Download Anxiety Disorders

Chapter 3
Anxiety Disorders
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Writing about anxiety
Write about an anxiety you are struggling with
(or have struggled with).
What are your “symptoms” of anxiety?
Is your response adaptive or maladaptive?
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Fear responses:
Adaptive vs. Maladaptive
Adaptive Fear
vs.
Maladaptive Anxiety
•Realistic concerns
Unrealistic
•In proportion to threat
Out of proportion
•Fear response subsides
Response is persistent/Chronic
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Symptoms of Anxiety
Chapter 7
Somatic
Emotional
Cognitive
Behavioral
Goosebumps emerge
Muscles tense
Heart rate increases
Respiration accelerates
Respiration deepens
Peripheral blood vessels
dilate
Liver releases
carbohydrates
Bronchioles widen
Pupils dilate
Perspiration increases
Adrenaline is secreted
Stomach acid is inhibited
Salivation decreases
Sense of dread
Terror
Restlessness
Irritability
Anticipation of
harm
Exaggerating of
danger
Problems in
concentrating
Hypervigilance
Worried, ruminative
thinking
Fear of losing
control
Fear of dying
Sense of unreality
Escape
Avoidance
Aggression
Freezing
Decreased
appetitive
responding
Increased
aversive
responding
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Anxiety Disorders
Many different disorders (GAD, PTSD,
phobias, OCD, etc.)
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Post-Traumatic Stress Disorder



Tape 2 (World of Ab Psych)
Exposure to traumatic event +
Symptoms
–
–
–
Chapter 7
Reexperiencing – flashbacks, intrusive memories,
bad dreams
Avoidance and numbing – feeling detached,
avoiding people and activities
Increased arousal – hypervigilance, insomnia,
startle response, irritability/outbursts
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
PTSD: Causes

Trauma + Vulnerability
–
Chapter 7
Vulnerability is biopsychosocial (next slide)
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Explanations of PTSD Vulnerability
Sociocultural factors
1. Social support
2. Nature of trauma itself
(severity, etc.)
Psychological factors
1. Personal assumptions
2. Distress
3. Coping styles Biological factors
1. Physiological
hyperactivity
2. Genetics
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Treatments for PTSD

Cognitive- behavioral
therapy

Systematic desensitization is used to extinguish
fear reactions to memories (e.g., imaginal
reexposure; cognitive techniques are used to
challenge irrational thoughts.

Stress management

Therapist helps client solve concrete problems
to reduce stress

Biological therapies

Antianxiety and antidepressant drugs can be
used to quell specific symptoms

Sociocultural
approaches

PTSD symptoms are understood and treated
within the norms of people’s culture.
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Phobic Disorders
Agoraphobia
Fear of places where help might not
be available in case of an emergency
Specific Phobias
Fear of specific objects, places or
situations
 Animal type
 Natural environment type
 Situational type
 Blood-injection-injury type
Social Phobia
Chapter 7
Fear of being judged or embarrassed
by others
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Shyness: A disorder??
Shy on Drugs NY Times, Sept 2007, by Christopher Lane, author of
“Shyness: How Normal Behavior Became a Sickness.”
Read in class and discuss
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Treatment of Phobias
Behavioral
1)
2)
3)
Cognitive-Behavioral
Systematic desensitization
Modeling
Flooding
Helps clients identify and
challenge negative,
catastrophizing thoughts
about feared situations
Biological
Reduce symptoms of anxiety
generally so that they do not
arise in the feared situation
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Panic Disorder Symptoms
Panic attack symptoms
Panic Disorder can be diagnosed when panic
attacks…
•become common
•are not typically provoked by any particular
situation
•include worry and changing behaviors due to the
worry
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Panic Disorder -- facts
 Occurs in 3.5% of population
(occurs worldwide and across
ethnicities)
 Affects women more
 Onset: late teens – mid-thirties
 Seek medical care frequently
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Causes of Panic Disorder
•Biological Theories
•Genetic (30-40% contribution)
•Human studies (families; twins)
•Rodent studies (stathmin gene may contrib
to fear and anxiety)
•Neurotransmitter contributions
•Poor regulation of norepinephrine, serotonin, and
perhaps GABA in the locus ceruleus and limbic
systems
Chapter 7
•Kindling Model (next slide)
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Kindling Model of Panic Disorder
Poor regulation in locus ceruleus
Panic Attacks
Lowers threshold for chronic anxiety in limbic system
Chronic anxiety increases likelihood
of dysregulation
in locus ceruleus
Panic Attacks
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Causes of Panic Disorder (cont.)
Cognitive Factors
– People
prone to panic attacks
– (1) pay very close attention to their bodily sensations
– (2) misinterpret these sensations
– (3) engage in snowballing, catastrophizing thinking
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Panic and agoraphobia
•Faces DVD (Annie)
•World of Abnormal Psych (tape 3 -- start at 8 min mark)
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Treatments


Depends upon whom you go to see!
Meds (e.g., antidepressants, benzodiazepines)
–

Problems?
Cognitive-behavioral treatment (next slide)
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Classes of Medications for
Anxiety Disorders
Benzodiazepines.
These drugs were often used to treat anxiety disorders from the 1960s until the 1980s. They act on
GABA, which seems to play a role in fear. They generally work quickly, but due to concerns about
abuse or dependency, other medications are now more commonly prescribed.
Tricyclic antidepressants (TCAs).
These medications were developed in the 1950s and 1960s. They help prevent reuptake of 5HT and
NE, but they also affect other neurotransmitters and can have serious side effects. They are not as
commonly prescribed in the United States as are newer classes of antidepressants.
Monoamine oxidase inhibitors (MAOIs).
The MAOIs were developed at about the same time as the TCAs, but they are believed to work
differently. They seem to stop the brain from breaking down 5HT and NE after reuptake.
Selective serotonin reuptake inhibitors (SSRIs).
The SSRIs prevent reuptake of neurotransmitters in the brain. Although the various SSRIs seem to
work in basically the same way and have similar side effects, people seem to respond differently to
different SSRIs.
Serotonin-norepinephrine reuptake inhibitors (SNRIs).
Developed in the 1990s, Effexor XR® (venlafaxine HCl) was the first SNRI. It works on 5HT, like an
SSRI, but also helps prevent reuptake of NE.
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Cognitive-Behavioral Therapy
1. Clients are taught relaxation and breathing
exercises.
2. The clinician guides clients in identifying the
catastrophizing cognitions they have about
changes in bodily sensations.
3. Clients practice using their relaxation and breathing
exercises while experiencing panic symptoms in
the therapy session.
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Cognitive-Behavioral Therapy,
continued
4. The therapist will challenge clients’ catastrophizing
thoughts about their bodily sensations and teach
them to challenge their thoughts for themselves
5. The therapist will use systematic desensitization
techniques to gradually expose clients to those
situations they most fear while helping them to
maintain control
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Generalized Anxiety Disorder
(GAD)







Excessive anxiety and worry
Difficulty in controlling the worry
Restlessness or feeling keyed-up or on edge
Easily fatigued
Difficulty concentrating
Irritability
Muscle tension and sleep disturbance
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Obsessive-Compulsive Disorder
• a chronic anxiety disorder most commonly
characterized by obsessive, distressing, intrusive
thoughts and related compulsions (tasks or "rituals")
which attempt to neutralize the obsessions.
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Obsessions (as defined by DSM-IV-TR)




Recurrent and persistent thoughts, impulses, or
images that are experienced intrusive and
inappropriate and that cause anxiety or distress
Thoughts, impulses, or images that are not simply
excessive worries about real life problems
Thoughts, impulses or images that the person
attempts to ignore or suppress or to neutralize with
some other thought or action
Obsessive thoughts, impulses or images that the
person recognizes are a product of his or her own
mind
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Compulsions
(as defined by DSM-IV-TR), continued


Repetitive behaviors (such as hand washing,
ordering, checking) or mental acts (such as praying,
counting, repeating words silently) 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 that are aimed at
preventing or reducing distress or preventing some
dreaded event or situation; however, these behaviors
or mental acts are not connected in a realistic way
with what they should prevent
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Treatments for OCD
• Biological Treatments
– as before, mostly psychotropic meds
• Cognitive-behavioral Treatments
– Expose the client to obsessions until anxiety
about obsessions decreases, prevent
compulsive behaviors and help the client
manage anxiety that is aroused. For example,
systematic desensitization may be used to help
a person with a germ obsession gradually
materials.
Chapter 7 tolerate exposure to “dirty”
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Just Checking by Emily Colas
Discuss Assignment
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.