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Complete Summary GGZ2024 Anxiety and Related Disorders
Complete summary of all tasks and lectures of the course "Anxiety and Related Disorders" written in 2024.
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SUMMARY GGZ2024 ANXIETY AND RELATEDDISORDERS
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.
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations
10. Paresthesia (numbness or tingling sensations)
11. Derealization (feelings or unreality) or depersonalization (being detached from oneself)
12. Fear of losing control or “going crazy”
13. Fear of dying
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the
following:
1. Persistent concern or worry about additional panic attacks or their consequences.
2. A significant maladaptive change in behavior related to the attacks (e.g. behaviors to
avoid panic attacks).
C. The disturbance is not attributable to the physiological effects of a substance or another
medical condition.
D. The disturbance is not better explained by another mental disorder.
Risk and prognostic factors:
Temperamental: negative affectivity (neuroticism) and anxiety sensitivity are risk factors for
the onset of panic attacks and for worry about panic. History of “fearful spells” may be a risk
factor for later panic attacks and panic disorder.
Environmental: reports of childhood experiences of sexual and physical abuse are more
common in panic disorder than in other anxiety disorders. Smoking is a risk factor for panic
attacks and disorder. Most individuals report identifiable stressors in the months before their
first panic attack.
Genetic and physiological: multiple genes confer vulnerability to panic disorder. However, the
exact genes related to the genetic regions implicated remain unknown. Current neural systems
models for panic disorder emphasize the amygdala and related structures, much as in other
anxiety disorders. There is an increase for panic disorder in children of parents with anxiety,
depressive, and bipolar disorders.
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