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Chapter 5 Anxiety Disorders

Chapter 5 Anxiety Disorders. 0. Nature of Anxiety and Fear. 0. Fear Immediate, present-oriented Sympathetic nervous system activation Anxiety Apprehensive, future-oriented Somatic symptoms = tension Both: Negative affect. Nature of Anxiety, Fear, and Panic. 0.

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Chapter 5 Anxiety Disorders

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  1. Chapter 5Anxiety Disorders 0

  2. Nature of Anxiety and Fear 0 • Fear • Immediate, present-oriented • Sympathetic nervous system activation • Anxiety • Apprehensive, future-oriented • Somatic symptoms = tension • Both: Negative affect

  3. Nature of Anxiety, Fear, and Panic 0 • Panic attacks –abrupt experience of intense fear • Symptoms: palpitations, chest pain, dizziness • Three types • Situationally-bound/cued • Unexpected/uncued • Situationally predisposed

  4. Nature of Anxiety, Fear, and Panic 0

  5. Causes of Anxiety - Biological Contributions 0 • Increased physiological vulnerability • Polygenetic influences • Corticotropin releasing factor (CRF) • Brain circuits and neurotransmitters • GABA • noradrenergic • serotonergic systems • CRF and the HPAC axis

  6. Causes of Anxiety - Biological Contributions 0 • Limbic system • Behavioral inhibition system (BIS) • Brain stem • Septal-hippocampal system • Amygdala • Fight/flight (FF) system • Panic circuit • Alarm and escape response

  7. Causes of Anxiety - Biological Contributions 0 • Brain circuits are shaped by environment • Ex. teenage cigarette smoking • Interactive relationship with somatic symptoms

  8. Psychological Contributions 0 • Freud • Anxiety = psychic reaction to danger • Reactivation of infantile fear situation • Behaviorists • Classical and operant conditioning • Modeling

  9. Psychological Contributions 0 • Integrated psychological model • Early experiences and perceptions • Controllability • Dangerousness • Parental actions/modeling • Associations or cues to stimuli

  10. Social Contributions 0 • Biological vulnerabilities triggered by stressful life events • Familial • Interpersonal • Occupational • Educational

  11. An Integrated Model 0 • Triple Vulnerability • Generalized biological vulnerability • Diathesis • Generalized psychological vulnerability • Beliefs/perceptions • Specific psychological vulnerability • Learning/modeling

  12. An Integrated Model 0

  13. Comorbidity of Anxiety Disorders 0 • High rates of comorbidity • 55% to 76% • Commonalities • Features • Vulnerabilities • Links with physical disorders

  14. Anxiety Disorders and Disability 0

  15. Panic Disorder and Suicide • Suicide attempt rates • Similar to major depression • 20% • Increases for all anxiety disorders • Comorbidity with depression??

  16. The Anxiety Disorders: An Overview 0 • Generalized Anxiety Disorder • Panic Disorder with and without Agoraphobia • Specific Phobias • Social Phobia • Posttraumatic Stress Disorder • Obsessive-Compulsive Disorder

  17. Generalized Anxiety Disorder 0 • Clinical Description • Excessive apprehension and worry • Uncontrollable • Strong, persistent anxiety • Somatic symptoms • (e.g., muscle tension, fatigue, mental agitation) • 6 months or more

  18. Generalized Anxiety Disorder 0 • Clinical Description (cont.) • Shift from possible crisis to crisis • Worry about minor, everyday concerns • Job, family, chores, appointments • Problems sleeping • GAD in Children • Need only one physical symptom • Worry = academic, social, athletic performance

  19. Generalized Anxiety Disorder 0 • Statistics • 3.1% (year) • 5.7% (lifetime) • Similar rates worldwide • Female : Male = ~2 : 1 • Insidious onset • Early adulthood • Chronic course

  20. Generalized Anxiety Disorder 0 • GAD in the Elderly • Worry about failing health, loss • Up to 7% prevalence • Use of minor tranquilizers - 17-50% • Medical problems? • Sleep problems? • Falls • Cognitive impairments

  21. GAD : Causes 0 • Inherited tendency to become anxious • “Neuroticism”? • Less responsiveness • “autonomic restrictors” • Threat sensitivity • Frontal lobe activation • Left vs. right

  22. GAD : Causes

  23. GAD : Treatments 0 • Pharmacological • Benzodiazepines • Risks versus benefits • Antidepressants

  24. GAD : Treatments 0 • Psychological • Cognitive-behavioral treatments • Exposure to worry process • Confronting anxiety-provoking images • Coping strategies • Acceptance • Meditation • Similar benefits • Better long-term results

  25. Panic Disorder with and without Agoraphobia 0 • Clinical Description • Unexpected panic attacks • Anxiety, worry, or fear of another attack • Persists for 1 month or more • Agoraphobia • Fear or avoidance of situations/events

  26. Panic Disorder with and without Agoraphobia 0 • Clinical Description (cont.) • Avoidance can be persistent • Use and abuse of drugs and alcohol • Interoceptive avoidance

  27. Panic Disorder with and without Agoraphobia 0 PLAY VIDEO

  28. Panic Disorder with and without Agoraphobia 0 • Statistics • 2.7% (year) • 4.7% (life) • Female : male = 2:1 • Acute onset, ages 20-24

  29. Panic Disorder - Special Populations 0 • Children • Hyperventilation • Cognitive development • Elderly • Health focus • Changes in prevalence

  30. Panic Disorder: Cultural Influences 0 • Social/Gender roles • ~75% of those with agoraphobia are female • Similar prevalence rates • Variable symptom expression • Somatic symptoms

  31. Panic Disorder: Cultural Influences 0 • Culture-bound syndromes • Ataque de nervios • Susto • Kyol goeu

  32. Panic Disorder: Nocturnal Panic 0 • 60% with PD experience nocturnal attacks • non-REM sleep • Delta wave • Caused by deep relaxation, • Sensations of “letting go” • Sleep terrors • Isolated sleep paralysis

  33. Panic Disorder: Causes 0 • Generalized biological vulnerability • Alarm reaction to stress • Cues get associated with situations • Conditioning occurs • Generalized psychological vulnerability • Anxiety about future attacks • Hypervigilance • Increase interoceptive awareness

  34. Panic Disorder: Causes 0

  35. Panic Disorder: Treatment 0 • Medications • Multiple systems • serotonergic • noradrenergic • benzodiazepine GABA • SSRIs (e.g., Prozac and Paxil) • High relapse rates when d/c’d

  36. Panic Disorder: Treatment 0 • Psychological • Exposure- based • Reality testing • Relaxation • Breathing • Panic Control Treatment • Exposure to interoceptive cues • Cognitive therapy • Relaxation/breathing • High degree of efficacy

  37. Panic Disorder: Treatment 0 PLAY VIDEO

  38. Panic Disorder: Treatment 0 Combined Medication/Psychological • No better than individual tx • CBT = better long term

  39. Panic Disorder: Treatment 0

  40. Specific Phobias 0 • Clinical Description • Extreme and irrational fear of a specific object or situation • Significant impairment • Recognizes fears as unreasonable • Avoidance

  41. Specific Phobias 0 • Blood-Injection-Injury Phobia • Decreased heart rate and blood pressure • Fainting • Inherited vasovagal response • Onset = ~ 9

  42. Specific Phobias 0 • Situational Phobia • Fear of specific situations • Transportation, small places • No uncued panic attacks • Onset = early to mid 20s

  43. Specific Phobias 0 • Natural Environment Phobia • Heights, storms, water • May cluster together • Associated with real dangers • Onset = ~7

  44. Specific Phobias 0 • Animal Phobia • Dogs, snakes, mice • May be associated with real dangers • Onset = ~7

  45. Other Phobias 0 • Illness • Choking • Separation Anxiety Disorder • School phobia

  46. Specific Phobias: An Overview 0 • Statistics • 12.5% (life); 8.7% (year) • Female : Male = 4:1 • Chronic course • Onset = 7 (median)

  47. Specific Phobias: Causes 0 • Inherited vulnerability • Biological and evolutionary • Traumatic exposure • Direct conditioning • Observational learning • Information transmission • Social and Gender Roles

  48. Specific Phobias: Causes 0

  49. Specific Phobias: Treatment 0 • Cognitive-behavior therapies • Exposure • Graduated • Structured • Consistent • Relaxation • Blood-injury-injection • Tensing

  50. Social Phobia 0 • Clinical Description • Extreme and irrational fear/shyness • Social/performance situations • Significant impairment • Avoidance or distressed endurance • Generalized subtype

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