Chapter 7 Objectives O1 Anxiety includes four book says three types of symptoms Name define and be prepared to recognize examples of all four types Anxiety is the condition experience of being afraid Anxiety is immediate fearful reaction to a perceived threat Feels the same if the threat is real or not real car backfires thinks its sound of gunshot Anxiety is ALSO anxious anticipation Cognitive thoughts Suzy thinks I m stupid I m so embarrassed why am I feeling Somatic physiological muscle tension bunch of bodily symptoms to prepare for physical action if tiger is chasing you you must get away somehow Sweat more blood goes away from digestive system and to big muscles so you can run away from the tiger Behavioral hiding making himself small trying to avoid experience foot taping fidgeting cowering Fight or flight faking illness to not go to school related to avoidance to whatever is causing anxiety Emotional dread or embarrassment fear consistent with thoughts cognitive result of this way thoughts O2 What is the fight or flight response and what does it have to do with adaptive or normal anxiety Maladaptive anxiety Why do we get anxious some anxiety is useful Whatever stimulus is activates fight or flight response big pupils blood to muscles Threatening situations body prepares to USE energy Sympathetic nervous system prepares to USE energy stimulates organs parasympathetic nervous system returns body to normal Negative reinforcement taking away something unpleasant that strengthens a behavior O3 How is maladaptive anxiety i e not useful likely to be part of a disorder different from normal anxiety i e useful and not likely to be part of a disorder Are concerns realistic Anxiety about earthquakes reasonable for anxiety adaptive Is the anxiety proportional to the threat prepare some for earthquake adaptive spend 6 Does the anxiety persist in the absence of a threat Worry about test then once its over hrs a day maladaptive anxiety goes away adaptive Does it cause distress or IMPAIRMENT How are they doing at school peers home O4 different from book How are the following terms related anxiety fear panic Differentiating Anxiety from Fear and Panic Anxiety is the umbrella term that holds fear and panic Anxiety includes 4 components Emotions fear embarrassment Cognitions Behaviors Somatic physiological Panic is a specific combination of anxiety symptoms O5 What is known about the normal expression of fear anxiety worry and rituals repetitive behaviors How can these normal expressions be differentiated from abnormal ones i e symptoms Normal feared stimuli Appropriate age would not be surprised if a 3 yr old is afraid of strangers normal but if a 15 yr old is afraid of strangers Short duration how long has this been happening Absence of impairment is this maladaptive If it doesn t cause problems not maladaptive and normal anxiety Age patterns 2yr old afraid of being disliked by peers not normal does it change in an unexpected way or expected way Decrease over time Normal Anxiety Common 25 of children Examples Separation from adults taking a test Taking care of themselves Usually decrease with age Temperament effects Positive emotionality negative emotionality effortful control High negative emotionality most clearly related to anxiety focused on consequences if he forgets lines for play Emotional state before play I don t want to look at script practice get away from anxiety sweating forgetting lines dreading thinking of play low effortful control plays video game feels better no more anxiety negative reinforcement only part that was rewarding was not doing it Normal worry helps anticipate real problems Differences in intensity Realistic vs unrealistic Normal Rituals think everything out Routine is useful Child knows exactly what to expect next and adult doesn t have to Control and predictability but might still not be a problem child sense of control and predictability in environment May become too rigid impairment routine needs to be flexible O6 During what age range is separation anxiety typical How is typical adaptive separation anxiety different from pathological separation anxiety Separation anxiety disorder Normal 7 months to preschool Can cause impairment by keeping child out of environment School attendance School interactions Unintentionally rewarded by parents positive reward Picking them up giving reward when they get home staying with child for a little Anxiety increased because parent unintentionally rewarded I was in danger mom dad stayed with me so I must have been in danger O7 How could separation anxiety lead to depression Mechanism of why separation anxiety might lead to depression Pathway to depression 50 prevalence chance with separation anxiety will have depression Fewer friends Fewer activities Don t develop interests competence don t develop sense that they can go out and do things themselves O9 How is separation anxiety disorder related to school refusal School refusal Stomach hurts Somatic complaints Changes in environment new school parents separate Not IQ or academic skills not that its too hard for them to do work more driven by separation anxiety BUT can become problem for academics Negative cycle of staying home Increases anxiety staying home leads to approval of fears O10 How is the anxiety in GAD different from typical anxiety and what role is played by avoidance of negative emotions Generalized anxiety disorder Different from normal anxiety Disproportionate non specific feels uncontrollable worries about several things may spend several hours worrying about many different things Impairing Excessive anxiety and worry most days for 6 months Difficult to control the worry 3 symptoms for adults 1 for children less common among children Topic is not specific to another disorder Impairment not better explained NEGATIVE reinforcement cycle Emotional experience of whatever is worrysome is being avoided Worry about house burning down only way to get away from this worry is to worry about something else Symptoms Restlessness Easily fatigued Irritable Muscle tension Sleep disturbance onset falling asleep maintenance staying asleep having one of these with other criteria for a child is enough for GAD in child O11 How is a specific phobia different from a typical fear and why are certain stimuli snake tiger more likely than others flower grass to be the objects of a phobia Fear is normal but if someone comes up behind me with a gun I will be afraid not because I