1. Chapter 6 Anxiety Disorders Copyright © 2006 Pearson Education Canada Inc.

2. 2 Quote of the day Worrying helps you some. It seems as if you are doing something when you’re worrying. – Lucy Maud Montgomery

3. Copyright © 2006 Pearson Education Canada Inc. 3 Overview Most common type of abnormal behaviour Commonalities with mood disorders

4. Copyright © 2006 Pearson Education Canada Inc. 4 Origin of the term “Panic” Greek God Pan who sometimes scared people to death with his blood-curdling scream

5. Copyright © 2006 Pearson Education Canada Inc. 5 Case Study: Panic Disorder with Agoraphobia Johanna Schneller – freelance writer describes debilitating panic attacks – nausea, dizziness, shortness-of-breath, feelings of doom, and fear of escape – progressive fear of leaving her home negative effects of life – relationships – employment

6. Copyright © 2006 Pearson Education Canada Inc. 6 Symptoms and Associated Features Anxiety – different from fear – low levels can be adaptive Maladaptive anxiety – high levels of diffuse negative emotion – sense of uncontrollability – shift in attention to state of self-preoccupation

7. Copyright © 2006 Pearson Education Canada Inc. 7 Symptoms and Associated Features Excessive Worry – uncontrollable sequence of negative thoughts of danger – pathological worry high quantity and negative, unrealistic content

8. Copyright © 2006 Pearson Education Canada Inc. 8 Panic Attack Sudden overwhelming experience of terror involving somatic and cognitive symptoms.

9. Copyright © 2006 Pearson Education Canada Inc. 9 Panic Attack: Somatic Symptoms DSM-IV-TR requires at least 4 of 13 symptoms: – Palpitations – sweating – trembling/shaking – sensations of shortness of breath/smothering – feelings of choking – chest pain/discomfort – nausea – feeling dizzy/light-headed – derealization or depersonalization – fear of losing control/going crazy – fear of dying – tingling/numbness of extremities – chills/hot flushes

10. Copyright © 2006 Pearson Education Canada Inc. 10 Panic Attack: Cognitive Symptoms Catastrophic misinterpretation of bodily sensations (e.g., heart palpitation) “I’m going crazy”; “I think I’m dying”

11. Copyright © 2006 Pearson Education Canada Inc. 11 Phobias persistent, excessive, unrealistic fear of a specific object/situation avoidance behaviour  Agoraphobia: fear of public spaces Can accompany panic disorder

12. Copyright © 2006 Pearson Education Canada Inc. 12 Obsessions and Compulsions OBSESSIONS – repetitive thoughts, images, impulses – person realizes their unreasonable nature (not delusional) – themes of sex, violence, contamination COMPULSIONS – behavioural responses to obsessions (“tension reduction”) – rituals (e.g., hand-washing, checking) – mental acts (counting)

13. Copyright © 2006 Pearson Education Canada Inc. 13 Historical Perspective Freud’s etiological description : – psychological conflicts – biological impulses  focus on sex and aggression

14. Copyright © 2006 Pearson Education Canada Inc. 14 DSM-IV-TR Approach emphasis on description – little consideration on etiology eight specific subtypes

15. Copyright © 2006 Pearson Education Canada Inc. 15 Panic Disorder recurrent unexpected panic attacks persistent concern about additional attacks for one month with or without agoraphobia

16. Copyright © 2006 Pearson Education Canada Inc. 16 Specific Phobia marked, persistent, fear unrealistic (with awareness) significant life impairments

17. Copyright © 2006 Pearson Education Canada Inc. 17 Social Phobia fear of social situations – performance anxiety – interpersonal interactions rooted in fear of negative evaluations

18. Copyright © 2006 Pearson Education Canada Inc. 18 Generalized Anxiety Disorder (GAD) excessive, uncontrollable worry majority of days for at least 6 months affective, cognitive, & somatic symptoms

19. Copyright © 2006 Pearson Education Canada Inc. 19 Obsessive-Compulsive Disorder (OCD) presence of obsessions or compulsions attempts to suppress thoughts or impulses

20. Copyright © 2006 Pearson Education Canada Inc. 20 Prognosis for Anxiety Disorders chronic conditions individual differences in recovery

21. Copyright © 2006 Pearson Education Canada Inc. 21 Epidemiology Gender - higher prevalence in females Age - lower prevalence in the elderly Cross-cultural studies – similar prevalence rates – different symptom patterns

22. Copyright © 2006 Pearson Education Canada Inc. 22 Etiology of Anxiety Disorders: Social Factors Stressful (dangerous) life events Childhood abuse/neglect Insecure attachment

23. Copyright © 2006 Pearson Education Canada Inc. 23 Etiology of Anxiety Disorders: Psychological Factors preparedness through evolution observational learning

24. Copyright © 2006 Pearson Education Canada Inc. 24 Etiology of Anxiety Disorders: Cognitive Factors perceived control versus helplessness Clark’s “catastrophic misinterpretation” anxiety sensitivity – focus on threat-related stimuli paradox of thought suppression – “try to not think of a white bear”

25. Copyright © 2006 Pearson Education Canada Inc. 25 Etiology of Anxiety Disorders: Biological Factors strong genetic component – family and twin studies two genetic factors identified – GAD/major depression – panic disorder/phobias

26. Copyright © 2006 Pearson Education Canada Inc. 26 Etiology of Anxiety Disorders: Biological Factors neuroanatomy – thalamus-amygdala circuit – OCD: caudate nucleus/orbital prefrontal cortex/anterior cingulate cortex

27. Copyright © 2006 Pearson Education Canada Inc. 27 Psychological Interventions systematic desensitization exposure and response prevention relaxation training

28. Copyright © 2006 Pearson Education Canada Inc. 28 Biological Interventions I antianxiety medications – benzodiazapines (Valium, Xanax) – serious side effect: addiction

29. Copyright © 2006 Pearson Education Canada Inc. 29 Biological Interventions II Antidepressant medications – SSRIs (Prozac, Zoloft, Paxil) preferred – tricyclics OK but serious side effects – clomipramine for OCD