Download Anxiety Disorders - Kelley Kline Phd

Anxiety Disorders
“The Dark side of Fear”
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.
Anxiety Disorders:

Phobias
 panic disorder
 generalized anxiety disorder
 obsessive-compulsive disorder
 posttraumatic stress disorder
 acute stress disorder
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.
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)
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)

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Lifetime prevalence: 7% (men) and 16% (women).
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)
What causes phobias?

Data show we learn phobias, they are not innate.

We learn phobias by:

1. Classical & operant conditioning (avoidance
learning)

2. Modeling (observational learning)
Modeling:

We learn phobias by observing others’ fear to
the object or event.

Do we need to observe the person’s fear
response to the stimulus & the stimulus
itself?

Yes!!!!
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
monkey’s fear.

Later when shown the snake, the lab-reared
monkey didn’t show fear to the snakes.

You need to see the other person’s response to the
feared stimulus & the stimulus itself for phobia
formation.
Therapy for phobias:

Systematic desensitization

Flooding
B. Generalized Anxiety Disorder (GAD)

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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.
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.
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.)
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.
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.
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.
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.
C. Panic Disorder
attacks.

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– characterized by
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).
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.
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.
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.
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.
Therapies for Panic disorder and agoraphobia

Biological:
1. Antidepressants & anxiolytics can reduce
frequency of attacks.
Psychological: Barlow’s therapy (well validated):
3 components:
1. Relaxation training2. A combination of Ellis & Beck type cognitive
behavioral interventions
3. Exposure to the internal cues that trigger panic
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
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.
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.
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.
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.
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
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.
F. Acute Stress Disorder

an individual encounters a traumatic
experience that causes problems with social
or occupational functioning for less than 1
month.