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 afraidAnxiety 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 this way, 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 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 behaviorO3. 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 hrs a day? (maladaptive)Does the anxiety persist in the absence of a threat? Worry about test, then once its over 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 PanicAnxiety is the “umbrella term” that holds fear and panicAnxiety includes 4 components: Emotions(fear, embarrassment) CognitionsBehaviorsSomatic/ 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 timeNormal Anxiety:Common 25% of childrenExamples: Separation from adults taking a test Taking care of themselves Usually decrease with ageTemperament 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 problemsDifferences in intensity Realistic vs. unrealistic Normal Rituals: Routine is useful! Child knows exactly what to expect next, and adult doesn’t have to think everything outControl 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 environmentSchool attendanceSchool interactionsUnintentionally rewarded by parents?(positive reward) Picking them up, giving reward when they get home, staying with child for a littleAnxiety 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 complaintsChanges 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 fearsO10. 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 disorderImpairment & 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: RestlessnessEasily fatigued IrritableMuscle tensionSleep disturbance (onset- falling asleep, maintenance-staying asleep) (having one of these with other criteria for a child is