Assignment

1
Assignment

• Monitor your emotions and moods over the next
  week.
• Label each feeling state (e.g., fear)
• Write down what your cognitive, behavioral, and
  physiological experiences were
• Write a 1 paragraph reaction. What did you
  notice? What did you learn?
• E-Mail me it by 9PM on Tues (Apr 8)

2
Anxiety (Continued)
3
Brief Recap

• Whats anxiety
• What are some common features across the anxiety
  disorders?
• Hows anxiety different from fear?
• Whats worry?

4
So Far

• OCD
• Obsessions and compulsions

5
GAD

• Excessive worry in many areas of life
• Additional symptoms
• Strong, persistent anxiety
• Somatic symptoms (e.g., muscle tension, fatigue,
  irritability, difficulty concentrating and
  sleeping)
• Persists for 6 months or more

6
GAD

• Facts and Statistics
• 4 of the general population meets diagnostic
  criteria for GAD
• Females outnumber males approximately 2 or 31
• Early adulthood onset, chronic

7
Worry

• Pathological worry involves biased perceived
• Severity
• Likelihood
• Ability to cope

• The reason why worry kills more people than work
  is that more people worry than work. Robert Frost

Salkovskis (1996)
8
Whats Your Biggest Worry?

• My biggest worry is X
• What would be so bad if X occurred?
• What would be so bad if that occurred?
• What would be so bad if?

9
GAD Etiology

• Emotion avoidance (Borkovec, 1994)
• Emotion non-acceptance

10
Worry Chains

• Your biggest worry
• Failing class ?
• Low overall GPA ?
• Not get into grad school ?
• Not get a good job ?
• Disappoint parents ?
• Lose parents approval

F
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Worry Exercise

• Your biggest worry
• Failing class ?
• Low overall GPA ?
• Not get into grad school ?
• Not get a good job ?
• Disappoint parents ?
• Lose parents approval

surface worry
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GAD Diatheses

• Emotional avoidance
• Emotion non-acceptance
• Genes, social support, life stress

13
CBT for GAD

• Worry outcome diaries
• Encouraging multiple perspectives
• Challenging links in worry chain
• Worry exposure relaxation training

14
Treatment Medicine
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GAD Treatment

• Biological treatments
• Often prescribed benzodiazepines (target GABA)
  and selective serotonin reuptake inhibitors
  (SSRIs)
• Relapse 20-50 for SSRIs 90 for benzodiazepines

16
Side Effects

• Benzodiazepines
• Drowsiness, fatigue, depression, aggressiveness,
  memory impairment
• SSRIs
• Sexual dysfunction, headache, dizziness, nausea,
  weight gain/loss

17
GAD Emotion Dysregulation Model

• Heightened intensity of negative emotions
• Poor understanding, management, and clarity of
  emotions
• More fear of emotions/moods

Mennin et al. (2005)
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GAD Emotion Dysregulation Model

• More fear of
• Anxiety
• Once I get nervous, I think that my anxiety
  might get out of hand
• Depression
• Depression could really take me over, so its
  important to fight off sad feelings
• Anger
• I am afraid that I will hurt someone if I get
  really furious

19
GAD Emotion Dysregulation Model

• AND fear of
• Positive emotions
• Being filled with joy sounds great, but I am
  concerned that I could lose control over my
  actions if I get too excited

20
Emotion Regulation Therapy for GAD

• Psychoeducation about emotion
• Functions and management
• Maladaptiveness of non-acceptance

21
Common Social Anxiety
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Social Phobia

• Fear in social and performance situations
• Fear of EMBARRASSMENT
• Avoid or endure with great distress

23
Social Phobia Prevalence

• Lifetime prevalence rate 7 to 13
• Females slightly gt males
• Adolescent onset common
• Average 15 years of age

24
Social Phobia

• Self-focused attention on
• Visible signs of anxiety
• Social behaviors
• Physical appearance
• Personality/intelligence
• Safety Behaviors
• Conceal/hide aspects of self that are focus of
  concern

25
Treatment of Social Phobia

• Exposure
• In vivo
• Virtual
• Cognitive
• Medication
• SSRIs
• benzodiazepenes

26
Anxiety Summary

• Overestimated
• Perceived threat, danger
• Avoidance
• Symptoms interfere with quality of life
• Anxiety disorders are common
• CBT and medication are helpful

27
Mood Disorders

• Whats mood?

28
Sadness vs. Depression

• Sadness vs. depression

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Normal vs. Clinical Depression
Like anyone else I have always had times when I
felt deeply depressed, but this was something
altogether new in my experiencea despairing,
unchanging paralysis of the spirit beyond
anything I had ever known or imagined could
exist.
William Styron, novelist, 1925-2006
30
Clinical Depression Barbara

• What similarities and what differences are there
  between Barbaras and Chucks experiences?

31
What Are the Mood Disorders?
Major Depressive Disorder

• One of
• Extremely sad or depressed mood state
• Anhedonia loss of pleasure/interest in usual
  activities

32
Major Depressive Disorder

• Four of the following
• 1) Weight loss or gain
• 2) Insomnia or hypersomnia
• 3) Psychomotor retardation or agitation
• 4) Fatigue
• 5) Worthlessness
• 6) Concentration, thinking
• 7) Thoughts of death, suicide

33
Major Depressive Disorder

• At least 2 weeks
• Distress/impairment
• Life-time prevalence 16.2 of population
• Recurrent
• Two-thirds will relapse
• Average of episodes is 4

34
Gender Differences in MDD

• Two-thirds of cases are females
• Group task What factors might explain this
  gender difference?

35
Dysthymia

• Defining Features
• At least 2 years
• Less severe but more chronic than MDD

36
Dysthymia

• Facts and Statistics
• Late onset typically in the early 20s
• Early onset before age 20 ? greater chronicity,
  poorer prognosis
• Can persist for a long time (20 years)
• Significant impairment