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Nature of Anxiety and Fear
 Differences between Anxiety and Fear
 Normal Emotional States?
 Roller Coaster Ride
 Driving on the freeway
 Taking a test
Yerkes-Dodson Law
Characteristics of Anxiety Disorders
 Pervasive and persistent symptoms of anxiety and fear
 Excessive avoidance and escape tendencies
 Clinically significant distress and impairment
 Are the most common forms of psychopathology
Factors in Anxiety and Fear
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Biological Explanation
Freudian Explanation
Behavioral Views
Cognitive Views
Social Factors
Cultural Factors
Biological Factors of Anxiety and Panic
 Genetic vulnerability
 Anxiety and brain circuits
 Depleted levels of GABA
 Corticotropin releasing factor (CRF) and HYPAC axis
 Limbic (amygdala) and the
septal-hippocampal systems
 Behavioral inhibition (BIS)
 Fight/flight (FF) systems
Psychological Factors of Anxiety and Fear
 Began with Freud
 Anxiety is a psychic reaction to fear
 Anxiety involves reactivation of an infantile fear situation
 Behavioral and cognitive views
 Invokes conditioning and cognitive explanations
 Anxiety and fear are learned responses
 Catastrophic thinking and appraisals play a role
 Early childhood contributions
 Experiences with uncontrollability and unpredictability
 Social contributions
 Stressful life events trigger vulnerabilities
 Cultural Expectations
Fig. 4-2, p. 123
Anxiety Disorders Categories
 Generalized Anxiety Disorder
 Panic Disorder with and without
Agoraphobia
 Specific Phobias
 Social Phobia
 Posttraumatic Stress Disorder
 Obsessive-Compulsive Disorder
Generalized Anxiety Disorder
 Worry
 About Everything
 Worrying is Unproductive (Interferes with
Functioning)
 Strong, Persistent
 Uncontrollable
 Somatic symptoms
 Differ from panic (e.g., muscle tension, fatigue,
irritability)
“Do you worry excessively about minor things?”
Fig. 4-3, p. 127
Treatment of GAD
 Generally Weak
 Benzodiazepines
 Most often prescribed
 Offers some relief
 Psychological interventions
 Cognitive-Behavioral Therapy
 Including “exposure” to worries
Symptoms of Panic Attacks
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Palpitations / Sweating
Trembling / Shaking
Shortness of Breath
Feeling of Choking
Feeling of Dying
Loss of Control
Derealization
 Connection to?
Panic Attack
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Abrupt Autonomic Surge
Intense Fear or Discomfort
Unexpected and Uncontrollable
Absence of Actual Threat
 “False Alarm”
Panic Disorder
 An Unexpected Panic Attack
 Develop Anxiety Over:
 The Next Attack or
 The Implications of the Attack and
Consequences
 Agoraphobia is Common
 “Fear of the Marketplace”
 Consequence of Unexpected Panic Attacks
 Can be a separate disorder
Fig. 4-5, p. 133
Panic Disorder Treatment
 Medication Treatment of Panic Disorder
 Benzodiazepines
 Relapse and avoidance
 SSRIs
 Preferred drugs
 Relapse rates are high following medication
discontinuation
 Psychological and Combined Treatments
 Cognitive-behavior therapies seem highly effective
 Panic Control Treatment
 Graded Exposure plus Coping Skills
 Combined treatments do well in the short term
 Some indication that CBT alone is most effective
Fig. 4-6, p. 136
Types of Specific Phobia
 Natural Environment
 Water, spaces, storms, etc.
 Often more than one
 Peak onset about 7 years old
 Animals
 Snakes, spiders, dogs, etc.
 Blood-Injection Injury
 Situational
 Planes, heights, etc.
 Separation anxiety/school phobia
 Others, including…
Specific Phobia Diagnosis
 Extreme and irrational fear of a specific
object or situation
 Go to great lengths to avoid phobic objects
 Often recognize fears are unreasonable
 Markedly interferes with one's ability to
function
Fig. 4-7, p. 142
Treatment of Specific Phobias
 Psychological Treatments
 Cognitive-behavior therapies are highly effective
 Graduated exposure-based exercises
 Structured and consistent
 Systematic Desensitization
 Prevent Avoidance/Escape
 Blood/Injection Phobia Different
 Actually Increase Tension to Prevent Fainting
Social Phobia Diagnosis
 Marked and Persistent Fear of
 Social or Performance Situations
 Often avoid social situations or endure them
with great distress
 Most Common Type of Social Fear?
 Public Speaking
 Interferes with Life Functioning
Fig. 4-8, p. 146
Treatment for Social Phobia
 Medication Treatment of Social Phobia
 Antidepressants
 Tricyclics and MAO Inhibitors
 SSRIs
 Paxil, Zoloft, Effexor FDA approved
 High relapse rates following discontinuation
 Psychological Treatment
 Cognitive-behavioral treatment
 Exposure, rehearsal, role-play in a group
setting
 Highly effective
Posttraumatic Stress Disorder (PTSD)
 Exposure to a traumatic event
 War and Combat
 Rape and Assault
 Car Accidents
 Natural Disasters
 Re-experience the event (e.g., memories, nightmares,
flashbacks)
 Avoidance of cues that remind person of event
 Emotional numbing, sleep disturbance, hyperarousal, and
interpersonal problems are common
 Markedly interferes with one's ability to function
Subtypes of Post Traumatic Stress
 Acute Stress Disorder
 Immediately post-trauma
 Acute PTSD
 1-3 months post trauma
 Chronic PTSD
 3+ months post trauma
 Delayed Onset PTSD
 Onset of symptoms 6 months or more post
trauma
Fig. 4-10, p. 153
PTSD Treatment
 Psychological Treatment of PTSD
 Cognitive-behavioral treatment
 Face the Original Trauma
 Imaginal Reexposure
 Flooding
 Corrective Emotional Learning
 Virtual Reality
 Increase positive coping skills and social support
 Cognitive-behavior therapies are highly effective
 Eye Movement Desensitization and Retraining (EMDR)
 Controversial, but has research support
Obsessive-Compulsive Disorder
 Culmination of All Anxiety Disorders
 Obsessions
 Intrusive Thoughts, Images, or Urges
 Attempts to Suppress or Eliminate
 Compulsions
 Thoughts or Actions
 Attempts to Suppress the Obsessions
 Attempts to Obtain Relief
 Most people with OCD display multiple obsessions
 Most Common Problem?
 Cleaning and washing or checking rituals
 NOT the same as Obsessive-Compulsive Personality
Disorder
Fig. 4-11, p. 157
Treatment for OCD
 Biological Interventions
 SSRIs seem to benefit up to 60% of patients
 Limited extent of help
 Relapse is common with medication discontinuation
 Psychosurgery (cingulotomy) is used in extreme cases
 Psychological Treatment
 Cognitive-behavioral therapy is most effective with OCD
 Exposure and response prevention
 Combining medication with CBT may be no better than
CBT alone
Factors in Treating Anxiety Disorders
 Biological Interventions
 Cognitive-Behavioral Interventions
 What about:
 Psychoanalytic Interventions
 Existential Interventions
 Humanistic Interventions
 Constructivist Interventions
 And, then again, what about:
 Social Interventions
 Cultural Interventions
Comorbidity
 Comorbidity is common across the anxiety disorders
 About half of patients have two or more secondary
diagnoses
 Major depression is the most common secondary
diagnosis
 Comorbidity suggests common factors across anxiety
disorders
 Comorbidity suggests a relation between anxiety and
depression
pp. 162-163