Anxiety Disorders

Anxiety Disorders - Terms Fear: emotional reaction to danger Anxiety: Future orientation Feelings of apprehension No danger may be present Panic: physiological reaction; fight or flight Phobias: pathological fears

Fears vs. Phobias Phobias are: Out of proportion Cannot be explained away Leads to avoidance Not adaptive Persists over time Not age or stage specific

Fears Common and normal 90% of children have at least one specific fear 50% have numerous fears Common fears Fears of physical injury or personal loss Fears of natural or supernatural danger Fears reflecting psychic distress animals Generally decline with age; peak around 11 Phobias only 1%

Developmental changes in fears 1st year: loud noises, separation from parent Preschoolers – animals, the dark, imaginary creatures school age – school, injury, social fears Adolescence – interpersonal fears, appearance, school, safety

When does anxiety become a disorder? Anxiety is a normal human response to objects, situations or events that are threatening Anxiety is different from fear due to its cognitive component (i.e. fear of the future) Anxiety can be helpful and adaptive (e.g. anxiety about giving lectures!) Anxiety becomes a disorder when out of proportion or when it significantly interferes with life. Pyschological disorder- A psychological disorder is a pattern of behavioral or psychological symptoms that causes significant personal distress and impairs the ability to function in one or more important areas of life

Anxiety disorders are Highly treatable yet also resistant to extinction (no cure) Often begins early in life Reported more by women than men Reported more in Western countries Often occur with other anxiety diagnoses and with other disorder groups (e.g. Mood disorders, psychoses)

DSM-V Anxiety Disorders Obsessive Compulsive Disorder Post Traumatic Stress Disorder Generalized Anxiety Disorder Panic Disorder phobia social phobia agoraphobia acute stress disorder

Specific Phobias Selective, persistent and out of proportion Includes cognition that leads to behavioural response, whether or not the threat is present May be genetically, neurologically or experientially based Maintained through the processes of classical and operant conditioning.

Top Ten Phobias #10: Necrophobia – Fear of death

Top Ten Phobias #9: Brontophobia – Fear of thunder/lightning storms

Top Ten Phobias #8: Mysophobia – Fear of germs/dirt

Top Ten Phobias #7: Emetophobia – Fear of vomit

Top Ten Phobias #6: Claustrophobia – Fear of confinement

Top Ten Phobias #5: Agoraphobia – Fear of open spaces/crowds

Top Ten Phobias #4: Aerophobia – Fear of flying

Top Ten Phobias #3: Acrophobia – Fear of heights

Top Ten Phobias #2: Social Phobia – Fear of public embarrassment

Social Phobia A more pervasive, highly cognitive type of phobia Distinguishing feature is the fear of doing something in front of others Extreme shyness Children may not recognize why they feel anxious Must have capacity for social relationships with familiar people Must occur in peer setting, not just with adults May be situation or context (e.g. performance versus interaction anxiety) specific Fear of one’s own behaviour causing negative attention from others

Top Ten Phobias #1: Arachnophobia – Fear of spiders

Phobic Anxiety Disorder A phobia is defined as an irrational, intense fear of an object or situation that poses little or no actual danger. At first glance, a phobia may seem similar to a normal fear, but it's is the degree to which a person is affected that determines whether that fear has become a phobia.

Phobic Anxiety Disorder Typical symptoms include: Dizziness, rapid heartbeat, trembling, or other uncontrollable physical response Sensation of terror, dread or panic Preoccupation of thoughts; inability to change focus from the feared situation Intense desire to flee the situation

Phobic Anxiety Disorder The two most common treatments include: 1. Cognitive Behavior Therapy (CBT) In this form of therapy, the clinician works with the client to confront the feared situation and change the phobic reaction by changing the automatic thoughts that occur. Exposure therapy is a leading form of cognitive behavior therapy that works well in treating phobias. A popular type of exposure therapy is known as systematic desensitization, in which the client is gradually exposed to the feared object, learning to tolerate increased exposure bit by bit.

Phobic Anxiety Disorder The two most common treatments include: 1. Cognitive Behavior Therapy (CBT) 2. Medication Some medications that are effective at treating phobias include: Anti-depressants Anti-anxiety medications Beta-blockers, which limit the effects of adrenaline on the body

Agoraphobia type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed. You fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd. The anxiety is caused by fear that there's no easy way to escape or get help if the anxiety intensifies. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack and avoid the places where it may happen again. People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. You may feel that you need a companion, such as a relative or friend, to go with you to public places. The fear can be so overwhelming that you may feel unable to leave your home.

Agoraphobia treatment Agoraphobia treatment can be challenging because it usually means confronting your fears, but with psychotherapy and medications patients can live a more enjoyable life.

Panic Disorder Two major types: with or without agoraphobia Consists of a pattern of recurring panic attacks Emotional, physical, cognitive and behavioural components Main fear is of losing control (consequence = dying, going crazy, embarrassment, not being able to get help) The fear of having a panic attack becomes a problem of itself, possibly leading to agoraphobia (fear of open spaces, crowds etc. Any place where escape or finding help is difficult or embarrassing) or other phobias

Treatment of Panic Disorder Debate about the extent to which Panic Disorder is biological versus psychological (most likely both) Genetic and medication studies support biological view Cognitive strategies - reality testing, psycho education, cognitive restructuring, graded exposure - all may add to effectiveness of treatment supporting psychological argument

Obsessive Compulsive Disorder Classified as anxiety disorder, but with unique presentation Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) behaviors (compulsions) that he or she feels the urge to repeat over and over. Compulsions may be physical or mental Types of presentation: contamination fear; doubt/checking; magic thinking; symmetry; hoarding

Treatment of OCD Medical: particularly high doses of SSRIs (antidepressants) Psychoanalysis Cognitive-behavioural therapy Exposure and response prevention Thought-stopping not generally effective alone

Generalised Anxiety Disorder Characterised by persistent and global worry: worry about “everything”, “worry about worry” Distinguished from normal worry by severity, interference, irrationality Common problem but little is known Resistant to change A product of Western society?

Treatment of GAD Medication (SSRIs used more for GAD than other anxiety disorders) Psychoanalysis: GAD is caused by conflict between the ego and id impulses. The ego fears punishment but id cannot be extinguished = constant anxiety and conflict (has not been displaced as with phobia) Behavioural Techniques: difficult to implement due to global nature of GAD. May choose themes or priorities Cognitive Therapy: apparently most useful but still shows limited success Others: Rational Emotive Therapy, Existential Therapy, Gestalt Therapy, Narrative Therapy

Post Traumatic Stress Disorder Is it an anxiety disorder? Main diagnostic criteria: Witness or experience of an event that (a) involved actual or threatened death or injury, and Feelings of intense fear, horror, or helplessness Person must relive the event in some way (e.g. dreams, “flashbacks”, internal distress, physiological reactions) Avoidance (subconscious and/or conscious) Mood instability Usually persisting for at least three months

Therapeutic Treatment of PTSD Medication (treats the symptoms, but minimally effective) Exposure Therapy Critical Incident Stress Debriefing Supportive psychotherapy Eye Movement Desensitisation and Reprogramming (EMDR) Rapid saccadic eye movements coupled with exposure and positive thought Huge movement but has attracted much criticism due to its secrecy and lack of controlled studies