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Summary GGZ2024 Task 1-3
Summary of TASKS 1-3 of the course "Anxiety and Related disorders", with additional information throughout from the lectures.
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SUMMARY GGZ2024 ANXIETY ANDRELATED DISORDERS
TASK 1: ANXIETY AND HYPERVENTILATION
ANXIETY DISORDERS
Anxiety: the feeling of fear or panic. Most people only feel anxious in stressful situations and
once these are over, they feel calmer. However, sometimes the feelings of anxiety continua
after the difficult situation or someone may feel a stronger sense of fear than others. This is
when anxiety may become a problem and can affect your daily life.
Functionality of anxiety:
Survival: anxiety makes us approach situations that increase survival and avoid
situations that decrease survival.
Social function: signaling danger and a motivation of social adapt behavior.
Conceptualization of anxiety:
Common sense: “I tremble because I
feel afraid.”
James & Lange: viscera are the center
of emotion. Senses cortex muscles &
viscera response perceived as emotion
reaction. “I feel afraid because I
tremble.”
Canon & Bard: the thalamus is key.
Bodily changes and emotional experience
occur separately and independently of
one another. “The dog makes me tremble
and feel afraid.”
Schachter & Singer: two factor theory
of emotion a person uses the
immediate environment to search for
emotional cues to label the arousal. “I
label my trembling as fear, because I
appraise the situation as dangerous.”
The reaction to threat is first a moment of
freeze to prepare for fight-or-flight and decrease
the chance for detection.
After the freeze-phase, there is a phase of defense, which can either be fight or flight.
Physiological reaction to anxiety:
Parasympathetic NS down
o Contraction of bladder and intestines urge to go to the toilet.
o Digestion stops dry mouth and throat.
o Feeling sick.
Sympathetic NS up
o Blood pressure, heart rate, respiration increases.
o Sweating
o Increase of blood in muscles.
o Tense muscles trembling of hands or other parts.
o Tingling of hands or feet
, o Pupils enlarge seeing more light.
o Goosebumps/hairs standing upright.
Cognitive reactions to anxiety:
Hyperalert
Narrowing of attention
Idea that time goes slower.
Present or actual situation seems unreal.
Perception that you watch yourself from a distance.
Thinking you might faint.
Behavioral reactions to anxiety:
Protect yourself safety behaviors.
Urge to run.
Urge to cry.
Fight
Mental symptoms of anxiety:
Anxious thoughts
Ruminating
Worry
Wanting to hide/hiding.
Wanting to get away.
Becoming upset/angry.
Differences between fear and anxiety:
Fear Anxiety
Threat present Threat expected
Clear threat source No threat source
Short Long
High tension Discomfort
Clear start Unclear start
Emergency response Heightened vigilance
Views on anxiety:
Terror management theory (Greenberg et al., 1986): humans are motivated to quell
the potential for terror inherent in the human awareness of vulnerability and mortality
by investing in cultural belief systems. Self-esteem consists of the perception that one
is a valuable member of a meaningful universe.
Usually, children will start to learn and become concerned with the problem of death
around 3 years old and the anxieties regarding darkness and monsters become more
linked to real threats that culminate with the realization of the inevitability of death.
They find out that parents/caregivers are mortal and fallible.
Self-esteem thus functions as an anxiety buffer to maintain relative equanimity despite
the awareness of vulnerability and mortality.
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.
Irvin Yalom: death agony has been a taboo even under psychotherapists. People do
experience this fear. Some dream about it, others try to suppress it, which leads to
psychological symptoms.
Culture comes into play to provide a secure base in which the virtuous are rewarded
and the evil are punished.
Psycho-analytic view (Freud): the importance of anxiety was recognized. Anxiety is
an aversive inner state that people seek to avoid or escape. There are 3 major types of
anxiety:
, o Reality anxiety: most basic form, rooted in reality. Fear of a dog bite or fear
arising from an impending accident.
o Neurotic anxiety: 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.
o Moral anxiety: 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. This is done through defense mechanisms. These defense
mechanisms can be 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:
o Problem solving efforts increase.
o Defense mechanisms are triggered. These are tactics developed by the Ego 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 developed a comprehensive list of defense mechanisms:
o Repression/defensiveness: can be conscious but is most commonly
unconscious.
o Denial: severe form of memory repression.
o Projection: anxiety is reduced by claiming another person actually has the
unpleasant thoughts that you are thinking. The repressed thoughts are
attributed to someone else.
o Rationalization: allows to find logical reasons for inexcusable actions.
o Intellectualization: protects against anxiety by repressing the emotions
connected with an event.
o Regression: the giving up of mature problemsolving methods in favor of child-
like approaches to fixing problems.
o Displacement: shifting of intended targets, especially when the initial target is
threatening.
Learning theory: anxiety is based on conditioning.
Classical conditioning is about when one will have an anxiety response. Thus, when
adrenaline is released and as a result their heart rate, blood pressure and breathing
increases.
Which conditioned stimuli (CS) are associated with the conditioned response (CR) of
anxiety and fear. In classical conditioning one learns the meaning of stimuli and to
predict what will happen if the stimulus appears. Classical conditioning if therefore
about predictability.
Operant conditioning is about how to cope with this anxiety response and what to do
(R) to avoid or reduce this bodily anxiety response. How can one get control over
these stimuli. Operant conditioning in about controllability.
Anxiety disorders:
Differ from developmentally normative fear or anxiety by being excessive or persisted
beyond developmentally appropriate periods.
The fear/anxiety/avoidance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Each disorder is diagnosed only when the symptoms are not attributable to the
physiological effects of a substance/medication or another medical condition, or are not
better explained by another mental disorder.
, Types of anxiety disorders:
Specific phobia: fearful or anxious about circumscribed objects or situations. The fear
is almost immediately induced by the phobic situation, to a degree that is persistent
and out of proportion to the actual risk posed.
Social anxiety disorder / social phobia: individual is anxious about social
interactions and situations that involve the possibility of being scrutinized. These
include social interactions such as meeting new people, being observed eating, and
situations in which the person performs in front of others. The cognitive ideation is of
being negatively evaluated by others, being embarrassed, humiliated, or rejected, or
offending others.
Panic disorder: individual experiences recurrent unexpected panic attacks and is
persistently concerned or worried about having more panic attacks or changes in their
behavior in maladaptive ways because of the panic attacks.
Agoraphobia: fear about not being able to escape in the event of developing panic-
like symptoms or other incapacitating or embarrassing symptoms. These situations
almost always induce fear and are often avoided.
Generalized anxiety disorder: persistent and excessive anxiety and worry about
various domains. In addition, the individual experiences physical symptoms, being
easily fatigued, difficulty concentrating, irritability, muscle tension and sleep
disturbance.
Anxiety disorders differ from one another in the types of objects or situations that induce fear
or avoidance, and the associated cognitive ideation.
Anxiety related disorders:
Posttraumatic Stress Disorder
Obsessive Compulsive Disorder
Prevalence of anxiety disorders:
1 in 5 people eventually develops an anxiety disorder (lifetime prevalence).
Largest group in mental health care.
High DALY’s
Globally, anxiety disorders accounted for 390 DALYs per 100.000 people.
Anxiety disorders are the most common mental illness in the world and have a big
impact on the global burden of disease.
Epidemiology:
Anxiety disorders are the most prevalent among all forms of mental disorders in children,
adolescents, and adults. They commonly emerge early in development and are associated
with substantial impairments and psychosocial problems.
Most recent estimates of 12-month and lifetime prevalence indicate that anxiety disorder are
more than twice as frequent as mood disorders with rates of 32.4%-33.7% in the US. Across
Europe the best estimate is 14% in the past 12 months.
For specific anxiety disorders, lifetime and 12-month rates are the highest for specific phobia
(16.3-20%) and social anxiety disorder (10-14%), and the lowest for panic disorder (5.2%),
agoraphobia (3%), and OCD (3%).
Many anxiety disorders develop in childhood and tend to persist if not treated. Most occur
more frequently in females than in males (2:1 ratio).
PANIC DISORDER
Diagnostic criteria:
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense
fear or intense discomfort that reaches a peak within minutes, and during which time
four (or more) of the following symptoms occur:
1. Palpitations, pounding heart, or accelerated heart rate.
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