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PSYC 2621

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feelings of nausea or other signs of abdominal distress ... The aim is to get in touch/express genuine talents/feelings. Biological ... – PowerPoint PPT presentation

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Title: PSYC 2621


1
PSYC 2621
  • Anxiety Disorders

2
Anxiety Disorders
  • Anxiety is a generalized state of apprehension.
  • Anxiety can be normal/adaptive but it can also be
    excessive/inappropriate

3
Features
4
Historical perspectives
  • Anxiety/dissociative/somatoform were classified
    as neuroses in 19th century.
  • Identified by William Cullen with a biological
    origin.
  • Freud, in the 20th century, explained it as the
    threatened emergence of unacceptable
    anxiety-evoking ideas into conscious awareness
  • An attempt of the ego to defend itself against
    anxiety.

5
Panic Disorder
  • Symptoms
  • Recurrent panic attacks.
  • Intense anxiety reactions that are accompanied by
    physical symptoms.
  • Stronger bodily component than the other anxiety
    disorders.
  • Last for several minutes to hours.
  • Initially occurs unexpectedly (these seem more
    severe), later they may be cued.

6
DSM-IV features of Panic Attack
  • Involves at least 4 of the following
  • lasts 10 minutes
  • repeated unexpected attacks and one must be
    followed for 1 month by a fear of subsequent
    attack.
  • heart palpitations
  • sweating
  • trembling
  • shortness of breath or smothering sensations
  • choking sensations

7
  • Chest pains or discomfort
  • feelings of nausea or other signs of abdominal
    distress
  • feelings of dizziness, unsteadiness,
    lightheadedness, faintness
  • feelings of strangeness or unrealty about ones
    surroundings (derealization) or detachment from
    self (depersonalization)
  • fear of losing control
  • fear of dying.

8
  • Numbness or tingling sensations
  • chills or hot flushes

9
Additional features
  • Usually begins in late adolescence/early
    adulthood.
  • Women experience panic attacks two or three times
    more often as men.
  • About 1 of the population can be diagnosed with
    panic disorder at any given time
  • About 3.5 have experienced panic disorder at
    some point in their lives.

10
Generalized Anxiety disorder
  • Persistent, diffused sense of anxiety that is not
    triggered by any specific object, situation, or
    activity.
  • Differs from panic disorder in quality.

11
Features
  • Restlessness
  • feeling keyed up
  • easily fatigued
  • difficulty concentrating or finding ones mind
    going blank
  • irritable
  • muscle tension
  • disturbance of sleep

12
Prevalence
  • Twice as common in women as in men.
  • Initially arises in mid-teens/mid-twenties
    throughout lifetime.
  • Lifetime prevalence in the general population is
    about 5.
  • May experience depression.

13
Phobic Disorders
  • Phobia means fear.
  • Fear/anxiety are closely related.
  • Fear is feeling some anxiety/agitation in
    response to a threat.
  • Phobic disorders are persistent fears of
    objects/situations disproportionate to threat
    posed by them.

14
  • Interfere with normal routines.
  • Phobics realize their fears are irrational.
  • Quite common they affect 1 in 7 adults at some
    point in their lives.
  • Appear at different ages.

15
  • 3 Types
  • Specific Phobias
  • the fear of specific objects. It is associated
    with high levels of physiological arousal. It
    must impact the individuals life. Often begins
    in childhood.
  • 5 subtypes
  • animal
  • natural environment
  • blood-injection-injury
  • situational most frequently occurring
  • other

16
  • Cont. specific phobia
  • Prevalence
  • Affects 1 in 10 people at some point in their
    lives
  • Occurs more frequently in women than men.
  • Social phobia
  • The fear of social situations due to fear of
    judgment, humility, and embarrassment.
  • Includes stage fright/speech anxiety.
  • Affects more women than men.

17
  • Cont. social phobia
  • The roots may begin in childhood.
  • People typically report being shy as a child.
    Then, social phobia tends to begin in adolescence
    and is chronic.
  • Agoraphobia
  • The fear of places/situations where it is
    difficult or embarrassing to escape.
  • May become house-bound/difficult to treat.

18
  • More common in women
  • Begins in late adolescence or early adulthood.
  • May occur with or without panic attacks.

19
Obsessive/Compulsive Disorder
  • Obsessions are intrusive, recurrent thoughts.
  • Compulsions are repetitive behavior or mental
    acts that a person are compelled to perform.
  • Most compulsions fall into 2 categories
  • checking
  • cleaning relieves the anxiety of obsessions.

20
  • Prevalence
  • 2 to 3 of adults are affected by OCD during
    their lifetime.
  • It affects men and women equally.
  • Obsessions are difficult to distinguish from
    delusions.

21
Acute/Post-traumatic Stress Disorder
  • A stress related disorder that arises from
    exposure to traumatic events.
  • The event involves either actual/threatened
    death/injury/physical safety.
  • Response can be acute ? acute stress d/o
  • or prolonged ? PTSD

22
  • Response involves intense fear, helplessness,
    horror (children may show disorganized/agitated
    behavior)

23
Features
  • Reexperiencing the event (memories or flashbacks)
  • Avoiding the cues connected with the incidence
  • Numbing emotions
  • arousal/anxiety (difficulty sleeping, angry,
    hypervigilance, difficulty concentrating,
    exaggerated startle)

24
Cont. Features
  • Impairment in functioning
  • Dissociation.

25
Theoretical Perspectives
  • Psychodynamic
  • Anxiety reflects
  • the efforts of unacceptable, repressed impulses
    to break into consciousness.
  • fear as to what might happen if they do.
  • Phobias develop through the use of defense
    mechanisms of projection/displacement. For
    example, Freuds description of Little Hans.

26
  • Phobias help to contain impulses/keep person away
    from feared object/situation.
  • In GAD, conflicts remain hidden but anxiety leaks
    through to awareness.
  • In Panic D/O, unacceptable sex/aggressive
    impulses approach boundaries of conscious/ego
    must repress, generating high anxiety/panic
    attack.
  • In OCD, obsessions are leakage of unconscious
    impulses into consciousness, and compulsions are
    acts to keep impulses repressed.

27
Learning
  • Mowrers 2-factor model.
  • GAD is product of stimulus generalization.
  • Panic attacks that descend out of nowhere, are
    triggered by unidentifiable cues.
  • Reinforcement of O/C compulsive behaviors are
    operant responses that are negatively reinforced
    by relief of the anxiety that is engendered by
    obsessional thoughts.

28
Cont. Learning
  • Prepared conditioning genetically prepared to
    acquire phobias.
  • GAD a Safety Perspective (Woody/ Rachman, 1994)
  • People with GAD see the world as a highly
    threatening place and perceive very few safe
    places to turn where they can feel secure. No
    place causes anxiety though finding a place
    brings some relief.

29
Cont. Learning
  • PTSD (Classical Conditioning)
  • The trauma is the UCS and becomes associated with
    the sights, smells, sounds (CS) of the
    surroundings.
  • Symptoms are likely to persist when survivor
    avoids the CS.

30
Cognitive
  • Various patterns associated with anxiety
    disorders.
  • Overprediction of fear overpredict the amount of
    fear that will be experienced when exposed to
    feared stimuli, ie., dental fear.
  • Self-defeating or irrational beliefs.
  • OCD is the tendency to exaggerate the risk of
    negative outcomes.
  • Oversensitivity to threats

31
Cont. Cognitive
  • Low self-efficacy expectancies
  • Anxiety sensitivity - the extent to which a
    person believes that their own internal anxiety
    will lead to harmful consequences.
  • Missattributions for Panic Sensations
  • Catastrophic misinterpretations of bodily
    sensations.

32
Biological
  • Studies show strong support for genetic influence
    for anxiety d/o.
  • The evidence is most prominent for agoraphobia.
  • Modestly prominent in GAD and
  • Least prominent in specific phobias.
  • There is some evidence in OCD Panic D/O

33
Cont. Biological
  • The nerotransmitter, gamma-aminobutyric acid
    (GABA) is implicated in anxiety d/o.
  • It is an inhibitory neurotransmitter. When GABA
    is inadequate, neurons fire excessively resulting
    inseizures or anxiety. Benzodiazepines enhance
    the calming effect of GABA. Some researchers
    think hyperventilation with catastrophic thinking
    prompt Panic attacks agoraphobia.

34
TReatment
  • Psychodynamic
  • Work on freeing ego from the energy put into
    repression.
  • More contemporary approaches focus on sources of
    anxiety that arise from current and past
    relationships.

35
Cont. Treatment
  • Humanistic/Existential
  • Anxiety is the social repression of our genuine
    selves.
  • The aim is to get in touch/express genuine
    talents/feelings.
  • Biological
  • Most common treatment is Benzodiazepines
  • Valuim, Tranxene, Xanax, Librium. Addictive.

36
Cont. Treatment
  • Other medications Paxil, Zoloft, Tofranil.
  • OCD is usually treated with Prozac and Anafranil.

37
Cont. Treatment
  • Learning-based
  • Systematic desensitization
  • Gradual exposure
  • cognitive restructuring
  • Behavioral treatment of social phobia exposure
    and flooding
  • Behavioral treatment of PTSD, OCD,
  • Relaxation, GAD
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