1. Anxiety Disorders

2. Anxiety Disorders - Terms
Fear: emotional reaction to danger
Anxiety:
Future orientation
Feelings of apprehension
No danger may be present
Panic: physiological reaction; fight or flight
Phobias: pathological fears

3. Fears vs. Phobias Phobias are:
Out of proportion
Cannot be explained away
Leads to avoidance
Not adaptive
Persists over time
Not age or stage specific

4. Fears Common and normal
90% of children have at least one specific fear
50% have numerous fears
Common fears
Fears of physical injury or personal loss
Fears of natural or supernatural danger
Fears reflecting psychic distress
animals
Generally decline with age; peak around 11
Phobias only 1%

5. Developmental changes in fears
1st year: loud noises, separation from parent
Preschoolers – animals, the dark, imaginary creatures
school age – school, injury, social fears
Adolescence – interpersonal fears, appearance, school, safety

6. When does anxiety become a disorder?
Anxiety is a normal human response to objects, situations or events that are threatening
Anxiety is different from fear due to its cognitive component (i.e. fear of the future)
Anxiety can be helpful and adaptive (e.g. anxiety about giving lectures!)
Anxiety becomes a disorder when out of proportion or when it significantly interferes with life.
Pyschological disorder- A psychological disorder is a pattern of behavioral or psychological symptoms that causes significant personal distress and impairs the ability to function in one or more important areas of life

7. Anxiety disorders are
Highly treatable yet also resistant to extinction (no cure)
Often begins early in life
Reported more by women than men
Reported more in Western countries
Often occur with other anxiety diagnoses and with other disorder groups (e.g. Mood disorders, psychoses)

8. DSM-V Anxiety Disorders
Obsessive Compulsive Disorder
Post Traumatic Stress Disorder
Generalized Anxiety Disorder
Panic Disorder
phobia
social phobia
agoraphobia
acute stress disorder

9. Specific Phobias Selective, persistent and out of proportion
Includes cognition that leads to behavioural response, whether or not the threat is present
May be genetically, neurologically or experientially based
Maintained through the processes of classical and operant conditioning.

10. Top Ten Phobias
#10: Necrophobia – Fear of death

11. Top Ten Phobias
#9: Brontophobia – Fear of thunder/lightning storms

12. Top Ten Phobias
#8: Mysophobia – Fear of germs/dirt

13. Top Ten Phobias
#7: Emetophobia – Fear of vomit

14. Top Ten Phobias
#6: Claustrophobia – Fear of confinement

15. Top Ten Phobias
#5: Agoraphobia – Fear of open spaces/crowds

16. Top Ten Phobias
#4: Aerophobia – Fear of flying

17. Top Ten Phobias
#3: Acrophobia – Fear of heights

18. Top Ten Phobias
#2: Social Phobia – Fear of public embarrassment

19. Social Phobia A more pervasive, highly cognitive type of phobia
Distinguishing feature is the fear of doing something in front of others
Extreme shyness
Children may not recognize why they feel anxious
Must have capacity for social relationships with familiar people
Must occur in peer setting, not just with adults
May be situation or context (e.g. performance versus interaction anxiety) specific
Fear of one’s own behaviour causing negative attention from others

20. Top Ten Phobias
#1: Arachnophobia – Fear of spiders

21. Phobic Anxiety Disorder
A phobia is defined as an irrational, intense fear of an object or situation that poses little or no actual danger.
At first glance, a phobia may seem similar to a normal fear, but it's is the degree to which a person is affected that determines whether that fear has become a phobia.

22. Phobic Anxiety Disorder
Typical symptoms include:
Dizziness, rapid heartbeat, trembling, or other uncontrollable physical response
Sensation of terror, dread or panic
Preoccupation of thoughts; inability to change focus from the feared situation
Intense desire to flee the situation

23. Phobic Anxiety Disorder
The two most common treatments include:
1. Cognitive Behavior Therapy (CBT)
In this form of therapy, the clinician works with the client to confront the feared situation and change the phobic reaction by changing the automatic thoughts that occur.
Exposure therapy is a leading form of cognitive behavior therapy that works well in treating phobias.
A popular type of exposure therapy is known as systematic desensitization, in which the client is gradually exposed to the feared object, learning to tolerate increased exposure bit by bit.

24. Phobic Anxiety Disorder
The two most common treatments include:
1. Cognitive Behavior Therapy (CBT)
2. Medication
Some medications that are effective at treating phobias include:
Anti-depressants
Anti-anxiety medications
Beta-blockers, which limit the effects of adrenaline on the body

25. Agoraphobia
type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.
You fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd.
The anxiety is caused by fear that there's no easy way to escape or get help if the anxiety intensifies. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack and avoid the places where it may happen again.
People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. You may feel that you need a companion, such as a relative or friend, to go with you to public places. The fear can be so overwhelming that you may feel unable to leave your home.

26. Agoraphobia treatment
Agoraphobia treatment can be challenging because it usually means confronting your fears, but with psychotherapy and medications patients can live a more enjoyable life.

27. Panic Disorder Two major types: with or without agoraphobia
Consists of a pattern of recurring panic attacks
Emotional, physical, cognitive and behavioural components
Main fear is of losing control (consequence = dying, going crazy, embarrassment, not being able to get help)
The fear of having a panic attack becomes a problem of itself, possibly leading to agoraphobia (fear of open spaces, crowds etc. Any place where escape or finding help is difficult or embarrassing) or other phobias

28. Treatment of Panic Disorder
Debate about the extent to which Panic Disorder is biological versus psychological (most likely both)
Genetic and medication studies support biological view
Cognitive strategies - reality testing, psycho education, cognitive restructuring, graded exposure - all may add to effectiveness of treatment supporting psychological argument

29. Obsessive Compulsive Disorder
Classified as anxiety disorder, but with unique presentation
Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has
uncontrollable, reoccurring thoughts (obsessions)
behaviors (compulsions) that he or she feels the urge to repeat over and over. Compulsions may be physical or mental
Types of presentation: contamination fear; doubt/checking; magic thinking; symmetry; hoarding

30. Treatment of OCD
Medical: particularly high doses of SSRIs (antidepressants)
Psychoanalysis
Cognitive-behavioural therapy
Exposure and response prevention
Thought-stopping not generally effective alone

31. Generalised Anxiety Disorder
Characterised by persistent and global worry:
worry about “everything”, “worry about worry”
Distinguished from normal worry by severity, interference, irrationality
Common problem but little is known
Resistant to change
A product of Western society?

32. Treatment of GAD
Medication (SSRIs used more for GAD than other anxiety disorders)
Psychoanalysis: GAD is caused by conflict between the ego and id impulses. The ego fears punishment but id cannot be extinguished = constant anxiety and conflict (has not been displaced as with phobia)
Behavioural Techniques: difficult to implement due to global nature of GAD. May choose themes or priorities
Cognitive Therapy: apparently most useful but still shows limited success
Others: Rational Emotive Therapy, Existential Therapy, Gestalt Therapy, Narrative Therapy

33. Post Traumatic Stress Disorder
Is it an anxiety disorder?
Main diagnostic criteria:
Witness or experience of an event that (a) involved actual or threatened death or injury, and
Feelings of intense fear, horror, or helplessness
Person must relive the event in some way (e.g. dreams, “flashbacks”, internal distress, physiological reactions)
Avoidance (subconscious and/or conscious)
Mood instability
Usually persisting for at least three months

35. Therapeutic Treatment of PTSD
Medication (treats the symptoms, but minimally effective)
Exposure Therapy
Critical Incident Stress Debriefing
Supportive psychotherapy
Eye Movement Desensitisation and Reprogramming (EMDR)
Rapid saccadic eye movements coupled with exposure and positive thought
Huge movement but has attracted much criticism due to its secrecy and lack of controlled studies