1. Anxiety Disorders Panic Disorder Specific Phobias Social Phobia Obsessive-Compulsive Disorder (OCD) Posttraumatic Stress Disorder (PTSD) Generalized Anxiety Disorder (GAD)

2. Panic Attack A period of intense fear or discomfort involving at least 4 of the following symptoms that develop abruptly and peak within 10 min. Racing heart, pounding heart (palpitations) Racing heart, pounding heart (palpitations) Sweating Sweating Trembling or shaking Trembling or shaking Feeling short of breath or smothering sensations Feeling short of breath or smothering sensations Feeling of choking Feeling of choking Chest pain or discomfort Chest pain or discomfort Nausea or abdominal distress Nausea or abdominal distress Feeling dizzy, unsteady, lightheaded, & faint Feeling dizzy, unsteady, lightheaded, & faint Derealization or depersonalization Derealization or depersonalization Fear of losing control or going crazy Fear of losing control or going crazy Fear of dying Fear of dying Numbness or tingling Numbness or tingling Chills or hot flushes Chills or hot flushes May be expected or unexpected (“out of the blue”)

3. Main Diagnostic Criteria for Panic Disorder Recurrent unexpected panic attacks Persistent worry about having more attacks Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy") Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy") Significant change in behavior related to the attacks Significant change in behavior related to the attacks Presence or Absence of agoraphobia Presence or Absence of agoraphobia The attacks are not due to a substance or a medical condition (thyroid problems)

4. Main Diagnostic Criteria for Specific Phobia Excessive or unreasonable fear triggered by a specific object or situation (e.g., flying, animals). Exposure to the phobic stimulus invariably provokes anxiety. The person recognizes the fear is irrational. The phobic situation(s) is avoided or endured with intense anxiety. Significant personal distress or interference with routine.

5. Categories of Specific Phobias Animal Dogs, spiders, snakes Dogs, spiders, snakes Natural environment Water, storms, heights Water, storms, heightsSituational Bridges/tunnels, flying, driving, elevators, tight spaces Bridges/tunnels, flying, driving, elevators, tight spacesBlood-injection-injury Involves drop in blood pressure and can involve fainting Involves drop in blood pressure and can involve faintingOther Choking, vomiting, balloons, clowns Choking, vomiting, balloons, clowns

6. Main Diagnostic Criteria for Social Phobia Excessive fear of one or more social and performance situations where the person is exposed to unfamiliar people or to possible scrutiny by others. Fear of acting in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Exposure to the feared social situation invariably provokes anxiety May take the form of a panic attack May take the form of a panic attack The person recognizes the fear is excessive or unreasonable. The feared social or performance situations are avoided or endured with intense anxiety Excessive personal distress/interference in functioning

7. Main Diagnostic Criteria for OCD Obsessions as defined by: Obsessions as defined by: Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive, senseless, and inappropriate Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive, senseless, and inappropriate Cause marked anxiety or distress Cause marked anxiety or distress the thoughts, impulses, or images are not simply excessive worries about real-life problems the thoughts, impulses, or images are not simply excessive worries about real-life problems the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind

8. Main Diagnostic Criteria for OCD (2) Compulsions as defined by: Compulsions as defined by: Rituals: Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) Rituals: Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) The person feels driven to perform the rituals in response to an obsession, or according to certain rules The person feels driven to perform the rituals in response to an obsession, or according to certain rules the rituals are aimed at preventing or reducing distress or preventing some dreaded event or situation the rituals are aimed at preventing or reducing distress or preventing some dreaded event or situation The rituals either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive The rituals either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

9. Main Diagnostic Criteria for OCD (3) At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's routine. With Poor insight: if, for most of the time the person does not recognize the obsessions and compulsions are excessive or unreasonable

10. Some Common Obsessions  contamination - dirt, germs, bodily waste, chemicals  mistakes - locks, appliances, paperwork, decisions  impulses - violent, sexual, religious, embarrassing  order - neatness, symmetry, numbers

11. Uncommon Obsessions  Contamination from people with disabilities  Thoughts of becoming pregnant (male)  Crumbs of the communion wafer fell in my underwear  Put the baby in the oven by mistake

12. Some Common Compulsive Rituals Washing/Cleaning – hand washing, showering, toilet, inanimate objects, hand gel Checking – locks, appliances, for assurance, Mental rituals – praying, neutralizing, mental reviewing Repeating – steps, touching Ordering/arranging – left-right balance

13. Causes of anxiety disorders Biological/genetic General vulnerability General vulnerability Negative affect Negative affect Intensity of fight/flight response Intensity of fight/flight responsePsychological/environmental/learning Personal experiences (traumatic?) Personal experiences (traumatic?) Vicarious learning Vicarious learning Informational transmission Informational transmission

14. Persistence of anxiety disorders Physiological Fight/flight response Fight/flight responseCognitive Dysfunctional beliefs and interpretations Dysfunctional beliefs and interpretations Overestimates of probability and severity Overestimates of probability and severityBehavioral Avoidance Avoidance Safety behaviors, rituals, & safety signals Safety behaviors, rituals, & safety signals

15. Types of Exposure Therapy In vivo: confrontation with fear-evoking situations example: party, closet, floor, driving example: party, closet, floor, driving Imaginal: confrontation with anxiety-evoking thoughts/doubts Fires, responsibility for harming a loved one Fires, responsibility for harming a loved one Interoceptive: confrontation with fear- evoking bodily sensations example: dizziness, breathlessness, headache example: dizziness, breathlessness, headache

16. Criteria for Fear Reduction During Exposure Therapy Elicit fear Allow habituation to occur Provide corrective information

17. Effects of Repeated and Prolonged Exposure on Irrational fear

18. Sarah: Contamination OCD Married female in her late 20s, has baby Fears of contamination from animals (pets, bugs) Will get germs and then perhaps get sick Will get germs and then perhaps get sick Compulsive washing, cleaning, & changing clothes rituals to minimize contact with contaminants and to keep anxiety manageable Avoidance: neighbor’s home, own baby, certain clothes, handling food Asks others to touch many things Asks others to touch many things

19. Exposure Therapy Hierarchy: Fear of contamination from animals Situation (SUDS) Office floor (40) Office floor (40) Floor near entry to home (45) Floor near entry to home (45) Neighbor’s house/couch (65) Neighbor’s house/couch (65) Neighbor’s pet Neighbor’s pet Dresser where bug was found (70) Dresser where bug was found (70) Clothes from “buggy” dresser (75) Clothes from “buggy” dresser (75) Bugs (85) Bugs (85)

20. Response Prevention: Washer No contact with water except for 1 daily ten-minute shower No changing clothes during the day No cleaning objects in the house No use of gloves/towels to touch surfaces No asking others to open doors, hold baby, prepare food, etc.