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Lecture summary Anxiety and Related Disorders GGZ2024
Summary of all lectures in Anxiety and Related Disorders 2022
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Lecture 1: Introduction in anxiety disordersHow do you know you’re anxious?
- Heartrate increases
- Respiration increases
- Sweating (cold hands)
- Tense muscle: trembling of hands, other parts
- Tingling of hands and feet
- Goosebumps
- Feel sick
- Anxious thoughts
- Ruminate
- Worry
- Hide
- Get away
- Become upset – angry
Functionality anxiety
There actually is a function of this behavior
- To survive
Approach situations that increase survival
Avoid situations that decrease survival
- Social function
Signaling danger
Motivation of social adapt behavior
Conceptualization of anxiety
Scientists don’t agree with each other, see here the different conceptualizations of anxiety:
James & Lange: viscera are center of
emotion. Senses -> cortex -> muscles,
viscera -> response perceived as emotion
-> reaction
Canon & Bard: thalamus is key, bodily
changes and emotional experience occur
separately and independently of one
another
Schachter & Singer: two factor theory of
emotion. A person uses the immediate
environment to search for emotional cues
to label the arousal
,Anxiety as a reaction to threat
These are the different stages of anxiety as a reaction of threat. You’ll either fight or flight, depending
on the situation.
Fight
Danger Freeze Defense
Flight
t
Physiology of Anxiety
Parasympathetic down and sympathetic up
Most important neurotransmitters: adrenalin (epinephrine) and noradrenalin (norepinephrine) -> they
cause the physiological reaction
Sympathetic
- Blood pressure increases
- Heartrate increases
- Respiration increases
- Sweating
- Increase of blood in muscles
- Tense muscle
- Tingling of hand and feet
- Pupils enlarge
- Hairs upright
Parasympathetic
- Contraction of bladder and intestinalis
- Feel sick
- Digestion stops dry mouth and throat
Cognitive reactions
- Hyperalert
- Narrowing of attention
- Idea that time goes slower
- Present or actual situation seems unreal (dissociations)
- Perception that you watch yourself from a distance (dissociation)
- Think you might faint
Behavioral reactions
- Protect oneself (safety behaviors)
- Urge to run
- Urge to cry
- Fight
Fear versus anxiety
Fear Anxiety
- Threat present - Threat expected
- Clear threat source - Not threat source
- Short - Long
- High tension - Discomfort
- Clear start - Unclear start
- Emergency response - Heightened vigilance
,What is anxiety?
Anxiety is the feeling of fear or panic. Most people feel anxious, panicky, or fearful about situations in
life, such as money problems or exams but often once the difficult situation is over, you feel better and
calmer.
Sometimes….
The feelings of fear or anxiety continue after the difficult situation, or you may feel a stronger sense of
fear than other people and this is when anxiety might become a problem and can affect your daily
life/functioning
Different views on anxiety
Social psychological view
- Terror management theory (Jeff Greenberg, Sheldon Solomon, and Tom Pyszceynski 1986)
The basic gist of the theory is that humans are motivated to quell the potential for terror inherent in the
human awareness of vulnerability and mortality by investing in cultural belief systems......Since its
inception, the theory has generated empirical research into not just the nature of self-esteem
motivation and prejudice, but also a host of other forms of human social behavior.... depression and
psychopathology (e.g., phobias) ....
- Self-esteem
Self-esteem consists of the perception that one is a valuable member of a meaningful universe
- Anxiety
Usually around three years of age children begin to learn about and become concerned with the
problem of death and anxieties regarding darkness and monsters become more and more linked to real
threats...that culminate with the realization of the inevitability of death.
➔ So, a child becomes aware that the parents or caregivers are not omniscient and omnipotent
but fallible and mortal.
➔ Self-esteem thus functions as an anxiety buffer to maintain relative equanimity despite the
awareness of vulnerability and mortality
Existentialism, Irvin Yalom
Death agony has been a taboo even under psychotherapists. But people do experience this fear, some
dream about it, others try to suppress it which leads to psychological symptoms.
Our fear is related to four core big fears.
- The universe is full of chaos (trying to structure)
- We are born and we die (how do we give meaning to life?)
- That you feel not connected to other people (I have no one, I don’t matter)
- We will die (I will die too), this is the deepest human wound
Culture comes into play to provide a secure base (stories, myths, religious doctrines) in which the
virtuous are rewarded and the evil are punished.
, Psychoanalytic view
Psychoanalyses, Sigmund Freud:
Freud recognized the importance of anxiety. He was one of the first writers to argue that anxiety was a
critical component of neurosis.
Anxiety is an aversive inner state that people seek to avoid or escape
Three major types of anxiety:
- Reality anxiety: the most basic form,
rooted in reality. Fear of a dog bite, fear
arising from an impending accident
- Neurotic anxiety: Anxiety which arises
from an unconscious fear that the libidinal
impulses of the ID will take control at an
in opportune time. This type of anxiety is
driven by a fear of punishment that will
result from expressing the ID's desires
without proper sublimation.
- Moral anxiety: Anxiety which results from
fear of violating moral or societal codes,
moral anxiety appears as guilt or shame
In Freud’s view, the human is driven towards tension reduction, in order to reduce feelings of anxiety
Humans seek to reduce anxiety through Defense Mechanisms. Defense mechanisms can be
psychologically healthy or maladaptive, but tension reduction is the overall goal in both cases
When some type of anxiety occurs, the mind responds in two ways:
- First: problem solving efforts are increases, and
- Secondly, defense mechanisms are triggered. These are tactics which the Ego develops to help
deal with the ID and the Super Ego
All defense mechanisms share two common properties:
- They can operate unconsciously
- They can distort, transform, or falsify reality in some way:
The changing of perceived reality allows for a lessening of anxiety, reducing the psychological tension
felt by an individual
Anna Freud
A comprehensive list of Defense Mechanisms was developed by Anna Freud, Sigmund’s daughter.
- Repression (defensiveness): can be conscious but is most commonly unconscious
- Denial: severe form of memory repression
- Projection: anxiety is reduced by claiming another person actually has the unpleasant thoughts
that you are thinking. You are attributing your own repressed thoughts to someone else
- Rationalization (post-hoc): rationalization allows to find logical reasons for inexcusable
actions
- Intellectualization: protects against anxiety by repressing the emotions connected with an
event
- Regression: regression is giving up of mature problem-solving methods in favor of childlike
approaches to fixing problems
- Displacement: displacement is the shifting of intended targets, especially when the initial
target is threatening
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