conditioned response to stimuli in the environment, if it can be learnt then it can be unlearned

4.1.2. Wolpe (1958) Putting fearful feelings associated with a phobic stimulus directly in conflict with feelings of deep relaxation and calm Stages 1. Teaching patient relaxation techniques - muscle relaxation exercises, visualisation, anti-anxiety 2. Patient and therapist work together to create anxiety hierarchy (At each stage, they were assisted to remain calm and to be in a relaxed state with chosen technique, cannot move on until they report no anxiety) Fear and calm become incompatible so the fearful response to the stimuli is gradually unlearned and will no longer produce anxiety Introduced the idea of 'reciprocal inhibition': the impossibility of feeling two strong and opposing emotions simultaneously

4.1.3. Evidence (Agras, 1967) Agarophobia (Kimura et al., 1972) Fear of snakes

4.2. Applied tension

4.2.1. What is it? Applying tension to muscle, to increase blood pressure in certain areas Reducing instances of fainting and other unpleasant responses

4.2.2. Öst et al. (1989) Sample 30 patients from same hospital Healthy 18-60 years old 19F 11M Aim To establish which of any of these: applied tension, applied relaxation or any combination of the two, was the most effective treatment To see whether applied tension could produce quicker improvements for phobic patients Procedure Session 1. Self-report 2. Behavioral and physiological measures 3. Applied tension technique 4. Practiced this technique during exposure to several situations involving blood 5. Given same set of measures after completing and six months to see changes Results 73% of all groups showed noticeable improvements in their behavioral and physiological responses to blood Conclusion Applied tension is the most appropriate treatment choice for blood phobia

4.3. Cognitive Behavioural Therapy (CBT)

4.3.1. Öst and Westling, 1995 Aim To compare the effectiveness of CBT with applied relaxation in the treatment of individuals with panic disorder Sample 38 patients Treated individually across 12 weekly sessions Assessed before, after and in one-year follow up Measure Self-report Self observation Procedure 1. Identifying misinterpretations of bodily sensations 2. Envisaged to generate alternative, non-catastrophic interpretations of their bodily sensations 3. Challenging patient’s evidence for their beliefs, using behavioral experiments to induce misinterpreted sensations 4. (Applied relaxation group) teaching progressive muscle relaxation techniques to practice in both panic and non panic-inducing situations Results No significant difference between group of applied relaxation and CBT No relapses in either group at follow up Conclusion Both methods were successful in short to medium term alleviation of panic attack symptoms