ANXIETY DISORDERS

1. ANXIETY DISORDERS

2. Anxiety vs. Fear • anxiety: (future oriented) negative affect, bodily tension, and apprehension about the future • fear: (reaction to current danger) immediate alarm in response to danger – initiates flight or fight response

3. Causes of Anxiety - Biological Contributions • Increased physiological vulnerability • Polygenetic influences • Corticotropin releasing factor (CRF) • CRF influences the HPA axis • Neurotransmitters • GABA • Limbic system • Reactivity to fear and punishment cues • Involved in panic and fear

4. Psychological Contributions • Behaviorists • Classical, operant conditioning, and modeling • Early experiences with parents • Controllability of the environment • Learned associations resulting from experience of “true alarm” • E.g., experiencing fear/panic when riding in a car after being in a serious auto accident

5. Social Contributions • Diathesis-stress: effects of stressful life events influenced by biological dispositions • Potential stressors that could trigger anxiety: • Familial • Interpersonal • Occupational • Educational

6. Phobias unrealistic fear of a specific situation, activity, or object

7. Types of specific phobias • Blood-Injection-Injury • Situational Phobia • Natural Environment Phobia • Animal Phobia • Other phobias

8. Phobia and treatment • http://video.nytimes.com/video/2007/07/23/health/1194817094474/flight-phobia.html

9. Common Phobia Treatments • systematic desensitization: combines relaxation with exposure • invivo • imaginal • virtual reality • http://www.youtube.com/watch?v=JK-vVMMN43Y • flooding:expose individual directly to feared stimulus

10. Social Phobia DSM criteria: • Extreme shyness and fear in social situations • focus is on situation in which the person is exposed to unfamiliar people or to possible scrutiny by others • person fears will be humiliated or embarrassed • Avoidance or endure with extreme distress • Impairment • Rule out cause by other disorder

11. Social Phobia: Treatment • Medications • Beta blockers (largely ineffective) • Antidepressants: often effective • Tricyclic antidepressants • Monoamine Oxidase Inhibitors (MAOI) • SSRI (Prozac, Paxil) • D-cycloserine

12. Social Phobia: Treatment (cont.) • Psychological • Cognitive-behavioral treatment • Exposure • Skill building • Group settings

13. Social Phobia: Treatment

14. PANIC

16. Panic Disorder • At least one of the panic attacks is followed by at least a month of (a) persistent fear of having another attack, or (b) a significant maladaptive change in behavior following the attacks. • The disturbance is not better understood by the physiological effects of a substance or medical condition. • The disturbance is not better understood by another psychological condition.

17. Panic Disorder with Agoraphobia (PDA) • agoraphobia: fear of being away from a safe place

18. Development of Panic Disorder Panic Attack Step 1 Real Stressor Step 2 Step 3 Fear of Having Another Attack Step 4 Increased Attention to Body Step 5 More Fear

19. Summary The fear of having another panic attack just makes you more frightened. This “fear of your fear” increases the chances of future attacks. Solution

20. Treatment for Panic Disorder: 1) Immipramine (tricyclic antidepressant) 2) SSRIs 3) Exposure and relaxation training 4) Panic control treatment

21. Picture yourself near a stream.Birds are singing in the crisp, cool mountain air. Nothing can bother you here. No one knows this secret place. You are in total seclusion from that place called the world. The soothing sound of a gentle waterfall fills the air with a cascade of serenity. The water is clear. You can easily make out the face of the person whose head you’re holding under the water.There now, feeling better?

22. Example Interoceptive Exposure Exercises

23. generalized anxiety disorder

24. GAD Symptoms • continuous feelings of anxiety; experienced across situations • continues for at least 6 months and is uncontrollable more days than not • involves muscle tension, fatigue, irritability, difficulty sleeping

25. GAD Treatment • anxiolytics: drugs that reduce anxiety • Benzodiazepines • cognitive-behavioral treatment • relaxation training

26. Obsessive Compulsive Disorder and Related Disorders

27. DSM-V Criteria for OCD • Presence of obsessions or compulsions (or both) • the person recognizes that the obsessions or compulsions are excessive or unreasonable (not required for children) • they cause marked distress, are time-consuming (more than 1 hour per day), or interfere with the person’s functioning

28. DSM-V Criteria for Obsessions • recurrent and persistent thoughts, impulses, or images • experienced as intrusive and inappropriate • cause marked anxiety or distress • the thoughts are not simply excessive worries about real-life problems • the person attempts to ignore or suppress the thoughts • the person recognizes that the thoughts are a product of his or her own mind (not imposed from outside)

29. Content of Obsessions • contamination 55% • aggressive impulses 50% • sexual content 32% • somatic concerns 35% • need for symmetry 37%

30. Examples of Intrusive Thoughts of People Who Do Not Have OCD • Impulse to hurt someone • Thought of an accident occurring to a loved one • Thoughts of unnatural "sexual acts" • Thought that something is wrong with one's health • Impulse to say rude things to people

31. DSM-V Criteria for Compulsions • Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly • Behaviors are aimed at preventing or reducing distress, or preventing some dreaded event or situation. However, behaviors not connected in a realistic way with what they are designed to prevent, or are clearly excessive

32. OCD : Compulsions • Four major categories • Checking • Ordering • Arranging • Washing/cleaning

33. Possible Causes of OCD 1) Mowrer’s two stage theory 2) Cognitive theories -exaggerated beliefs about negative consequence 3) Biological theories • abnormal serotonin metabolism • abnormal PET scans 4) Psychodynamic view – defense mechanisms failed

34. Treatment of OCD • SSRI’s • Exposure and response prevention • How does it compare to medication? • Psychosurgery (cingulotomy)

35. Obsessive Compulsive Related Disorders • Hoarding Disorder. • Hair-Pulling Disorder. • Excoriation Disorder. • Body Dysmorphic Disorder.

36. Post Traumatic Stress Disorder

37. PTSD • exposure to traumatic event • traumatic event is reexperienced (e.g., recollections, dreams, flashbacks) • try to avoid stimuli associated with the trauma • symptoms of increased arousal (e.g., problems sleeping, concentrating) • negative alterations of cognitions or mood

38. PTSD • acute stress disorder – PTSD symptoms have lasted less than one month • acute PTSD – symptoms last between 1 and 3 months after event • chronic PTSD – symptoms last longer than 3 months • delayed onset – few immediate symptoms – years later

39. Treatment of PTSD • Cognitive-behavioral treatment • Exposure • Identify and correct cognitive distortions. • SSRI’s (Prozac, Paxil)