PowerPoint® Presentation by Jim Foley

© 2013 Worth Publishers

Anxiety Disorders

Anxiety Disorders

• Are psychological disorders where the primary symptom is anxiety, or a feeling of impending doom or disaster from a specific or unknown source.

• Anxiety disorders are characterized by mood symptoms of tension or agitation; bodily symptoms of sweating or increased heart rate and blood pressure as well as cognitive symptoms such as worry or rumination (repetitively focusing on the symptoms or causes of distress).

• Anxiety disorders include panic disorder, generalized anxiety disorder, phobias, obsessive-compulsive disorder, and posttraumatic stress disorder.

Anxiety Disorders

Anxiety disorders…

• Highly treatable yet also resistant to extinction

• Often begins early in life• Reported more by women than men• Reported more in Western countries• Often comorbid both with other anxiety

diagnoses and with other disorder groups (e.g. Mood disorders, psychoses)

Sensory Input 2. Amygdala registers danger

3. Amygdala triggers fast response

4. More considered response based on cortical processing1. Thalamus

receives stimulus and sends to both amygdala and cortex

• Parts of the brain involved in fear response = thalamus, amygdala, hypothalamus, which then instruct the endocrine glands and autonomic nerv.sys.

• Evolved fear module (pink) versus considered response (green) = “fight or flight” versus “feel the fear and do it anyway (or do it differently)”!

Specific Phobias

• Selective, persistent and out of proportion• Includes cognition that leads to behavioural

response, whether or not the threat is present• May be genetically, neurologically or

experientially based• Maintained through the processes of classical

and operant conditioning.

Social Phobia

• A more pervasive, highly cognitive type of phobia

• Distinguishing feature is the fear of doing something in front of others

• May be situation or context (e.g. performance versus interaction anxiety) specific

• Fear of one’s own behaviour causing negative attention from others

Therapeutic Treatment of Phobia

• Mainly behavioural or cognitive behavioural techniques are used

Systematic Desensitisation (with or without relaxation training)Flooding (with or without relaxation training)ModellingCognitive restructuring, skills training, gradual exposure

[Relaxation not recommended for blood phobia where fainting is a risk]

• Hypnosis• Medication (mainly social phobia)

MOAIs SSRIs

Panic Disorder

• Two major types: with or without agoraphobia• Consists of a pattern of recurring panic attacks• Emotional, physical, cognitive and behavioural

components• Main fear is of losing control (consequence = dying, going

crazy, embarrassment, not being able to get help)

• The fear of having a panic attack becomes a problem of itself, possibly leading to agoraphobia (fear of open spaces, crowds etc. Any place where escape or finding help is difficult or

embarrassing) or other phobias

Treatment of Panic Disorder

• Debate about the extent to which Panic Disorder is biological versus psychological (most likely both)

• Genetic and medication studies support biological view

• Cognitive strategies - reality testing, psycho education, cognitive restructuring, graded exposure - all may add to effectiveness of treatment supporting psychological argument

Obsessive Compulsive Disorder

• Classified as anxiety disorder, but with unique presentation

• Characterised by obsessions and compulsions (in most cases)

• Compulsions may be physical or mental• Types of presentation: contamination fear;

doubt/checking; magic thinking; symmetry; hoarding• Severity = frequency + capacity to resist + interference

with normal functioning

• Panic Disorder

The experience of repeated attacks of intense anxiety accompanied by: severe chest pain

Tightness of muscles

Choking

Sweating

Or other acute symptoms

Symptoms can last anywhere from a few minutes to a couple of hours

Diagnosed as…

• Generalized Anxiety Disorder

Symptoms must occur for at least 6 months and include chronic anxiety not associated with any specific situation or object

The individual frequently experiences:

Sleep problems Difficulty

concentrating Irritability Tenseness Being

hypervigilant

Similar to Panic disorder however,

• Phobias Intense, irrational

fear responses to specific stimuli

A fear turns into a phobia when it provokes a compelling, irrational desire to avoid a dreaded situation or object, disrupting the person’s daily life

Nearly 5% of the population suffers from some mild form of phobic disorder

Phobias are…

• Obsessive-Compulsive Disorder (OCD) Compound

disorder of thought and behavior

Characterized by obsessions and compulsions

Obsessions are persistent, intrusive, & unwanted thoughts that a person cannot get out of their mind

Compulsions are ritualistic behaviors performed repeatedly in order to reduce the tension created by the obsession

OCD is a…

• Posttraumatic Stress Disorder (PTSD) Some trauma

experienced (natural disaster, war, violent crime) by the victim

Trauma is re-experienced through realistic nightmares and flashbacks

Victims may

experience reduced involvement with the outside world

General arousal is also experienced characterized by hyper alertness, guilt, and difficulty concentrating

PTSD is a result of…

• Freud assumed that anxiety disorders are symptoms of submerged mental energy that derives from intolerable impulses that were repressed during childhood.

• Learning theorists, drawing on research in which rats are given unpredictable shocks, link general anxiety with classical conditioning of fear.

• Some fears arise from stimulus generalizations, such as when a person who fears heights after a fall also comes to fear planes.

Learning and Biological Perspectives of Anxiety Disorders

Development

• Through observational learning, someone might also learn fear by seeing others display their own fears.

• Research suggest humans might be biologically prepared to develop certain fears.

• Compulsive acts typically are exaggerations of behaviors that contributed to our species’ evolution.

Development Continued…

• Research shows the anxiety response is genetically influenced

• PET scans of individuals with OCD reveal excessive activity in the region of the brain called the anterior cingulate cortex.

• Some anti-depressant drugs dampen fear-circuit activity in the amygdala, thus reducing OCD behavior.

Development Continued…

• Maitland, L. L. (2003). Psychology: five steps to a 5 on the AP exam. New York: McGraw-Hill.

References

GAD: Generalized Anxiety Disorder

Emotional-cognitive symptoms include worrying, having anxious feelings and thoughts about many subjects, and sometimes “free-floating” anxiety with no attachment to any subject. Anxious anticipation interferes with concentration.

Physical symptoms include autonomic arousal, trembling, sweating, fidgeting, agitation, and sleep disruption.

Panic Disorder: “I’m Dying”

A panic attack is not just an “anxiety attack.” It may include:many minutes of intense dread or terror. chest pains, choking, numbness, or other frightening physical sensations. Patients may feel certain that it’s a heart attack.a feeling of a need to escape. Panic disorder refers to repeated and unexpected panic attacks, as well as a fear of the next attack, and a change in behavior to avoid panic attacks.

Specific PhobiaA specific phobia is more than just a strong fear or dislike. A specific phobia is diagnosed when there is an uncontrollable, irrational, intense desire to avoid the some object or situation. Even an image of the object can trigger a reaction--“GET IT AWAY FROM ME!!!”--the uncontrollable, irrational, intense desire to avoid the object of the phobia.

Obsessive-Compulsive Disorder [OCD] Obsessions are intense, unwanted

worries, ideas, and images that repeatedly pop up in the mind.

A compulsion is a repeatedly strong feeling of “needing” to carry out an action, even though it doesn’t feel like it makes sense.

When is it a “disorder”? Distress: when you are deeply

frustrated with not being able to control the behaviors

or Dysfunction: when the time and

mental energy spent on these thoughts and behaviors interfere with everyday life

Common OCD Behaviors

Common pattern: RECHECKING Although you know that you’ve already made sure the door is locked, you feel you must check again. And again.

Percentage of children and adolescents with OCD reporting these obsessions or compulsions:

Post-Traumatic Stress Disorder

[PTSD]About 10 to 35 percent of people who experience trauma not only have burned-in memories, but also four weeks to a lifetime of:

repeated intrusive recall of those memories.

nightmares and other re-experiencing.

social withdrawal or phobic avoidance.

jumpy anxiety or hypervigilance.

insomnia or sleep problems.

Which People get PTSD? Those with less control in the

situation Those traumatized more frequently Those with brain differences Those who have less resiliency Those who get re-traumatized

Resilience and Post-Traumatic GrowthResilience/recovery after trauma may include:some lingering, but not overwhelming, stress.finding strengths in yourself.finding connection with others.finding hope.seeing the trauma as a challenge that can be overcome. seeing yourself as a survivor.

Understanding Anxiety Disorders: Explanations from Different Perspectives

Psychodynamic/Freudian: repressed impulses

Classical conditioning:

overgeneralizing a conditioned

response

Operant conditioning:

rewarding avoidance

Observational learning:

worrying like mom

Cognitive appraisals:

uncertainty is danger

Evolutionary: surviving by

avoiding danger

Understanding Anxiety Disorders: Freudian/Psychodynamic Perspective Sigmund Freud felt that

anxiety stems from repressed childhood impulses, socially inappropriate desires, and emotional conflicts.

We repress/bury these issues in the unconscious mind, but they still come up, as anxiety.

Operant Conditioning and Anxiety

Classical Conditioning and Anxiety

We may feel anxious in a situation and make a decision to leave. This makes us feel better and our anxious avoidance was just reinforced.

If we know we have locked a door but feel anxious and compelled to re-check, rechecking will help us temporarily feel better.

The result is an increase in anxious thoughts and behaviors.

In the experiment by John B. Watson and Rosalie Rayner in 1920, Little Albert learned to feel fear around a rabbit because he had been conditioned to associate the bunny with a loud scary noise.

Sometimes, such a conditioned response becomes overgeneralized. We may begin to fear all animals, everything fluffy, and any location where we had seen those, or even fear that those items could appear soon along with the noise.

The result is a phobia or generalized anxiety.

Observational Learning and

Anxiety Experiments with humans

and monkeys show that anxiety can be acquired through observational learning. If you see someone else avoiding or fearing some object or creature, you might pick up that fear and adopt it even after the original scared person is not around.

In this way, fears get passed down in families.

Cognition and Anxiety

Cognition includes worried thoughts, as well as interpretations, appraisals, beliefs, predictions, and ruminations.

Cognition includes mental habits such as hypervigilance (persistently watching out for danger). This accompanies anxiety in PTSD.

In anxiety disorders, such cognitions appear repeatedly and make anxiety worse.

Examples of Cognitions that can Worsen Anxiety:

Cognitive errors, such as believing that we can predict that bad events will happen

Irrational beliefs, such as “bad things don’t happen to good people, so if I was hurt, I

must be bad”

Mistaken appraisals, such as seeing aches as diseases, noises as dangers, and strangers as

threats

Misinterpretations of facial expressions and actions of others, such as thinking “they’re

talking about me”

Biology and Anxiety: Genes

Studies show that identical twins, even raised separately, develop similar phobias (more similar than two unrelated people).

Some people seem to have an inborn high-strung temperament, while others are more easygoing.

Temperament may be encoded in our genes.

Genes and Neurotransmitters

Genes regulate levels of neurotransmitters.People with anxiety have problems with a gene associated with levels of serotonin, a neurotransmitter involved in regulating sleep and mood. People with anxiety also have a gene that triggers high levels of glutamate, an excitatory neurotransmitter involved in the brain’s alarm centers.

Biology and Anxiety: The Brain

Traumatic experiences can burn fear circuits into the amygdala; these circuits are later triggered and activated.

Anxiety disorders include overarousal of brain areas involved in impulse control and habitual behaviors.

The OCD brain shows extra activity in the ACC, which monitors our actions and checks for errors.

ACC = anterior cingulate gyrus

Biosocial Roots of Crime: The BrainPeople who commit murder seem to have less tissue and activity in the part of the brain that suppresses impulses.

Other differences include: less amygdala response when viewing violence.an overactive dopamine reward-seeking system.

How common are psychological disorders?

Countries vary greatly in the percentage of people reporting mental health issues in the past year.

Rates of Psychological

Disorders

This list takes a closer look at the past-year prevalence of various mental health diagnoses in the United States.

Who is at risk of mental disorders?Who is less at risk?

Risks and Protective Factors for Mental Disorders

Outcomes for People with Psychological Disorders

There are risks to be watchful of, obstacles to be overcome, and improvements to be made, often with the help of with treatment.Some people with psychological disorders do not recover.Some achieve greatness, even with a psychological disorder.