Anxiety Disorder

1. Anxiety Disorder

2. Three Components of Anxiety • Physical symptoms • Cognitive component • Behavioral component

3. Physiology of Anxiety: Physical System • Perceived danger • Brain sends message to autonomic nervous system • Sympathetic nervous system is activated (all or none phenomena) • Sympathetic nervous system is the fight/flight system • Sympathetic nervous system releases adrenaline and noradrenalin (from adrenal glands on the kidneys). • These chemicals are messengers to continue activity

4. Parasympathetic Nervous System • Built in counter-acting mechanism for the sympathetic nervous system • Restores a realized feeling • Adrenalin and noradrenalin take time to destroy

5. Cardiovasular Effects • Increase in heart rate and strength of heartbeat to speed up blood flow • Blood is redirected from places it is not needed (skin, fingers and toes) to places where it is more needed (large muscle groups like thighs and biceps) • Respiratory Effects-increase in speed and dept of breathing • Sweat Gland Effects-increased sweating

6. Behavioral System • Fight/flight response prepares the body for action-to attack or run • When not possible behaviors such as foot tapping, pacing, or snapping at people

7. Cognitive System • Shift in attention to search surroundings for potential threat • Can’t concentrate on daily tasks • Anxious people complain that they are easily distracted from daily chores, cannot concentrate, and have trouble with memory

8. “U” Shaped Function of Anxiety • Useful part of life • Expressed differently at various age levels

9. Generalized Anxiety Disorder • Unfocused worry

10. Generalized Anxiety Disorder: Diagnostic Criteria • Excessive anxiety or worry occurring more days than not for at least 6 months about a number of events or activities • Difficulty controlling worry • 3 of 6 symptoms are present for more days than not:restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance

11. Generalized Anxiety Disorder (GAD): Prevalence • ~ 4% of the population (range from 1.9% to 5.6%) • 2/3 or those with GAD are female in developed countries • Prevalent in the elderly (about 7%)

12. Generalized Anxiety Disorder: Genetics • Familial studies support a genetic model (15% of the relatives of those with GAD display it themselves-base rate is 4% in general population) • Risk of GAD was greater for monozygotic female twin pairs than dizygotic twins. • The tendency to be anxious tends to be inherited rather than GAD specifically • Heritability estimate of about 30%

13. Generalized Anxiety Disorder: Neurotransmitters • Finding that benzodiazepines provide relief from anxiety (e.g. valium) • Benzodiazepine receptors ordinarily receive GABA (gamma-aminobutyric acid) • GABA causes neuron to stop firing (calms things down)

14. Getting Anxious Hypothesized Mechanism: Normal fear reactions Key neurons fire more rapidly Create a state of excitability throughout the brain and body –perspiration, muscle tension etc. Excited state is experiences as anxiety Calming Down Feedback system is triggered Neurons release GABA Binds to GABA receptors on certain neurons and “orders” neurons to stop firing State of calm returns GAD: problem in this feedback system Generalized Anxiety Disorder: Neurotransmitters

15. GABA Problems? • Low supplies of GABA • Too few GABA receptors • GABA receptors are faulty and do not capture the neurotransmitter

16. Generalized Anxiety Disorder: Cognitions • Intense EEG activity in GAD patients reflecting intense cognitive processing: low levels of imagery • Worrying is a form of avoidance • They restrict their thinking to thoughts but do not process the negative affect • Worry hinders complete processing of more disturbing thoughts or images • Content of worry often jumps from one topic to another without resolving any particular concern

17. Generalized Anxiety Disorder: Treatment • Short term-benzodiazepine (valium) • Cognitive Therapy (focus on problem)

18. Phobia: Diagnostic Criteria • Marked & persistent unreasonable fear of object or situation • Anxiety response • Unreasonable • Object or situation avoided or endured with distress

19. Differential Diagnosis of Specific Phobia • Vs. SAD: not related to fear of separation • Vs. Social Phobia: not related to fear of a social situation or fear of humiliation • Vs. Agoraphobia: fear not related to closed places • Vs. PTSD: fear not related to a specific past traumatic event

20. Phobias: Types Specific phobias • Blood-Injection Injury phobias • Situational phobia • Natural environment phobia • Animal phobia • Pa-leng (Chinese) colpa d’aria (Italian) • Germs • Choking phobia…..

21. What are your fears???

22. Developmentally Normal Fears

23. Normal Rituals and Behaviors • Even some ritualistic behaviors are normal • Any rituals?

24. Phobias: Prevalence • Fears are very prevalent • Phobias occur in about 11% of the population • More common among women • Tends to be chronic

25. Etiology of Phobias: Genetics • 31% of first degree relatives of phobics also had a phobia (compared to 11% in the general population) • Relatives tended to have the same type of phobia • Not clear if transmission is environmental or genetic

26. Specific Phobia: Behavioral Perspective Case of Little Albert Two-factor model: • Acquisition-classical conditioning • Maintenance-operant conditioning

27. Specific Phobia: Behavioral Perspective • Classical conditioning • Modeling • Stimulus generalization

28. Specific Phobia: Behavioral-Evolution Perspective (Preparedness) • Discussion Section Topic

29. Specific Phobia: Cognitive Perspective

30. Specific Phobia: Social and Cultural Factors • Predominantly female • Unacceptable in cultures around the world for men to express fears

31. Specific Phobia: Treatment • Systematic Desensitization

32. Social Phobia • Fearful apprehension • Social situations

33. Social Phobia: Diagnostic Criteria • Marked or persistent fear in one or more social or performance situations • Exposure to fear situation is associated with extreme anxiety • Person recognizes that fear is excessive or unreasonable • Feared social and performance situations are avoided or endured with intense anxiety

34. Social Phobia: Prevalence • 13% of the general population • About equally distributed in males and females, however, males more often seek treatment • Usually begins around age 15 • Equally distributed among ethnic groups

35. Etiology Social Phobia: Emotions Temperament and Biological Theories (Kagan) • Behaviorally inhibited children 2 remained inhibited at age 7 and 12 (see video) Biological preparedness • We are prepared to fear rejecting people • Social phobics more likely to foucs on critical facial experessions

36. Biological Basis of Temperament Kagan proposed temperamental differences related to inborn differences in brain structure and chemistry: He found inhibited children have: • Higher resting heart rates • Greater increase in pupil size in response to unfamiliar • Higher levels of cortisol (released with stress)

37. Temperament and Anxiety Disorders • Inhibited temperament: risk factor in social phobia

38. Kagan’s Temperamental/Biological Theory and Prevention • Early identification of at risk children • Parental training • Avoid overprotecting • Encourage children to enter new situations • Help kids to develop coping skills • Avoid forcing the child

39. Encouraging Shy Children: helpful hints • Use rewards • Arrange don’t push • No nagging

40. Cognitive-Behavioral Therapy Assess which social situations are problematic Assess their behavior in these situations Assess their thoughts in these situations Teaches more effective strategies Rehearse or role play feared social situations in a group setting Medication Tricyclic antidepressants Monoamine oxidase inhibitors SSRI (Paxil) approved for treatment Relapse is common with medications are discontinued Social Phobia: Treatment