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Anxiety
Disorders
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Presentation
by Jim Foley
© 2013 Worth Publishers
Anxiety Disorders
GAD: Generalized anxiety disorder
Panic disorder
Phobias
OCD: Obsessive-compulsive disorder
PTSD: Post-traumatic stress disorder
Anxiety Disorders
• Are psychological disorders where the primary
symptom is anxiety, or a feeling of impending
doom or disaster from a specific or unknown
source.
• Anxiety disorders are characterized by mood
symptoms of tension or agitation; bodily
symptoms of sweating or increased heart rate
and blood pressure as well as cognitive
symptoms such as worry or rumination
Anxiety disorders…
•
•
•
•
•
Highly treatable yet also resistant to extinction
Often begins early in life
Reported more by women than men
Reported more in Western countries
Often comorbid both with other anxiety
diagnoses and with other disorder groups (e.g.
Mood disorders, psychoses)
4. More considered
response based on
cortical processing
1. Thalamus
receives stimulus
and sends to both
amygdala and
cortex
Sensory Input
2. Amygdala
registers
danger
3. Amygdala
triggers fast
response
• Parts of the brain involved in fear response = thalamus, amygdala,
hypothalamus, which then instruct the endocrine glands and autonomic nerv.sys.
• Evolved fear module (pink) versus considered response (green) = “fight or flight”
versus “feel the fear and do it anyway (or do it differently)”!
Specific Phobias
• Selective, persistent and out of proportion
• Includes cognition that leads to behavioural
response, whether or not the threat is present
• May be genetically, neurologically or
experientially based
• Maintained through the processes of classical
and operant conditioning.
Social Phobia
• A more pervasive, highly cognitive type of
phobia
• Distinguishing feature is the fear of doing
something in front of others
• May be situation or context (e.g. performance
versus interaction anxiety) specific
• Fear of one’s own behaviour causing negative
attention from others
Therapeutic Treatment of Phobia
• Mainly behavioural or cognitive behavioural techniques
are used
Systematic Desensitisation (with or without relaxation training)
Flooding (with or without relaxation training)
Modelling
Cognitive restructuring, skills training, gradual exposure
[Relaxation not recommended for blood phobia where fainting is a risk]
• Hypnosis
• Medication (mainly social phobia)
MOAIs
 SSRIs

Panic Disorder
• Two major types: with or without agoraphobia
• Consists of a pattern of recurring panic attacks
• Emotional, physical, cognitive and behavioural
components
• Main fear is of losing control (consequence = dying, going
crazy, embarrassment, not being able to get help)
• The fear of having a panic attack becomes a problem
of itself, possibly leading to agoraphobia (fear of open
spaces, crowds etc. Any place where escape or finding help is difficult or
embarrassing) or
other phobias
Treatment of Panic Disorder
• Debate about the extent to which Panic
Disorder is biological versus psychological
(most likely both)
• Genetic and medication studies support
biological view
• Cognitive strategies - reality testing, psycho
education, cognitive restructuring, graded
exposure - all may add to effectiveness of
treatment supporting psychological argument
Obsessive Compulsive Disorder
• Classified as anxiety disorder, but with unique
presentation
• Characterised by obsessions and compulsions (in most
cases)
• Compulsions may be physical or mental
• Types of presentation: contamination fear;
doubt/checking; magic thinking; symmetry; hoarding
• Severity = frequency + capacity to resist + interference
with normal functioning
• Panic Disorder
Diagnosed as…
The experience of
repeated attacks of
intense anxiety
accompanied by:
 severe chest pain
 Tightness of
muscles
 Choking
 Sweating
 Or other acute
symptoms
Symptoms can last
anywhere from a few
minutes to a couple of
hours
• Generalized AnxietySimilar to
Panic disorder
Disorder
however,
 Symptoms must
occur for at least 6
months and include
chronic anxiety not
associated with any
specific situation or
object
 The individual
frequently
experiences:
 Sleep problems
 Difficulty
concentrating
 Irritability
 Tenseness
 Being
hypervigilant
• Phobias
Phobias are…
 Intense, irrational
fear responses to
specific stimuli
 A fear turns into a
phobia when it
provokes a
compelling,
irrational desire to
avoid a dreaded
situation or object,
disrupting the
person’s daily life
 Nearly 5% of the
population suffers
from some mild
form of phobic
disorder
• Obsessive-Compulsive
OCD is a…
 Compound
Disorder (OCD)
disorder of
thought and
behavior
 Characterized by
obsessions and
compulsions
 Obsessions are
persistent,
intrusive, &
unwanted
thoughts that a
person cannot get
out of their mind
 Compulsions are
ritualistic
behaviors
performed
repeatedly in
order to reduce
the tension
created by the
obsession
• Posttraumatic Stress Disorder
(PTSD)
PTSD is a result
of…
 Some trauma
experienced (natural
disaster, war, violent
crime) by the victim
 Trauma is reexperienced through
realistic nightmares
and flashbacks
 Victims may
experience reduced
involvement with
the outside world
 General arousal is
also experienced
characterized by
hyper alertness,
guilt, and difficulty
concentrating
Learning and Biological Perspectives
of Anxiety Disorders Development
• Freud assumed that anxiety disorders are
symptoms of submerged mental energy that
derives from intolerable impulses that were
repressed during childhood.
• Learning theorists, drawing on research in
which rats are given unpredictable shocks, link
general anxiety with classical conditioning of
Development Continued…
• Through observational learning, someone
might also learn fear by seeing others display
their own fears.
• Research suggest humans might be
biologically prepared to develop certain fears.
Development Continued…
• Research shows the anxiety response is
genetically influenced
• PET scans of individuals with OCD reveal
excessive activity in the region of the brain
called the anterior cingulate cortex.
References
• Maitland, L. L. (2003). Psychology: five steps to
a 5 on the AP exam. New York: McGraw-Hill.
GAD: Generalized
Anxiety Disorder
 Emotional-cognitive
symptoms include
worrying, having anxious
feelings and thoughts about
many subjects, and
sometimes “free-floating”
anxiety with no attachment
to any subject. Anxious
anticipation interferes with
concentration.
 Physical symptoms include
autonomic arousal,
trembling, sweating,
fidgeting, agitation, and
sleep disruption.
Panic Disorder:
“I’m Dying”
A panic attack is not just an
“anxiety attack.” It may include:
 many minutes of intense dread
or terror.
 chest pains, choking,
numbness, or other frightening
physical sensations. Patients
may feel certain that it’s a
heart attack.
 a feeling of a need to escape.
Panic disorder refers to repeated
and unexpected panic attacks, as
well as a fear of the next attack,
and a change in behavior to avoid
panic attacks.
Specific Phobia
A specific phobia is more than just
a strong fear or dislike. A specific
phobia is diagnosed when there is
an uncontrollable, irrational,
intense desire to avoid the some
object or situation. Even an image
of the object can trigger a
reaction--“GET IT AWAY FROM
ME!!!”--the uncontrollable,
irrational, intense desire to avoid
the object of the phobia.
Obsessive-Compulsive Disorder [OCD]
 Obsessions are intense,
unwanted worries, ideas, and
images that repeatedly pop up in
the mind.
 A compulsion is a repeatedly
strong feeling of “needing” to
carry out an action, even though
it doesn’t feel like it makes sense.
 When is it a “disorder”?
 Distress: when you are deeply
frustrated with not being able
to control the behaviors
or
 Dysfunction: when the time
and mental energy spent on
these thoughts and behaviors
interfere with everyday life
Common OCD Behaviors
Percentage of children and adolescents with OCD reporting
these obsessions or compulsions:
Common pattern: RECHECKING
Although you know that you’ve
already made sure the door is
locked, you feel you must check
again. And again.
Post-Traumatic
Stress Disorder
[PTSD]
About 10 to 35 percent of
people who experience
trauma not only have
burned-in memories, but also
four weeks to a lifetime of:
 repeated intrusive recall of
those memories.
 nightmares and other reexperiencing.
 social withdrawal or phobic
avoidance.
 jumpy anxiety or
hypervigilance.
 insomnia or sleep problems.
Which People get PTSD?
 Those with less control in the
situation
 Those traumatized more frequently
 Those with brain differences
 Those who have less resiliency
 Those who get re-traumatized
Resilience and PostTraumatic Growth
Resilience/recovery
after trauma may
include:
 some lingering,
but not
overwhelming,
stress.
 finding strengths
in yourself.
 finding connection
with others.
 finding hope.
 seeing the trauma
as a challenge that
can be overcome.
 seeing yourself as
a survivor.
Understanding Anxiety Disorders:
Explanations from Different Perspectives
Psychodynamic/
Freudian:
repressed
impulses
Observational
learning:
worrying like
mom
Classical
conditioning:
overgeneralizing
a conditioned
response
Cognitive
appraisals:
uncertainty is
danger
Operant
conditioning:
rewarding
avoidance
Evolutionary:
surviving by
avoiding danger
Understanding Anxiety Disorders:
Freudian/Psychodynamic Perspective
 Sigmund Freud felt that
anxiety stems from
repressed childhood
impulses, socially
inappropriate desires, and
emotional conflicts.
 We repress/bury these
issues in the unconscious
mind, but they still come
up, as anxiety.
Classical Conditioning
and Anxiety
 In the experiment by John B.
Watson and Rosalie Rayner in
1920, Little Albert learned to
feel fear around a rabbit
because he had been
conditioned to associate the
bunny with a loud scary noise.
 Sometimes, such a conditioned
response becomes
overgeneralized. We may begin
to fear all animals, everything
fluffy, and any location where
we had seen those, or even fear
that those items could appear
soon along with the noise.
 The result is a phobia or
generalized anxiety.
Operant Conditioning
and Anxiety
 We may feel anxious in a
situation and make a decision
to leave. This makes us feel
better and our anxious
avoidance was just reinforced.
 If we know we have locked a
door but feel anxious and
compelled to re-check,
rechecking will help us
temporarily feel better.
 The result is an increase in
anxious thoughts and
behaviors.
Observational
Learning and
Anxiety
 Experiments with humans
and monkeys show that
anxiety can be acquired
through observational
learning. If you see
someone else avoiding or
fearing some object or
creature, you might pick
up that fear and adopt it
even after the original
scared person is not
around.
 In this way, fears get
passed down in families.
Cognition and
Anxiety
 Cognition includes worried
thoughts, as well as
interpretations, appraisals,
beliefs, predictions, and
ruminations.
 Cognition includes mental
habits such as
hypervigilance (persistently
watching out for danger).
This accompanies anxiety in
PTSD.
 In anxiety disorders, such
cognitions appear
repeatedly and make
anxiety worse.
Examples of Cognitions that can
Worsen Anxiety:
Cognitive errors, such as believing that we
can predict that bad events will happen
Irrational beliefs, such as “bad things don’t
happen to good people, so if I was hurt, I
must be bad”
Mistaken appraisals, such as seeing aches as
diseases, noises as dangers, and strangers as
threats
Misinterpretations of facial expressions and
actions of others, such as thinking “they’re
talking about me”
Biology and Anxiety: Genes
 Studies show that
identical twins, even
raised separately,
develop similar
phobias (more similar
than two unrelated
people).
 Some people seem to
have an inborn highstrung temperament,
while others are more
easygoing.
 Temperament may be
encoded in our genes.
Genes and
Neurotransmitters
 Genes regulate levels of
neurotransmitters.
 People with anxiety have
problems with a gene
associated with levels of
serotonin, a neurotransmitter
involved in regulating sleep
and mood.
 People with anxiety also have
a gene that triggers high levels
of glutamate, an excitatory
neurotransmitter involved in
the brain’s alarm centers.
Biology and Anxiety: The Brain
 Traumatic
experiences can burn
fear circuits into the
amygdala; these
circuits are later
triggered and
activated.
 Anxiety disorders
include overarousal
of brain areas
involved in impulse
control and habitual
behaviors.
The OCD brain shows extra
activity in the ACC, which
monitors our actions and checks
for errors.
ACC = anterior cingulate gyrus
Biosocial Roots of Crime: The Brain
People who
commit murder
seem to have
less tissue and
activity in the
part of the
brain that
suppresses
impulses.
Other differences include:
 less amygdala response when viewing violence.
 an overactive dopamine reward-seeking system.
How common are psychological
disorders?
Countries vary greatly in the percentage of people reporting
mental health issues in the past year.
Rates of
Psychological
Disorders
This list takes a closer look at
the past-year prevalence of
various mental health
diagnoses in the United
States.
Risks and Protective Factors for
Mental Disorders
Who is at risk of mental disorders?
Who is less at risk?
Outcomes for People with
Psychological Disorders
There are risks to be watchful of, obstacles
to be overcome, and improvements to be
made, often with the help of with
treatment.
 Some people with psychological
disorders do not recover.
 Some achieve greatness, even with a
psychological disorder.