Download Anxiety Disorders - Terri L. Weaver, Ph.D.

Anxiety Disorders
Fundamental Features of Anxiety
Disorders
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Fear and Threat
Effortful Avoidance
Compulsions or Rituals
Detachment
Experiential Avoidance
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A person is unwilling to remain in contact with particular private
experiences (e.g., bodily sensations, emotions, thoughts,
memories, images, behavioral predispositions) and takes steps
to alter the form or frequency of these experiences or the
contexts that occasion them, even when these forms of
avoidance cause behavioral harm
Multidimensional Construct
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Three Categories
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Subjective Distress (Cognitive Symptoms)
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Physiological Responses
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Worry about specific events harm/danger
Broader constellation of anxious cognitions
Sympathetic nervous system
Tachycardia
Tremulousness
Dizziness
Lightheadedness
Parathesias
Dyspnea
Avoidance or Escape Behaviors
Anxiety symptom baserates
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1/3 of nonclinical populations have had
symptoms of a panic attack at some time
in their lifetimes
90% of nonclinical populations have had
obsessive thoughts no different from OCD
Types of Anxiety Disorders
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Panic Disorder (w/o Agoraphobia)
Agoraphobia without panic
Social Anxiety Disorder
Specific Phobia
Obsessive Compulsive Disorder
Posttraumatic Stress Disorder
Acute Stress Disorder
Generalized Anxiety Disorder
Other Anxiety Conditions secondary to medical
conditions
Medical Conditions and Other
Etiologies
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Mitral valve prolapse
Hypothyroidism
Cardiovascular problems
Vestibular abnormalities
Hyperthyroidism
Cushing’s Syndromes
Alcohol, caffeine, amphetamines, cannabis,
cocaine, hallucinogens, inhalants, phencyclidine,
sedatives, hypnotics, anxiolytics and a host of
medications
Comorbidity
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½ of patients with an anxiety disorder
have had at least one other clinically
significant anxiety or depressive disorder
diagnosis
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Panic Disorder with Agoraphobia had the
highest comorbidity rates
GAD and Social Phobia had the highest rates
as assignments to other disorders (e.g.
depression or other anxiety disorders)
Prevalence
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Anxiety disorders are very prevalent second only
to substance abuse (LT) and highest (past year)
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31% lifetime rate; 18.7% past year rate
Most common are social phobia and specific phobia
Women experience anxiety dx 2x rate of men
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Exceptions are that social phobia is disproportionate but not
as great
OCD rates are roughly comparable for men and women
Diatheses
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Evidence for heritability for the broad category
of anxiety disorders and
Specific category for panic, agoraphobia, social
phobia and OCD (less evidence for GAD and
specific phobia)
Depression and anxiety may share common
genetic factors
Modest support for genetic markers for AD,
better evidence for genetic marker for
temperament
Personality
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Children who were more inhibited at
earlier ages evidenced more social
inhibition as adults
Theories
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Mower’s Two Factor Theory
Exposure Therapy
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Guidelines for Exposure
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Identify the entire stimulus complex (including verbal
processes)
Avoid small exposures that potentiate fear
Be attuned to escape behavior
When escape is blocked watch out for frustration/anger
Reconditioning of fear occurs more rapidly than the original
conditioning
Panic Disorder: Phenomenology
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Misinterpretation of bodily sensations. Fear of
physical sensations.
A panic attack appears at inappropriate or
unexpected times with no apparent stimulus.
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Intense fear and discomfort
Palpitations
Smothering
Dizziness
Losing Control
Fear of dying or going crazy
Peak within 10 minutes often within 1-5 minutes
Physiology of Panic
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Panic is an emergency response
If safe, look for explanation of symptoms
Sympathetic system either runs its course or the
parasympathetic system takes our and stops the
response
Cardiovascular effects
Respiratory effects
Sweat glands
Effect of overbreathing