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Anxiety Disorders
Chapter 3
• The Complexity of Anxiety Disorders
• Generalized anxiety disorder
• Panic disorder with and without
• Specific Phobia
• Social Phobia
• Posttraumatic Stress Disorder
• Obsessive-Compulsive Disorder
The complexity of Anxiety
• Anxiety
– Negative mood state characterized by bodily
symptoms of physical tension, and apprehension
about the future
• Fear
– Immediate alarm reaction to present danger activating
a massive response from the autonomic nervous
system (flight or fight)
• Panic attack
– Abrupt experience of intense fear or discomfort in the
absence of danger accompanied by physical
symptoms (dizziness, heart palpitations, chest, pain,
shortness of breath)
Anxiety and its causes
• Causes of Anxiety
– Biological contributions
• Inherited tendency to be tense, behavioral inhibition system
(anxiety), flight or fright system (panic)
– Psychological contributions
• Early childhood (overprotective and overintrusive parents,
psychological vulnerability
– Social contributions
• Social pressures (family, job, school)
– Comorbidity of anxiety disorders
• Co-occurrence of two or more disorders in a single individual
(high (50%) in anxiety disorders)
Generalized anxiety disorder
• Intense, uncontrollable, unfocused, chronic, and
continuous worry and mental agitation that is distressing
and unproductive accompanied by physical symptoms of
tenseness, irritability and restlessness (generalized to
everyday life)
• 4% of population (two thirds are women), onset in early
• Psychological treatments (CBT, meditation) have approx.
the same benefit as drugs (benzodiazepines) but are
better in the long term
• Cognitive-Behavioral Therapy (CBT)
– systematic exposure to anxiety-provoking situations or thoughts
– learning to substitute positive behaviors and thoughts for
negative ones
– learning new coping skills; relaxation, meditation, breathing
Generalized anxiety disorder
Panic disorder with and without
• Individuals experience severe unexpected panic
attacks, they may think they’re dying Y
• Agoraphobia is fear and avoidance of situations
in which they would feel unsafe in the event of a
panic attack (e.g. public places, “fear of market
• 3.5% of population (two thirds are women),
onset in early adulthood
• Treatment usually involves medication
(antidepressants) but it has high levels of
relapse (20-50%), psychological treatments
involve gradual exposure combined with coping
exercises (panic control treatment)
Specific phobia
• Irrational fear of a specific object or situation that
markedly interferes with an individual’s ability to
function Y-Snake Phobia
• There are four major subtypes of specific phobia
Animal type
Natural environment type (heights, storms, water)
Blood-injection-injury phobia (runs in families)
Situational phobia (planes, elevators, claustrophobia)
Other (e.g. choking, contracting an illness)
• 11% of population with different onsets
• Treatment consists of exposure-based therapy
Social phobia
• Extreme, enduring, irrational fear and avoidance
of social or performance situations Y-Virtual Reality
• Social phobia generalized type vs. performance
• 13.3.% of population at some point in their lives
(favors females only somewhat); onset 15 years
of age
• The most effective treatment is cognitive
behavioral group therapy; medication in severe
cases (antidepressants)
Social phobia
Posttraumatic stress disorder
• Enduring, distressing emotional disorder that follows
exposure to a severe helplessness or fear-inducing
threat Y - PTSD
• It is characterized by reexperiencing the trauma,
avoiding stimuli associated with it, increased vigilance
and arousal, sometimes suicidal thoughts and attempts,
and sometimes memory impairments
• Acute PTSD (1-3 months after event) or chronic PTSD
(more than 3 months)
• Combat and sexual assault are the most common
• Treatments – catharsis, gradual imaginal exposure,
possibly antidepressants
Obsessive-compulsive disorder
• Anxiety disorder involving unwanted, persistent,
intrusive thoughts and impulses as well as
repetitive actions intended to suppress them
• Most frequent obsessions (contamination,
sexual content, aggressive impulses, need for
symmetry) and compulsions (checking, ordering,
arranging, washing, cleaning)
• 2.6% of population (majority female)
• Exposure and ritual prevention and CBT
• Y-OCD patient