* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Durand and Barlow Chapter 4: Anxiety Disorders
Autism spectrum wikipedia , lookup
Gender dysphoria wikipedia , lookup
Moral treatment wikipedia , lookup
Mental status examination wikipedia , lookup
Obsessive–compulsive personality disorder wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Classification of mental disorders wikipedia , lookup
Controversy surrounding psychiatry wikipedia , lookup
Excoriation disorder wikipedia , lookup
Mental disorder wikipedia , lookup
Posttraumatic stress disorder wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Depersonalization disorder wikipedia , lookup
History of psychiatry wikipedia , lookup
Emergency psychiatry wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Asperger syndrome wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Conduct disorder wikipedia , lookup
Conversion disorder wikipedia , lookup
Selective mutism wikipedia , lookup
Spectrum disorder wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
History of mental disorders wikipedia , lookup
Obsessive–compulsive disorder wikipedia , lookup
Child psychopathology wikipedia , lookup
Abnormal psychology wikipedia , lookup
Panic disorder wikipedia , lookup
Anxiety disorder wikipedia , lookup
Claustrophobia wikipedia , lookup
Treatments for combat-related PTSD wikipedia , lookup
Chapter 4 Anxiety Disorders Nature of Anxiety and Fear • Fear – The Present-Oriented Mood State – Immediate fight or flight response to danger or threat – Involves abrupt activation of the sympathetic nervous system – Strong avoidance/escapist tendencies – Marked negative affect Nature of Anxiety and Fear • Anxiety – The Future-Oriented Mood State – Apprehension about future danger or misfortune – Somatic symptoms of tension – Characterized by marked negative affect • Anxiety and Fear are Normal Emotional States From Normal to Disordered Anxiety and Fear • Characteristics of Anxiety Disorders – Pervasive and persistent symptoms of anxiety and fear – Involve excessive avoidance and escape – Cause clinically significant distress and impairment The Phenomenology of Panic Attacks • What is a Panic Attack? – Abrupt experience of intense fear or discomfort – Several physical symptoms (e.g., breathlessness, chest pain) – Fear as an alarm response The Phenomenology of Panic Attacks (continued) • DSM-IV-TR Subtypes of Panic Attacks – Situationally bound (cued) – Unexpected (uncued) – Situationally predisposed Fig. 4.1, p. 126 Biological Contributions to Anxiety and Panic • Genetic Vulnerability • Anxiety and brain circuits – Depleted levels of GABA • Corticotropin releasing factor (CRF) and HYPAC axis Biological Contributions to Anxiety and Panic (continued) • Limbic (amygdala) and the septalhippocampal systems • Behavioral inhibition (BIS) – Anxiety • Fight/flight (FF) systems – Fear Psychological Contributions to Anxiety and Fear • Began with Freud – Anxiety is a psychic reaction to fear – Anxiety involves reactivation of an infantile fear situation Psychological Contributions to Anxiety and Fear (continued) • Behavioral and Cognitive Views – Invokes conditioning and cognitive explanations – Anxiety and fear are learned responses – Catastrophic thinking and appraisals play a role Psychological Contributions to Anxiety and Fear (continued) • Early Childhood Contributions – Experiences with uncontrollability and unpredictability • Social Contributions – Stressful life events trigger vulnerabilities An Integrated Model • Integrative View – Triple Vulnerability Model – Generalized biological vulnerability – Generalized psychological vulnerability – Specific psychological vulnerability An Integrated Model (continued) • Common Processes: The Problem of Comorbidity – Comorbidity is common across the anxiety disorders – Major depression is the most common secondary diagnoses An Integrated Model (continued) – About half of patients have two or more secondary diagnoses – Comorbidity Suggests • Common factors • A relation between anxiety and depression The Anxiety Disorders: An Overview • Generalized Anxiety Disorder • Panic Disorder with and without Agoraphobia • Specific Phobias • Social Phobia • Posttraumatic Stress Disorder • Obsessive-Compulsive Disorder “Do you worry excessively about minor things?” Fig. 4.3, p. 132 Generalized Anxiety Disorder: The “Basic” Anxiety Disorder • Overview and Defining Features – Excessive uncontrollable anxious apprehension and worry – Coupled with strong, persistent anxiety – Persists for 6 months or more – Somatic symptoms differ from panic (e.g., muscle tension) Generalized Anxiety Disorder: The “Basic” Anxiety Disorder (continued) • Statistics – Affects about 4% of the general population – Females outnumber males approximately 2:1 – Onset is often insidious, beginning in early adulthood – Very prevalent among the elderly – Tends to run in families Generalized Anxiety Disorder: Associated Features and Treatment • Associated Features – Persons with GAD have been called “autonomic restrictors” – Fail to process emotional component of thoughts and images • Treatment of GAD: Generally Weak – Benzodiazapines – Often Prescribed – Psychological interventions – CognitiveBehavioral Therapy – Combined treatments – Acute vs. LongTerm Outcomes Fig. 4.4, p. 134 Panic Disorder With and Without Agoraphobia • Overview and Defining Features – Experience of unexpected panic attack (i.e., a false alarm) – Develop anxiety, worry, or fear about another attack – Many develop agoraphobia Panic Disorder With and Without Agoraphobia (continued) • Facts and Statistics – Affects about 3.5% of the general population – Onset is often acute, beginning between 25 and 29 years of age – 75% of individuals with agoraphobia are female Panic Disorder: Associated Features and Treatment • Associated Features – Nocturnal panic attacks – 60% panic during deep non-REM sleep – Interoceptive/exteroceptive avoidance • Medication Treatment – Target serotonergic, noraadrenergic, and GABA systems – SSRIs (e.g., Prozac and Paxil) are preferred drugs – Relapse rates are high following medication discontinuation Panic Disorder: Associated Features and Treatment (continued) • Psychological and Combined Treatments – Cognitive-behavior therapies are highly effective – No evidence that combined treatment produces better outcome – Best long-term outcome is with cognitivebehavior therapy alone Specific Phobias: An Overview • Overview and Defining Features – Extreme irrational fear of a specific object or situation – Persons will go to great lengths to avoid phobic objects – Most recognize that the fear and avoidance are unreasonable – Markedly interferes with one’s ability to function Specific Phobias: An Overview (continued) • Facts and Statistics – Females are again over-represented – Affects about 11% of the general population – Phobias tend to run a chronic course Specific Phobias: Associated Features and Treatment • Associated Features and Subtypes of Specific Phobia – Blood-injury-injection phobia – Unusual vasovagal response – Situational phobia – Trains, planes, automobiles, closed spaces – Natural Environment phobia – Natural events (e.g., heights, storms) – Animal phobia – Animals and insects – Separation Anxiety – Seen in children Specific Phobias: Associated Features and Treatment (continued) • Causes of Phobias – Biological and evolutionary vulnerability – Three pathways -- Conditioning, observational learning, information • Psychological Treatments of Specific Phobias – Cognitive-behavior therapies are highly effective – Exposure Fig. 4.8, p. 150 Social Phobia: An Overview • Overview and Defining Features – Extreme and irrational fear in social/performance situations – Markedly interferes with one’s ability to function – Often avoid social situations or endure them with great distress – Generalized subtype – Affects many social situations Social Phobia: An Overview (continued) • Facts and Statistics – Affects about 13% of the general population – Prevalence is slightly greater in females than males – Onset is usually during adolescence – Peak age of onset at about 15 years Social Phobia: Associated Features and Treatment • Causes – Biological and evolutionary vulnerability – Similar learning pathways as specific phobias • Psychological Treatment – Cognitive-behavioral treatment – Cognitive-behavior therapies are highly effective Social Phobia: Associated Features and Treatment (continued) • Medication Treatment – Tricyclic antidepressants and monoamine oxidase inhibitors – SSRIs Paxil, Zoloft, and Effexer – Are FDA approved – Relapse rates are high following medication discontinuation Posttraumatic Stress Disorder (PTSD): An Overview • Overview and Defining Features – Main etiologic characteristics – Trauma exposure and response – Reexperiencing (e.g., memories, nightmares, flashbacks) – Avoidance Posttraumatic Stress Disorder (PTSD): An Overview (continued) – Emotional numbing and interpersonal problems – Markedly interferes with one's ability to function – PTSD diagnosis – Only after 1 month posttrauma Posttraumatic Stress Disorder (PTSD): An Overview (continued) • Statistics – Combat and sexual assault are the most common traumas – About 7.8% of the general population meet criteria for PTSD Posttraumatic Stress Disorder (PTSD): Causes and Associated Features • Subtypes and Associated Features of PTSD – Acute – May be diagnosed 1-3 months post trauma – Chronic – Diagnosed after 3 months post trauma – Delayed onset – Onset 6 months or more post trauma – Acute stress disorder – PTSD immediately post-trauma Posttraumatic Stress Disorder (PTSD): Causes and Associated Features (continued) • Causes of PTSD – Intensity of the trauma and one's reaction to it (i.e., true alarm) – Learn alarms -- Direct conditioning and observational learning – Biological vulnerability – Uncontrollability and unpredictability – Extent of social support, or lack thereof post-trauma Posttraumatic Stress Disorder (PTSD): Treatment • Psychological Treatments – Cognitive-behavior therapies (CBT) are highly effective – CBT may include graduated or massed (e.g., flooding) imaginal exposure – Aim of CBT for PTSD Obsessive-Compulsive Disorder (OCD): An Overview • Overview and Defining Features – Obsessions - Intrusive and nonsensical thoughts, images, or urges – Compulsions - Thoughts or actions to neutralize thoughts – Vicious cycle of obsessions and compulsions – Cleaning and washing or checking rituals are common Obsessive-Compulsive Disorder (OCD): Causes and Associated Features • Statistics – Affects about 2.6% of the general population – Most with OCD are female – Onset is typically in early adolescence or young adulthood – OCD tends to be chronic Obsessive-Compulsive Disorder (OCD): Causes and Associated Features (continued) • Causes of OCD – Parallels the other anxiety disorders – Early life experiences – Learning that some thoughts are dangerous/unacceptable – Thought-action fusion -- The thought is similar to the action Obsessive-Compulsive Disorder (OCD): Treatment • Medication Treatment – Clomipramine and other SSRIs – Benefit up to 60% of patients – Relapse is common with medication discontinuation – Psychosurgery (cingulotomy) is used in extreme cases Obsessive-Compulsive Disorder (OCD): Treatment (continued) • Psychological Treatment – Cognitive-behavioral therapy is most effective – CBT involves exposure and response prevention – Combining CBT with medication -- No better than CBT alone Summary of the Anxiety Disorders • Most Common Forms of Psychopathology • From a Normal to a Disordered Experience of Anxiety and Fear – Triple Vulnerabilities – Bio-psycho-social – Fear and anxiety – Non-dangerous bodily or environmental cues – Symptoms and avoidance – Significant distress and impairment Summary of the Anxiety Disorders (continued) • Psychological Treatments are Generally Superior in the Long-Term – Similar treatments for different anxiety disorders – Suggests that anxiety-related disorders share common processes