Anxiety Disorders: Aetiology & Treatment PDF

[Anxiety Disorders: Aetiology & Treatment] [Fear] Is a **response** to an **immediate threat**. It is a basic emotion associated with a **reaction** to a threat that is **useful for mobilising quick and adaptive reactions** to threatening situations (**Ekman, 1992**). [Anxiety] Is the **apprehen...

[Anxiety Disorders: Aetiology & Treatment] [Fear] Is a **response** to an **immediate threat**. It is a basic emotion associated with a **reaction** to a threat that is **useful for mobilising quick and adaptive reactions** to threatening situations (**Ekman, 1992**). [Anxiety] Is the **apprehension** about a **future** **threat**, conceptualised as a future-focused **cognitive association** that **connects basic emotions** (fear) to **events**, meanings and responses. These are less "hardwired" than basic emotions, therefore, **vary** widely depending on the **individual** and **situation**. Both are **adaptive** responses to **threat** and are useful. **Anxiety increases preparedness** as shown in **Yerkes & Dodson** (1908) "**inverted U curve**". **Fear** triggers the **"Fight or Flight response"** which aids survival. However, if these emotions become **maladaptive** (excessive intensity, frequency or duration), they may develop into emotional or **anxiety disorders** (**Barlow, 2002**). [The Cycle of Anxiety] A diagram of a mental health situation Description automatically generated Cognitive thoughts about the anxiety-provoking situation leads to an emotional response of fear, causing a physiological reaction leading to avoidance. Eventually the cycle repeats. The avoidance acts as **negative reinforcement**, reinforcing the anxiety and avoidance behaviour. [Fear Conditioning ] **Mowrer's two-factor model** consists of both **classical** and **operant** conditioning. **Classical conditioning** is where an individual learns a **fear response** to a **neutral stimulus (CS)** that is **repeatedly** paired with an **intrinsically aversive stimulus (UCS).** **Operant conditioning** is where the individual gains **relief by avoiding** the **CS** and that avoidance behaviour is then **maintained** through **negative reinforcement**. The problem with anxiety is that is creates **a secondary problem** of flawed **informational processing**. [Generalised Anxiety Disorder (GAD)] A close-up of a white text Description automatically generated [Aetiology] [and Prevalence] It is more common in women than men, ages 35-59.\  Aetiology of GAD focuses on **Biological** (genes, brain areas, NT) or **Psychological** (informational processing biases, beliefs/meta beliefs & function of worrying, dispositional characteristics of worriers) theories. Biological: Anxiety and GAD have a **genetic component** (**Noyes et al., 1992**). **Twin studies** (MZ compared to DZ) found **heritability of 30% (Dellava, Kendler & Neale, 2011**). These Heritable **risk factors** are cast but **not specific**. Found the **Amygdala** (emotional regulation) and **Prefrontal** (decision making, goal orientated behaviour) **brain regions** may be involved. Those with anxiety have **overactivity** in their **Amygdala** and **underactive** **Prefrontal** activity. This suggests possible **abnormalities in emotional regulation of GAD sufferers**. GAD sufferers experience **NT imbalance**. More specifically **Serotonin, Norepinephrine and GABA.** Environmental: **Unpredictable, stressful events** can increase the **risk** of developing GAD. **Parenting style** may also pose a risk to development. For example, **Bowlby's attachment style** suggests that when a child is **reared in a disorganised, uncaring environment,** they are unable to deal with difficult situations. Also from a **learning perspective**, children may **replicate** the **modelling parents' behaviour**. Psychological: A screenshot of a cell phone Description automatically generated **Borkovec & Newman (1998)** suggested worry in GAD serves as a **distraction, a cognitive avoidance response** to threatening material (negative reinforcement). **Intolerance of uncertainty** can also cause people to be more likely to develop GAD (**Dugas, Marchand & Ladouceur; 2005**). This is **dispositional characteristics** where people **cannot tolerate ambiguity and uncertainty**. Different researchers have created a variety of worry models. The **Metacognitive Model (Wells, 1995)** labels **adaptive worry** as **Type 1** and **Meta-worry as Type 2**. They argue worry was normal, functional and useful if it allows you to come to a solution. However, when someone begins to **worry about the worry** itself, it become **pathological.** The **Cognitive Avoidance model** is where worry is used to **avoid emotional processing of fear/control negative emotions (**Berkocev et al 2004). The **Contrast Avoidance model** suggested that people with GAD engage in **worrying to be distressed and ensure they are ready for a worst-case scenario** (**Newman and Llera 2011).** And the **Intolerance of Uncertainty model.** People with GAD have **superstitious beliefs/reinforcement** that if they do not worry, something bad will happen. They believe that **worry is necessary to prevent future catastrophe**, causing superstitious reinforcement. **Cognitive Mechanisms research** found those with GAD pay a lot of **attention** to the **threatening stimuli** (may be partly explained by **Amygdala overactivity**), finding is **difficult to disengage** from. Attentional avoidance (cognitive avoidance model) and interpretation biases (superstitious reinforcement) are used.  **Integrated Cognitive model** of worry refers to **the interaction between involuntary (bottom-up) processes and voluntary (top-down) processes**. A screenshot of a white background Description automatically generated [Treatment of GAD] There is **Pharmacological treatments** like medication: **Anxiolytics** or **Anti-depressants** (SSRI). There are also **Psychological treatments** like certain therapies. For example, stimulus control and exposure with **CBT**. **Stimulus control treatment (Borkovec, 2005**) makes clients **identify the worrisome thought** from pleasant ones. They then discover their **contextual triggers** (situations that cause these thoughts). The clients are then instructed to have a **designated place to worry for 30 mins a day**. When they find themselves worrying, they must **postpone** it until their **scheduled worrying period**, **replacing the worrying thought with attending to the present moment.** Also told to **engage in problem solving** in their worrying period.  Or there can be **combination therapies,** that use both forms of treatments. [Panic Disorder & Agoraphobia] Panic is described as an abrupt surge of fear/intense discomfort that peaks in minutes. A white background with black text Description automatically generated  A white background with black text Description automatically generated  A black and white text on a white background Description automatically generated  [Psychological theories of PD] **Classical conditioning** between the **bodily sensations** related to panic attacks and the anxiety-provoking situation. A diagram of a problem Description automatically generated A white background with black text Description automatically generated **Anxiety sensitivity** is the theory that the sufferer cannot help attending to the body symptoms. **Catastrophic misinterpretation of bodily sensations** causes worry about death or losing control (creates cycle).  **Role of safety behaviours** is helpful but encourages avoidance and causes a reliance on the behaviours rather than overcoming the anxiety. [Biological theories of PD] **Hyperventilation** is the **rapid breathing** that results in ventilation **exceeding metabolic demand.** During a panic attack a person breathes faster or more deeply than usual, the amount of **oxygenated air entering the lungs, pushed blood carbon dioxide below its normal rate**. The body recognises it has too much air and **constricts blood vessels to restrict oxygen**, which causes the bodily symptoms (dizziness). Some researchers believe hyperventilation triggers a lot of anxieties, creating a cycle. A blue background with white text Description automatically generated Individuals with PD are **deficient in GABA** neurons and **overactivity of Noradrenaline**.  A white paper with black text Description automatically generated The **most effective CBT** technique is **Interoceptive exposure and cognitive restructuring.** A white text on a black background Description automatically generated