1. Anxiety Disorders

2. Anxiety What is it? Tripartite Model –Overt Behavioral Responses –Physiological responses –Subjective responses

3. Prevalence of Anxiety Symptom Syndrome Disorder Reporter

4. Nerves/Fears vs. Anxiety Adaptive----------------- Maladaptive –fear --------------------------- phobia –worry -------------------------- rumination –tension ----------------------- overanxious –self-soothing ------------------ compulsion

5. Fear at Different Ages possible biological basis of "fear": Moro reflex Birth - 6 months:.............. Loud noises Loss of support (falling).5 -.75 years:................ Strangers 1.5 - 4 years:................ Separation 1.25-4 years:................ Creatures, Bad people, Death, Being alone 2 years:.............. Toilet, bathtub drain

6. Fears at Different Ages (cont’d) 3 years:.................... Animals 4 years:.................... Darkness 4 - 6 years:.................. School 11 years:.................. Injury, Natural events, Social events, All fears 12 years:.................Social events, Sexual material 19+ years:............... Natural events

7. Patterns of Anxiety Phobia –Specific, School Separation Anxiety Disorder Obsessive-Compulsive Disorder (OCD) Panic Disorder –Without Agoraphobia, With Agoraphobia Posttraumatic Stress Disorder (PTSD) Acute Stress Disorder Generalized Anxiety Disorder (Overanxious Disorder of Childhood) Adjustment Disorder With Anxiety

8. Disorders related to anxiety Somatoform Dissociative

9. Phobia Mark (1969) –a special form of fear which, –is out of proportion to demands of the situation, –cannot be explained or reasoned away, –is beyond voluntary control, –leads to avoidance of the feared situation, –persists over an extended period of time, –and is unadaptive.

10. Phobia (cont’d) Miller, Barrett, & Hampe's (1974) modified definition for children –is not age or stage specific.

11. School Phobia vs. Truancy 1. Linger at home with parents' knowledge and/or consent 2. Earn average or better grades 3. Profess to like school 4. Bluntly refuse to go to school 5. Show more somatic signs of anxiety 6. Tend to come from stable homes with no history of parental absence. Truancy is a symptom of conduct problems.

12. 2 Subtypes of School Phobia Young First episode Monday onset, often following minor illness preceding week Acute onset Expressed concern about death Child thinks Mom may be ill Good communication between parents Mom and Dad well-adjusted Father involved in home and housework Parents easy for school/counselor to work with Older 2nd, 3rd, etc. episode No Monday onset pattern Incipient onset No death theme Mom's health not an issue Poor communication between parents Mental health problems in parents Dad shows little interest in family, home, housework Parents difficult for school/counselor to work with

13. Obsessive-Compulsive Disorder Obsessions=thoughts Compulsions=acts not the same as Obsessive– Compulsive Personality Disorder

14. OCD Diagnostic Criteria Obsessions as defined by (1), (2), (3), and (4): –(1) recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress –(2) the thoughts, impulses, or images are not simply excessive worries about real-life problems –(3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action –(4) the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

15. OCD Diagnostic Criteria (cont’d) Compulsions as defined by (1) and (2): –(1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., 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 –(2) the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

16. OCD Diagnostic Criteria (cont’d) B. At some point, person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children. C. The obsessions or compulsions cause marked distress, are time consuming, or significantly interfere with the person's normal functioning,, activities or relationships. D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it. E. The disturbance is not due to the direct physiological effects of a substance or a general medical condition. Specify if poor insight (most children).

17. Panic Disorder/Agoraphobia Acute episode (attacks) of fear, anxiety, panic May lead to attempts to control future episodes (Agoraphobia) Agoraphobia=pathological anxiety about being outside of a safe place and helpless.

18. Generalized Anxiety Disorder (GAD) “Overanxious Disorder” in children and adolescents. Worry, threat sensitivity, chronic tension Probably the most frequently occurring anxiety disorder in children

19. Posttraumatic Stress Disorder (PTSD) Traumatic event (threat + fear/helplessness/horror) leads to: 1. Over arousal 2. Avoidance / “numbing of emotions” 3. Re-experiencing: –serial dreams –flashbacks –repetitive toy play –failed general adaptation syndrome (GAS) as a model of PTSD

20. Adjustment Disorder with Anxiety Two defining features: –transient--will not last very long –situational--caused by the child’s circumstances

21. Assessment Criteria for a good assessment? Assessing the three response systems –Behavior –Cognition –Affect Clinical interviews –Anxiety Disorders Interview Schedule for Children (ADIS-C/P)

22. Assessment Measures –Broad band measures (e.g., BASC, CBCL) –State-Trait Anxiety Inventory for Children –RCMAS (“What I Think and Feel”) –Multidimensional Anxiety Scale for Children (MASC) –Negative Affectivity Self-Statement Questionnaire –The Coping Questionnaire—Child Version –Revised Fear Survey Schedule for Children –Social Anxiety Scale for Children—Revised –Social Phobia and Anxiety Inventory

23. Assessment Observations –Behavioral avoidance tasks –Naturalistic Physiological Recordings –Skin conductance –Heart rate –Palmar sweat

24. Treatment Aimed at four primary problems (Barlow): –Excessive escape & avoidance behaviors –Emergency physiological reactions to perceived threat –Sense of lack of control –Distorted info processing (e.g., hypervigilance for threat, cognitive avoidance)

25. Treatment (cont’d) Behavioral methods –Relaxation –Exposure Systematic desensitization In vivo exposure Flooding (coupled with response prevention) –Modeling –Contingency management

26. Treatment (cont’d) Cognitive-Behavioral methods –FEAR plan (Kendall & Treadwell) F=Feeling afraid? E=Expecting bad things to happen? A=Actions & attitudes that can help R=Results & rewards Pharmacological methods –(e.g., SSRIs, Tricyclic antidepressants, anxiolytics)