1. Anxiety Disorders Chapter 5
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2. The Nature of Anxiety Disorders
Anxiety: Individual is inordinately:
Apprehensive, tense, and uneasy about the prospect of something terrible happening
Fear: Innate alarm response to a dangerous or life-threatening situation
Anxiety disorders: Characterized by intense, irrational, and incapacitating apprehension.
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3. Panic Disorder Panic attacks on a recurrent basis
Has constant apprehension and worry about the possibility of recurring attacks
Panic attack: A period of intense fear and physical discomfort accompanied by the feeling that one is being overwhelmed and is about to lose control
During a panic attack, the individual feels overwhelmed by a range of highly unpleasant physical sensations:
Respiratory distress
Autonomic disturbances
Sensory abnormalities
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4. Panic Disorder
Agoraphobia: Intense anxiety about being trapped or stranded in a situation without help if a panic attack occurs
Panic disorder is often associated with agoraphobia
Panic disorder with agoraphobia: Agoraphobia is considered to be a subcategory within panic disorder.
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5. Panic Disorder: Theories and Treatment
Biological perspectives
Neurotransmitters
Anxiety Sensitivity
Psychological perspectives
Conditioned Fear Reactions
Relaxation training
Panic control therapy (PCT)
Biological perspectives
Focus on norepinephrine.
Norepinephrine - The neurotransmitter involved in preparing the body to react to stressful situations.
Anxiety sensitivity theory: The belief that panic disorder is caused in part by the tendency to interpret cognitive and somatic manifestations of stress and anxiety in a catastrophic manner.
Psychological perspectives
Conditioned fear reactions: Acquired associations between an internal or external cue and feelings of intense anxiety.
Relaxation training: Used to help clients gain control over the bodily reactions involved in panic attacks.
Panic control therapy (PCT): Consists of cognitive restructuring, exposure to bodily cues associated with panic attacks, and breathing retraining.
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6. Specific Phobias
Phobia: An irrational fear associated with a particular object or situation
Specific Phobia: An irrational and unabating fear of a particular object, activity, or situation
People with specific phobia go to great lengths to avoid the object or situation that is the target of their fear.
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7. Specific Phobias Categories Animals Natural environment
Blood-injection-injury
Engaging in activities in particular situations
Variety of miscellaneous stimuli
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8. Specific Phobias: Theories and Treatment
Systematic desensitization
Flooding
Imaginal flooding
Graduated exposure
Thought stopping
Biological perspectives focus on symptom management.
Psychological perspectives
Systematic desensitization - Individuals learn to substitute adaptive (relaxation) for maladaptive (fear or anxiety) responses.
Flooding: Client is totally immersed in the sensation of anxiety by being exposed to the feared situation in its entirety.
Imaginal flooding: Client is immersed through imagination in the feared situation.
Graduated exposure: Clients initially confront situations that cause only minor anxiety and gradually progress toward those that cause greater anxiety.
Thought stopping: Individual learns to stop anxiety-provoking thoughts.
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9. Social Phobia
Irrational and unabating fear that one’s behavior will be scrutinized by others
Causes the individual to feel embarrassed and humiliated
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10. Social Phobia: Theories and Treatment
Biological perspectives
SSRIs and SNRIs
Psychological perspectives
Motivational interviewing
Acceptance and commitment therapy
Mindfulness/meditation
Biological perspectives
Categories of medications shown to be most effective for social phobia are SSRIs and SNRIs.
Benzodiazepines have significant potential for abuse.
MAOIs have potentially dangerous side effects.
Psychological perspectives
Cognitive-behavioral perspective approach - Unable to gain a realistic view of how others really perceive them.
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11. Generalized Anxiety Disorder
Anxiety that is not associated with a particular object, situation, or event
A constant feature of a person's day-to-day existence
Symptoms - General restlessness, sleep disturbances, feelings of being easily fatigued, irritability, muscle tension, and trouble concentrating to the point where their mind goes blank.
Biological perspective - People experience their symptoms due to disturbances in GABA, serotonergic, and noradrenergic systems.
Cognitive-behavioral therapy - Cognitive distortions contribute to generalized anxiety.
Clients learn how to recognize anxious thoughts, to seek more rational alternatives to worrying, and to take action to test these alternatives.
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12. Obsessive-Compulsive Disorder
Obsession: Persistent and intrusive idea, thought, impulse, or image
Compulsion: Repetitive and seemingly purposeful behavior performed in response to:
Uncontrollable urges or according to a ritualistic or stereotyped set of rules
Obsessions cause marked anxiety or distress.
Compulsions are carried out in an effort to neutralize the obsession.
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13. Obsessive-Compulsive Disorder
Recurrent obsessions that are inordinately time-consuming or that cause significant distress or impairment
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14. Obsessive-Compulsive Disorder
4 major dimensions
Obsessions associated with checking compulsions
Need for symmetry and order
Obsessions about cleanliness associated with washing compulsions
Hoarding-related behaviors
Individuals with OCD experience tics.
Tic: A rapid, recurring, involuntary movement or vocalization.
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15. Obsessive-Compulsive Disorder
Most effective biological treatments available for OCD
Treatment with clomipramine
Treatment with other serotonin reuptake inhibiting medications
Fluoxetine (Prozac)
Treated with psychiatric neurosurgery in extreme cases.
Cognitive-behavioral perspective - Maladaptive thought patterns contribute to the development and maintenance of OCD symptoms.
Metacognitions lead people with OCD to worry, ruminate, and feel that they must monitor their every thought.
Psychological interventions provide an important supplement to or replacement for medication to treat OCD symptoms.
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16. Acute Stress Disorder and Post-Traumatic Stress Disorder
Traumatic experience: Disastrous or extremely painful events
Has severe psychological and physiological effects
Flashbacks
Nightmares
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17. Trauma-Induced Disorders
Acute stress disorder:
Arises within the month following the trauma
Lasts 2- 4 weeks
Symptoms
Intrusion of distressing reminders of the event
Dissociative symptoms
Avoidance of situations that serve as reminders of the event
Hyper-arousal
Risk of developing acute stress disorder
When people are exposed to the threat of death, or to actual or threatened serious injury, or sexual violation.
People with this disorder may reexperience the event and desperately avoid reminders of the trauma.
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18. Trauma-Induced Disorders
Post-traumatic stress disorder: Individual experiences several distressing symptoms for more than a month following a traumatic event
Symptoms fall into categories:
Intrusions
Dissociation
Avoidance
Symptoms of PTSD and related disorders can persist for many years.
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19. Post-Traumatic Stress Disorder: Theories and Treatment
Hippocampus
SSRI antidepressants
Combines exposure (in vivo or imaginal) with relaxation and cognitive restructuring
EMDR
Traumatic experience - External event that impinges on the individual and hence does not have biological “causality.”
People experience alterations in the hippocampus, the structure responsible for consolidating memory.
SSRI antidepressants are the only FDA-approved pharmacotherapy.
Eye Movement Desensitization Reprocessing (EMDR) - Clinician asks the client to think about a traumatic memory while focusing on rapid movement of the clinician’s finger for 10 to 12 eye movements.
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20. Anxiety Disorders: The Biopsychosocial Perspective
Problems
Differences and similarities in symptoms and causes
Unique combination represented in that person’s life by:
Confluence of genetics, brain functioning, life experiences, and social context
Anxiety disorders span a broad spectrum of problems.
Ranging from specific, seemingly idiosyncratic responses to diffuse and undifferentiated feelings of dread.
What determines whether an individual with a propensity toward developing an anxiety disorder is:
Unique combination represented in that person’s life by the confluence of genetics, brain functioning, life experiences, and social context.
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