Chapter 3

1. Chapter 3 Anxiety Disorders

2. Writing about anxiety Write about an anxiety you are struggling with (or have struggled with). What are your “symptoms” of anxiety? Is your response adaptive or maladaptive?

3. Fear responses: Adaptive vs. Maladaptive • Adaptive Fear vs. Maladaptive Anxiety • Realistic concerns Unrealistic • In proportion to threat Out of proportion • Fear response subsides Response is persistent/Chronic

4. Symptoms of Anxiety

5. Anxiety Disorders Many different disorders (GAD, PTSD, phobias, OCD, etc.)

6. Post-Traumatic Stress Disorder • Tape 2 (World of Ab Psych) • Exposure to traumatic event + • Symptoms • Reexperiencing – flashbacks, intrusive memories, bad dreams • Avoidance and numbing – feeling detached, avoiding people and activities • Increased arousal – hypervigilance, insomnia, startle response, irritability/outbursts

7. PTSD: Causes • Trauma + Vulnerability • Vulnerability is biopsychosocial (next slide)

8. Explanations of PTSD Vulnerability • Sociocultural factors • Social support • Nature of trauma itself • (severity, etc.) • Psychological factors • Personal assumptions • Distress • Coping styles Biological factors 1. Physiological hyperactivity 2. Genetics

9. Cognitive- behavioral therapy • Systematic desensitization is used to extinguish fear reactions to memories (e.g., imaginal reexposure; cognitive techniques are used to challenge irrational thoughts. • Stress management • Therapist helps client solve concrete problems to reduce stress • Biological therapies • Antianxiety and antidepressant drugs can be used to quell specific symptoms • Sociocultural approaches • PTSD symptoms are understood and treated within the norms of people’s culture. Treatments for PTSD

10. Phobic Disorders

11. Shyness: A disorder?? Shy on Drugs NY Times, Sept 2007, by Christopher Lane, author of “Shyness: How Normal Behavior Became a Sickness.” Read in class and discuss

12. Treatment of Phobias • Behavioral • Systematic desensitization • Modeling • Flooding Cognitive-Behavioral Helps clients identify and challenge negative, catastrophizing thoughts about feared situations Biological Reduce symptoms of anxiety generally so that they do not arise in the feared situation

13. Panic Disorder Symptoms • Panic attack symptoms • Panic Disorder can be diagnosed when panic attacks… • become common • are not typically provoked by any particular situation • include worry and changing behaviors due to the worry

14. Panic Disorder -- facts • Occurs in 3.5% of population (occurs worldwide and across ethnicities) • Affects women more • Onset: late teens – mid-thirties • Seek medical care frequently

15. Causes of Panic Disorder • Biological Theories • Genetic (30-40% contribution) • Human studies (families; twins) • Rodent studies (stathmin gene may contrib to fear and anxiety) • Neurotransmitter contributions • Poor regulation of norepinephrine, serotonin, and perhaps GABA in the locus ceruleus and limbic systems • Kindling Model (next slide)

16. Kindling Model of Panic Disorder Poor regulation in locus ceruleus Panic Attacks Lowers threshold for chronic anxiety in limbic system Chronic anxiety increases likelihood of dysregulation in locus ceruleus Panic Attacks

17. Causes of Panic Disorder (cont.) • Cognitive Factors • People prone to panic attacks • (1) pay very close attention to their bodily sensations • (2) misinterpret these sensations • (3) engage in snowballing, catastrophizing thinking

18. Panic and agoraphobia • Faces DVD (Annie) • World of Abnormal Psych (tape 3 -- start at 8 min mark)

19. Treatments • Depends upon whom you go to see! • Meds (e.g., antidepressants, benzodiazepines) • Problems? • Cognitive-behavioral treatment (next slide)

21. Classes of Medications for Anxiety Disorders • Benzodiazepines. • These drugs were often used to treat anxiety disorders from the 1960s until the 1980s. They act on GABA, which seems to play a role in fear. They generally work quickly, but due to concerns about abuse or dependency, other medications are now more commonly prescribed. • Tricyclic antidepressants (TCAs). • These medications were developed in the 1950s and 1960s. They help prevent reuptake of 5HT and NE, but they also affect other neurotransmitters and can have serious side effects. They are not as commonly prescribed in the United States as are newer classes of antidepressants. • Monoamine oxidase inhibitors (MAOIs). • The MAOIs were developed at about the same time as the TCAs, but they are believed to work differently. They seem to stop the brain from breaking down 5HT and NE after reuptake. • Selective serotonin reuptake inhibitors (SSRIs). • The SSRIs prevent reuptake of neurotransmitters in the brain. Although the various SSRIs seem to work in basically the same way and have similar side effects, people seem to respond differently to different SSRIs. • Serotonin-norepinephrine reuptake inhibitors (SNRIs). • Developed in the 1990s, Effexor XR® (venlafaxine HCl) was the first SNRI. It works on 5HT, like an SSRI, but also helps prevent reuptake of NE.

22. Cognitive-Behavioral Therapy • Clients are taught relaxation and breathing exercises. • The clinician guides clients in identifying the catastrophizing cognitions they have about changes in bodily sensations. • Clients practice using their relaxation and breathing exercises while experiencing panic symptoms in the therapy session.

23. Cognitive-Behavioral Therapy, continued • The therapist will challenge clients’ catastrophizing thoughts about their bodily sensations and teach them to challenge their thoughts for themselves • The therapist will use systematic desensitization techniques to gradually expose clients to those situations they most fear while helping them to maintain control

24. Generalized Anxiety Disorder (GAD) • Excessive anxiety and worry • Difficulty in controlling the worry • Restlessness or feeling keyed-up or on edge • Easily fatigued • Difficulty concentrating • Irritability • Muscle tension and sleep disturbance

25. Obsessive-Compulsive Disorder • a chronicanxiety disorder most commonly characterized by obsessive, distressing, intrusive thoughts and related compulsions (tasks or "rituals") which attempt to neutralize the obsessions.

26. Obsessions (as defined by DSM-IV-TR) • Recurrent and persistent thoughts, impulses, or images that are experienced intrusive and inappropriate and that cause anxiety or distress • Thoughts, impulses, or images that are not simply excessive worries about real life problems • Thoughts, impulses or images that the person attempts to ignore or suppress or to neutralize with some other thought or action • Obsessive thoughts, impulses or images that the person recognizes are a product of his or her own mind

27. Compulsions(as defined by DSM-IV-TR), continued • Repetitive behaviors (such as hand washing, ordering, checking) or mental acts (such as praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly • Behaviors or mental acts that are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they should prevent

28. Treatments forOCD • Biological Treatments • as before, mostly psychotropic meds • Cognitive-behavioral Treatments • Expose the client to obsessions until anxiety about obsessions decreases, prevent compulsive behaviors and help the client manage anxiety that is aroused. For example, systematic desensitization may be used to help a person with a germ obsession gradually tolerate exposure to “dirty” materials.

29. Just Checking by Emily Colas Discuss Assignment