Anxiety Disorders

1. Anxiety Disorders

2. Anxiety is an unpleasant emotional state characterized by physical arousal and feelings of tension, apprehension, and worry • Puts us on physical alert, preparing us to defensively “fight” or “flee” potential dangers, • Also puts us on mental alert, making us focus our attention squarely on the threatening situation Anxiety

3. Anxiety Disorders • In the anxiety disorders, the anxiety is maladaptive, disrupting everyday activities, moods, and thought processes • Three features distinguish normal anxiety from pathological anxiety. Pathological anxiety is: • Irrational—it is provoked by perceived threats that are exaggerated or nonexistent, and the anxiety response is out of proportion to the actual importance of the situation. • Uncontrollable—the alarm reaction cannot be shut off even when the person knows it’s unrealistic. • Disruptive—it interferes with relationships, job or academic performance, or everyday activities

6. Generalized Anxiety Disorder(GAD) • Disruptive levels of persistent, unexplained feelings of apprehension and tenseness • Lasting for 6 months or more • Concentration switches from worry to worry making one jittery, agitated & sleep-deprived.

7. GAD

8. Genetic predisposition or childhood trauma Hypervigilance GAD following life change or major event Model of Development of GAD • GAD has some genetic component • Related genetically to major depression • Childhood trauma also related to GAD

10. Are Your Worries Excessive? • Add up your TOTAL Score • 0-11 points = You are not the fretful type. Worry, which no doubt makes you uncomfortable, goads you to take necessary action in your life. • 12-20 points = You’re a potentially unhealthy worrier. • 21-30 points = Danger zone! Agonizing constantly about small matters isn’t good for you physically or emotionally.

11. Panic Disorder • An anxiety disorder characterized by sudden bouts of intense, unexplained panic • Panic attacks—sudden episode of helpless terror with high physiological arousal • Very frightening—sufferers live in fear of having them • may happen several times a day • Agoraphobia often develops as a result

12. Phobia • Disruptive, irrational fears of specific objects or situations • The fear must be both irrational and disruptive. • Causes one to avoid the feared situation • About 10 percent of the general population will experience a specific phobia at some point in their lives.

13. Phobias • Generally, the objects or situations that produce specific phobias tend to fall into four categories • Natural environment—heights, water, lightning • Situation—flying, tunnels, crowds, social gathering • Injury—needles, blood, dentist, doctor • Animals or insects—insects, snakes, bats, dogs

14. Study of normal anxieties 100 90 80 70 60 50 40 30 20 10 0 Percentage of people surveyed Snakes Being in high, exposed places Mice Flying on an airplane Being closed in, in a small place Spiders and insects Thunder and lightning Being alone in a house at night Dogs Driving a car Being in a crowd of people Cats Afraid of it Bothers slightly Not at all afraid of it Phobias • It is not phobic to simply be anxious or afraid about something • It needs to be irrational & debilitating

16. Some Unusual Phobias • Watch this video of a girl with a phobia for pickles. • Ailurophobia—fear of cats • Algobphobia—fear of pain • Anthropophobia—fear of men • Monophobia—fear of being alone • Pyrophobia—fear of fire

17. Social Anxiety Disorder • Fear of failing or being embarrassed in public • public speaking (stage fright) • fear of crowds, strangers • meeting new people • eating in public • Considered phobic if these fears interfere with normal behavior • Equally found in males and females

18. Agoraphobia • Fear of situations the person views as difficult to escape or help unavailable when panic strikes • Fear of leaving one’s home or room in the house

19. Obsessive-Compulsive Disorder • An anxiety disorder characterized by unwanted, repetitive thoughts and actions • Obsessions – repetitive thoughts • Compulsions – repetitive actions • The obsessions/compulsions begin to take control of the person’s life.

20. Obsessive-Compulsive Disorder (OCD) • Obsessions—irrational, disturbing thoughts that intrude into consciousness • Compulsions—repetitive actions performed to alleviate obsessions • Overt physical behaviors, such as repeatedly checking or washing your hands • Covert mental behaviors, such as counting or reciting certain phrases to yourself • Potential Biological Causes: • The caudate nucleus is located in the basal ganglia and is associated with initiation of learned, habitual motor activities • Drugs that increaseSerotonin reduces the activity of the caudate nucleus and leads to a reduction in the obsessions and compulsions - people who recover from OCD using behavioral and cognitive therapies also show a reduction in activity in the caudate nucleus

24. Finding Your OCD Score • Circle the following item numbers if you marked TRUE for them: 1, 2, 4, 6, 7, 8, 16, 17, 21 • Circle the following item numbers if you marked FALSE for them: 5, 9, 10, 11, 12, 13, 14, 19, 20, 22 • Now add up your total score. Highest score possible is a 20 (items 3 & 15 are validity checks) • The mean (average) score is 11.15 for males and 11.24 for females. • Remember, even if you scored high on this scale it doesn’t mean you have OCD. Always ask yourself, “Do these tendencies I have disrupt my daily life and relationships?” If the answer is NO you don’t have a problem.

25. Trichotillomannia: The Disease of Hair Pulling • Quick example (3 min) • What it’s like to live with it – video • Trich – An explanation – video Other Obsessions… • Obsessive Texting - video

26. Posttraumatic Stress Disorder(PTSD) • Reliving a severely upsetting event in unwanted recurring memories (flashbacks) and dreams • Greater the emotional distress during a trauma, the higher the risk for PTSD

27. Follows events that produce intense horror or helplessness (traumatic episodes) Core symptoms include: Frequent recollection of traumatic event, often intrusive and interfering with normal thoughts Avoidance of situations that trigger recall of the event Increased physical arousal associated with stress There is a high correlation of suicide and drug abuse in PTSD – See news report on Military Suicides in Soldiers fighting in Iraq – 2 min. Posttraumatic Stress Disorder (PTSD) • Survivor Resiliency – Even though 50% of adults will have a traumatic experience only 1 in 10 women & 1 in 20 men will develop PTSD • Posttraumatic Growth – after struggling through a challenging crisis, people may report and increase in appreciation for life, more meaningful relationships, increased personal growth, increased personal strength, changed priorities & a richer spiritual life.

28. Potential Causes of PTSD • Studies of the Hippocampus in PTSD patients find that on average, their hippocampus is 25% smaller. • Some think this is a warning sign that someone is susceptible to PTSD. • Others say it is due to overactive limbic system triggering excessive stress hormones whenever memories of traumatic experience come into consciousness • Right Temporal Lobe over activated during a flashback.

29. Causes of Anxiety Disorders

31. Development of Phobias • Classical conditioning may be involved in the development of a specific phobia that can be traced back to some sort of traumatic event. • People with phobias may have developed a conditioned response of fear to a conditioned stimulus then generalize that onto all similar stimuli • Problems with this theory: • often no memory of a traumatic experience • traumatic experience may not produce phobia

32. Other Learning Factors • Observational learning--watching another experiencing fearfulness--may result in developing fear. • Operant Conditioning - Fear of an object may be negativelyreinforced by avoiding the feared objects.

33. Cognitive-Behavioral Theory of Panic Disorder • Sufferers tend to misinterpret the physical signs of arousal as catastrophic and dangerous • This interpretation leads to further physical arousal, tending toward a vicious cycle • After their first panic attack, they become even more attuned to physical changes, increasing the likelihood of future panic attacks • Therapy involves trying to get the person to rethink their phobia. Video (7 min)

34. Biological PerspectiveNatural Selection/Preparedness Theory • We fear threats that were faced by our ancestors. • Humans seem biologically prepared to acquire fears of certain animals and situations that were survival threats in human evolutionary history • Compulsions typically exaggerate behaviors that contributed to our species’ survival • Grooming, hand-washing, checking

35. Biological Factors • Hereditary/Gene factors may result in a predisposition for developing anxiety disorders • Brain functions appear to be different in an anxiety disorder patient • The Caudate Nucleus is located in the Basal Ganglia and is associated with initiation of learned, habitual motor activities is overactive in OCD • Anterior Cingulate Cortex – monitors our actions and checks for errors is hyperactive with OCD • PTSD seems affected by an overactive Amygdala