Chapter 5 Anxiety and the Anxiety Disorders

2005© John Wiley & Sons, Inc. Defining Anxiety and Anxiety Disorders Case vignettes Anxiety: Unpleasant feeling associated with idea of “danger” Anxiety is abnormal when occurring: In inappropriate contexts On intense end of the anxiety continuum

2005© John Wiley & Sons, Inc. Classifying Anxiety Disorders: The Six DSM-IV-TR Categories Generalized anxiety disorder (chronic anxiety) Panic disorder (acute anxiety attacks) Phobia (irrational fear) Obsessive-compulsive disorder (obsessions and compulsions) Posttraumatic stress disorder and Acute stress disorder(posttraumatic anxiety symptoms)

2005© John Wiley & Sons, Inc. Phobia subtypes Persistent, irrational fear and avoidance of specific: Social activities (Social phobia) Crowded or open spaces (Agoraphobia) Objects (Specific phobia)

2005© John Wiley & Sons, Inc. Stress Disorder Symptoms Re-experiencing (flashbacks, nightmares) General avoidance and decreased responsiveness Heightened arousal (startle, guilt) PTSD if > 6 months; ASD if < 6 months

2005© John Wiley & Sons, Inc. Classification Issues The advantages and limitations of the DSM-IV-TR categories Classification in demographic context Age Gender Class Cultural and historical relativism

2005© John Wiley & Sons, Inc. Explaining and treating anxiety disorders: Behavioral Components Classical conditioning: Watson’s Little Albert Operant conditioning Modeling Modern revision: prepared conditioning Behavioral interventions

2005© John Wiley & Sons, Inc. Cognitive Components Maladaptive beliefs and schemas Cognitive distortions Cognitive interventions Identify, evaluate, and change negative thought contents Identify, challenge and correct distorted thought processes

2005© John Wiley & Sons, Inc. Biological components The autonomic nervous system The limbic system Neurotransmission Genetic factors Biological interventions: Medications

2005© John Wiley & Sons, Inc. Psychodynamic components Relationship of anxiety and defense mechanisms Phobias: Displacement and projection (Little Hans) OCD: Isolation of affect and undoing Anxiety due to attachment and relational problems Psychodynamic interventions

2005© John Wiley & Sons, Inc. The Principle of Multiple Causality Combined cognitive-behavioral approaches Behavioral and psychodynamic overlap Combined biological and psychotherapy interventions

2005© John Wiley & Sons, Inc. The Connection between mind and body in anxiety disorders Examples: The HPA axis Brain changes in PTSD Brain changes after behavioral interventions for OCD

2005© John Wiley & Sons, Inc. Case Vignettes: Treatment Arthur: Treatment of panic disorder Rob: Treatment of obsessive-compulsive disorder

2005© John Wiley & Sons, Inc. Related Topics High Risk Takers: Too Little Anxiety? (Box 5.1) Some Not So Common Phobias (Box 5.2)