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ANXIETY DISORDERS LECTURE OUTLINE Panic and anxiety – background and history

ANXIETY DISORDERS LECTURE OUTLINE Panic and anxiety – background and history Etiology – theoretical perspectives Types of anxiety disorders and their treatment Treatments. ANXIETY DISORDERS Who is afraid of ? small insect animal, reptile speaking to a large audience

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ANXIETY DISORDERS LECTURE OUTLINE Panic and anxiety – background and history

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  1. ANXIETY DISORDERS • LECTURE OUTLINE • Panic and anxiety – background and history • Etiology – theoretical perspectives • Types of anxiety disorders and their treatment • Treatments

  2. ANXIETY DISORDERS • Who is afraid of ? • small insect • animal, reptile • speaking to a large audience • speaking in front of a small group of familiar people • meeting new people • attending social gatherings

  3. ANXIETY DISORDERS • Background and history • experience of anxiety – cognitive, somatic, behavioural, emotional • panic – discrete period of intense fear or discomfort (brief and intense) • palpitations, shaking, chest pain, fear of dying, going crazy, losing control • anxiety – negative affect, sense of uncontrollability of future threat, self-preoccupation

  4. ANXIETY DISORDERS • Background and history • panic attacks occur spontaneously • both panic and anxiety can be “normal” experiences • they become maladaptive when they become excessive, chronic, and in absence of any real danger

  5. ANXIETY DISORDERS • Background and history • Prevalence • 25% of population may be expected to have an anxiety disorder at some time in their lives • Ontario Health Supplement – 1-year prevalence rates of 9% for men, 16% for women

  6. ANXIETY DISORDERS • Background and history • 1800s and early 1900s – neuroses, Freudian perspective • 1920s – Watson, classical conditioning model, Little Albert • later 1900s – Eysenck – neuroticism as a basic personality dimension – strong emotions, moody, restless, anxious

  7. ANXIETY DISORDERS • Etiology • Psychodynamic perspective • realistic, neurotic, moral anxiety • defense mechanisms • origins in early parent-child relationships • neurotic paradox – contradicts pleasure principle

  8. ANXIETY DISORDERS • Etiology • Neurotic styles – Shapiro • inhibition of assertion/aggression • inhibition of responsibility/independence • inhibition of compliance/submission • inhibition of trust/intimacy

  9. ANXIETY DISORDERS • Etiology • Biological perspective - Genetics • family studies show up to 25% have an immediate family member with an anxiety disorder • twin studies - higher concordance rates for MZ than DZ twins • genetics may operate through behavioural inhibition

  10. ANXIETY DISORDERS • Etiology • Biological perspective - Neuroanatomy • locus ceruleus • amygdala • one form of peptide (combo of amino acids), CCK4, related to panic; CCK4 is found in amygdala, hippocampus, cerebral cortex, brain stem

  11. ANXIETY DISORDERS • Etiology • Biological perspective - Neurotransmitters • norepinephrine (NE) – concentrated in locus ceruleus • serotonin • dopamine in social phobia and OCD • interactions – serotonin affects locus ceruleus (where NE is produced) and may also influence GABA

  12. ANXIETY DISORDERS • Etiology – Limitations of 2-factor theory • cannot explain all phobias – some seem to develop without conditioning • difficult to create some fears in the lab • cannot explain why some stimuli are more likely to become feared than others

  13. ANXIETY DISORDERS • Etiology – Rachman’s revised theory • classical conditioning • modelling • informational or instructional transmission

  14. ANXIETY DISORDERS • Etiology – Biological preparedness theory • Seligman – evolutionary significance of stimuli that are easily conditioned • Bandura – properties of stimuli themselves (unpredictability and uncontrollability) and the cognitive processing that defines their threatening nature

  15. ANXIETY DISORDERS • Etiology – Cognitive theories • Bandura – low perceived self-efficacy • Beck – experiences, beliefs, appraisals • Ellis – irrational beliefs, catastrophization

  16. ANXIETY DISORDERS • Etiology – Biopsychosocial perspective • emotion • biology • environment • behaviour • cognition

  17. ANXIETY DISORDERS • Types – Specific phobia • animal • environmental • blood, injury, injection • specific situation – elevators, flying • other

  18. ANXIETY DISORDERS • Types – Specific phobia – Diagnostic features • marked and persistent fear and avoidance of specific stimulus or situation • must interfere significantly with person’s life • must be considered excessive or unrealistic • ANS arousal

  19. ANXIETY DISORDERS • Types – Specific phobia • prevalence rates from 7-11% • often emerge during adolescence, usually earlier than age 25 • tend to be chronic, but may fluctuate over life course • usually assessed with self-report • conditioning theories systematic desensitization

  20. ANXIETY DISORDERS • Systematic desensitization (SD) for specific phobia • Wolpe (1958) – reciprocal inhibition and SD • 3 components of SD • construction of stimulus hierarchy • progressive (deep muscle) relaxation training • progress through the hierarchy while practicing relaxation response

  21. ANXIETY DISORDERS • Panic disorder - Elements • recurrent, unexpected panic attacks • persistent concern, preoccupation with having another attack • worry about consequences of attack • significant behaviour change in response to attacks

  22. ANXIETY DISORDERS • Panic disorder – Other clinical features • often accompanied by avoidance behaviours (agoraphobia) • possible to have agoraphobia without panic attacks • onset around late adolescence, early adulthood • more women than men • high rates of service utilization, poor quality of life

  23. ANXIETY DISORDERS • Clark’s cognitive model of panic disorder) • catastrophic misinterpretation of arousal-related bodily sensations • agoraphobia (avoidance) as way of coping

  24. ANXIETY DISORDERS • Obsessive-compulsive disorder (OCD) - Elements • recurrent obsessions, compulsion, or both • obsessesions – thoughts, images, impulses, that are persistent, markedly distressing • compulsion – repetitive behaviours performed in response to an obsession

  25. ANXIETY DISORDERS • Obsessive-compulsive disorder (OCD) - Elements • common obsessions – violence, sex, contamination, order • common compulsions – washing, cleaning, checking, seeking reassurance, ordering or arranging objects • cleaners vs. checkers – focus on harm vs. order

  26. ANXIETY DISORDERS • Obsessive-compulsive disorder (OCD) - Background • very rare – 2.5% lifetime prevalence rate • little gender difference • high overlap with depression and Tourette’s syndrome

  27. ANXIETY DISORDERS • Obsessive-compulsive disorder (OCD) – Psychodynamic perspective • anal fixation – “Does anal-retentive have a hyphen?” • reaction formation, undoing, displacement

  28. ANXIETY DISORDERS • Obsessive-compulsive disorder (OCD) –Treatments • Prozac - SSRIs • Exposure and response prevention

  29. ANXIETY DISORDERS • Post-traumatic stress disorder (PTSD) –Description • Person has been exposed to traumatic event • 3 symptom clusters • recurrent re-experiencing of event • avoidance of trauma-related stimuli and numbing • increased arousal • Persists for at least 1 month after trauma

  30. ANXIETY DISORDERS • Post-traumatic stress disorder (PTSD) –Etiology • Cognitive theories • expectations and appraisals • fear structure in long-term memory • fear conditioning

  31. ANXIETY DISORDERS • Generalized anxiety disorder (GAD) –Description • Core feature is worrying – worries are unrealistic, difficult to control, excessive • “Free floating” anxiety • Verbal thoughts rather than images as in OCD • Motor tension, vigilance, scanning • “What if?” – background of intolerance of uncertainty

  32. ANXIETY DISORDERS • Generalized anxiety disorder (GAD) –Description • 3 key features • uncontrollability • intolerance of uncertainty • ineffective problem-solving skills

  33. ANXIETY DISORDERS • Treatments - Pharmacotherapy • 3 main drugs • Xanax • Paxil • Zoloft • SSRIs, bezodiazepines, tricyclic anti-depressants, MAOs

  34. ANXIETY DISORDERS • Treatments - Exposure • flooding, response prevention • confrontation with anxiety-producing stimulus • developing more adaptive internal representations of the stimuli and their non-threatening consequences

  35. ANXIETY DISORDERS • Treatments – Cognitive restructuring • identify maladaptive cognitions • challenge maladaptive cognitions • develop more adaptive cognitions

  36. ANXIETY DISORDERS • Treatments – Relaxation training • decreases physiological arousal through: • deep muscle relaxation • positive imagery • meditation • deep breathing

  37. ANXIETY DISORDERS • Treatments – Problem-solving training • What is my problem? What is my goal? What solutions can I generate to solve the problem? What might be the consequences of each solution? Try a solution • particularly relevant to GAD • divides problems into manageable units

  38. ANXIETY DISORDERS • SUMMARY • both biological and psychological factors involved in etiology of anxiety disorders – biopsychosocial model • shift away from Freudian perspective on “neuroses” • both biological and psychological treatments for the various disorders

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