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Anxiety Disorders

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Title: Anxiety Disorders


1
Anxiety Disorders
  • Barlow and Durand
  • Brown and Barlow

2
Anxiety Disorders
  • Anxiety
  • Very hard to study because subjective, sense of
    unease, differences in behavior sets,
    physiological responses that one cannot
    necessarily see

3
Anxiety
  • Anxiety is good for us in moderate amounts we
    perform better when a little anxious Yerkes
    Dodson

4
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

5
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

6
Panic Attacks can be
  • Situationally bound
  • Unexpected
  • Situationally Predisposed You are more likely
    to have an attack in a place you have

7
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,

8
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

9
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

10
Psychological Causes of Anxiety Disorders Cont.
  • Conditioning
  • Associations

11
Social Contributions to Anxiety Disorders
  • Stressful life events can trigger the

12
An integrated model
  • All of the above contributions weave together to
    increase vulnerability to Anxiety

13
Comorbidity of Anxiety Disorders
  • The occurrence of two or more disorders within an
    individual
  • The most common comorbid disorder with Anxiety
    Disorders is

14
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

15
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

16
GAD
  • GAD is characterized by
  • Mental Agitation
  • Susceptibility to
  • Irritability
  • Difficulty
  • Difficulty
  • Excessive worry over

17
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

18
Statistics on GAD
  • Mostly a
  • Once it develops it is
  • 8 become symptom free after
  • Most common in groups over
  • Least common in groups

19
Causes of GAD
  • Can run in families
  • Persons already highly sensitive to
  • Autonomic Restrictors

20
Treatment of GAD
  • Meds
  • Benzodiazapines
  • These drugs impair cognitive and motor
    functioning and physical and psychological
    dependence can
  • Antidepressants

21
Treatments for GAD
  • Psychological Treatments
  • Cognitive Behavioral Treatments (CBT)

22
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

23
PDA
  • Agoraphobia
  • Sometimes agoraphobia is so severe that they will
    not leave their house

24
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

25
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

26
Agoraphobia cont.
  • They may also avoid feelings associated with
    panic attacks

27
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

28
Cultural Influences on PDA
  • PDA exists worldwide
  • The expression is what differs
  • African Americans have more
  • This could be because of

29
Causes of PDA
  • Some can inherit a trait that may make them more
    susceptible to PDA
  • Behavioral conditioning
  • Cognitive distortions in believing something
    terrible

30
Causes of PDA
  • Persons that pay too close attention to internal
    bodily processes
  • Early separation anxiety

31
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

32
Treatments of PDA
  • 60 of patients with panic disorders are free of
    panic attacks as long as they stay on an
    effective drug, but

33
Treatments of PDA
  • Psychological Interventions for PDA
  • Very effective for PDA
  • Exposure
  • Use of anxiety reducing coping mechanisms
  • 70 of patients improve

34
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

35
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

36
Specific Phobia
  • Clinical Description
  • An irrational fear of a specific object or
    situation which markedly interferes with an
    individuals ability to function

37
Four main subtypes of SP
38
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

39
Situational phobia
  • Onset early to mid 20s
  • Examples include claustrophobia and public
    transportation

40
Natural environment phobia
  • Examples include heights, storms, and water
  • Age of onset
  • Have to be persistent and interfere substantially
    with functioning

41
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

42
Other Phobia
  • Includes things that dont fit into the other
    categories
  • Examples include

43
Separation Anxiety Disorder
  • Unique to
  • Unrealistic and persistent worry that something
    will happen to parents or loved ones or to the
    child themselves

44
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

45
Causes of Specific Phobia
  • Some by direct experience
  • Experiencing a false alarm
  • Observing someone else experience severe fear to
    something
  • Being told about danger

46
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

47
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

48
Statistics on Social Phobia
  • 13.3 of the general population at some point in
    their lives will experience social phobia

49
Causes of Social Phobia
  • Genes (inherit tendency)
  • Initial panic attacks in a social situation can
    become conditioned into social phobia

50
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

51
Treatments for Social Phobia
  • Meds
  • Antidepressants
  • MAOIs
  • SSRIs
  • Relapse is common when drugs are stopped

52
Post Traumatic Stress Disorder (PTSD)
  • Clinical Description
  • Exposure to a traumatic event during which one
    feels intense fear, helplessness, or horror

53
PTSD subdivided into groups
  • Acute
  • Chronic
  • Cannot be diagnosed as PTSD until 1 month after
    the trauma
  • Otherwise

54
PTSD
  • PTSD symptoms are usually accompanied by
  • Severe dissociative symptoms
  • Emotional numbing
  • Derealization

55
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

56
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

57
Causes of PTSD cont.
  • A weak support group makes a person mores
    susceptible to developing PTSD
  • Damage to the hippocampus

58
Treatment of PTSD
  • Psychological Interventions
  • Reliving emotional trauma
  • Imaginal exposure
  • Meds
  • SSRIs

59
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

60
OCD
  • IE Pink Elephants
  • Obsessions
  • Compulsions

61
OCD
  • Most common obsessions
  • Contamination
  • Aggressive Impulses
  • Sexual Content
  • Somatic Concerns
  • Need for Symmetry

62
OCD
  • Most common compulsions
  • Checking
  • Ordering
  • Arranging
  • Washing
  • Cleaning
  • Counting
  • Hoarding

63
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

64
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

65
Treatment for OCD
  • Meds
  • SSRIs benefit up to 60 of OCD patients
  • Relapse is frequent after the stopping of the
    medications

66
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

67
Treatment for OCD cont.
  • Psychosurgery
  • This is a last effort
  • It helps
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