Chapter 5 Anxiety Disorders

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 2 Fear: Fight-or-Flight Response

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 3 Emotional, cognitive, and behavioral responses to threat

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 4 Fear in People with Anxiety Disorders Severe enough to lower the quality of life Chronic and frequent enough to interfere with functioning Out of proportion to the dangers that they truly face

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 5 Posttraumatic Stress Disorder and Acute Stress Disorder By definition, are the consequences of experiencing extreme stressors

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 6 Symptoms of PTSD

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 7 Events that can precipitate PTSD Disasters  Tornadoes, floods, earthquakes, fires Common Traumatic Events  Car accidents, sudden deaths of loved ones Combat and War-Related Traumas  Combat fatigue syndrome, “Shell Shock” Abuse  Physical, emotional, sexual

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 8 Acute Stress Disorder Occurs in response to similar traumas as does PTSD Diagnosed when symptoms arise within 1 month of exposure to the stressor and last no longer than 4 weeks Dissociative symptoms are prominent At high risk of developing PTSD

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 9 Adjustment Disorder Stress-related diagnosis Consists of emotional and behavioral symptoms (depressive symptoms, anxiety symptoms, and /or antisocial behaviors) Arise within 3 months of the experience of a stressor The stressors that lead to adjustment disorder can be of any severity

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 10 Explanations of PTSD Vulnerability Environmental and Social Factors  Event characteristics: severity, duration, and proximity  Available social support. Psychological Factors  Preexisting anxiety, depression, or distress  Coping styles  Dissociation Gender and Cross-Cultural Differences Biological Factors

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 11 Treatments for PTSD Cognitive behavioral therapy Systematic desensitization is used to extinguish fear reactions to memories; cognitive techniques are used to challenge irrational thoughts Stress management Therapist helps client solve concrete problems to reduce stress; may use thought stopping strategies to quell intrusive thoughts Biological therapies Antianxiety and antidepressant drugs are used to quell symptoms

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 12 PANIC DISORDER AND AGORAPHOBIA

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 13 Panic Disorder

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 14 Panic Disorder Panic attacks become a common occurrence Panic attacks not usually provoked by any particular situation Person begins to worry about having panic attacks and changes behaviors as a result of this worry

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 15 Agoraphobia About one-third to one-half of people diagnosed with panic disorder develop agoraphobia. Agoraphobics fear places where they might have trouble escaping or getting help if they become anxious or suffer a panic attack. Agoraphobics also often fear they will embarrass themselves if others see their symptoms or efforts to escape during an attack.

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 16 Theories of Panic Disorder

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 17 Genetics Neurobiological contributors

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 18

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 19

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 20 The Cognitive Model Anxiety sensitivity Interoceptive awareness and conditioning

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 21 Biological Treatments for Panic Disorder Tricyclic antidepressants – Increase levels of norepinephrine and a number of other neurotransmitters Serotonin reuptake inhibitors – Increase levels of serotonin Benzodiazepines – Suppress the central nervous system and influence functioning in the GABA, norepinephrine, and serotonin neurotransmitter systems

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 22 Cognitive-Behavioral Therapy 1.Clients are taught relaxation and breathing exercises. 2.The clinician guides clients in identifying the catastrophizing cognitions they have about changes in bodily sensations. 3.Clients practice using their relaxation and breathing exercises while experiencing panic symptoms in the therapy session.

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 23 Cognitive-Behavioral Therapy, continued 4.The therapist will challenge clients’ catastrophizing thoughts about their bodily sensations and teach them to challenge their thoughts for themselves. 5.The therapist will use systematic desensitization techniques to gradually expose clients to those situations they most fear while helping them to maintain control.

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 24 SPECIFIC PHOBIAS AND SOCIAL PHOBIA People can develop phobias of many objects and situations Specific phobias: fear of specific items or situations Social phobia: fear of social encounters

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 25 Specific Phobias Animal type Natural environment type Situational type Blood-injection-injury type

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Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 27 Social Phobia

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Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 29 Theories of Phobias Psychodynamic Behavioral  Negative reinforcement  Prepared classical conditioning Cognitive Biological

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 30 Treatment of Phobias Behavioral 1)Systematic desensitization 2)Modeling 3)Flooding Biological Reduce symptoms of anxiety generally so that they do not arise in the feared situation Cognitive-Behavioral Helps clients identify and challenge negative, catastrophizing thoughts about feared situations

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 31 Generalized Anxiety Disorder (GAD)

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 32 Theories and Treatment of GAD Cognitive Biological

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 33 OBSESSIVE-COMPULSIVE DISORDER Obsessions: thoughts, images, ideas, or impulses that are persistent, that uncontrollably intrude upon consciousness, and that cause significant anxiety or distress. Compulsions: repetitive behaviors or mental acts that an individual feels he or she must perform.

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 34

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 35 Theories of OCD Biological Theories Cognitive Theories

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 36 Treatments for OCD Biological therapies  Serotonin-enhancing drugs like Paxil, Prozac Behavioral therapies  Exposure and response prevention

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 5 37 Vulnerability (diathesis)-stress models