anxiety disorders - vague, negative, high arousal state, often intrusive thoughts of possible futures, helplessness. too much of a good thing- anxiety is useful response system to threats (evolutionarily adaptive) motivate for change. generalized anxiety disorder- 5% lifetime risk, prolonged (>6 months), vague, distress. not connected to life events. worry, vigilance, bodily tension and reactivity. panic disorder- 1.5%, intense, relatively brief wave of feeling ‘out of control’, high arousal, sweating/shortness of breath, fear of death/losing mind, fear of future panic, associated stimuli- agoraphobia.
comorbidity/overlap with depression- over half mood disordered folks meet criteria for an anxiety disorder (an especially close link with G.A.D.) high negative affect common to both, low positive affect more specific to depression. anxious folks also hyperaroused. anxiety gives way to depression (future anticipation of loss vs. perceived past loss) phobias-unlike GAD, the feared objects are known. often evolutionarily relevant- specific phobias (11%): spiders, dogs, snakes, heights, but also social (2.7%): fear of blushing and eating in public are difficult to treat. agoraphobia (5.6%) fear of the marketplace. role of learning: event X paired with anxiety-->avoidance--> reduced anxiety. So you learn to avoid X. ~ exposure treatment.
panic disorder with agoraphobia (Lundh et al., 1999) stroop color naming task- delayed color naming for words specific to disorder but less so for threatening words (social, phobics). automatic attention grabbing- unconscious (17ms) subliminal findings related to trait anxiety- preattentive bias for panic related words. obsessive-compulsive disorder (2-3%) identified by Freud (1894) thoughts and behaviors- sexual, religious, aggressive, threatened harm (symbolic nature). obsessions-doubting, contamination, fear of aggression compulsions-counting, ordering, checking, touching & washing.--compulsions protective against anxiety.
undoing- a conflict (ambivalence) between two opposing impulses of equal strength where the second magically ‘undoes’ the first. chronic indecision [These thoughts are condensed from Shapiro (1965)]. reaction formation-reversed of repressed impulse- sympathy rather than sadistic, bashful rather than exhibitionistic isolation of affect-isolating thoughts or behaviors so that links to other thoughts or affective context are removed. Rituals, formulas, thought stopping. akin to the repression of hysterics- separating affect from thought-thought remains. ‘living machines’: ‘I must be in love with her-- she has all the qualities I want in a wife.’ intellectual rigidity, sharp, intense focus-insensitive to the tone of social interaction. good workers (often) more or less continuously active (even in play)-- “I should be doing _____”. tolerate no interference. they are not delusional- they don’t say ‘I have cancer, I have been contaminated’ but ‘I’m worried I have cancer…’ (obsessional doubt and dogma). Lost capacity for conviction.
post-traumatic stress disorder (1-14%) fear, hopelessness, or horror. re-experiencing, emotional numbness, hypervigilance, startle. risks-depression, alcohol abuse, dissociative style, inhibited withdrawn. Treatments for many anxiety disorders: behavioral- exposure, flooding, in-vivo, etc. cognitive- restructuring, thought stopping, rehearsal biological- benzodiazepines-librium,valium, -addictive antidepressants drugs of choice now psychosurgery (making a comeback?)