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Anxiety Disorders Chapter 5


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Title: Anxiety Disorders Chapter 5

Anxiety DisordersChapter 5
Anxiety Disorders
  • Anxiety Feelings of fear and apprehension.
  • Anxiety Disorders A group of disorders primarily
    characterized by extreme, unrealistic, or
    debilitating anxiety with one of these criteria
  • Anxiety is the major disturbance.
  • Anxiety is manifested only in particular
  • Anxiety results from an attempt to master other

Types of Anxiety Disorders
  • Anxiety is a part of everyones lives.
  • Anxiety is the price we pay for society
  • If it becomes intense and perseveres, then it may
    be categorized as an anxiety disorder.
  • Types of anxiety disorders
  • Panic Disorder
  • Generalized Anxiety Disorder (GAD)
  • Phobias
  • Obsessive-Compulsive Disorders (OCD)

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Understanding Disorders from Multipath Perspective
  • Biological Dimension
  • Two main biological factors
  • Brain structure
  • Genetic influences
  • Biological, psychological, and social factors
    interact with one another
  • Interplay between genetic and environmental

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Understanding Disorders from Multipath Perspective
  • Psychological Dimension
  • Psychoanalytic theorists focus primarily on
    parent-child relationship
  • Psychological variables such as ones sense of
    control may also be involved
  • Early experiences can play a role in determining
    vulnerability of children and need to be

Understanding Disorders from Multipath Perspective
  • Social and Sociocultural Dimensions
  • Daily environmental stress
  • Gender
  • Acculturation factors among minority groups

  • An anxiety disorder marked by a persistent,
    irrational fear and avoidance of a specific
    object or situation that disrupts normal
  • Phobias focus anxiety on a specific object,
    activity, or situation.
  • Powerful imagination, can vividly anticipate
    terrifying consequences
  • Recognize fear as excessive and irrational
  • Unable to control anxiety

  • Phobia Strong, persistent, unwarranted fear of a
    specific object or situation.
  • Agoraphobia Intense fear of being in public
    places where escape or help may not be available
    in extreme cases, fear of leaving home.
  • Social Phobia Intense, excessive fear of being
    scrutinized in one or more social situations.
  • Specific Phobia Extreme fear of a specific
    object or situation a phobia not classified as
    agoraphobia or social phobia.

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PhobiasCommon Fears
  • Common and uncommon fears

PhobiasPhobia Onset
Etiology of Phobias
  • Psychodynamic Unconscious conflicts (expressions
    of unacceptable wishes, fears and fantasies)
  • Behavioral
  • Classical conditioning
  • Baby Albert generalization
  • Operant Conditioning
  • Object avoidance behavior reinforced with anxiety
  • Observational learning (modeling)
  • Cognitive-behavioral Cognitive distortions and
    catastrophic thoughts
  • Biological Genetics or biological preparedness

PhobiasBiological Preparedness
  • The brains shortcut for emotions

Treatment of Phobias
  • Biochemical
  • Neurobiological abnormalities can be normalized
    with medication
  • Antidepressants, benzodiazepines, SSRIs
  • Behavioral
  • Exposure therapy (plus applied tension)
  • Systematic desensitization
  • Modeling
  • Cognitive restructuring
  • Skills training
  • Virtual Reality

Panic Disorder and Generalized Anxiety Disorder
  • Panic Disorder Characterized by intense fear
    accompanied by bodily sensations.
  • Generalized Anxiety Disorder (GAD)
    Characterized by milder anxiety-evoking thoughts
    chronic pathological worry.
  • Predominant characteristic Free-floating
    (unfocused) anxiety

Panic Disorder
  • Somatic symptoms Breathlessness, sweating,
    choking, nausea, heart palpitations.
  • May lead to Agoraphobia Anxiety about leaving
    ones home.
  • Lifetime prevalence 3.5 twice as common in
    women as in men.
  • An anxiety disorder marked by a minutes-long
    episode of intense dread in which a person
    experiences terror and accompanying chest pain,
    choking, or other frightening sensations.
  • A panic attack is anxiety to the extreme
  • 1 in 75 suffers from this disorder with smokers
    having a fourfold risk of a first attack.

Panic Attacks
  • Panic Attacks Intense fear accompanied by
    pounding heart, trembling, shortness of breath,
    fear of losing control, fear of dying.
  • Panic attacks may be experienced in any of the
    anxiety disorders.
  • Though panic attacks are relatively common, panic
    disorder is quite rare.
  • Three types of panic attacks
  • Situationally bound
  • Situationally predisposed
  • Unexpected or uncued

Generalized Anxiety Disorder (GAD)
  • Persistent high levels of anxiety and excessive
    worry over major and minor life circumstances
    (more persistent, less intense than Panic
  • DSM-IV-TR Symptoms present at least six months
  • Somatic symptoms Heart palpitations, muscle
    tension, restlessness, trembling, sleep
    difficulties, poor concentration, persistent

Generalized Anxiety Disorder (GAD)
  • An anxiety disorder in which a person is
    continually tense, apprehensive, and in a state
    of autonomic nervous system arousal.
  • Characterized by free-floating anxiety
  • Person cannot identify, avoid, or deal with
    source of anxiety.
  • Most have co-morbid disorders
  • World-wide Most frequently diagnosed anxiety
  • Lifetime Prevalence 5 twice as common in women
    as in men

Etiology of Panic Disorder and Generalized
Anxiety Disorder
  • Psychodynamic Internal conflicts from
    unconscious sexual and aggressive impulses.
  • When an unconsciously repressed memory seeks
    conscious representation, we feel the anxiety.
  • Cognitive-behavioral Interpretation of bodily
  • Anxiety-sensitivity theory of panic
  • Anxiety Sensitivity Index (ASI) Measures a
    persons reactions to anxiety.

Positive Feedback Loop Between Cognitions and
Somatic Symptoms Leading to Panic Attacks
Etiology of Panic Disorder and Generalized
Anxiety Disorder
  • Biological Changes and dysfunction of neural
    structures and neurochemical responses to
    stressful stimuli.
  • Valium and Librium can treat therefore might be
    due to chemical imbalances.
  • Biological challenge tests
  • Give people w/ and w/o disorder certain chemicals
    which raise internal processes (or ask to
  • People w/ disorder much more likely to experience
    panic attack.
  • Genetic studies indicate at least some
  • A stronger role in panic disorder than in GAD

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Treating Panic Disorder and Generalized Anxiety
  • Biochemical treatment
  • Benzodiazepines for GAD, but problems of
    tolerance and dependence
  • Antidepressants are medications of choice
  • SSRIs are most frequently prescribed because they
    have fewest side effects.
  • High relapse rates after stopping medications

Treating Panic Disorder and Generalized Anxiety
  • Behavioral treatment (individual and/or group)
  • Cognitive-behavioral therapy
  • Educate about disorder and symptoms
  • Muscle-relaxation training
  • Symptom-induction
  • Change unrealistic thoughts
  • Provide coping statements/use coping strategies
  • Identify antecedents of panic

Obsessive-Compulsive Disorder
  • Obsessive-Compulsive Disorder (OCD)
    Characterized by intrusive and repetitive
    thoughts or images, or by the need to perform
    acts or dwell on thoughts to reduce anxiety.
  • Ego-Dystonic Symptoms The symptoms are felt to
    be alien thoughts and actions, not under
    voluntary control of patient.
  • Lifetime prevalence rate 2.5 (possibly
    underestimated) same for males and females

Obsessive-Compulsive Disorder
  • Obsession Recurrent or persistent preoccupation
    with something.
  • an idea thought image impulse
  • Common obsessions include dirt, germs,
    something terrible happening, symmetry, order or
  • Approximately 80 of normal population
    experience obsessions (a song we cant get out of
    our head!).
  • Patients with OCD Obsessions last longer, are
    more intense, produce more discomfort, and are
    more difficult to dismiss.

Obsessive-Compulsive Disorder
  • Compulsion An impulse experienced as
    irresistible (The need to perform acts or to
    dwell on thoughts to reduce anxiety).
  • Repetitive and seemingly purposeful behaviors
    performed according to a rule or in a stereotyped
  • Common compulsions include grooming, hand
    washing, repeating rituals (e.g., in/out of
    door) checking locks, appliances, car brakes,
  • Children and adolescents with obsessive-compulsive
    disorder, compulsions most commonly involve
    washing, checking, and repeating acts.
  • Approximately 55 of normal population
    acknowledges compulsive behaviors (dont step on
    a crack!).
  • Severe compulsive state Stereotyped/rigid
    behaviors, often with magical qualities.

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Obsessive-Compulsive Disorder
  • Four Identified Types
  • Harm-related, sexual, aggressive, and/or
    religious obsession w/ checking compulsions
  • Symmetry obsessions w/ arranging and repeating
  • Contamination obsessions w/ cleaning compulsions
  • Hoarding and saving compulsions

Etiology of Obsessive-Compulsive Disorder
  • Psychodynamic perspective Attempts to fend off
    anal sadistic, anal libidinous, and genital
  • Defense mechanisms used substitution, undoing,
    reaction formation, isolation
  • Behavioral and cognitive perspectives Anxiety
  • Disconfirmatory bias-Search for evidence of
    failure to perform an act rather than success of
    an act.

Etiology of Obsessive-Compulsive Disorder
  • Biological perspective Brain structure, genetic
    factors, biochemical abnormalities.
  • Brain imaging procedures provide visual insight
  • Medications provide only partial relief

Treatment of Obsessive-Compulsive Disorder
  • Biological treatments Partial relief with
    fluoxetine and clomipramine, but side effects and
    relapse after medication stops.
  • Behavioral treatments
  • Exposure (similar to systematic desensitization),
    plus response prevention.
  • Flooding An exposure therapy that extinguishes
    fear by placing client in continued in vivo or
    imagined high anxiety-provoking situations.
  • Cognitive treatments Identify and modify
    irrational thoughts