1. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 3 Anxiety Disorders

2. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Writing about anxiety Write about an anxiety you are struggling with (or have struggled with). What are your “symptoms” of anxiety? Is your response adaptive or maladaptive?

3. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Fear responses: Adaptive vs. Maladaptive Adaptive Fear vs. Maladaptive Anxiety Realistic concerns Unrealistic In proportion to threat Out of proportion Fear response subsides Response is persistent/Chronic

4. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Symptoms of Anxiety SomaticEmotionalCognitiveBehavioral Goosebumps emerge Muscles tense Heart rate increases Respiration accelerates Respiration deepens Peripheral blood vessels dilate Liver releases carbohydrates Bronchioles widen Pupils dilate Perspiration increases Adrenaline is secreted Stomach acid is inhibited Salivation decreases Sense of dread Terror Restlessness Irritability Anticipation of harm Exaggerating of danger Problems in concentrating Hypervigilance Worried, ruminative thinking Fear of losing control Fear of dying Sense of unreality Escape Avoidance Aggression Freezing Decreased appetitive responding Increased aversive responding

5. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Anxiety Disorders Many different disorders (GAD, PTSD, phobias, OCD, etc.)

6. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Post-Traumatic Stress Disorder Tape 2 (World of Ab Psych) Exposure to traumatic event + Symptoms – Reexperiencing – flashbacks, intrusive memories, bad dreams – Avoidance and numbing – feeling detached, avoiding people and activities – Increased arousal – hypervigilance, insomnia, startle response, irritability/outbursts

7. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 PTSD: Causes Trauma + Vulnerability – Vulnerability is biopsychosocial (next slide)

8. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Explanations of PTSD Vulnerability Sociocultural factors 1.Social support 2.Nature of trauma itself (severity, etc.) Sociocultural factors 1.Social support 2.Nature of trauma itself (severity, etc.) Psychological factors 1.Personal assumptions 2.Distress 3.Coping styles Psychological factors 1.Personal assumptions 2.Distress 3.Coping styles Biological factors 1. Physiological hyperactivity 2. Genetics Biological factors 1. Physiological hyperactivity 2. Genetics

9. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Treatments for PTSD PTSD symptoms are understood and treated within the norms of people’s culture. Sociocultural approaches Antianxiety and antidepressant drugs can be used to quell specific symptoms Biological therapies Therapist helps client solve concrete problems to reduce stress Stress management Systematic desensitization is used to extinguish fear reactions to memories (e.g., imaginal reexposure; cognitive techniques are used to challenge irrational thoughts. Cognitive- behavioral therapy

10. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Phobic Disorders Agoraphobia Fear of places where help might not be available in case of an emergency Specific Phobias  Animal type  Natural environment type  Situational type  Blood-injection-injury type Fear of specific objects, places or situations Social Phobia Fear of being judged or embarrassed by others

11. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Shyness: A disorder?? Shy on Drugs NY Times, Sept 2007, by Christopher Lane, author of “Shyness: How Normal Behavior Became a Sickness.” Read in class and discuss

12. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 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

13. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Panic Disorder Symptoms Panic attack symptoms Panic Disorder can be diagnosed when panic attacks… become common are not typically provoked by any particular situation include worry and changing behaviors due to the worry

14. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7  Occurs in 3.5% of population (occurs worldwide and across ethnicities)  Affects women more  Onset: late teens – mid-thirties  Seek medical care frequently  Occurs in 3.5% of population (occurs worldwide and across ethnicities)  Affects women more  Onset: late teens – mid-thirties  Seek medical care frequently Panic Disorder -- facts

15. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Biological Theories Genetic (30-40% contribution) Human studies (families; twins) Rodent studies (stathmin gene may contrib to fear and anxiety) Neurotransmitter contributions Poor regulation of norepinephrine, serotonin, and perhaps GABA in the locus ceruleus and limbic systems Kindling Model (next slide) Causes of Panic Disorder

16. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Poor regulation in locus ceruleus Panic Attacks Lowers threshold for chronic anxiety in limbic system Chronic anxiety increases likelihood of dysregulation in locus ceruleus Panic Attacks Kindling Model of Panic Disorder

17. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Cognitive Factors – People prone to panic attacks – (1) pay very close attention to their bodily sensations – (2) misinterpret these sensations – (3) engage in snowballing, catastrophizing thinking Causes of Panic Disorder (cont.)

18. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Faces DVD (Annie) World of Abnormal Psych (tape 3 -- start at 8 min mark) Panic and agoraphobia

19. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Treatments Depends upon whom you go to see! Meds (e.g., antidepressants, benzodiazepines) – Problems? Cognitive-behavioral treatment (next slide)

20. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7

21. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Classes of Medications for Anxiety Disorders Benzodiazepines. These drugs were often used to treat anxiety disorders from the 1960s until the 1980s. They act on GABA, which seems to play a role in fear. They generally work quickly, but due to concerns about abuse or dependency, other medications are now more commonly prescribed. Tricyclic antidepressants (TCAs). These medications were developed in the 1950s and 1960s. They help prevent reuptake of 5HT and NE, but they also affect other neurotransmitters and can have serious side effects. They are not as commonly prescribed in the United States as are newer classes of antidepressants. Monoamine oxidase inhibitors (MAOIs). The MAOIs were developed at about the same time as the TCAs, but they are believed to work differently. They seem to stop the brain from breaking down 5HT and NE after reuptake. Selective serotonin reuptake inhibitors (SSRIs). The SSRIs prevent reuptake of neurotransmitters in the brain. Although the various SSRIs seem to work in basically the same way and have similar side effects, people seem to respond differently to different SSRIs. Serotonin-norepinephrine reuptake inhibitors (SNRIs). Developed in the 1990s, Effexor XR ® (venlafaxine HCl) was the first SNRI. It works on 5HT, like an SSRI, but also helps prevent reuptake of NE.

22. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 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.

23. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 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

24. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Generalized Anxiety Disorder (GAD) Excessive anxiety and worry Difficulty in controlling the worry Restlessness or feeling keyed-up or on edge Easily fatigued Difficulty concentrating Irritability Muscle tension and sleep disturbance

25. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Obsessive-Compulsive Disorder a chronic anxiety disorder most commonly characterized by obsessive, distressing, intrusive thoughts and related compulsions (tasks or "rituals") which attempt to neutralize the obsessions.chronicanxiety disorderdistressingintrusive thoughtsrituals

26. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Obsessions (as defined by DSM-IV-TR) Recurrent and persistent thoughts, impulses, or images that are experienced intrusive and inappropriate and that cause anxiety or distress Thoughts, impulses, or images that are not simply excessive worries about real life problems Thoughts, impulses or images that the person attempts to ignore or suppress or to neutralize with some other thought or action Obsessive thoughts, impulses or images that the person recognizes are a product of his or her own mind

27. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Compulsions (as defined by DSM-IV-TR), continued Repetitive behaviors (such as hand washing, ordering, checking) or mental acts (such as praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly Behaviors or mental acts that are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they should prevent

28. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Biological Treatments – as before, mostly psychotropic meds Cognitive-behavioral Treatments – Expose the client to obsessions until anxiety about obsessions decreases, prevent compulsive behaviors and help the client manage anxiety that is aroused. For example, systematic desensitization may be used to help a person with a germ obsession gradually tolerate exposure to “dirty” materials. Treatments for OCD

29. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 7 Just Checking by Emily Colas Discuss Assignment