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ANXIETY DISORDERS

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ANXIETY DISORDERS Post-traumatic stress disorder (PTSD) Etiology Cognitive theories expectations and appraisals fear structure in long-term memory fear ... – PowerPoint PPT presentation

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Title: 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

29
  • 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
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