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Anxiety
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Anxiety Disorders
Anxiety: Feelings of fear and apprehension.Anxiety Disorders: A group of disorders
primarily characterized by extreme, unrealistic, or debilitating anxiety with one of these criteria:Anxiety is the major disturbance.Anxiety is manifested only in particular
situations.Anxiety results from an attempt to master
other symptoms.
Types of Anxiety Disorders
Anxiety is a part of everyone’s lives.“Anxiety is the price we pay for society”
If it becomes intense and perseveres, then it may be categorized as an anxiety disorder.
Types of anxiety disorders:Panic DisorderGeneralized Anxiety Disorder (GAD)PhobiasObsessive-Compulsive Disorders (OCD)
Understanding Disorders from Multipath Perspective
Biological Dimension: Two main biological factors:
Brain structureGenetic influences
Biological, psychological, and social factors interact with one another Interplay between genetic and environmental
influences
Understanding Disorders from Multipath Perspective
Psychological Dimension:Psychoanalytic theorists focus primarily on
parent-child relationshipPsychological variables such as one’s sense
of control may also be involved Early experiences can play a role in
determining vulnerability of children and need to be considered
Understanding Disorders from Multipath Perspective
Social and Sociocultural Dimensions:Daily environmental stressGenderAcculturation factors among minority groups
Phobias
An anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object or situation that disrupts normal functioning.
Phobias focus anxiety on a specific object, activity, or situation.
Powerful imagination, can vividly anticipate terrifying consequences
Recognize fear as excessive and irrationalUnable to control anxiety
Phobias
Phobia: Strong, persistent, unwarranted fear of a specific object or situation.Agoraphobia: Intense fear of being in public places
where escape or help may not be available; in extreme cases, fear of leaving home.
Social Phobia: Intense, excessive fear of being scrutinized in one or more social situations.
Specific Phobia: Extreme fear of a specific object or situation; a phobia not classified as agoraphobia or social phobia.
Etiology of Phobias
Psychodynamic: Unconscious conflicts (expressions of unacceptable wishes, fears and fantasies)
Behavioral: Classical conditioning
Baby Albert; generalizationOperant Conditioning
Object avoidance behavior reinforced with anxiety reduction
Observational learning (modeling)Cognitive-behavioral: Cognitive distortions and
catastrophic thoughtsBiological: Genetics or biological preparedness
Treatment of Phobias
Biochemical:Neurobiological abnormalities can be normalized
with medicationAntidepressants, benzodiazepines, SSRIs
Behavioral:Exposure therapy (plus applied tension)Systematic desensitizationModelingCognitive restructuringSkills trainingVirtual Reality
Panic Disorder and Generalized Anxiety Disorder
Panic Disorder: Characterized by intense fear accompanied by bodily sensations.
Generalized Anxiety Disorder (GAD): Characterized by milder anxiety-evoking thoughts; “chronic pathological worry”.Predominant characteristic: Free-floating (unfocused)
anxiety
Panic Disorder
Somatic symptoms: Breathlessness, sweating, choking, nausea, heart palpitations.
May lead to Agoraphobia: Anxiety about leaving one’s home.Lifetime prevalence: 3.5%; twice as common in women as in
men.An anxiety disorder marked by a minutes-long episode of
intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations.A panic attack is anxiety to the extreme1 in 75 suffers from this disorder with smokers having a
fourfold risk of a first attack.
Panic Attacks
Panic Attacks: Intense fear accompanied by pounding heart, trembling, shortness of breath, fear of losing control, fear of dying.
Panic attacks may be experienced in any of the anxiety disorders.
Though panic attacks are relatively common, panic disorder is quite rare.
Three types of panic attacks:Situationally boundSituationally predisposedUnexpected or uncued
Generalized Anxiety Disorder (GAD)
Persistent high levels of anxiety and excessive worry over major and minor life circumstances (more persistent, less intense than Panic Disorder).
DSM-IV-TR: Symptoms present at least six months
Somatic symptoms: Heart palpitations, muscle tension, restlessness, trembling, sleep difficulties, poor concentration, persistent apprehension/nervousness.
Generalized Anxiety Disorder (GAD)
An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.
Characterized by “free-floating anxiety”Person cannot identify, avoid, or deal with
source of anxiety.Most have co-morbid disordersWorld-wide: Most frequently diagnosed anxiety
disorderLifetime Prevalence: 5%; twice as common in women
as in men
Etiology of Panic Disorder and Generalized Anxiety Disorder
Psychodynamic: Internal conflicts from unconscious sexual and aggressive impulses.When an unconsciously repressed memory seeks
conscious representation, we feel the anxiety.Cognitive-behavioral: Interpretation of bodily
sensations Anxiety-sensitivity theory of panic
Anxiety Sensitivity Index (ASI): Measures a person’s reactions to anxiety.
Etiology of Panic Disorder and Generalized Anxiety Disorder
Biological: Changes and dysfunction of neural structures and neurochemical responses to stressful stimuli.Valium and Librium can treat therefore might be
due to chemical imbalances.Biological challenge tests
Give people w/ and w/o disorder certain chemicals which raise internal processes (or ask to hyperventilate).
People w/ disorder much more likely to experience panic attack.
Genetic studies indicate at least some heritabilityA stronger role in panic disorder than in GAD
Treating Panic Disorder and Generalized Anxiety Disorder
Biochemical treatment:Benzodiazepines for GAD, but problems of
tolerance and dependenceAntidepressants are medications of choiceSSRIs are most frequently prescribed
because they have fewest side effects.High relapse rates after stopping
medications
Treating Panic Disorder and Generalized Anxiety Disorder
Behavioral treatment (individual and/or group)Cognitive-behavioral therapy:
Educate about disorder and symptomsMuscle-relaxation trainingSymptom-inductionChange unrealistic thoughtsProvide coping statements/use coping
strategiesIdentify antecedents of panic
Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD): Characterized by intrusive and repetitive thoughts or images, or by the need to perform acts or dwell on thoughts to reduce anxiety.
Ego-Dystonic Symptoms: The symptoms are felt to be alien thoughts and actions, not under voluntary control of patient.
Lifetime prevalence rate: 2.5% (possibly underestimated); same for males and females
Obsessive-Compulsive Disorder
Obsession: Recurrent or persistent preoccupation with something.an idea; thought; image; impulseCommon obsessions include – dirt, germs,
something terrible happening, symmetry, order or exactnessApproximately 80% of “normal” population
experience obsessions (a song we can’t get out of our head!).
Patients with OCD: Obsessions last longer, are more intense, produce more discomfort, and are more difficult to dismiss.
Obsessive-Compulsive Disorder
Compulsion: An impulse experienced as irresistible (The need to perform acts or to dwell on thoughts to reduce anxiety).Repetitive and seemingly purposeful behaviors performed
according to a rule or in a stereotyped fashion. Common compulsions include: grooming, hand washing,
repeating rituals (e.g., in/out of door); checking locks, appliances, car brakes, homework.Children and adolescents with obsessive-compulsive
disorder, compulsions most commonly involve washing, checking, and repeating acts.
Approximately 55% of “normal” population acknowledges compulsive behaviors (don’t step on a crack!).
Severe compulsive state: Stereotyped/rigid behaviors, often with magical qualities.
Obsessive-Compulsive Disorder
Four Identified Types: Harm-related, sexual, aggressive, and/or
religious obsession w/ checking compulsionsSymmetry obsessions w/ arranging and
repeating compulsionsContamination obsessions w/ cleaning
compulsionsHoarding and saving compulsions
Etiology of Obsessive-Compulsive Disorder
Psychodynamic perspective: Attempts to fend off anal sadistic, anal libidinous, and genital impulses.Defense mechanisms used: substitution,
undoing, reaction formation, isolationBehavioral and cognitive perspectives: Anxiety
reductionDisconfirmatory bias-Search for evidence of
failure to perform an act rather than success of an act.
Etiology of Obsessive-Compulsive Disorder
Biological perspective: Brain structure, genetic factors, biochemical abnormalities.Brain imaging procedures provide visual
insightMedications provide only partial relief
Treatment of Obsessive-Compulsive Disorder
Biological treatments: Partial relief with fluoxetine and clomipramine, but side effects and relapse after medication stops.
Behavioral treatments:Exposure (similar to systematic desensitization),
plus response prevention.Flooding: An exposure therapy that extinguishes
fear by placing client in continued in vivo or imagined high anxiety-provoking situations.
Cognitive treatments: Identify and modify irrational thoughts