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1

Anxiety

a generalized state of apprehension or foreboding

2

Anxiety Disorder
- 3 domains of symptoms
- Prevalence
- DSM 3 major types

a maladaptive anxiety reaction which causes significant emotional distress or impairment of ability to function.
1) physical features- jumpiness jitteriness trembling tightness in stomach or chest, sweating, cold fingers, nausea
2) behavioral- avoidance behavior, clinging behavior. agitation
3) Cognitive- worry, nagging sense of dread or apprehension about future, preoccupation with bodily senses and over awareness
- affect nearly 1 in 5 adults in the US or 40 million people
1. panic disorder 2. phobic disorder 3. GAD

3

neurosis

means an abnormal or diseased condition of the NS. Described anxiety disorders in the 19th century. Will Cullen termed it in 18th century.

4

Freud's definition of anxiety disorders

At beginning of 20th century Freud replaced Cullen's organic assumption. Anxiety represents easy in which ego attempts to defend against anxiety. Concepts featured in DSM until 1980.

5

Panic disorder
- prevalence of panic attacks
- prevalence of panic disorder

repeated unexpected panic attacks; panic attacks are intense anxiety reactions that are accompanied by physical symptoms like pounding heart, shortness of breath, dizziness. People tend to be keenly aware of changes in their heart rates. Attack builds to peak of intensity within 10 to 15 minutes.
For a diagnois to be made there must be presence of recurrent panic attacks that begin unexpectedly and at least one of them followed by a period of at least one onto by either of following symptoms: Persistent fear of attacks & significant maaldaptive change in behavior.
- 10% of population may experience an isolated attack
- 5.1% of the general population develop disorder, usually begins in late adolescence thru mid 30s and occurs twice as often in women.

6

Theoretical perspective of panic disorder

Combination of cognitive (misattributions) and biological factors (physic symptoms).
Panic prone ppl tend to misattribute minor changes in internal bodily sensations to underlying dire causes; this triggers anxiety which activates sympathetic NS which activates adrenal glands to release epinephrine and norepinphrine.
Changes in body sensations that trigger a panic attack may result from many factors such as unrecognized hyperventilation, exertion, changes in temp, or reactions to drugs.

7

Biological factors of panic disorder
(3)

1) May involve an unusually sensitive internal alarm system. Donal klein proposed suffocation false alarm theory: A defect in brains respiratory alarm triggers a false alarm in response to minor cues of suffocation. Small changes in CO2 produces sensations of suffocation.
2) Gamma aminobutryic acid (GABA) a inhibitory neuroT. People with panic disorder ten to have low levels of GABA. Benzodiazepines act to make receiving stations more sensitive to GABA.
3) responses of people with panic disorder to bio challenges like dizziness (by infusing sodium lactate) or manipulation of CO2 in blood.

8

Cognitive factors of panic disorder

Anxiety sensitivity (AS) means fear of fear itself and involves fear of one's emotions and bodily sensations getting out of control. Ppl with high levels of AS experience anxiety they perceive it as signs of impending catastrophe. These thoughts intensify their anxiety reactions making them vulnerable to a vicious cycle.

9

Treatment approaches to panic disorder (2)
- rates of success

Two most used are drug therapy and CBT.
1) Antidepressants used are Tofranil, Anafranil, Paxil, Zoloft. (however many side effects such as heart palpitations)
2) CBT therapists use a variety of techniques like coping skills for handling attacks, breathing retraining and relaxation training. Help clients recognize that bodily cues are fleeting sensations. Learn to place catastrophizing thoughts with calming ones.
Breathing retraining aims at restoring a normal level of CO2 in blood by breathing from abdom.
- average response rates to CBT of more than 60% of cases.

10

Phobia

Derives from phobos meaning fear. A fear of an object or situations that is disproportionate to the threat it poses. Fear exceeds any reasonable appraisal of danger. Many recognize their fears are excessive. DSM recognizes three types: specific, social and agoraphobia.

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Fear

is anxiety experienced in response to a particular threat.

12

Specific Phobia
- to diagnose?
- Prevelance

a persistent, excessive fear of a specific object or situation that is our of proportion to the actual danger. Includes fear of animals, natural environments, blood injection. To diagnose: phobia must significantly affect the persons lifestyle or functioning or cause significant distress. Fear and anxiety assoc with phobia persists for 6 months of longer before treated.
- Most common phobic disorder; affects 9% More common in women.

13

Social anxiety disorder
- Prevelance
- Diathesis stress model

AKA social phobia; intense fear of social situations, excessive fear of negative evaluations from others. Include stage fright, speech anxiety, and dating fears. Relief from anxiety negatively reinforces escape behavior but escape prevents learning how to cope.
- 5% affected, more common in women. Avg age of onset is 15 and about 80% of affected ppl develop it by 20. Usually don't receive help until age 27
- Shyness may represent a diathesis that makes a person more vulnerable to developing social anxiety in face of stress.

14

Agoraphobia
- Prevelance

Has potential to become one of the most incapacitating type of phobia. Women more likely to develop. Frequently begins in late adolescence and may occur without panic disorder.

15

Psychodynamic perspective of Phobic disorder

Anxiety is a danger signal that threatening impulses of sexual or aggressive nature are nearing level of awareness. Ego mobilizes defense mechanisms to fend off threatening impulses. Defense mechanism in phobias is projection of persons own threatening impulses onto the phobic object. Phobic object symbolizes these unconscious wishes or desires.

16

Learning perspective of Phobic disorder (3)

O. Hobart Mowrer's two factor model in corps roles for both classical and operant conditioning in developing phobias.
1)Fear component of phobia is believed to be acquired through classical conditioning where neural objects are feared by being paired with aversive stimuli. US is the unpleasant experience and CS is the phobic object.
2) avoidance part of phobia is acquired thru operant conditioning. Relief from anxiety negatively reinforces the avoidance of fearful stimuli. Extinction is the weakening of the CR (fear) when the CS (phobic object) is presented in absence of the US (aversive stimulus)
3) observational learning does not require direct conditioning of fears but by observing parents model a fearful reaction.

17

Biological perspective of Phobic disorder (3)

1)Some with particular gene variation show greater activation of amygdala. May become overly excitable. Research shows increased levels of activation in social anxiety and PTSD ppl.
2) Prefrontal cortex sends a safety signal or all clear to the amygdala.
3) Prepared conditioning suggests that evolution favored the survival of human ancestors who were genetically predisposed to develop fears of potentially threatening objects like snakes.

18

Amygdala

structure in limbic system that produces fear responses to triggering stimuli without conscious thought

19

Cognitive perspective of phobic disorder (3)

1. Oversensitivity to threatening cues- phobic ppl tend to perceive danger in situations that are safe. May have inherited a sensitive internal alarm.
2. Over prediction of danger- Phobic ppl tend to over predict how much fear they will experience.
3. Self-defeating thoughts and irrational beliefs- self defeating thoughts can heighten anxiety. Thoughts like this can intensify autonomic arousal, disrupt planning, magnify the aversive stimuli, prompt avoidance, decrease self efficacy.
4. Drug therapy- use of antidepressants Paxil and Zoloft

20

Treatment approaches to Phobic disorder (2)

1) learning based- held ppl cope more effectively with phobic object/situation. Use of Gradual exposure, flooding, and systematic desensitization.
2) cognitive therapy - seek to correct dysfunctional or distorted beliefs. Help ppl recognize the logical flaws in their thinking and to via situations rationally use of cognitive restructuring. CBT in corps exposure along with cognitive techniques.

21

Flooding

Learning based approach to treating phobic disorders; form of exposure therapy where ppl are exposed to high levels of fear inducing stimuli either in imagination or real life. Belief that if person remains in situation for a long enough time without consequences the conditioned response will disappear.

22

Gradual exposure

Learning based approach to treating phobic disorders; is when person gradually confronts the object; with repeated exposure to phobia without aversive event which leads to extinction. Exposure therapy can be imaginal exposure or in vivo exposure ( real life situations)

23

VRT

Virtual reality therapy is a behavior therapy used to treat phobias using a computer generated simulated environment. Used for PTSD, social anxiety, autism spectrum disorders.

24

Cognitive restructuring

Cognitive method for treating phobias where therapists help clients pinpoint self defeating thoughts and generate rational ones.

25

Generalized Anxiety Disorder
- diagnose?
- Prevelance

excessive anxiety and worry that is not limited to any one object, situation, or activity. Central feature is excessive worry. To diagnose: GAD needs to be assoc with either emotional distress or impairment in daily functioning. Symptoms include feeling tense, keyed up, on edge, fatigue, difficulty concentrating, irritability, muscle tension, disturbances in sleep. Tends to be a stable disorder that arises in mid teens to 20s.
- 4%, twice as common in women. 2% of adults affected by GAD in any year.

26

Theoretical Perspectives of GAD (4)

1) Freud characterized GAD as free floating. Psychdynamic says GAD represents the threatened leakage of unacceptable sexual or aggressive impulses.
2) learning perspective says GAD is a generalization of anxiety across many situations.
3) Cognitive perspective emphasizes role of exaggerated thoughts and beliefs.
4) Cognitive and Bio perspective converges in evidence showing irregularities in functioning of the amygdala in GAD ppl. Prefrontal cortex may rely on worrying as a cognitive strategy for dealing with the fear from overactive amygdala.

27

Treatment approaches in GAD (2)

Major forms are drugs and CBT.
CBT uses combo of techs including training in relaxation skills, learning to substitute calming, adaptive thoughts for intrusive, worrisome thoughts, and learning skills of decatastrophizing.
CBT has lower drop out rates than drug therapy.

28

Rates of social anxiety and GAD in:
- Blacks, and Latinos

have lower rates than european americans

29

Obsessive-Compulsive and related disorders
-3

Disorders that have in common a pattern of compulsive or driven repetitive behaviors that are associated with significant personal distress or impaired functioning in meeting demands of daily life. OCD, Hoarding, BDD

30

OCD
-prevalence

troubled by recurrent obsessions or compulsions that are time consuming such as lasting more than an our a day, or causing significant distress or interference with a routine.
-effects between 2 and 3%