Developmental Psychology - Anxiety (When Does Adaptive Anxiety Become Pathological?)

Developmental Psychology - Anxiety (When Does Adaptive Anxiety Become Pathological?)

1. What is Anxiety?

   • Subjective state of being, that has a diverse set of symptoms. Causes the sufferer to 'worry'. It is a normal part of experience and it varies in intensity.

2. Anxiety Vs. Fear

   • Physiological manifestations are similar
   • Fear is a primary emotion, anxiety is a secondary emotion
   • Fear is a response to danger in the present. Anxiety is anticipation of potential threat in the future.

3. What is Good About Anxiety?

   • Survival: - protective mechanism, - escaping dangerous situations,. Achievement: Anxiety increases performance due to the fear of failure.

4. Anxiety as a Marker of Complex Cognition

   • Evolution from transient fears of animals to elaborate fears of supernatural phenomenon signals progression in the capability for abstract thought.

5. Anxiety as a Problem

   • - Duration - Intensity - Frequency - Causes Distress - Interferes with Functioning

6. Physiological Symptoms

   • - Restlessness - Shortness of breath - Sweaty palms - Increased heart rate - Chest pain - Muscle tension - Trembling - Nausea - ‘Butterflies’ - Exaggerated startle response
   • - Chills - Numbness - Sleep disturbance - Fatigue - Lethargy - Poor appetite - Hot Flush - Dizziness - Dry throat - Lump in the throat

7. Behavioral Symptoms

   • - Avoidance - Escape - Withdrawal - Apprehension - Self-destructive behaviors - Becoming over attached - Distress - Depressive behaviors

8. Cognitive Symptoms

   • - Negative self-appraisals - Negative automatic thoughts - Negative interpretations - Negatives biases - Inability concentrating - Problems with memory - Low self-esteem

9. Anxiety Disorders in DSM-5

   • Generaliszed Anxiety Disorder, Panic Attacks, Social Phobia, Separation Anxiety Disorder, Panic Disorder, Selective Mutism, Specific Phobia, Agrophobia
   • - Both in Children & Adults: some more common in children, dissimilarities described, symptoms differ, duration differs. - Many develop during childhood. - Culture differences play major role.

10. Prevalence : Most common problem during childhood and adolescence, approx. 13/100 children aged between 9-17 suffer. Girls affected more than boys. Often overlaps with other anxiety disorders eg. depression. * one of the earliest forms = separation anxiety

11. Co-Morbidities

    • - Anxiety is symptomatic of many psychiatric disorders: - The presence of anxiety does not automatically indicate an anxiety disorder. - Most of the addictive disorders have some anxious features. - Extreme fear of fatness is an eating disorder, not a phobia.
    • - Co-occurring disorders: - Two separate disorders can and may be present at the same time.
    • Anxiety and Depression commonly occur together and have a 50% comorbidity rate.

12. ANXIETY DISORDER: Separation - Developmentally inappropriate and excessive fear of being separated from an attachment figure

    • Characterized by: - excessive distress when separation is anticipated or occurs, - worry about well-being or death of attachment figure, - reluctance to go out for fear of separation, - refusal to be alone at home, - refusal to sleep alone, - repeated nightmares involving theme of separation.
    • Lasts at least 4 wks in children & 6 mnts. in adults. Causes clinically significant distress. Not better explained bt another mental disorder.
    • Differentiating from the norm: normal stranger anxiety = 8-10mnts, SAD is more intense, persistent and unrealistic concern - unrealistic worried about the harm that might occur to the attachment figure. *cultural context to be considered *varying development course
      • School refusal = most common symptom of SAD (75%), only 1/3 of kids who refuse to attend school do so because of SAD, often occurs after a period of legitimate absence.
        • Prevalence of SAD: - affects children, adults and elderly (difference based on duration). Occurrence prior to age 6 = early onset. - 1/25 children suffer. - Higher in girls (community), equal in clinical samples. CO-MORBIDITIES: Children - GAD and specific phobias. Adults - GAD, social phobias, OCD, depression, agoraphobia, personality disorders.

13. Etiological Perspectives: exact cause unknown, genetics & biology, learning (behavior), attachment/parental practices, cognition.

    • Genetics: environmental influences add to genetic influences. 80% of mothers who have children with SAD have a history of anxiety disorders. Shared genetic diathesis between SAD and adult onset panic attacks (Roberson-Nay et al., 2012)
    • 'Separation Anxiety Hypothesis' - link with panic disorder (Kossowsky et al, 2013). - SAD reflects general susceptibility to future psychopathology. - Maybe genuine co-morbidity. - SAD & panic disorder = elements of non-specific vulnerability. - Shared genetic diathesis.
    • Attachment: Bowlby’s “Anxious Attachment” - Arises from disturbances in primary bonds. - Typical separation anxiety symptoms are characteristic of early development. - Older children show symptoms as a form of ‘regression’. - Adults manifest in theform of panic disorder / agoraphobia (see ‘Separation Anxiety Hypothesis’)
    • Parental Practices & Pathology: - Parent overprotectiveness, overcontrolling, reinforcement of avoidance, authoritarian / critical parenting practices, parental intrusiveness. - Parental stress or psychopathology: Parental anxiety influences child’s genetic tendencies and parental reactions / style. - Maternal depression and family dysfunction leads to over parentification
      • RESEARCH: Perez-Olivas, Stevenson, & Hadwin (2008); Wood (2007); UC Berkeley, 2008: Low Cortisol Levels Found in Kids Whose Mothers Show Signs of Depression (Genetics)
    • Cognitive: Beck (1976) - Information Processing Biases. - Attention to threat-relevant material. - Bias towards recalling negative memories. - Misinterpretation of information. - Over-estimating the likelihood of negative events

14. Interpretation Bias

    • Children with SAD interpreted ambiguous situations negatively and had lower estimations of competency to cope (Bogels & Zigterman, 2000)
    • Content-specificity: children with SAD report more negative thoughts on separation themes compared to GAD
    • Children with SAD gaze significantly more at separating pictures than non-anxious controls after a period of 1s (In-Albon, Kossowsky & Schneider, 2010)

15. Treatment

    • - Anxiety disorders are one of the most treatable psychiatric conditions. - Early intervention is vital. - Research has identified what works and what doesn’t . - Therapy is unique to the patient and symptoms, and also the therapist
      • Other Forms of Therapy: Family therapy, Art therapy, Mindfulness, Interpersonal Psychotherapy, Pharmacological, Systematic Desensitisation, Relaxation
    • Cognitive Behavioual Therapy (CBT): Participant modelling, exposure and reinforced practice. Cognitive restructuring (adapted based on age): - Challenging cognitive distortions, - Identify key fearful thoughts or beliefs that trigger those thoughts, - Taught techniques for generating less-anxiety provoking thoughts, - Rehearsal, - Thought records
    • Play Therapy: - Particularly useful for younger children. - Uses toys, puppets, games and art for expression of feelings. - Helps child understand reasons behind feelings. - Therapist provides alternative ways of coping with the feelings