Anxiety Disorders

Anxiety Disorders GAD, Specific Phobias, Social Phobias, OCD, Panic Disorder, Agoraphobia, PTSD, Acute Stress Disorder

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

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

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

Cardiovascular 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

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

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

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

Anxiety Disorders Generalized Anxiety Disorder GAD

Generalized Anxiety Disorder • Unfocused worry

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

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

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 for dizygotic twins. • The tendency to be anxious tends to be inherited rather than GAD specifically • Heritability estimate of about 30%

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)

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 experienced 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

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

Generalized Anxiety Disorder: Cognitions • Intense EEG activity in GAD patients reflecting intense cognitive processing • Worrying as a form of avoidance • 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

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

Anxiety Disorders Phobias: Specific & Social

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

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

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…..

Developmentally Normal Fears

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

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

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

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

Evolutionary Preparedness • Predilection (or preparedness inherited from ancient ancestors) to be afraid of hazards • Good evolutionary reasons to be afraid of some things (snakebites, falls from large heights, and being trapped in small places)

Biological Preparedness: Exercise • Write down an object or situation of which you are particularly afraid • Write down the events that led to the fear • As a group, tally the feared objects and the percentage of times the person could recall the beginning of the fear • As a group, indicate which group of fears are associated with dangerous consequences, e.g. fear of snakes

Hypothesis According to biological preparedness theory, objects of phobic fear are nonrandomly distributed to objects or situations that were threatening to the survival of the species. Hypothesis: More threatening objects or situations (that are threatening) will be listed than those that are not threatening

Specific Phobia: Cognitive Perspective

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

Specific Phobia: Treatment • Systematic Desensitization

Social Phobia • Fearful apprehension • Social situations

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

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

Etiology of Social Phobia • Biological vulnerability to develop anxiety or be socially inhibited. May increase under stress or when the situation is uncontrollable • Unexpected panic attack during a social situation or experience a social trauma resulting in conditioning (i.e. a learned alarm). • Modeling of socially anxious parents • Preparedness

Kagan’s theory: inhibited temperament • Inhibited temperament: risk factor in social phobia • Behaviorally inhibited children at age 2 remained inhibited at age 7 and 12

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)

Kagan’sTemperamental/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

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

Phobias: content vs. function • Psychoanalysts: believe content is important • Phobic stimulus has symbolic value • Little Hans & the horse • Behaviorists: believe function is important • All phobias acquired in same manner & can be treated in same manner • All means of avoidance, treat with exposure

Psychoanalytic Etiology • Phobias as defenses against anxiety from id impulses • Anxiety taken from id impulse and placed onto symbolic representation of the impulse • Ex: Little Hans fear of his father (i.e. Oedipal conflict) displaced onto horses • Horses symbolized his father

Behavioral Etiology: Phobias are learned. But how? • Avoidance-conditioning model: classical conditioning results in fear • Ex: fear of heights following a bad fall • Problem #1: phobias can develop without prior exposure to the feared stimulus • Ex: snake phobics • Problem #2: many have frightening experiences without developing a phobia • Ex: car accidents

Avoidance-conditioning cont. • Fewer problems if preparedness of stimuli considered • Preparedness: phobias may result from stimuli to which an organism is prepared to have a fear reaction • Evolutionary prepared fear response • Snakes, spiders, heights • Vs. electrical outlets, lambs • Ohman’s studies • Provides method of addressing findings that feared stimuli are not random • Mc Nally: against the A-C model

Behavioral cont: Modeling • Phobias learned by watching reactions of others • “vicarious learning” • Can also be learned by listening to warnings • Mineka & the rhesus monkeys • Teen monkeys placed with snake phobic adults developed fear of snakes • Monkeys shown videos of a monkey reactingfearfully to neutral vs. prepared stimuli • Only monkeys exposed to prepared stimulus developed phobia

Cognitive Theories • Anxiety due to attending to negative stimuli & to believing negative events likely to occur • Social phobics thoughts focused on image they present and negative evaluation • “I think I am boring when I talk to others” • Fears seem irrational to phobics • Maybe b/c the fear is unconscious • Ohman & Soares study • Increased response to pictures matching their phobia

Anxiety Disorders Obsessive Compulsive Disorder (OCD)

Obsession and Compulsions Obsession: Unwanted repetitive intrusive thoughts, images or urges Exs: contamination, sexual impulses, &/or hypochondriacal fears Compulsion: Repeated thoughts or actions designed to provide relief Ex: cleanliness, checking, avoiding certain objects Perceived of as irrational or silly

Relationship between Compulsion and Obsession • The most common obsession- germs and dirt is related to the most common compulsion handwashing • Obsessions create considerable anxiety • Compulsions are an attempt to cope with the anxiety. • Repeating rituals (second most common compulsion) is often a way-in their mind-to avoid harm (eg. “step on the crack” game) • Children recognize that compulsions are unreasonable and will attempt to hide the behavior with nonfamily members

Anxiety Disorders