Anxiety Disorders

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Anxiety Disorders

• Barlow and Durand
• Brown and Barlow

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Anxiety Disorders

• Anxiety
• Very hard to study because subjective, sense of
  unease, differences in behavior sets,
  physiological responses that one cannot
  necessarily see

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Anxiety

• Anxiety is good for us in moderate amounts we
  perform better when a little anxious Yerkes
  Dodson

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Anxiety versus Fear

• Anxiety is a future oriented mood state,
  characterized by apprehension because one cannot
  predict or control upcoming events
• Fear is an immediate and current reaction to
  danger characterized by a strong escapist action
  and a surge in the sympathetic branch of the ANS

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Panic Attack

• An abrupt experience of intense fear or acute
  discomfort accompanied by physical Sx that
  include heart palpitations, chest pain, shortness
  of breath, dizziness, and fear at an
  inappropriate time for such behaviors

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Panic Attacks can be

• Situationally bound
• Unexpected
• Situationally Predisposed You are more likely
  to have an attack in a place you have

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Causes of Anxiety Disorders

• Biological causes
• We may inherit tendencies to be tense or uptight
• Panic disorders also
• Researchers have found evidence in animals that
  tendencies to be uptight,

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More biological causes of Anxiety Disorders

• Depleted levels of GABA are associated
• Corticotrophin releasing factor (CRF) has effects
  on the limbic system or the emotional brain
• One study has shown that smoking as a teenager
  may lead to anxiety disorders particularly panic
  disorder and GAD

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Psychological Causes of Anxiety Disorders

• An early fear of uncontrollability in life as a
  child and adolescent
• Children should be allowed to explore their
  world so they can learn the necessary skills to
  cope with unexpected occurrences

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Psychological Causes of Anxiety Disorders Cont.

• Conditioning
• Associations

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Social Contributions to Anxiety Disorders

• Stressful life events can trigger the

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An integrated model

• All of the above contributions weave together to
  increase vulnerability to Anxiety

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Comorbidity of Anxiety Disorders

• The occurrence of two or more disorders within an
  individual
• The most common comorbid disorder with Anxiety
  Disorders is

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Generalized Anxiety Disorder (GAD)

• Clinical Description
• Worrying indiscriminately about everything.
• No matter how much they worry, they cant figure
  out what to do about it
• The focus of the anxiety in

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DSM-IV-TR States

• 6 months of excessive anxiety and worry must be
  present more days than not
• The worry process must be difficult to control or
  turn off
• This is what separates normal worry from
  excessive worry

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GAD

• GAD is characterized by
• Mental Agitation
• Susceptibility to
• Irritability
• Difficulty
• Difficulty
• Excessive worry over

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Statistics on GAD

• 4 of the population meet criteria for
• This makes GAD one of the most common Anxiety
  Disorders
• Similar rates are reported throughout the world

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Statistics on GAD

• Mostly a
• Once it develops it is
• 8 become symptom free after
• Most common in groups over
• Least common in groups

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Causes of GAD

• Can run in families
• Persons already highly sensitive to
• Autonomic Restrictors

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Treatment of GAD

• Meds
• Benzodiazapines
• These drugs impair cognitive and motor
  functioning and physical and psychological
  dependence can
• Antidepressants

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Treatments for GAD

• Psychological Treatments
• Cognitive Behavioral Treatments (CBT)

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Panic Disorder with Agoraphobia (PDA)

• An expression of severe unexpected panic attacks
• They think they are dying or otherwise loosing
  control
• Anxiety present about the next attack because

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PDA

• Agoraphobia
• Sometimes agoraphobia is so severe that they will
  not leave their house

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PDA

• Clinical Description
• Anxiety and panic are combined with
• Criteria states that a person must experience an
  unexpected panic attack and develop
• They feel that each attack means impending death
  or incapacitation

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Development of Agoraphobia

• Afraid of the onset of the next attack
• Therefore they begin avoiding unsafe places
  that may cause attacks
• Always plan a rapid escape from every situation
• Retreat to a safe place
• This is a way of coping with future attacks
• They may also endure

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Agoraphobia cont.

• They may also avoid feelings associated with
  panic attacks

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Statistics on PDA

• 3.5 of population meet criteria at some point in
  their lives
• 2/3 women
• Onset is
• Mid teens through
• Mean age is

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Cultural Influences on PDA

• PDA exists worldwide
• The expression is what differs
• African Americans have more
• This could be because of

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Causes of PDA

• Some can inherit a trait that may make them more
  susceptible to PDA
• Behavioral conditioning
• Cognitive distortions in believing something
  terrible

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Causes of PDA

• Persons that pay too close attention to internal
  bodily processes
• Early separation anxiety

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Treatment of PDA

• Meds
• Antidepressants blocked panic attacks, but did
  less in reducing GAD
• Benzodiazapines reduced GAD but did not block
  panic attacks ie Xanax but psychological and
  physical addictions can occur
• SSRIs preferred currently for panic attacks
  because they appear to work with less side effects

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Treatments of PDA

• 60 of patients with panic disorders are free of
  panic attacks as long as they stay on an
  effective drug, but

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Treatments of PDA

• Psychological Interventions for PDA
• Very effective for PDA
• Exposure
• Use of anxiety reducing coping mechanisms
• 70 of patients improve

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Psychological Interventions for PDA cont.

• Panic Control Treatment (PCT) exposes patients to
  a cluster of sensations that remind the person of
  their panic attacks
• They also get cognitive therapy which seeks to
  change attitudes and perceptions of the
  dangerous and feared situations and modify
  them with better attitudes and perceptions

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Combined Treatments for PDA

• Psychological interventions and meds
• Combined treatments are no better than either
  treatment alone at the beginning and middle of
  treatment
• There appears to be a lower rate of relapse with
  CBT treatment alone as compared to meds or
  combined treatments post treatment

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Specific Phobia

• Clinical Description
• An irrational fear of a specific object or
  situation which markedly interferes with an
  individuals ability to function

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Four main subtypes of SP
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Blood-injection-injury type

• Differ in physiological reaction blood and
  heart rates decrease rather than increase as in
  other types
• Runs in families more strongly than others

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Situational phobia

• Onset early to mid 20s
• Examples include claustrophobia and public
  transportation

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Natural environment phobia

• Examples include heights, storms, and water
• Age of onset
• Have to be persistent and interfere substantially
  with functioning

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Animal phobia

• Examples include animals and insects
• Must interfere with functioning like if they
  cant read a magazine because they are afraid of
  encountering a picture of the animal or insect

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Other Phobia

• Includes things that dont fit into the other
  categories
• Examples include

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Separation Anxiety Disorder

• Unique to
• Unrealistic and persistent worry that something
  will happen to parents or loved ones or to the
  child themselves

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Statistics on Specific Phobias

• Fears of snakes and heights are the most common
• 11 of the population at some point in their
  lives will experience a phobia
• Predominately

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Causes of Specific Phobia

• Some by direct experience
• Experiencing a false alarm
• Observing someone else experience severe fear to
  something
• Being told about danger

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Treatment for Specific Phobia

• Exposure based excersizes
• Gradual - or may do too much to soon and escape
  the situation which can strengthen the avoidance
  habits of the phobia

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Social Phobia

• Clinical description
• Marked fear of social or performance situations
• Required to do something while others are
  watching and evaluating
• Only when others are watching does the behavior
  deteriorate

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Statistics on Social Phobia

• 13.3 of the general population at some point in
  their lives will experience social phobia

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Causes of Social Phobia

• Genes (inherit tendency)
• Initial panic attacks in a social situation can
  become conditioned into social phobia

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Treatment for Social Phobia

• Psychological Interventions
• CBGT
• Role play in front of groups
• At the same time the therapist works to uncover
  and change automatic thoughts of danger in such
  social situations

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Treatments for Social Phobia

• Meds
• Antidepressants
• MAOIs
• SSRIs
• Relapse is common when drugs are stopped

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Post Traumatic Stress Disorder (PTSD)

• Clinical Description
• Exposure to a traumatic event during which one
  feels intense fear, helplessness, or horror

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PTSD subdivided into groups

• Acute
• Chronic
• Cannot be diagnosed as PTSD until 1 month after
  the trauma
• Otherwise

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PTSD

• PTSD symptoms are usually accompanied by
• Severe dissociative symptoms
• Emotional numbing
• Derealization

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Statistics on PTSD

• Prevalence levels differ between populations of
  trauma victims
• Some people experience intense trauma and are
  fine
• Others experience small traumas and meet the
  criteria for PTSD

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Causes of PTSD

• Trauma followed by disorder
• Intensity of trauma appears to play a role some
  of the time
• Genetic vulnerability (family history of anxiety
  disorders, twin studies)
• Family instability contributes to an
  uncontrollable environment and may make one more
  susceptible

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Causes of PTSD cont.

• A weak support group makes a person mores
  susceptible to developing PTSD
• Damage to the hippocampus

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Treatment of PTSD

• Psychological Interventions
• Reliving emotional trauma
• Imaginal exposure
• Meds
• SSRIs

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Obsessive Compulsive Disorder (OCD)

• Clinical Description
• Establishing even a foothold of control and
  predictability over the dangerous events in life
  seem so utterly hopeless that victims resort to
  magic and rituals
• The dangerous event is

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OCD

• IE Pink Elephants
• Obsessions
• Compulsions

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OCD

• Most common obsessions
• Contamination
• Aggressive Impulses
• Sexual Content
• Somatic Concerns
• Need for Symmetry

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OCD

• Most common compulsions
• Checking
• Ordering
• Arranging
• Washing
• Cleaning
• Counting
• Hoarding

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Statistics on OCD

• 2.6 lifetime prevalence of OCD
• Majority female, but not by much
• However, in children more males have OCD than
  females
• Onset age is

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Causes of OCD

• Thought action fusion
• Causes a person to not be able to throw the
  thought away because it is almost as if they are
  doing it

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Treatment for OCD

• Meds
• SSRIs benefit up to 60 of OCD patients
• Relapse is frequent after the stopping of the
  medications

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Treatment for OCD cont.

• Psychological Interventions
• Exposure and ritual prevention (ERP)
• The rituals are actively prevented and the
  patient is systematically and gradually exposed
  to the feared thoughts or situations
• This is kind of like reality testing
• ERP found to be superior to drug treatments

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Treatment for OCD cont.

• Psychosurgery
• This is a last effort
• It helps