copyright © 2007 by the mcgraw-hill companies, inc. all rights reserved. chapter 3 anxiety...

Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.

Chapter 3

Anxiety Disorders

Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7

Writing about anxiety

Write about an anxiety you are struggling with (or have struggled with).

What are your “symptoms” of anxiety?

Is your response adaptive or maladaptive?


Fear responses: Adaptive vs. Maladaptive

Adaptive Fear vs. Maladaptive Anxiety

•Realistic concerns Unrealistic

•In proportion to threat Out of proportion

•Fear response subsides Response is persistent/Chronic


Symptoms of Anxiety

Somatic Emotional Cognitive Behavioral

Goosebumps emergeMuscles tenseHeart rate increasesRespiration acceleratesRespiration deepensPeripheral blood vessels dilateLiver releases carbohydratesBronchioles widenPupils dilatePerspiration increases Adrenaline is secretedStomach acid is inhibitedSalivation decreases

Sense of dread

Terror

Restlessness

Irritability

Anticipation of harm

Exaggerating of danger

Problems in concentrating

Hypervigilance

Worried, ruminative thinking

Fear of losing control

Fear of dying

Sense of unreality

Escape

Avoidance

Aggression

Freezing

Decreased appetitive responding

Increased aversive responding


Anxiety Disorders

Many different disorders (GAD, PTSD, phobias, OCD, etc.)


Post-Traumatic Stress Disorder

Tape 2 (World of Ab Psych) Exposure to traumatic event + Symptoms

– Reexperiencing – flashbacks, intrusive memories, bad dreams

– Avoidance and numbing – feeling detached, avoiding people and activities

– Increased arousal – hypervigilance, insomnia, startle response, irritability/outbursts


PTSD: Causes

Trauma + Vulnerability– Vulnerability is biopsychosocial (next slide)


Explanations of PTSD Vulnerability

Sociocultural factors1. Social support2. Nature of trauma itself

(severity, etc.)

Sociocultural factors1. Social support2. Nature of trauma itself

(severity, etc.)Psychological factors1. Personal assumptions2. Distress3. Coping styles

Psychological factors1. Personal assumptions2. Distress3. Coping styles Biological factors

1. Physiological hyperactivity2. Genetics

Biological factors1. Physiological hyperactivity2. Genetics


Treatments for PTSD

PTSD symptoms are understood and treated within the norms of people’s culture.

Sociocultural approaches

Antianxiety and antidepressant drugs can be used to quell specific symptoms

Biological therapies

Therapist helps client solve concrete problems to reduce stress

Stress management

Systematic desensitization is used to extinguish fear reactions to memories (e.g., imaginal reexposure; cognitive techniques are used to challenge irrational thoughts.

Cognitive- behavioral therapy


Phobic Disorders

Agoraphobia Fear of places where help might not be available in case of an emergency

Specific Phobias Animal type Natural environment type Situational type Blood-injection-injury type

Fear of specific objects, places or situations

Social Phobia Fear of being judged or embarrassed by others


Shyness: A disorder??

Shy on Drugs NY Times, Sept 2007, by Christopher Lane, author of “Shyness: How Normal Behavior Became a Sickness.”

Read in class and discuss


Treatment of Phobias

Behavioral 1) Systematic desensitization 2) Modeling 3) Flooding

Biological Reduce symptoms of anxiety

generally so that they do not arise in the feared situation

Cognitive-Behavioral Helps clients identify and

challenge negative, catastrophizing thoughts about feared situations


Panic Disorder Symptoms

Panic attack symptoms

Panic Disorder can be diagnosed when panic attacks…

•become common

•are not typically provoked by any particular situation

•include worry and changing behaviors due to the worry


Occurs in 3.5% of population (occurs worldwide and across ethnicities)

Affects women more Onset: late teens – mid-thirties Seek medical care frequently

Occurs in 3.5% of population (occurs worldwide and across ethnicities)

Affects women more Onset: late teens – mid-thirties Seek medical care frequently

Panic Disorder -- facts


•Biological Theories •Genetic (30-40% contribution)

•Human studies (families; twins)•Rodent studies (stathmin gene may contrib to fear and anxiety)

•Neurotransmitter contributions•Poor regulation of norepinephrine, serotonin, and perhaps GABA in the locus ceruleus and limbic systems

•Kindling Model (next slide)

Causes of Panic Disorder


Poor regulation in locus ceruleus

Panic Attacks

Lowers threshold for chronic anxiety in limbic system

Chronic anxiety increases likelihood of dysregulation in locus ceruleus

Panic Attacks

Kindling Model of Panic Disorder


Cognitive Factors– People prone to panic attacks

– (1) pay very close attention to their bodily sensations– (2) misinterpret these sensations– (3) engage in snowballing, catastrophizing thinking

Causes of Panic Disorder (cont.)


•Faces DVD (Annie)•World of Abnormal Psych (tape 3 -- start at 8 min mark)

Panic and agoraphobia


Treatments

Depends upon whom you go to see! Meds (e.g., antidepressants, benzodiazepines)

– Problems? Cognitive-behavioral treatment (next slide)


Classes of Medications for Anxiety Disorders

Benzodiazepines.These drugs were often used to treat anxiety disorders from the 1960s until the 1980s. They act on GABA, which seems to play a role in fear. They generally work quickly, but due to concerns about abuse or dependency, other medications are now more commonly prescribed.

Tricyclic antidepressants (TCAs).These medications were developed in the 1950s and 1960s. They help prevent reuptake of 5HT and NE, but they also affect other neurotransmitters and can have serious side effects. They are not as commonly prescribed in the United States as are newer classes of antidepressants.

Monoamine oxidase inhibitors (MAOIs).The MAOIs were developed at about the same time as the TCAs, but they are believed to work differently. They seem to stop the brain from breaking down 5HT and NE after reuptake.

Selective serotonin reuptake inhibitors (SSRIs).The SSRIs prevent reuptake of neurotransmitters in the brain. Although the various SSRIs seem to work in basically the same way and have similar side effects, people seem to respond differently to different SSRIs.

Serotonin-norepinephrine reuptake inhibitors (SNRIs).Developed in the 1990s, Effexor XR® (venlafaxine HCl) was the first SNRI. It works on 5HT, like an SSRI, but also helps prevent reuptake of NE.


Cognitive-Behavioral Therapy

1. Clients are taught relaxation and breathing exercises.

2. The clinician guides clients in identifying the catastrophizing cognitions they have about changes in bodily sensations.

3. Clients practice using their relaxation and breathing exercises while experiencing panic symptoms in the therapy session.


Cognitive-Behavioral Therapy, continued

4. The therapist will challenge clients’ catastrophizing thoughts about their bodily sensations and teach them to challenge their thoughts for themselves

5. The therapist will use systematic desensitization techniques to gradually expose clients to those situations they most fear while helping them to maintain control


Generalized Anxiety Disorder (GAD)

Excessive anxiety and worry Difficulty in controlling the worry Restlessness or feeling keyed-up or on edge Easily fatigued Difficulty concentrating Irritability Muscle tension and sleep disturbance


Obsessive-Compulsive Disorder

• a chronic anxiety disorder most commonly characterized by obsessive, distressing, intrusive thoughts and related compulsions (tasks or "rituals") which attempt to neutralize the obsessions.


Obsessions (as defined by DSM-IV-TR)

Recurrent and persistent thoughts, impulses, or images that are experienced intrusive and inappropriate and that cause anxiety or distress

Thoughts, impulses, or images that are not simply excessive worries about real life problems

Thoughts, impulses or images that the person attempts to ignore or suppress or to neutralize with some other thought or action

Obsessive thoughts, impulses or images that the person recognizes are a product of his or her own mind


Compulsions(as defined by DSM-IV-TR), continued

Repetitive behaviors (such as hand washing, ordering, checking) or mental acts (such as praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly

Behaviors or mental acts that are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they should prevent


• Biological Treatments– as before, mostly psychotropic meds

• Cognitive-behavioral Treatments– Expose the client to obsessions until anxiety about obsessions decreases, prevent compulsive behaviors and help the client manage anxiety that is aroused. For example, systematic desensitization may be used to help a person with a germ obsession gradually tolerate exposure to “dirty” materials.

Treatments for OCD


Just Checking by Emily Colas

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copyright © 2007 by the mcgraw-hill companies, inc. all rights reserved. chapter 3 anxiety...

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