Nature of Anxiety and Fear

Differences between Anxiety and Fear Normal Emotional States?

Roller Coaster Ride Driving on the freeway Taking a test

Yerkes-Dodson Law

Characteristics of Anxiety Disorders

Pervasive and persistent symptoms of anxiety and fear Excessive avoidance and escape tendencies Clinically significant distress and impairment

Are the most common forms of psychopathology

Factors in Anxiety and Fear

Biological Explanation Freudian Explanation Behavioral Views Cognitive Views Social Factors Cultural Factors

Biological Factors of Anxiety and Panic

Genetic vulnerability Anxiety and brain circuits

Depleted levels of GABA Corticotropin releasing factor (CRF) and HYPAC axis Limbic (amygdala) and the

septal-hippocampal systems Behavioral inhibition (BIS) Fight/flight (FF) systems

Psychological Factors of Anxiety and Fear

Began with Freud Anxiety is a psychic reaction to fear Anxiety involves reactivation of an infantile fear situation

Behavioral and cognitive views Invokes conditioning and cognitive explanations Anxiety and fear are learned responses Catastrophic thinking and appraisals play a role

Early childhood contributions Experiences with uncontrollability and unpredictability

Social contributions Stressful life events trigger vulnerabilities

Cultural Expectations

Fig. 4-2, p. 123

Anxiety Disorders Categories

Generalized Anxiety Disorder Panic Disorder with and without

Agoraphobia Specific Phobias Social Phobia Posttraumatic Stress Disorder Obsessive-Compulsive Disorder

Generalized Anxiety Disorder

Worry About Everything Worrying is Unproductive (Interferes with

Functioning) Strong, Persistent Uncontrollable

Somatic symptoms Differ from panic (e.g., muscle tension, fatigue,

irritability)

“Do you worry excessively about minor things?”

Fig. 4-3, p. 127

Treatment of GAD

Generally Weak Benzodiazepines

Most often prescribed Offers some relief

Psychological interventions Cognitive-Behavioral Therapy

Including “exposure” to worries

Symptoms of Panic Attacks

Palpitations / Sweating Trembling / Shaking Shortness of Breath Feeling of Choking Feeling of Dying Loss of Control Derealization

Connection to?

Panic Attack

Abrupt Autonomic Surge Intense Fear or Discomfort Unexpected and Uncontrollable Absence of Actual Threat

“False Alarm”

Panic Disorder

An Unexpected Panic Attack Develop Anxiety Over:

The Next Attack or The Implications of the Attack and

Consequences Agoraphobia is Common

“Fear of the Marketplace” Consequence of Unexpected Panic Attacks Can be a separate disorder

Fig. 4-5, p. 133

Panic Disorder Treatment

Medication Treatment of Panic Disorder Benzodiazepines

Relapse and avoidance SSRIs

Preferred drugs Relapse rates are high following medication

discontinuation Psychological and Combined Treatments

Cognitive-behavior therapies seem highly effective Panic Control Treatment Graded Exposure plus Coping Skills

Combined treatments do well in the short term Some indication that CBT alone is most effective

Fig. 4-6, p. 136

Types of Specific Phobia

Natural Environment Water, spaces, storms, etc. Often more than one Peak onset about 7 years old

Animals Snakes, spiders, dogs, etc.

Blood-Injection Injury Situational

Planes, heights, etc. Separation anxiety/school phobia Others, including…

Extreme and irrational fear of a specific object or situation

Go to great lengths to avoid phobic objects Often recognize fears are unreasonable Markedly interferes with one's ability to

function

Specific Phobia Diagnosis

Fig. 4-7, p. 142

Treatment of Specific Phobias

Psychological Treatments Cognitive-behavior therapies are highly effective Graduated exposure-based exercises

Structured and consistent Systematic Desensitization Prevent Avoidance/Escape

Blood/Injection Phobia Different Actually Increase Tension to Prevent Fainting

Marked and Persistent Fear of Social or Performance Situations

Often avoid social situations or endure them with great distress

Most Common Type of Social Fear? Public Speaking

Interferes with Life Functioning

Social Phobia Diagnosis

Fig. 4-8, p. 146

Treatment for Social Phobia

Medication Treatment of Social Phobia Antidepressants

Tricyclics and MAO Inhibitors SSRIs

Paxil, Zoloft, Effexor FDA approved High relapse rates following discontinuation

Psychological Treatment Cognitive-behavioral treatment

Exposure, rehearsal, role-play in a group setting

Highly effective

Posttraumatic Stress Disorder (PTSD)

Exposure to a traumatic event War and Combat Rape and Assault Car Accidents Natural Disasters

Re-experience the event (e.g., memories, nightmares, flashbacks)

Avoidance of cues that remind person of event Emotional numbing, sleep disturbance, hyperarousal, and

interpersonal problems are common Markedly interferes with one's ability to function

Subtypes of Post Traumatic Stress

Acute Stress Disorder Immediately post-trauma

Acute PTSD 1-3 months post trauma

Chronic PTSD 3+ months post trauma

Delayed Onset PTSD Onset of symptoms 6 months or more post

trauma

Fig. 4-10, p. 153

Psychological Treatment of PTSD Cognitive-behavioral treatment

Face the Original Trauma Imaginal Reexposure Flooding Corrective Emotional Learning Virtual Reality

Increase positive coping skills and social support Cognitive-behavior therapies are highly effective Eye Movement Desensitization and Retraining (EMDR)

Controversial, but has research support

PTSD Treatment

Obsessive-Compulsive Disorder

Culmination of All Anxiety Disorders Obsessions

Intrusive Thoughts, Images, or Urges Attempts to Suppress or Eliminate

Compulsions Thoughts or Actions Attempts to Suppress the Obsessions Attempts to Obtain Relief

Most people with OCD display multiple obsessions Most Common Problem?

Cleaning and washing or checking rituals NOT the same as Obsessive-Compulsive Personality

Disorder

Fig. 4-11, p. 157

Treatment for OCD

Biological Interventions SSRIs seem to benefit up to 60% of patients

Limited extent of help Relapse is common with medication discontinuation Psychosurgery (cingulotomy) is used in extreme cases

Psychological Treatment Cognitive-behavioral therapy is most effective with OCD

Exposure and response prevention Combining medication with CBT may be no better than

CBT alone

Factors in Treating Anxiety Disorders

Biological Interventions Cognitive-Behavioral Interventions What about:

Psychoanalytic Interventions Existential Interventions Humanistic Interventions Constructivist Interventions

And, then again, what about: Social Interventions Cultural Interventions

Comorbidity

Comorbidity is common across the anxiety disorders About half of patients have two or more secondary

diagnoses Major depression is the most common secondary

diagnosis Comorbidity suggests common factors across anxiety

disorders Comorbidity suggests a relation between anxiety and

depression

pp. 162-163