Summary written in English. All lectures notes of the course Fear, Anxiety and related disorders of the third year of the bachelor Psychology at the Radboud University in Nijmegen.
Fears are very common and normal. Time periods where we are especially prone to be afraid of
certain things. Fear; a state of immediate alarm in response to a serious, known threat to one’s well-
being. Fight/flight (freeze) response, stronger response than anxiety. Clear trigger.
- An emotional response to perceived threat
- Adaptive and has high evolutionary value
- Predisposed biologically
- Involves activation of the sympathetic nervous system
- We talk of fear if there is a clear object (usually also fight/flight response)
Anxiety; state of alarm in response to a vague sense of threat or danger. Worrying.
- Normal anxiety is adaptive. It is an inborn response to threat or to the absence of people or
objects that signify safety can result in cognitive (worry) and somatic (racing heart, sweating,
shaking etc.) symptoms.
- Pathologic anxiety is anxiety that is excessive, impairs function.
- Same physiological features than fear; increase in respiration, perspiration, muscle tension
etc.
DSM; anxiety disorder
- Anxiety is unreasonably strong or permanent
- Arises without sufficient reason
- Cannot be controlled or endured
- Causes suffering and constrains life
- Typical symptom patterns are present
Diagnostic process; anxiety often part of other mental disorders
- Spontaneous anxiety = without concrete external trigger (GAD and PD) -> but internal trigger
- Panic disorder; spontaneous fight/flight responses, not linked to a situation
Avoidance; patients try to alleviate the unpleasant feeling of anxiety by;
- Avoiding the trigger
- Developing a safety behavior (perfectionism, reassurance seeking)
- Using a substance or medication
Epidemiology; Most common disorders.
- Lifetime prevalence for any anxiety disorders ranges from 10% to 29%.
- 12 month prevalence is 18% for any anxiety disorder (twice as more women)
o Specific phobia then most
o GAD
o SP
o Agoraphobia (three times more women)
o PD least
- Gender roles different for sexes, hormonal differences linked to gender bias in anxiety.
Biological gender reacts to stress in childhood differently. Women show anxious behavior,
man more violent behavior.
- Incidence; when a disorder has its very first occurrence, linked to a time-period
, - Prevalence; how many people get the diagnoses in a given timeframe
Development of fears/ disorders;
- SAD; triggered by basic understanding of death (early childhood)
- SP; triggered by fear of negative evaluation in school age/ adolescence
- PD; usually begins in twenties
- GAD; usually starts mid to end twenties
Progressive; gets worse
Persistent; staying at a bad level
Waxing and waning; on again, off again
Remitting; getting less
In infancy and early childhood; fear of immediate, concrete threats in the environment. Later; fears
begin to incorporate anticipatory event and stimuli of an imaginary or abstract nature. Spontaneous
remissions are frequent, but syndromal shifts frequently occur.
Causes of anxiety;
Susceptibility, vulnerability and predispositions (biological, learning, early experiences)
o Genetic influences; tendency to be tense or uptight, no single gene, tendency to
panic
o Epigenetics; what genes are being made use of, gene expression interacts with
environment (stress), coping (protective factors, social support, emotion regulation)
MAOA, COMT, 5-HT1A, NPSR1, ADORA2A (shared with depression)
o There seem to be underlying psychological or biological vulnerability factors for
anxiety disorders in general, which may already manifest in children.
Possible risk factor; behavioral inhibition and higher autonomic reactivity
(enhanced startle reflex, respiratory sensitivity).
Triggers/eliciting environmental conditions
Maintaining factors (usually make use of these in treatment)
Protective factors (coping, strengths)
Amygdala plays major role in threat perception and categorization. vmPFC help to control the
anxiety. Hippocampus important. Automatic, cognitive processing that is key to emotion regulation.
More reflective, rule-based cognitive control system.
Vulnerabilities; learning
Major learning theories;
- Classical conditioning; traumatic events (only in 20% of anxiety disorders)
- Operant conditioning; consequences of behavior (in almost all)
- Observational learning; enough to see someone else being anxious, humans can learn from
seeing and from hearing stories.
o Stimuli do not have the equipotentiality, if learning theories would be able to explain
everything than we would be anxious of many more things.
Mineka et al.; fears of specific objects are acquired by a genetic predisposition to learn. Not fear of
any object; most of us don’t learn to be afraid of flowers.
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