College aantekeningen
Lectures Anxiety and Related Disorders
- Instelling
- Maastricht University (UM)
Lectures Anxiety and Related Disorders
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Lecture 1 IntroductionWhat is anxiety?
● Anxiety is the feeling of fear or panic
○ Most people feel anxious, panickly 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..
● Sometimes…
○ 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
Social psychological view
● Terror management theory
○ The core is that life is temporary, that we die and that we are vulnerable and we
find it very hard to deal with, so we set up a social system where we add
meaning to our lives
■ Self-esteem
● Consists of the perception that one is valuable memeber 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 parent(s) or caregiver(s) are not omniscient
and omnipotent but fallible and mortal
○ Culture comes into play to provide a secure base (stories, myths, religious
doctrines) in which the virtuous are rewarded and the evil are punished
○ Self-esteem thus functions as an anxiety buffer to maintain relative equanimity
despite the awareness of vulnerablility and mortality
● Irvin Yalom
○ Death agony has been a taboe even under psychotherapists. But people do
experience this fear, some dream about it, others try to supress it which leads to
psychological symptoms
○ We are mortal and will die. It is the deepest human wound
● Psychoanalysis - Freud
○ 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 inopportune 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 anciety 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 anciety 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 increases
■ Second: defense mechanisms are triggered/ these are tactics which ite
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
■ Repression: 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): allows to find logical reasons for inexcusable
actions
■ Intellectualization: protects against anxiety by repressing the emotions
connected with an event
■ Regression: the giving up of mature problem solving methods in favor of
child like approaches to fixing problems
■ Displacement: displacement is the shifting of intended targets, especially
when the initial target is threatening
● Learning theory
○ Conditioning of fear
■ Classical conditioning
, ● Classical conditioning is about when one will have an anxiety/fear
response. Thus, when adrenaline is released and as a result their
heart rate, blood pressure and breathing increases.
● In classical conditioning terms: which CS are associated with the
CR of anxiety and fear. Someone learns the meaning of stimuli; to
predict what will happen if that stimulus appears. Classical
conditioning is therefore about predictability.
■ Operant conditioning
● Operant conditioning is about how to cope with this anxiety/fear
response: what to do (R) to avoid or reduce this bodily anciety
response. In other words: how one can get control over these
anxiety/fear eliciting stimuli. Operant conditioning is therefore
about controllability
How do you know your anxious?
● Anxious thoughts
● Ruminate
● Worry
● Hide
● Get away
● Become upset - angry
Functionality anxiety
● To survive
○ Approach situations that increase survival
○ Avoid situations that decrease survival
● Social function
○ Signaling danger
○ Motivation of social adapt behavior
Conceptualization of anxiety
● James & Lange: viscera are center of emotion
○ Senses → cortex → muscles, viscera → respons perceived as emotion → reaction
● Canon & Bard: thalamus is key, bodily changes and emtional experience occur
sperately and independantly 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: response to threat
Danger
, ↓
Freeze
↓
Defense
↓
Fight ←→ Flight
Physiology
Parasympathetic down:
● All uposite of sympathic
● Contraction of bladder and intestinals (urge to go to the toilet)
● Digestion stops: dry mouth and throat
● Feel sick
Sympathetic up:
● Blood pressure increases
● Heartrate increases
● Respiration increases
● Sweating (cold hands)
● Increase of blood in muscles
● Tense musle: trembling of hands, other parts
● Tingling of hand and feet
● Pupils enlarge (see more light)
● Hairs upright
Adrenaline (epinephrine) and Noradrenaline (norepinephrine)
Cognitive reactions
● Hyperalert
● Narrowing of attention
● Idea that time goes slower
● Present or actual situation seems unreal
● Perception that you watch yourself from a distance
Behavioral reactions
● Protect oneself
○ Safety behaviors
● (Urge to) Run
● Urge to cry
● Fight
Fear vs Anxiety
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