ANXIETY DISORDERS

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• ANXIETY DISORDERS
• LECTURE OUTLINE
• Panic and anxiety background and history
• Etiology theoretical perspectives
• Types of anxiety disorders and their treatment
• Treatments

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• ANXIETY DISORDERS
• Who is afraid of ?
• small insect
• animal, reptile
• speaking to a large audience
• speaking in front of a small group of familiar
  people
• meeting new people
• attending social gatherings

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• ANXIETY DISORDERS
• Background and history
• experience of anxiety cognitive, somatic,
  behavioural, emotional
• panic discrete period of intense fear or
  discomfort (brief and intense)
• palpitations, shaking, chest pain, fear of
  dying, going crazy, losing control
• anxiety negative affect, sense of
  uncontrollability of future threat,
  self-preoccupation

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• ANXIETY DISORDERS
• Background and history
• panic attacks occur spontaneously
• both panic and anxiety can be normal
  experiences
• they become maladaptive when they become
  excessive, chronic, and in absence of any real
  danger

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• ANXIETY DISORDERS
• Background and history
• Prevalence
• 25 of population may be expected to have an
  anxiety disorder at some time in their lives
• Ontario Health Supplement 1-year prevalence
  rates of 9 for men, 16 for women

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• ANXIETY DISORDERS
• Background and history
• 1800s and early 1900s neuroses, Freudian
  perspective
• 1920s Watson, classical conditioning model,
  Little Albert
• later 1900s Eysenck neuroticism as a basic
  personality dimension strong emotions, moody,
  restless, anxious

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• ANXIETY DISORDERS
• Etiology
• Psychodynamic perspective
• realistic, neurotic, moral anxiety
• defense mechanisms
• origins in early parent-child relationships
• neurotic paradox contradicts pleasure principle

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• ANXIETY DISORDERS
• Etiology
• Neurotic styles Shapiro
• inhibition of assertion/aggression
• inhibition of responsibility/independence
• inhibition of compliance/submission
• inhibition of trust/intimacy

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• ANXIETY DISORDERS
• Etiology
• Biological perspective - Genetics
• family studies show up to 25 have an immediate
  family member with an anxiety disorder
• twin studies - higher concordance rates for MZ
  than DZ twins
• genetics may operate through behavioural
  inhibition

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• ANXIETY DISORDERS
• Etiology
• Biological perspective - Neuroanatomy
• locus ceruleus
• amygdala
• one form of peptide (combo of amino acids),
  CCK4, related to panic CCK4 is found in
  amygdala, hippocampus, cerebral cortex, brain stem

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• ANXIETY DISORDERS
• Etiology
• Biological perspective - Neurotransmitters
• norepinephrine (NE) concentrated in locus
  ceruleus
• serotonin
• dopamine in social phobia and OCD
• interactions serotonin affects locus ceruleus
  (where NE is produced) and may also influence GABA

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• ANXIETY DISORDERS
• Etiology Limitations of 2-factor theory
• cannot explain all phobias some seem to
  develop without conditioning
• difficult to create some fears in the lab
• cannot explain why some stimuli are more likely
  to become feared than others

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• ANXIETY DISORDERS
• Etiology Rachmans revised theory
• classical conditioning
• modelling
• informational or instructional transmission

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• ANXIETY DISORDERS
• Etiology Biological preparedness theory
• Seligman evolutionary significance of stimuli
  that are easily conditioned
• Bandura properties of stimuli themselves
  (unpredictability and uncontrollability) and the
  cognitive processing that defines their
  threatening nature

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• ANXIETY DISORDERS
• Etiology Cognitive theories
• Bandura low perceived self-efficacy
• Beck experiences, beliefs, appraisals
• Ellis irrational beliefs, catastrophization

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• ANXIETY DISORDERS
• Etiology Biopsychosocial perspective
• emotion
• biology
• environment
• behaviour
• cognition

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• ANXIETY DISORDERS
• Types Specific phobia
• animal
• environmental
• blood, injury, injection
• specific situation elevators, flying
• other

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• ANXIETY DISORDERS
• Types Specific phobia Diagnostic features
• marked and persistent fear and avoidance of
  specific stimulus or situation
• must interfere significantly with persons life
• must be considered excessive or unrealistic
• ANS arousal

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• ANXIETY DISORDERS
• Types Specific phobia
• prevalence rates from 7-11
• often emerge during adolescence, usually earlier
  than age 25
• tend to be chronic, but may fluctuate over life
  course
• usually assessed with self-report
• conditioning theories systematic
  desensitization

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• ANXIETY DISORDERS
• Systematic desensitization (SD) for specific
  phobia
• Wolpe (1958) reciprocal inhibition and SD
• 3 components of SD
• construction of stimulus hierarchy
• progressive (deep muscle) relaxation training
• progress through the hierarchy while practicing
  relaxation response

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• ANXIETY DISORDERS
• Panic disorder - Elements
• recurrent, unexpected panic attacks
• persistent concern, preoccupation with having
  another attack
• worry about consequences of attack
• significant behaviour change in response to
  attacks

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• ANXIETY DISORDERS
• Panic disorder Other clinical features
• often accompanied by avoidance behaviours
  (agoraphobia)
• possible to have agoraphobia without panic
  attacks
• onset around late adolescence, early adulthood
• more women than men
• high rates of service utilization, poor quality
  of life

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• ANXIETY DISORDERS
• Clarks cognitive model of panic disorder)
• catastrophic misinterpretation of
  arousal-related bodily sensations
• agoraphobia (avoidance) as way of coping

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• ANXIETY DISORDERS
• Obsessive-compulsive disorder (OCD) - Elements
• recurrent obsessions, compulsion, or both
• obsessesions thoughts, images, impulses, that
  are persistent, markedly distressing
• compulsion repetitive behaviours performed in
  response to an obsession

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• ANXIETY DISORDERS
• Obsessive-compulsive disorder (OCD) - Elements
• common obsessions violence, sex,
  contamination, order
• common compulsions washing, cleaning,
  checking, seeking reassurance, ordering or
  arranging objects
• cleaners vs. checkers focus on harm vs. order

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• ANXIETY DISORDERS
• Obsessive-compulsive disorder (OCD) - Background
• very rare 2.5 lifetime prevalence rate
• little gender difference
• high overlap with depression and Tourettes
  syndrome

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• ANXIETY DISORDERS
• Obsessive-compulsive disorder (OCD)
  Psychodynamic perspective
• anal fixation Does anal-retentive have a
  hyphen?
• reaction formation, undoing, displacement

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• ANXIETY DISORDERS
• Obsessive-compulsive disorder (OCD) Treatments
• Prozac - SSRIs
• Exposure and response prevention

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• ANXIETY DISORDERS
• Post-traumatic stress disorder (PTSD)
  Description
• Person has been exposed to traumatic event
• 3 symptom clusters
• recurrent re-experiencing of event
• avoidance of trauma-related stimuli and numbing
• increased arousal
• Persists for at least 1 month after trauma

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• ANXIETY DISORDERS
• Post-traumatic stress disorder (PTSD) Etiology
• Cognitive theories
• expectations and appraisals
• fear structure in long-term memory
• fear conditioning

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• ANXIETY DISORDERS
• Generalized anxiety disorder (GAD) Description
• Core feature is worrying worries are
  unrealistic, difficult to control, excessive
• Free floating anxiety
• Verbal thoughts rather than images as in OCD
• Motor tension, vigilance, scanning
• What if? background of intolerance of
  uncertainty

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• ANXIETY DISORDERS
• Generalized anxiety disorder (GAD) Description
• 3 key features
• uncontrollability
• intolerance of uncertainty
• ineffective problem-solving skills

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• ANXIETY DISORDERS
• Treatments - Pharmacotherapy
• 3 main drugs
• Xanax
• Paxil
• Zoloft
• SSRIs, bezodiazepines, tricyclic
  anti-depressants, MAOs

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• ANXIETY DISORDERS
• Treatments - Exposure
• flooding, response prevention
• confrontation with anxiety-producing stimulus
• developing more adaptive internal
  representations of the stimuli and their
  non-threatening consequences

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• ANXIETY DISORDERS
• Treatments Cognitive restructuring
• identify maladaptive cognitions
• challenge maladaptive cognitions
• develop more adaptive cognitions

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• ANXIETY DISORDERS
• Treatments Relaxation training
• decreases physiological arousal through
• deep muscle relaxation
• positive imagery
• meditation
• deep breathing

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• ANXIETY DISORDERS
• Treatments Problem-solving training
• What is my problem? What is my goal? What
  solutions can I generate to solve the problem?
  What might be the consequences of each solution?
  Try a solution
• particularly relevant to GAD
• divides problems into manageable units

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• ANXIETY DISORDERS
• SUMMARY
• both biological and psychological factors
  involved in etiology of anxiety disorders
  biopsychosocial model
• shift away from Freudian perspective on
  neuroses
• both biological and psychological treatments for
  the various disorders