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Anxiety Disorders. “The Dark side of Fear”. What is Anxiety?. The unpleasant feeling of fear or apprehension we experience in response to some event or situation. Duration & intensity of anxiety --more severe in people with anxiety disorders than in people without. . Anxiety Disorders:.

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anxiety disorders

Anxiety Disorders

“The Dark side of Fear”

what is anxiety
What is Anxiety?
  • The unpleasant feeling of fear or apprehension we experience in response to some event or situation.
  • Duration & intensity of anxiety --more severe in people with anxiety disorders than in people without.
anxiety disorders1
Anxiety Disorders:
  • Phobias
  • panic disorder
  • generalized anxiety disorder
  • obsessive-compulsive disorder
  • posttraumatic stress disorder
  • acute stress disorder
comorbidity of other anxiety disorders is high
Comorbidity of other anxiety disorders is high!!
  • 1.Symptoms of various anxiety disorders are not disorder specific.
  • 2.) Cause of one disorder may be cause of another disorder.
a phobias an irrational fear out of proportion to the danger posed by the object or situation
A. Phobias – an irrational fear out of proportion to the danger posed by the object or situation.
  • Person knows fear is irrational, but avoids object or situation anyway.
  • Phobia may not be debilitating enough to warrant seeking treatment.

(e.g., A fear of snakes in the city is less a problem than in the country)

two kinds of phobias
Two kinds of phobias:
  • 1. Specific phobias - fears caused by the presence or anticipation of a specific object or situation.
  • Blood
  • injuries & injections
  • situations (planes, elevators)
  • animals (dogs, spiders)
  • natural environment (heights, water, tornadoes)

Lifetime prevalence: 7% (men) and 16% (women).

2 social phobias
2. Social phobias-
  • Fear linked to the presence of other people
  • Person avoids situation in which he or she could behavior in embarrassing way.
  • Speaking or performing in public
  • eating in public
  • Using public bathroom
  • Lifetime prevalence: 11% (men) & 15% (women)
what causes phobias
What causes phobias?
  • Data show we learn phobias, they are not innate.
  • We learn phobias by:
  • 1. Classical & operant conditioning (avoidance learning)
  • 2. Modeling (observational learning)
  • We learn phobias by observing others’ fear to the object or event.
  • Do we need to observe the person’s fear response to the stimulus & the stimulus itself?
  • Yes!!!!
mineka study
Mineka study:
  • Had lab-reared monkeys view wild-reared monkeys responses to a snake.
  • A barrier was in place to block the lab-reared monkeys from seeing the object of the wild-reared monkey’s fear.
  • Later when shown the snake, the lab-reared monkey didn’t show fear to the snakes.
  • You need to see the other person’s response to the feared stimulus & the stimulus itself for phobia formation.
therapy for phobias
Therapy for phobias:
  • Systematic desensitization
  • Flooding
b generalized anxiety disorder gad
B. Generalized Anxiety Disorder (GAD)
  • Symptoms:
  • persistent anxiety
  • chronic worry
  • focus on health/daily hassles
  • difficulty concentrating; irritable
  • tire easily; restless
  • Lifetime prevalence: 5% in population
  • Onset: midteens; comorbidity with other anxiety disorders & mood disorders.
causes of gad
Causes of GAD:
  • we develop GAD when confronted with painful stimuli over which we have no control.
  • Perception of not being in control may be enough for anxiety.
  • we develop GAD when we misperceive events to be out of our control & potentially threatening or harmful.
locus of control we feel less anxiety when we can control our lives
Locus of control- we feel less anxiety when we can control our lives.
  • Our “perception” of control may be more important than “actual” control to reducing unwanted anxieties in patients with GAD.

*Unpredictable events produce more anxiety than predictable ones.

Patients with GAD are easily drawn to stimuli associated with negative emotional content (traumas, physical harm, etc.)

worry as a tool to control emotion
Worry as a tool to control emotion!!
  • Patients with GAD use worry to distract themselves from thinking about negative events.
  • Worrying keeps us from focusing on negative emotions.
  • Worrying is negatively reinforcing because it blocks us from processing emotional stimuli, & keeps the cycle of anxiety going.
biological causes of gad
Biological Causes of GAD
  • There may be a genetic component.
  • We may have a defect in the GABA system so that fear is not brought under control.
  • Benzodiazipines, which enhance the inhibitory neurotransmitter, GABA, reduce anxiety.
therapies for gad
Therapies for GAD
  • 1. Transfer global anxiety into a phobia & treat phobia.
  • *Systematic desensitization may be used if anxiety can be linked to an identifiable source.
  • 2. Relaxation training

Have patients focus on relaxing during low-level anxiety.

treat worry
Treat worry!!!
  • Here, therapists require that patients extend & exaggerate their anxieties.
  • Because patient remains in a fearful situation, anxiety is believed to extinguish.
  • Patient learns his or her cognitions are illogical and unfounded.
c panic disorder characterized by attacks
C. Panic Disorder – characterized by attacks.
  • Increased HR
  • heart palpitations
  • nausea
  • chest pain
  • trembling; sweating, terror
  • Usually physiological symptoms occur without link to cause (with exceptions)

Lifetime prevalence: 2 % (men) & 5 % (women).

dsm iv diagnosis
DSM-IV diagnosis:
  • Recurrent uncued attacks & worry about having attacks in the future are required.
  • Is diagnosed as panic disorder with or without agoraphobia.
  • Comorbidity between panic disorder &

major depression, GAD, phobias, alcoholism, & personality disorders is high.

what causes panic disorder
What causes panic disorder?

1.There may be symptoms of an illness that leads to panic attacks.

  • (e.g., mitral valve prolapse causes heart palpitations, dizziness, etc.)
  • 2. Panic may be caused by overactivity in a nucleus in the pons called the locus ceruleus (LC).
  • In humans, a drug called Yohimbine, a drug that stimulates the LC, can elicit panic attacks in patients with panic disorder.
causes panic
Causes (panic):
  • However blocking activation in the LC has not been found to reduce panic attacks.
  • 3.Creating panic attacks experimentally:
  • Using hyperventilation to induce panic attacks has produced mixed results.
psychological theories
Psychological theories:

Patients with panic disorder may have an autonomic nervous system that is predisposed to be overly active.

  • People misconstrue internal bodily changes as signals they may be in jeopardy or dying.
  • With repeated exposures to attacks, patients worry about future attacks thereby making them more likely to occur.
therapies for panic disorder and agoraphobia
Therapies for Panic disorder and agoraphobia
  • Biological:

1. Antidepressants & anxiolytics can reduce frequency of attacks.

Psychological: Barlow’s therapy (well validated):

3 components:

1. Relaxation training-

2. A combination of Ellis & Beck type cognitive behavioral interventions

3. Exposure to the internal cues that trigger panic

d obsessive compulsive disorder ocd
D. Obsessive-Compulsive Disorder (OCD):
  • persistent unwanted thoughts & compulsive behaviors that impair normal functioning.
  • Lifetime prevalence: 1-2 % of general pop.
  • More common in women than men
  • Age of onset: early adulthood
  • Males: checking rituals most common

Females: cleaning rituals most common

components of ocd
Components of OCD:
  • 1. Obsessions-intrusive & recurring thoughts & images that appear irrational & uncontrollable to the individual experiencing them.
  • Frequency & force of thoughts always interfere with functioning.

Fears of contamination

  • Fears of expressing sexual or aggressive impulses
  • hypochondria
  • 2. Compulsions- repetitive behaviors performed over & over to reduce distress associated with the unwanted thoughts.
causes of ocd
Causes of OCD
  • 1. Behavioral & cognitive theories
  • Compulsions are learned behaviors reinforced by fear reduction (negative reinforcement).
  • E.g., frequency of hand washing increases to reduce or eliminate the aversive fear of dirt.
  • Compulsive checking may be the result of memory deficit.
therapies for ocd
Therapies for OCD
  • Exposure and response prevention (ERP)

Victory Meyer (1966)

1.Patients with OCD expose (flooding) themselves to situations that elicit compulsions.

  • E.g., touching a dirty dish
  • 2.  Person is instructed to refrain from performing compulsions (extinguish anxiety & compulsions).

Treatment is partially effective in half of OCD patients.  

e posttraumatic stress disorder ptsd
E. Posttraumatic Stress disorder (PTSD)
  • A traumatic event or witness to an event in which there is perceived or actual threat of death, serious injury, or other personal harm.
  • The event must have created intense fear, horror, or a sense of helplessness.

(May 3rd, 1999-OK)

Symptoms of PTSD fall into 3 major categories. Symptoms in each must occur longer than 1 month.

what happens
What happens?
  • 1. Reexperiencing the traumatic event
  • Person frequently recalls the event (has nightmares about the event).
  • 2. Avoidance of stimuli associated with the event or numbing of responsiveness
  • Person tries to avoid thinking about the trauma or encountering stimuli that will bring it to mind.

3. Symptoms of increased arousal

difficulty concentrating (sleeping), hypervigilance

ptsd general stats
PTSD: General Stats
  • General prevalence: 1-3 % in the general pop.
  • 3% for civilians exposed to a physical attack
  • 20 % among people wounded in Vietnam
  • 50 % of all rape victims
  • Women twice as likely to develop PTSD as men.
f acute stress disorder
F. Acute Stress Disorder
  • an individual encounters a traumatic experience that causes problems with social or occupational functioning for less than 1 month.