Anxiety Disorders

1. Anxiety Disorders “The Dark side of Fear”

2. What is Anxiety? • The unpleasant feeling of fear or apprehension we experience in response to some event or situation. • Duration & intensity of anxiety --more severe in people with anxiety disorders than in people without.

3. Anxiety Disorders: • Phobias • panic disorder • generalized anxiety disorder • obsessive-compulsive disorder • posttraumatic stress disorder • acute stress disorder

4. Comorbidity of other anxiety disorders is high!! • 1.Symptoms of various anxiety disorders are not disorder specific. • 2.) Cause of one disorder may be cause of another disorder.

5. A. Phobias – an irrational fear out of proportion to the danger posed by the object or situation. • Person knows fear is irrational, but avoids object or situation anyway. • Phobia may not be debilitating enough to warrant seeking treatment. (e.g., A fear of snakes in the city is less a problem than in the country)

6. Two kinds of phobias: • 1. Specific phobias - fears caused by the presence or anticipation of a specific object or situation. • Blood • injuries & injections • situations (planes, elevators) • animals (dogs, spiders) • natural environment (heights, water, tornadoes) Lifetime prevalence: 7% (men) and 16% (women).

7. 2. Social phobias- • Fear linked to the presence of other people • Person avoids situation in which he or she could behavior in embarrassing way. • Speaking or performing in public • eating in public • Using public bathroom • Lifetime prevalence: 11% (men) & 15% (women)

8. What causes phobias? • Data show we learn phobias, they are not innate. • We learn phobias by: • 1. Classical & operant conditioning (avoidance learning) • 2. Modeling (observational learning)

9. Modeling: • We learn phobias by observing others’ fear to the object or event. • Do we need to observe the person’s fear response to the stimulus & the stimulus itself? • Yes!!!!

10. Mineka study: • Had lab-reared monkeys view wild-reared monkeys responses to a snake. • A barrier was in place to block the lab-reared monkeys from seeing the object of the wild-reared monkey’s fear. • Later when shown the snake, the lab-reared monkey didn’t show fear to the snakes. • You need to see the other person’s response to the feared stimulus & the stimulus itself for phobia formation.

11. Therapy for phobias: • Systematic desensitization • Flooding

12. B. Generalized Anxiety Disorder (GAD) • Symptoms: • persistent anxiety • chronic worry • focus on health/daily hassles • difficulty concentrating; irritable • tire easily; restless • Lifetime prevalence: 5% in population • Onset: midteens; comorbidity with other anxiety disorders & mood disorders.

13. Causes of GAD: • we develop GAD when confronted with painful stimuli over which we have no control. • Perception of not being in control may be enough for anxiety. • we develop GAD when we misperceive events to be out of our control & potentially threatening or harmful.

14. Locus of control- we feel less anxiety when we can control our lives. • Our “perception” of control may be more important than “actual” control to reducing unwanted anxieties in patients with GAD. *Unpredictable events produce more anxiety than predictable ones. Patients with GAD are easily drawn to stimuli associated with negative emotional content (traumas, physical harm, etc.)

15. Worry as a tool to control emotion!! • Patients with GAD use worry to distract themselves from thinking about negative events. • Worrying keeps us from focusing on negative emotions. • Worrying is negatively reinforcing because it blocks us from processing emotional stimuli, & keeps the cycle of anxiety going.

16. Biological Causes of GAD • There may be a genetic component. • We may have a defect in the GABA system so that fear is not brought under control. • Benzodiazipines, which enhance the inhibitory neurotransmitter, GABA, reduce anxiety.

17. Therapies for GAD • 1. Transfer global anxiety into a phobia & treat phobia. • *Systematic desensitization may be used if anxiety can be linked to an identifiable source. • 2. Relaxation training Have patients focus on relaxing during low-level anxiety.

18. Treat worry!!! • Here, therapists require that patients extend & exaggerate their anxieties. • Because patient remains in a fearful situation, anxiety is believed to extinguish. • Patient learns his or her cognitions are illogical and unfounded.

19. C. Panic Disorder – characterized by attacks. • Increased HR • heart palpitations • nausea • chest pain • trembling; sweating, terror • Usually physiological symptoms occur without link to cause (with exceptions) Lifetime prevalence: 2 % (men) & 5 % (women).

20. DSM-IV diagnosis: • Recurrent uncued attacks & worry about having attacks in the future are required. • Is diagnosed as panic disorder with or without agoraphobia. • Comorbidity between panic disorder & major depression, GAD, phobias, alcoholism, & personality disorders is high.

21. What causes panic disorder? 1.There may be symptoms of an illness that leads to panic attacks. • (e.g., mitral valve prolapse causes heart palpitations, dizziness, etc.) • 2. Panic may be caused by overactivity in a nucleus in the pons called the locus ceruleus (LC). • In humans, a drug called Yohimbine, a drug that stimulates the LC, can elicit panic attacks in patients with panic disorder.

22. Causes (panic): • However blocking activation in the LC has not been found to reduce panic attacks. • 3.Creating panic attacks experimentally: • Using hyperventilation to induce panic attacks has produced mixed results.

23. Psychological theories: Patients with panic disorder may have an autonomic nervous system that is predisposed to be overly active. • People misconstrue internal bodily changes as signals they may be in jeopardy or dying. • With repeated exposures to attacks, patients worry about future attacks thereby making them more likely to occur.

24. Therapies for Panic disorder and agoraphobia • Biological: 1. Antidepressants & anxiolytics can reduce frequency of attacks. Psychological: Barlow’s therapy (well validated): 3 components: 1. Relaxation training- 2. A combination of Ellis & Beck type cognitive behavioral interventions 3. Exposure to the internal cues that trigger panic

25. D. Obsessive-Compulsive Disorder (OCD): • persistent unwanted thoughts & compulsive behaviors that impair normal functioning. • Lifetime prevalence: 1-2 % of general pop. • More common in women than men • Age of onset: early adulthood • Males: checking rituals most common Females: cleaning rituals most common

26. Components of OCD: • 1. Obsessions-intrusive & recurring thoughts & images that appear irrational & uncontrollable to the individual experiencing them. • Frequency & force of thoughts always interfere with functioning. Fears of contamination • Fears of expressing sexual or aggressive impulses • hypochondria • 2. Compulsions- repetitive behaviors performed over & over to reduce distress associated with the unwanted thoughts.

27. Causes of OCD • 1. Behavioral & cognitive theories • Compulsions are learned behaviors reinforced by fear reduction (negative reinforcement). • E.g., frequency of hand washing increases to reduce or eliminate the aversive fear of dirt. • Compulsive checking may be the result of memory deficit.

28. Therapies for OCD • Exposure and response prevention (ERP) Victory Meyer (1966) 1.Patients with OCD expose (flooding) themselves to situations that elicit compulsions. • E.g., touching a dirty dish • 2.  Person is instructed to refrain from performing compulsions (extinguish anxiety & compulsions). Treatment is partially effective in half of OCD patients.  

29. E. Posttraumatic Stress disorder (PTSD) • A traumatic event or witness to an event in which there is perceived or actual threat of death, serious injury, or other personal harm. • The event must have created intense fear, horror, or a sense of helplessness. (May 3rd, 1999-OK) Symptoms of PTSD fall into 3 major categories. Symptoms in each must occur longer than 1 month.

30. What happens? • 1. Reexperiencing the traumatic event • Person frequently recalls the event (has nightmares about the event). • 2. Avoidance of stimuli associated with the event or numbing of responsiveness • Person tries to avoid thinking about the trauma or encountering stimuli that will bring it to mind. 3. Symptoms of increased arousal difficulty concentrating (sleeping), hypervigilance

31. PTSD: General Stats • General prevalence: 1-3 % in the general pop. • 3% for civilians exposed to a physical attack • 20 % among people wounded in Vietnam • 50 % of all rape victims • Women twice as likely to develop PTSD as men.

32. F. Acute Stress Disorder • an individual encounters a traumatic experience that causes problems with social or occupational functioning for less than 1 month.