Anxiety Disorders

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Anxiety Disorders

• PSY 436
• Instructor Emily E. Bullock, Ph.D.

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ANXIETY

• Anxiety An emotional state characterized by
  physiological arousal, unpleasant feelings of
  tension, and a sense of apprehension or
  foreboding. (text p.169)
• Typically a normal response but becomes abnormal
  when its level is out of proportion to a threat
  or associated with no specific trigger
• Anxiety Disorder A class of psychological
  disorders characterized by excessive or
  maladaptive anxiety reactions

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DSM-IV-TR Anxiety Disorders

• Panic Disorder without Agoraphobia
• Panic Disorder with Agoraphobia
• Agoraphobia without History of Panic Disorder
• Specific Phobia
• Social Phobia
• Obsessive-Compulsive Disorder

• Posttraumatic Stress Disorder
• Acute Stress Disorder
• Generalized Anxiety Disorder
• Anxiety Disorder due to general medical condition
• Substance-Induced Anxiety Disorder
• Anxiety Disorder NOS

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Anxiety Disorders to be Covered in this Class

• Panic Attacks
• Panic Disorder with and without Agoraphobia
• Phobias
• Specific
• Social
• Obsessive-Compulsive Disorder (OCD)
• Posttraumatic Stress Disorder (PTSD)
• Generalized Anxiety Disorder (GAD)

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Anxiety-Panic

• Panic Attack discrete period of intense fear or
  discomfort in the absence of real danger that is
  accompanied by somatic or cognitive symptoms
• Panic Disorder presence of recurrent, unexpected
  panic attacks followed by at least 1 month of
  persistent concern related to having another
  panic attack or significant behavioral change
  related to the attack
• Agoraphobia anxiety about being in places or
  situations from which escape might be difficult
  or in which help may not be available in the
  event of having a panic attack

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Anxiety-Panic

• Panic Disorder without Agoraphobia
• Panic Disorder with Agoraphobia
• Agoraphobia without History of Panic Disorder

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Prevalence of Panic Disorder by Gender
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Panic Disorder Treatments

• Drug Therapy-Antidepressants
• Cognitive-Behavioral Therapies/Treatments
• Self Monitoring
• Exposure
• Development of coping responses
• Relaxation Exercises
• See 6-second Quieting Exercise on pg. 230

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Anxiety-Phobias

• Phobia excessive, irrational fear
• Do you have a phobia? Is it a problem for you?

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Anxiety-Specific Phobia Criteria

• Marked and persistent fear that is excessive or
  unreasonable, cued by the presence or
  anticipation of a specific object or situation
• Exposure to the phobic stimulus provokes an
  immediate anxiety response
• Person recognizes that the fear is excessive or
  unreasonable
• Phobic situation is avoided or endured with
  intense anxiety
• Phobia interferes significantly with the persons
  normal routine
• Duration is 6 months

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Anxiety-Social Phobia Criteria

• A marked and persistent fear of one or more
  social or performance situations in which the
  person is exposed to unfamiliar people or to
  possible scrutiny by others. Individual fears
  that they will act in a way that will be
  humiliating or embarrassing
• Exposure to the phobic stimulus provokes an
  immediate anxiety response
• Person recognizes that the fear is excessive or
  unreasonable
• Feared social or performance situation is avoided
  or endured with intense anxiety

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Anxiety-Social Phobia Criteria(cont.)

• Phobia interferes significantly with the persons
  normal routine
• Duration is 6 months
• Not due to physiological effects of a substance
  of general medical condition

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Phobic Disorders

• Treatment Approaches
• Learning-Based
• Systematic desensitization
• Fear-stimulus hierarchy
• Gradual exposure
• Flooding

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AnxietyObsessive-Compulsive Disorder (OCD)
Criteria

• Obsessions
• Recurrent and persistent thoughts, impulses, or
  images that are intrusive and inappropriate and
  cause marked anxiety or distress
• Obsessions are not simply excessive worries about
  real-life problems
• Attempts to ignore and suppress obsessions or
  neutralize them with some other thought or action
• Recognizes the obsessions are a product of their
  own mind (not thought insertion)

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AnxietyOCD Criteria

• Compulsion
• Repetitive behaviors or mental acts 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 are aimed at preventing
  or reducing distress or preventing some dreaded
  event or situation

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AnxietyOCD Other Criteria

• Person recognizes Obsessions or compulsions are
  excessive or unreasonable
• Cause marked distress, time consuming (more than
  1 hour a day) or significantly interfere with
  routine
• Content of obsession or compulsion is not
  restricted to another Axis I Diagnosis (e.g.,
  eating disorder)
• Not due to physiological effects of a substance
  or general medical condition

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OCD Treatments

• Exposure with response prevention
• Drug Therapy-SSRIs
• Combination of drug and Cognitive Behavioral
  Therapy show best results for most anxiety
  disorders

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Anxiety--Posttraumatic Stress Disorder (PTSD)
Criteria

• Exposure to a traumatic event
• Traumatic event is persistently reexperienced
• Persistent avoidance of stimuli associated with
  the trauma and numbing of general responsiveness
• Persistent symptoms of increased arousal (not
  present before trauma)
• Duration of disturbance more than 1 month
• Disturbance causes clinically significant
  distress or impairment

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PTSD Treatments

• Drug Therapy-antidepressants for associated
  symptoms of depression and anxiety
• PTSD-specific cognitive-behavioral treatment
  protocols (often in group therapy formats)
• EMDR

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Anxiety-Generalized Anxiety Disorder

• Generalized Anxiety Disorder persistent feelings
  of anxiety that are not triggered by any specific
  object, situation, or activity

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Anxiety-Generalized Anxiety Disorder Criteria

• Excessive anxiety and worry, occurring more days
  than not for at least 6 months, about a number of
  events or activities
• Person finds it difficult to control the worry
• Associated Symptoms
• Anxiety and worry not confined to another Axis I
  diagnosis (e.g., Social phobia)
• Cause clinically significant distress or
  impairment
• Not due to the direct physiological effect of a
  substance or general medical condition

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Generalized Anxiety Disorder Treatments

• Cognitive Behavioral Therapy
• Relaxation skills
• Drug Therapy-Paxil

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Ethnic Differences in Anxiety Disorders

• Evidence from a nationally representative sample
  of U.S. adults showed that rates of anxiety
  disorders were generally comparable across racial
  and ethnic groups.

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Review

• Panic Attacks
• Panic Disorder with and without Agoraphobia
• Phobias
• Specific
• Social
• Obsessive-Compulsive Disorder (OCD)
• Posttraumatic Stress Disorder (PTSD)
• Generalized Anxiety Disorder (GAD)