Anxiety Disorders

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Anxiety Disorders

• The Dark side of Fear

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What is Anxiety? 

• The unpleasant feeling of fear or apprehension we
  experience in response to some event or
  situation.
• Duration intensity of anxiety --more severe in
  people with anxiety disorders than in people
  without.

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Anxiety Disorders 

• Phobias
• panic disorder
• generalized anxiety disorder
• obsessive-compulsive disorder
• posttraumatic stress disorder
• acute stress disorder

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Comorbidity of other anxiety disorders is high!!

• 1.Symptoms of various anxiety disorders are not
  disorder specific.
•  
• 2.) Cause of one disorder may be cause of another
  disorder.

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A. Phobias an irrational fear out of
proportion to the danger posed by the object or
situation.

•  
• Person knows fear is irrational, but avoids
  object or situation anyway.
•  
• Phobia may not be debilitating enough to warrant
  seeking treatment.
•  
• (e.g., A fear of snakes in the city is less a
  problem than in the country)

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Two kinds of phobias

• 1. Specific phobias - fears caused by the
  presence or anticipation of a specific object or
  situation.
• Blood
• injuries injections
• situations (planes, elevators)
• animals (dogs, spiders)
• natural environment (heights, water, tornadoes)
• Lifetime prevalence 7 (men) and 16 (women).

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2. Social phobias-

• Fear linked to the presence of other people
• Person avoids situation in which he or she could
  behavior in embarrassing way.
•  
• Speaking or performing in public
• eating in public
• Using public bathroom
• Lifetime prevalence 11 (men) 15 (women)
•  
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What causes phobias?

• Data show we learn phobias, they are not innate.
•  
• We learn phobias by
•  
• 1. Classical operant conditioning (avoidance
  learning)
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• 2. Modeling (observational learning)
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Modeling

• We learn phobias by observing others fear to the
  object or event.
• Do we need to observe the persons fear response
  to the stimulus the stimulus itself?
• Yes!!!!

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Mineka study

• Had lab-reared monkeys view wild-reared monkeys
  responses to a snake.
•  
• A barrier was in place to block the lab-reared
  monkeys from seeing the object of the wild-reared
  monkeys fear.
•  
• Later when shown the snake, the lab-reared monkey
  didnt show fear to the snakes.
•  
• You need to see the other persons response to
  the feared stimulus the stimulus itself for
  phobia formation.

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Therapy for phobias

• Systematic desensitization
• Flooding

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B. Generalized Anxiety Disorder (GAD)

• Symptoms
• persistent anxiety
• chronic worry
• focus on health/daily hassles
• difficulty concentrating irritable
• tire easily restless
• Lifetime prevalence 5 in population
• Onset midteens comorbidity with other anxiety
  disorders mood disorders.

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Causes of GAD

•  
• we develop GAD when confronted with painful
  stimuli over which we have no control.
•  
• Perception of not being in control may be enough
  for anxiety.
•  
• we develop GAD when we misperceive events to be
  out of our control potentially threatening or
  harmful.

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Locus of control- we feel less anxiety when we
can control our lives.

• Our perception of control may be more important
  than actual control to reducing unwanted
  anxieties in patients with GAD.
• Unpredictable events produce more anxiety than
  predictable ones.
•  
• Patients with GAD are easily drawn to stimuli
  associated with negative emotional content
  (traumas, physical harm, etc.)
•  
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Worry as a tool to control emotion!! 

• Patients with GAD use worry to distract
  themselves from thinking about negative events.
•  
• Worrying keeps us from focusing on negative
  emotions.
•  
• Worrying is negatively reinforcing because it
  blocks us from processing emotional stimuli,
  keeps the cycle of anxiety going.

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Biological Causes of GAD

• There may be a genetic component.
•  
• We may have a defect in the GABA system so that
  fear is not brought under control.
•  
• Benzodiazipines, which enhance the inhibitory
  neurotransmitter, GABA, reduce anxiety.
•  

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Therapies for GAD

• 1. Transfer global anxiety into a phobia treat
  phobia.
•  
• Systematic desensitization may be used if
  anxiety can be linked to an identifiable source.
• 2. Relaxation training
• Have patients focus on relaxing during
  low-level anxiety.
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Treat worry!!!

• Here, therapists require that patients extend
  exaggerate their anxieties.
•  
• Because patient remains in a fearful situation,
  anxiety is believed to extinguish.
•  
• Patient learns his or her cognitions are
  illogical and unfounded.

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C. Panic Disorder characterized by attacks.

• Increased HR
• heart palpitations
• nausea
• chest pain
• trembling sweating, terror
• Usually physiological symptoms occur without link
  to cause (with exceptions)
•  
• Lifetime prevalence 2 (men) 5 (women).

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DSM-IV diagnosis

• Recurrent uncued attacks worry about having
  attacks in the future are required.
•  
• Is diagnosed as panic disorder with or without
  agoraphobia.
•  
• Comorbidity between panic disorder
• major depression, GAD, phobias, alcoholism,
  personality disorders is high.
•  
•  

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What causes panic disorder?

• 1.There may be symptoms of an illness that leads
  to panic attacks.
•  
• (e.g., mitral valve prolapse causes heart
  palpitations, dizziness, etc.)
•  
• 2. Panic may be caused by overactivity in a
  nucleus in the pons called the locus ceruleus
  (LC).
•  
• In humans, a drug called Yohimbine, a drug that
  stimulates the LC, can elicit panic attacks in
  patients with panic disorder.
•  

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Causes (panic)

• However blocking activation in the LC has not
  been found to reduce panic attacks.
• 3.Creating panic attacks experimentally
•  
• Using hyperventilation to induce panic attacks
  has produced mixed results.

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Psychological theories

• Patients with panic disorder may have an
  autonomic nervous system that is predisposed to
  be overly active.
• People misconstrue internal bodily changes as
  signals they may be in jeopardy or dying.
• With repeated exposures to attacks, patients
  worry about future attacks thereby making them
  more likely to occur.

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 Therapies for Panic disorder and agoraphobia

• Biological
• 1. Antidepressants anxiolytics can reduce
  frequency of attacks.
• Psychological Barlows therapy (well validated)
• 3 components
• 1. Relaxation training-
• 2. A combination of Ellis Beck type cognitive
  behavioral interventions
• 3. Exposure to the internal cues that trigger
  panic
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D. Obsessive-Compulsive Disorder (OCD)

• persistent unwanted thoughts compulsive
  behaviors that impair normal functioning.
• Lifetime prevalence 1-2 of general pop.
• More common in women than men
•  
• Age of onset early adulthood
• Males checking rituals most common
• Females cleaning rituals most common
•  

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Components of OCD

• 1. Obsessions-intrusive recurring thoughts
  images that appear irrational uncontrollable to
  the individual experiencing them.
• Frequency force of thoughts always interfere
  with functioning.
•  ?Fears of contamination
• ?Fears of expressing sexual or aggressive
  impulses
• ?hypochondria
•  
• 2. Compulsions- repetitive behaviors performed
  over over to reduce distress associated with
  the unwanted thoughts.

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Causes of OCD

• 1. Behavioral cognitive theories
•  
• Compulsions are learned behaviors reinforced by
  fear reduction (negative reinforcement).
• E.g., frequency of hand washing increases to
  reduce or eliminate the aversive fear of dirt.
• Compulsive checking may be the result of memory
  deficit.
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Therapies for OCD

• Exposure and response prevention (ERP)
• Victory Meyer (1966)
•  
• 1.Patients with OCD expose (flooding) themselves
  to situations that elicit compulsions.
• E.g., touching a dirty dish
•  
• 2.  Person is instructed to refrain from
  performing compulsions (extinguish anxiety
  compulsions).
•  
• Treatment is partially effective in half
  of OCD patients.  

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E. Posttraumatic Stress disorder (PTSD)

• A traumatic event or witness to an event in which
  there is perceived or actual threat of death,
  serious injury, or other personal harm.
• The event must have created intense fear,
  horror, or a sense of helplessness.
• (May 3rd, 1999-OK)
• Symptoms of PTSD fall into 3 major categories.
  Symptoms in each must occur longer than 1 month.

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What happens?

• 1. Reexperiencing the traumatic event
• Person frequently recalls the event (has
  nightmares about the event).
• 2. Avoidance of stimuli associated with the
  event or numbing of responsiveness
•  
• Person tries to avoid thinking about the trauma
  or encountering stimuli that will bring it to
  mind.
•  
•  3. Symptoms of increased arousal
• difficulty concentrating (sleeping),
  hypervigilance

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PTSD General Stats

• General prevalence 1-3 in the general pop.
•  
• 3 for civilians exposed to a physical attack
• 20 among people wounded in Vietnam
• 50 of all rape victims
• Women twice as likely to develop PTSD as men.

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F. Acute Stress Disorder

• an individual encounters a traumatic experience
  that causes problems with social or occupational
  functioning for less than 1 month.