ANXIETY DISORDERS

Anxiety vs. Fear  anxiety: (future oriented) negative affect, bodily tension, and apprehension about the future  fear: (reaction to current danger) immediate alarm in response to danger – initiates flight or fight response

Phobias unrealistic fear of a specific situation, activity, or object

Types of specific phobias  Blood-Injection-Injury  Situational Phobia  Natural Environment Phobia  Animal Phobia  Other phobias

Common Phobia Treatments  systematic desensitization: combines relaxation with exposure invivo imaginal virtual reality   flooding: expose individual directly to feared stimulus

Social Phobia DSM criteria:  Extreme shyness and fear in social situations  focus is on situation in which the person is exposed to unfamiliar people or to possible scrutiny by others  person fears will be humiliated or embarrassed  Avoidance or endure with extreme distress  Impairment  Rule out cause by other disorder

Social Phobia: Treatment

Social Phobia: Treatment (cont.)  Psychological Cognitive-behavioral treatment  Exposure  Skill building  Group settings

PANIC

Panic Disorder  At least one of the panic attacks is followed by at least a month of (a) persistent fear of having another attack, or (b) a significant maladaptive change in behavior following the attacks.  The disturbance is not better understood by the physiological effects of a substance or medical condition.  The disturbance is not better understood by another psychological condition.

Panic Disorder with Agoraphobia (PDA)  agoraphobia : fear of being away from a safe place

Development of Panic Disorder Step 1 Real Stressor Step 2 Step 3 Fear of Having Another Attack Step 4 Increased Attention to Body Step 5 More Fear

Summary The fear of having another panic attack just makes you more frightened. This “fear of your fear” increases the chances of future attacks. Solution

Treatment for Panic Disorder: 1) Imipramine (tricyclic antidepressant) 2) SSRIs 3) Exposure and relaxation training 4) Panic control treatment

Example Interoceptive Exposure Exercises

generalized anxiety disorder

GAD Symptoms  continuous feelings of anxiety; experienced across situations  continues for at least 6 months and is uncontrollable more days than not  involves muscle tension, fatigue, irritability, difficulty sleeping

GAD Treatment  anxiolytics: drugs that reduce anxiety  Benzodiazepines  anti-depressants  cognitive-behavioral treatment  relaxation training

Obsessive Compulsive Disorder and Related Disorders

DSM-V Criteria for OCD  Presence of obsessions or compulsions (or both)  the person recognizes that the obsessions or compulsions are excessive or unreasonable (not required for children)  they cause marked distress, are time-consuming (more than 1 hour per day), or interfere with the person’s functioning

DSM-V Criteria for Obsessions  recurrent and persistent thoughts, impulses, or images  experienced as intrusive and inappropriate  cause marked anxiety or distress  the thoughts are not simply excessive worries about real-life problems  the person attempts to ignore or suppress the thoughts  the person recognizes that the thoughts are a product of his or her own mind (not imposed from outside)

DSM-V Criteria for Compulsions  Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly  Behaviors are aimed at preventing or reducing distress, or preventing some dreaded event or situation. However, behaviors not connected in a realistic way with what they are designed to prevent, or are clearly excessive

OCD : Compulsions  Four major categories Checking Ordering Arranging Washing/cleaning zC2G6lf9fCs&list=PLYL4hYoJA9GcHQt 1Cf1owyPUbs-L2QOjN&index=9

Treatment of OCD  SSRI ’ s  Exposure and response prevention  How does it compare to medication?  Psychosurgery (cingulotomy)

Obsessive Compulsive Related Disorders  Hoarding Disorder.  Hair-Pulling Disorder.  Excoriation Disorder.  Body Dysmorphic Disorder.

Post Traumatic Stress Disorder

PTSD  exposure to traumatic event  traumatic event is reexperienced (e.g., recollections, dreams, flashbacks)  try to avoid stimuli associated with the trauma  symptoms of increased arousal (e.g., problems sleeping, concentrating)  negative alterations of cognitions or mood

PTSD  acute stress disorder – PTSD symptoms have lasted less than one month  acute PTSD – symptoms last between 1 and 3 months after event  chronic PTSD – symptoms last longer than 3 months  delayed onset – few immediate symptoms – years later

Treatment of PTSD  Cognitive-behavioral treatment Exposure Identify and correct cognitive distortions.  SSRI’s (Prozac, Paxil)