Anxiety Disorders Chapter 5 © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

The Nature of Anxiety Disorders Anxiety: Individual is inordinately: Apprehensive, tense, and uneasy about the prospect of something terrible happening Fear: Innate alarm response to a dangerous or life-threatening situation Anxiety disorders: Characterized by intense, irrational, and incapacitating apprehension. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Panic Disorder Panic attacks on a recurrent basis Has constant apprehension and worry about the possibility of recurring attacks Panic attack: A period of intense fear and physical discomfort accompanied by the feeling that one is being overwhelmed and is about to lose control During a panic attack, the individual feels overwhelmed by a range of highly unpleasant physical sensations: Respiratory distress Autonomic disturbances Sensory abnormalities © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Panic Disorder Agoraphobia: Intense anxiety about being trapped or stranded in a situation without help if a panic attack occurs Panic disorder is often associated with agoraphobia Panic disorder with agoraphobia: Agoraphobia is considered to be a subcategory within panic disorder. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Panic Disorder: Theories and Treatment Biological perspectives Neurotransmitters Anxiety Sensitivity Psychological perspectives Conditioned Fear Reactions Relaxation training Panic control therapy (PCT) Biological perspectives Focus on norepinephrine. Norepinephrine - The neurotransmitter involved in preparing the body to react to stressful situations. Anxiety sensitivity theory: The belief that panic disorder is caused in part by the tendency to interpret cognitive and somatic manifestations of stress and anxiety in a catastrophic manner. Psychological perspectives Conditioned fear reactions: Acquired associations between an internal or external cue and feelings of intense anxiety. Relaxation training: Used to help clients gain control over the bodily reactions involved in panic attacks. Panic control therapy (PCT): Consists of cognitive restructuring, exposure to bodily cues associated with panic attacks, and breathing retraining. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Specific Phobias Phobia: An irrational fear associated with a particular object or situation Specific Phobia: An irrational and unabating fear of a particular object, activity, or situation People with specific phobia go to great lengths to avoid the object or situation that is the target of their fear. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Specific Phobias Categories Animals Natural environment Blood-injection-injury Engaging in activities in particular situations Variety of miscellaneous stimuli © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Specific Phobias: Theories and Treatment Systematic desensitization Flooding Imaginal flooding Graduated exposure Thought stopping Biological perspectives focus on symptom management. Psychological perspectives Systematic desensitization - Individuals learn to substitute adaptive (relaxation) for maladaptive (fear or anxiety) responses. Flooding: Client is totally immersed in the sensation of anxiety by being exposed to the feared situation in its entirety. Imaginal flooding: Client is immersed through imagination in the feared situation. Graduated exposure: Clients initially confront situations that cause only minor anxiety and gradually progress toward those that cause greater anxiety. Thought stopping: Individual learns to stop anxiety-provoking thoughts. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Social Phobia Irrational and unabating fear that one’s behavior will be scrutinized by others Causes the individual to feel embarrassed and humiliated © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Social Phobia: Theories and Treatment Biological perspectives SSRIs and SNRIs Psychological perspectives Motivational interviewing Acceptance and commitment therapy Mindfulness/meditation Biological perspectives Categories of medications shown to be most effective for social phobia are SSRIs and SNRIs. Benzodiazepines have significant potential for abuse. MAOIs have potentially dangerous side effects. Psychological perspectives Cognitive-behavioral perspective approach - Unable to gain a realistic view of how others really perceive them. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Generalized Anxiety Disorder Anxiety that is not associated with a particular object, situation, or event A constant feature of a person's day-to-day existence Symptoms - General restlessness, sleep disturbances, feelings of being easily fatigued, irritability, muscle tension, and trouble concentrating to the point where their mind goes blank. Biological perspective - People experience their symptoms due to disturbances in GABA, serotonergic, and noradrenergic systems. Cognitive-behavioral therapy - Cognitive distortions contribute to generalized anxiety. Clients learn how to recognize anxious thoughts, to seek more rational alternatives to worrying, and to take action to test these alternatives. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Obsessive-Compulsive Disorder Obsession: Persistent and intrusive idea, thought, impulse, or image Compulsion: Repetitive and seemingly purposeful behavior performed in response to: Uncontrollable urges or according to a ritualistic or stereotyped set of rules Obsessions cause marked anxiety or distress. Compulsions are carried out in an effort to neutralize the obsession. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Obsessive-Compulsive Disorder Recurrent obsessions that are inordinately time-consuming or that cause significant distress or impairment © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Obsessive-Compulsive Disorder 4 major dimensions Obsessions associated with checking compulsions Need for symmetry and order Obsessions about cleanliness associated with washing compulsions Hoarding-related behaviors Individuals with OCD experience tics. Tic: A rapid, recurring, involuntary movement or vocalization. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Obsessive-Compulsive Disorder Most effective biological treatments available for OCD Treatment with clomipramine Treatment with other serotonin reuptake inhibiting medications Fluoxetine (Prozac) Treated with psychiatric neurosurgery in extreme cases. Cognitive-behavioral perspective - Maladaptive thought patterns contribute to the development and maintenance of OCD symptoms. Metacognitions lead people with OCD to worry, ruminate, and feel that they must monitor their every thought. Psychological interventions provide an important supplement to or replacement for medication to treat OCD symptoms. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Acute Stress Disorder and Post-Traumatic Stress Disorder Traumatic experience: Disastrous or extremely painful events Has severe psychological and physiological effects Flashbacks Nightmares © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Trauma-Induced Disorders Acute stress disorder: Arises within the month following the trauma Lasts 2- 4 weeks Symptoms Intrusion of distressing reminders of the event Dissociative symptoms Avoidance of situations that serve as reminders of the event Hyper-arousal Risk of developing acute stress disorder When people are exposed to the threat of death, or to actual or threatened serious injury, or sexual violation. People with this disorder may reexperience the event and desperately avoid reminders of the trauma. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Trauma-Induced Disorders Post-traumatic stress disorder: Individual experiences several distressing symptoms for more than a month following a traumatic event Symptoms fall into categories: Intrusions Dissociation Avoidance Symptoms of PTSD and related disorders can persist for many years. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Post-Traumatic Stress Disorder: Theories and Treatment Hippocampus SSRI antidepressants Combines exposure (in vivo or imaginal) with relaxation and cognitive restructuring EMDR Traumatic experience - External event that impinges on the individual and hence does not have biological “causality.” People experience alterations in the hippocampus, the structure responsible for consolidating memory. SSRI antidepressants are the only FDA-approved pharmacotherapy. Eye Movement Desensitization Reprocessing (EMDR) - Clinician asks the client to think about a traumatic memory while focusing on rapid movement of the clinician’s finger for 10 to 12 eye movements. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

Anxiety Disorders: The Biopsychosocial Perspective Problems Differences and similarities in symptoms and causes Unique combination represented in that person’s life by: Confluence of genetics, brain functioning, life experiences, and social context Anxiety disorders span a broad spectrum of problems. Ranging from specific, seemingly idiosyncratic responses to diffuse and undifferentiated feelings of dread. What determines whether an individual with a propensity toward developing an anxiety disorder is: Unique combination represented in that person’s life by the confluence of genetics, brain functioning, life experiences, and social context. © 2013 by McGraw-Hill Education.  This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner.  This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 

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