Anxiety Disorders GAD, Specific Phobias, Social Phobias - PowerPoint PPT Presentation

1 / 86
About This Presentation

Anxiety Disorders GAD, Specific Phobias, Social Phobias


Anxiety Disorders GAD, Specific Phobias, Social Phobias, OCD, Panic Disorder, Agoraphobia, PTSD, Acute Stress Disorder Three Components of Anxiety Physical symptoms ... – PowerPoint PPT presentation

Number of Views:879
Avg rating:3.0/5.0
Slides: 87
Provided by: psycholog76


Transcript and Presenter's Notes

Title: Anxiety Disorders GAD, Specific Phobias, Social Phobias

Anxiety Disorders
  • GAD, Specific Phobias, Social Phobias, OCD, Panic
    Disorder, Agoraphobia, PTSD, Acute Stress Disorder

Three Components of Anxiety
  • Physical symptoms
  • Cognitive component
  • Behavioral component

Physiology of Anxiety Physical System
  • Perceived danger
  • Brain sends message to autonomic nervous system
  • Sympathetic nervous system is activated (all or
    none phenomena)
  • Sympathetic nervous system is the fight/flight
  • Sympathetic nervous system releases adrenaline
    and noradrenalin (from adrenal glands on the
  • These chemicals are messengers to continue

Parasympathetic Nervous System
  • Built in counter-acting mechanism for the
    sympathetic nervous system
  • Restores a realized feeling
  • Adrenalin and noradrenalin take time to destroy

Cardiovascular Effects
  • Increase in heart rate and strength of heartbeat
    to speed up blood flow
  • Blood is redirected from places it is not needed
    (skin, fingers and toes) to places where it is
    more needed (large muscle groups like thighs and
  • Respiratory Effects-increase in speed and dept of
  • Sweat Gland Effects-increased sweating

Behavioral System
  • Fight/flight response prepares the body for
    action-to attack or run
  • When not possible behaviors such as foot tapping,
    pacing, or snapping at people

Cognitive System
  • Shift in attention to search surroundings for
    potential threat
  • Cant concentrate on daily tasks
  • Anxious people complain that they are easily
    distracted from daily chores, cannot concentrate,
    and have trouble with memory

U Shaped Function of Anxiety
  • Useful part of life
  • Expressed differently at various age levels

Anxiety Disorders
  • Generalized Anxiety Disorder
  • GAD

Generalized Anxiety Disorder
  • Unfocused worry

Generalized Anxiety Disorder Diagnostic Criteria
  • Excessive anxiety or worry occurring more days
    than not for at least 6 months about a number of
    events or activities
  • Difficulty controlling worry
  • 3 of 6 symptoms are present for more days than
    notrestlessness, easily fatigued, difficulty
    concentrating, irritability, muscle tension,
    sleep disturbance

Generalized Anxiety Disorder (GAD) Prevalence
  • 4 of the population (range from 1.9 to 5.6)
  • 2/3 of those with GAD are female in developed
  • Prevalent in the elderly (about 7)

Generalized Anxiety Disorder Genetics
  • Familial studies support a genetic model (15 of
    the relatives of those with GAD display it
    themselves-base rate is 4 in general population)
  • Risk of GAD was greater for monozygotic female
    twin pairs than for dizygotic twins.
  • The tendency to be anxious tends to be inherited
    rather than GAD specifically
  • Heritability estimate of about 30

Generalized Anxiety Disorder Neurotransmitters
  • Finding that benzodiazepines provide relief from
    anxiety (e.g. valium)
  • Benzodiazepine receptors ordinarily receive GABA
    (gamma-aminobutyric acid)
  • GABA causes neuron to stop firing (calms things

Generalized Anxiety Disorder Neurotransmitters
  • Getting Anxious
  • Hypothesized Mechanism
  • Normal fear reactions
  • Key neurons fire more rapidly
  • Create a state of excitability throughout the
    brain and body perspiration, muscle tension etc.
  • Excited state is experienced as anxiety
  • Calming Down
  • Feedback system is triggered
  • Neurons release GABA
  • Binds to GABA receptors on certain neurons and
    orders neurons to stop firing
  • State of calm returns
  • GAD problem in this feedback system

GABA Problems?
  • Low supplies of GABA
  • Too few GABA receptors
  • GABA receptors are faulty and do not capture the

Generalized Anxiety Disorder Cognitions
  • Intense EEG activity in GAD patients reflecting
    intense cognitive processing
  • Worrying as a form of avoidance
  • restrict their thinking to thoughts but do not
    process the negative affect
  • Worry hinders complete processing of more
    disturbing thoughts or images
  • Content of worry often jumps from one topic to
    another without resolving any particular concern

Generalized Anxiety Disorder Treatment
  • Short term-benzodiazepine (valium)
  • Cognitive Therapy (focus on problem)

Anxiety Disorders
  • Phobias Specific Social

Phobia Diagnostic Criteria
  • Marked persistent unreasonable fear of object
    or situation
  • Anxiety response
  • Unreasonable
  • Object or situation avoided or endured with

Differential Diagnosis of Specific Phobia
  • Vs. SAD not related to fear of separation
  • Vs. Social Phobia not related to fear of a
    social situation or fear of humiliation
  • Vs. Agoraphobia fear not related to closed
  • Vs. PTSD fear not related to a specific past
    traumatic event

Phobias Types
  • Specific phobias
  • Blood-Injection Injury phobias
  • Situational phobia
  • Natural environment phobia
  • Animal phobia
  • Pa-leng (Chinese) colpa daria (Italian)
  • Germs
  • Choking phobia..

Developmentally Normal Fears
Phobias Prevalence
  • Fears are very prevalent
  • Phobias occur in about 11 of the population
  • More common among women
  • Tends to be chronic

Etiology of Phobias Genetics
  • 31 of first degree relatives of phobics also had
    a phobia (compared to 11 in the general
  • Relatives tended to have the same type of phobia
  • Not clear if transmission is environmental or

Specific Phobia Behavioral Perspective
  • Case of Little Albert
  • Two-factor model
  • Acquisition-classical conditioning
  • Maintenance-operant conditioning

Specific Phobia Behavioral Perspective
  • Classical conditioning
  • Modeling
  • Stimulus generalization

Evolutionary Preparedness
  • Predilection (or preparedness inherited from
    ancient ancestors) to be afraid of hazards
  • Good evolutionary reasons to be afraid of some
    things (snakebites, falls from large heights, and
    being trapped in small places)

Biological Preparedness Exercise
  • Write down an object or situation of which you
    are particularly afraid
  • Write down the events that led to the fear
  • As a group, tally the feared objects and the
    percentage of times the person could recall the
    beginning of the fear
  • As a group, indicate which group of fears are
    associated with dangerous consequences, e.g. fear
    of snakes

  • According to biological preparedness theory,
    objects of phobic fear are nonrandomly
    distributed to objects or situations that were
    threatening to the survival of the species.
  • Hypothesis More threatening objects or
    situations (that are threatening) will be listed
    than those that are not threatening

Specific Phobia Cognitive Perspective
Specific Phobia Social and Cultural Factors
  • Predominantly female
  • Unacceptable in cultures around the world for men
    to express fears

Specific Phobia Treatment
  • Systematic Desensitization

Social Phobia
  • Fearful apprehension
  • Social situations

Social Phobia Diagnostic Criteria
  • Marked or persistent fear in one or more social
    or performance situations
  • Exposure to fear situation is associated with
    extreme anxiety
  • Person recognizes that fear is excessive or
  • Feared social and performance situations are
    avoided or endured with intense anxiety

Social Phobia Prevalence
  • 13 of the general population
  • About equally distributed in males and females,
    however, males more often seek treatment
  • Usually begins around age 15
  • Equally distributed among ethnic groups

Etiology of Social Phobia
  • Biological vulnerability to develop anxiety or be
    socially inhibited. May increase under stress or
    when the situation is uncontrollable
  • Unexpected panic attack during a social situation
    or experience a social trauma resulting in
    conditioning (i.e. a learned alarm).
  • Modeling of socially anxious parents
  • Preparedness

Kagans theory inhibited temperament
  • Inhibited temperament risk factor in social
  • Behaviorally inhibited children at age 2 remained
    inhibited at age 7 and 12

Biological Basis of Temperament
  • Kagan proposed temperamental differences related
    to inborn differences in brain structure and
  • He found inhibited children have
  • Higher resting heart rates
  • Greater increase in pupil size in response to
  • Higher levels of cortisol (released with stress)

KagansTemperamental/Biological Theory and
  • Early identification of at risk children
  • Parental training
  • Avoid overprotecting
  • Encourage children to enter new situations
  • Help kids to develop coping skills
  • Avoid forcing the child

Social Phobia Treatment
  • Cognitive-Behavioral Therapy
  • Assess which social situations are problematic
  • Assess their behavior in these situations
  • Assess their thoughts in these situations
  • Teaches more effective strategies
  • Rehearse or role play feared social situations in
    a group setting
  • Medication
  • Tricyclic antidepressants
  • Monoamine oxidase inhibitors
  • SSRI (Paxil) approved for treatment
  • Relapse is common with medications are

Phobias content vs. function
  • Psychoanalysts believe content is important
  • Phobic stimulus has symbolic value
  • Little Hans the horse
  • Behaviorists believe function is important
  • All phobias acquired in same manner can be
    treated in same manner
  • All means of avoidance, treat with exposure

Psychoanalytic Etiology
  • Phobias as defenses against anxiety from id
  • Anxiety taken from id impulse and placed onto
    symbolic representation of the impulse
  • Ex Little Hans fear of his father (i.e. Oedipal
    conflict) displaced onto horses
  • Horses symbolized his father

Behavioral Etiology Phobias are learned. But
  • Avoidance-conditioning model classical
    conditioning results in fear
  • Ex fear of heights following a bad fall
  • Problem 1 phobias can develop without prior
    exposure to the feared stimulus
  • Ex snake phobics
  • Problem 2 many have frightening experiences
    without developing a phobia
  • Ex car accidents

Avoidance-conditioning cont.
  • Fewer problems if preparedness of stimuli
  • Preparedness phobias may result from stimuli to
    which an organism is prepared to have a fear
  • Evolutionary prepared fear response
  • Snakes, spiders, heights
  • Vs. electrical outlets, lambs
  • Ohmans studies
  • Provides method of addressing findings that
    feared stimuli are not random
  • Mc Nally against the A-C model

Behavioral cont Modeling
  • Phobias learned by watching reactions of others
  • vicarious learning
  • Can also be learned by listening to warnings
  • Mineka the rhesus monkeys
  • Teen monkeys placed with snake phobic adults
    developed fear of snakes
  • Monkeys shown videos of a monkey reacting
    fearfully to neutral vs. prepared stimuli
  • Only monkeys exposed to prepared stimulus
    developed phobia

Cognitive Theories
  • Anxiety due to attending to negative stimuli to
    believing negative events likely to occur
  • Social phobics thoughts focused on image they
    present and negative evaluation
  • I think I am boring when I talk to others
  • Fears seem irrational to phobics
  • Maybe b/c the fear is unconscious
  • Ohman Soares study
  • Increased response to pictures matching their

Anxiety Disorders
  • Obsessive Compulsive Disorder (OCD)

Obsession and Compulsions
  • Obsession Unwanted repetitive intrusive
    thoughts, images or urges
  • Exs contamination, sexual impulses, /or
    hypochondriacal fears
  • Compulsion Repeated thoughts or actions designed
    to provide relief
  • Ex cleanliness, checking, avoiding certain
  • Perceived of as irrational or silly

Relationship between Compulsion and Obsession
  • The most common obsession- germs and dirt is
    related to the most common compulsion handwashing
  • Obsessions create considerable anxiety
  • Compulsions are an attempt to cope with the
  • Repeating rituals (second most common compulsion)
    is often a way-in their mind-to avoid harm (eg.
    step on the crack game)
  • Children recognize that compulsions are
    unreasonable and will attempt to hide the
    behavior with nonfamily members

OCD Diagnostic Criteria
  • A. Either obsession or compulsions
  • B. Recognition that obsessions or compulsions are
    excessive or unreasonable (does not apply to
  • C. The obsession or compulsions cause marked
    distress, and are time consuming (take over one
    hour a day) or significantly interfere with the
    persons normal functioning
  • D. If another Axis I disorder is present, the
    content of the obsession or compulsion is not
    restricted to it (preoccupation in food in eating
    disorder, concern with drugs in Substance Abuse
  • E. The disturbance is not due to the direct
    effects of drugs, medication or a physical
  • Specifier With poor insight if, most of the
    time, the person does not recognize the
    obsessions and compulsions are unreasonable

OCD Prevalence
  • 2.6 (may be a bit of an overestimate)
  • 10 to 15 of normal college students engage in
    clinically significant checking behavior
  • More common in females (reversed in childhood)
  • Age of onset is in teens to young adulthood
  • Chronic course

OCD Etiology Psychoanalytic
  • Obsessions and compulsions as a reaction to
    instinctual, Id, impulses
  • Due to harsh toilet training
  • Fixation in anal stage
  • Id vs. defense mechanisms (ego)
  • Id obsessions
  • Ego compulsions
  • Adler feel incompetent as a child, create
    control over environment through compulsions

OCD Etiology Cognitive Behavioral
  • Compulsions
  • learned behaviors based on consequences
  • Reduced fear after completing compulsions
  • But not obsessions
  • Poor memories?
  • Compulsive checkers have poor recall for whether
    they had completed the compulsion (e.g. turning
    off lights) previously
  • Obsessions
  • Thought suppression paradoxical effect
  • Increased prreoccupation and negative mood

Etiology OCD Biological Explanations
  • Neurotransmitter (low serotonin)
  • Brain structures/areas

(No Transcript)
(No Transcript)
(No Transcript)
OCD Treatment
  • Medication SSRIs (serotonin reuptake inhibitors)
  • Average treatment gain with medication is
    moderate and relapse occurs when medication is
  • Exposure and ritual prevention (ERP)
  • Psychosurgery

Anxiety Disorders
  • Panic Disorder with and without agoraphobia

Panic Disorder
  • Attack occurs suddenly, unexpectedly, peaking
    within a few minutes and lasting around ten
  • Heart palpitations, nausea, chest pain, choking,
    dizziness, apprehension
  • Depersonalization feeling outside your body
  • Derealization feeling world is unreal
  • Fear losing control, dying, going insane
  • Interoceptive avoidance
  • Can develop agoraphobia

Panic Disorder Diagnostic Criteria
  • Recurrent unexpected panic attacks( A discrete
    period of intense fear of discomfort in which
    four or more somatic/anxiety symptoms developed
    abruptly and reached a peak within 10 minutes)
  • At least one of the attacks has been followed by
    conern for additional attacks and significant
    change in behavior
  • Not due to physiological effects of medications,
    drugs, or medical conditions
  • Not accounted for by another disorder

Three Types of Panic Attacks
  • Unexpected out of the blue
  • Situationally bound almost always occur in
    certain contexts
  • Situationally predisposed or cued occur in
    certain contexts but not all the time
  • If only cued or situational, could be phobia

Panic Disorder
  • Prevalence 2 men, 5 women
  • Average age of onset is between 25 and 29
  • Commonly paired with a traumatic experience
  • With or without agoraphobia
  • Fears of public places and inability to escape
    from them (shopping malls, crowds)
  • Fear having a panic attack in public
  • Often dont leave the house
  • if avoidance widespread, agoraphobia results

Etiology Panic Disorder Biological Explanations
  • Neurotransmitters
  • Biological vulnerability neurotransmitters
  • Not clear whether the problem is excessive or
    deficient activity or some other form of
    dysfunction related to norepinephrine
  • Genetics
  • One study found 24 concordance among identical
    twins and 11 concordance in fraternal twins.
    (baserate is 3.5)

Fear of fear hypothesis
  • Goldstein Chambless
  • Agoraphobia as a fear of having a panic attack in
  • Panic disorder patients misinterpret bodily
    signs/symptoms catastrophically
  • Anxiety sensitivity focus on their bodily
    sensations and inability to assess these
    sensations logically

(No Transcript)
  • Panic attacks found in 80 of those diagnosed
    with an anxiety disorder other than PD
  • Not frequent enough to meet PD criteria
  • MDD, GAD, phobias, substance abuse

Panic Disorder Treatment
  • Medication
  • Antidepressant medications associated with some
    improvement in 80 of patients with 40 to 60
    recovering markedly or fully
  • Improvements contingent on medications
  • Benzodiazepines (such as Xanax) have also been
    empirically effective
  • Cognitive
  • Emphasis on correcting misinterpretations of body
  • Educating about panic attacks
  • Teach more accurate interpretations
  • Exposure
  • 70 of patients improve but few are cured

Panic Combined Treatment
  • Short Term
  • Combined treatment no more effective than
    individuals treatments in the short term
  • Long Term
  • Those receiving CBT alone maintained most of
    their treatment gains
  • Those taking medication (alone or in combination)
    deteriorated somewhat

Recommendation Psychological treatment offered
first, followed by medication
Anxiety Disorders
  • Post Traumatic Stress Disorder
  • PTSD

  • Extreme response to a stressor
  • Anxiety, avoidance of similar stimuli, emotional
  • Significant impairment
  • Person must have experienced or witnessed event
    involving actual/threatened death or serious
    injury to self or others
  • 25 experiencing a trauma develop PTSD

PTSD VS. Acute Stress Disorder
  • Acute Stress Disorder
  • Reaction to trauma, significant impairment
  • Lasts up to one month
  • Normal reaction to trauma
  • 60 recover without experiencing PTSD
  • PTSD
  • Acute stress disorder lasting greater than one

PTSD Symptoms
  • Symptoms in each category gt 1 month
  • Reexperiencing recalling the event, nightmares,
    emotional distress w/ similar stimuli or on
  • Avoidance/numbing attempt to avoid thinking
    about the event, amnesia, decreased ability to
    feel positive emotions, decreased
    contact/interest in others
  • Go back and forth between 1 2

PTSD Symptom Cont.
  • Increased arousal sleep difficulties, low
    concentration, hypervigilance, exaggerated
    startle response
  • Comorbidities MDD, anxiety disorders, marital
    problems, substance abuse, suicidality, somatic
  • Prevalence 1 3 general population
  • 20 in Vietnam veterans
  • 94 rape victims

PTSD in kids
  • Different manifestation of symptoms
  • Nightmares (monsters)
  • Behavioral changes
  • Quiet to aggressive, outgoing to withdrawn
  • Regression
  • Loss of acquired skills (toilet training, speech)
  • Difficulty discussing traumatic event

Risk Factors for PTSD
  • Given exposure to a trauma,
  • Female gender
  • Early separation from parents
  • Family history
  • Preexisting mental illness
  • Increased severity of trauma
  • Initial reaction to trauma
  • Depressed, anxious, dissociative symptoms

PTSD Etiology Behavioral
  • Classical conditioning to fear
  • Ex woman fears parking lots (CS) b/c she was
    shot in one (UCS)
  • Avoidance builds due to negative reinforcement
    (i.e. reduction in fear by avoiding parking lots)

Other PTSD Etiologies
  • Psychodynamic memories so painful they are
  • Person tries to reintegrate memories into
  • Biology twin studies support a genetic diathesis
  • Heightened norepinephrine
  • Increased startle
  • Evidence still mixed
  • No good evidence for why some develop PTSD
    others do not

General Etiology of Anxiety Disorders
  • Biological Contributions
  • Evidence that suggests individuals inherit the
    tendency to be anxious or highly emotional
  • What could be inherited?
  • Specific brain circuits and neurotransmitter
    systems (GABA noradrenergic serotonergic
  • Over production of corticotropin releasing factor
    (CRF) which is associated with activation of the
    HPA axis
  • Functional systems gone awry

Role of the Behavioral Inhibition System (BIS)
  • Functional system proposed by Jeffrey Gray
  • BIS is activated by brain stem signals of
    unexpected events or danger signals from the
  • Leads to anxiety
  • Corresponds to the Limbic system
  • Specifically, the septo-hippocampal system
    innervated by both serotonergic circuits and
    noradrenergic circuits

Fight/Flight Systems
  • Also proposed by Jeffrey Gray
  • Originates in the brain stem, activates the
    amygdala, and results in an immediate
    alarm-and-escape response in animals that looks a
    lot like panic
  • Most likely associated with Panic Disorder

Etiology of Anxiety Disorders (contd)
  • Psychological Contributions
  • Freud anxiety as a psychic reaction to danger
    surrounding the reactivation of an infantile fear
  • Behaviorists anxiety as a by product of
    conditioning experience
  • More recent view children initially obtain a
    perception that events are not under their
    control and this is dangerous
  • Sense of control develops via interactions with
  • Important psychological contribution

Etiology of Anxiety Disorders (contd)
  • Stressful life events
  • Many stressors activate biological and
    psychological vulnerabilities to anxiety
  • Integrated model
  • Interaction between biological, psychological,
    experiential, and social variables

Etiology for Specific Anxiety Disorders?
  • Why would it be hard to derive etiologies for
    specific types of anxiety disorders?

Comorbidity in Anxiety
  • Within anxiety disorders due to
  • Overlapping symptoms
  • Ex fast heart rate is a symptom of PTSD, Panic
    disorder, and GAD
  • Overlapping etiologies
  • Ex helplessness as a theory for both phobias
    and GAD
  • Across other DSM-IV disorders
  • Spectrum idea
  • Depression on a continuum with anxiety
  • Common symptoms lack of sleep, lack of
    concentration, worry
Write a Comment
User Comments (0)