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ANXIETY
DISORDERS
Anxiety vs. Fear
 anxiety:
(future oriented) negative
affect, bodily tension, and
apprehension about the future
 fear:
(reaction to current danger)
immediate alarm in response to
danger – initiates flight or fight
response
Phobias
unrealistic fear of a
specific situation,
activity, or object
Types of specific phobias
 Blood-Injection-Injury
 Situational
Phobia
 Natural
Environment Phobia
 Animal
Phobia
 Other
phobias
Common Phobia Treatments
systematic
desensitization:
combines relaxation with exposure
•
•
•
invivo
imaginal
virtual reality
 http://www.youtube.com/watch?v=JK-vVMMN43Y
flooding:
expose individual directly
to feared stimulus
Social Phobia
DSM criteria:
 Extreme
shyness and fear in social situations
 focus is on situation in which the person is
exposed to unfamiliar people or to possible
scrutiny by others
 person fears will be humiliated or embarrassed
 Avoidance or endure with extreme distress
 Impairment
 Rule out cause by other disorder
Social Phobia: Treatment
Social Phobia: Treatment
(cont.)
 Psychological
•
Cognitive-behavioral treatment
Exposure
Skill building
Group settings
PANIC
Panic Disorder
 At
least one of the panic attacks is
followed by at least a month of (a)
persistent fear of having another attack,
or (b) a significant maladaptive change
in behavior following the attacks.
 The
disturbance is not better
understood by the physiological effects
of a substance or medical condition.
 The
disturbance is not better
understood by another psychological
condition.
Panic Disorder with
Agoraphobia (PDA)
 agoraphobia:
a safe place
fear of being away from
Development of Panic Disorder
Step 1
Real Stressor
Step 2
Step 3
Fear of Having Another Attack
Step 4
Increased Attention to Body
Step 5
More Fear
Summary
The fear of having another panic attack just makes you more frightened.
This “fear of your fear” increases the chances of future attacks.
Solution
1.
Accept, don’t fear your fear.
2.
Actively put your self in situations that cause
fear. This is the only way to eventually get over it.
3.
Use relaxation techniques such as deep breathing
and visualization. These work because one can not
be very relaxed and very tense at the same time.
Treatment for Panic
Disorder:
1) Imipramine (tricyclic antidepressant)
2) SSRIs
3) Exposure and relaxation training
4) Panic control treatment
Example Interoceptive Exposure Exercises
generalized
anxiety
disorder
GAD Symptoms
 continuous
feelings of anxiety;
experienced across situations

continues for at least 6 months
and is uncontrollable more days
than not
 involves
muscle tension, fatigue,
irritability, difficulty sleeping
GAD Treatment
 anxiolytics:
anxiety
drugs that reduce
 Benzodiazepines
 anti-depressants
 cognitive-behavioral
 relaxation
training
treatment
Obsessive
Compulsive
Disorder and
Related
Disorders
DSM-V Criteria for OCD
 Presence
of obsessions or compulsions (or both)
 the person recognizes that the obsessions or
compulsions are excessive or unreasonable (not
required for children)
 they cause marked distress, are time-consuming
(more than 1 hour per day), or interfere with the
person’s functioning
DSM-V Criteria for Obsessions
 recurrent
and persistent thoughts, impulses, or
images
 experienced as intrusive and inappropriate
 cause marked anxiety or distress
 the thoughts are not simply excessive worries
about real-life problems
 the person attempts to ignore or suppress the
thoughts
 the person recognizes that the thoughts are a
product of his or her own mind (not imposed
from outside)
DSM-V Criteria for
Compulsions
 Repetitive
behaviors or mental acts that
the person feels driven to perform in
response to an obsession, or according to
rules that must be applied rigidly
 Behaviors
are aimed at preventing or
reducing distress, or preventing some
dreaded event or situation. However,
behaviors not connected in a realistic way
with what they are designed to prevent, or
are clearly excessive
OCD : Compulsions
 Four
•
•
•
•
major categories
Checking
Ordering
Arranging
Washing/cleaning
http://www.youtube.com/watch?v=
zC2G6lf9fCs&list=PLYL4hYoJA9GcHQt
1Cf1owyPUbs-L2QOjN&index=9
Treatment of OCD


SSRI’s
Exposure and response prevention


How does it compare to medication?
Psychosurgery (cingulotomy)
Obsessive Compulsive Related
Disorders
 Hoarding
Disorder.
 Hair-Pulling
Disorder.
 Excoriation
Disorder.
 Body
Dysmorphic Disorder.
Post Traumatic
Stress Disorder
PTSD
 exposure
to traumatic event
 traumatic
event is reexperienced (e.g.,
recollections, dreams, flashbacks)
 try
to avoid stimuli associated with the trauma
 symptoms
of increased arousal (e.g., problems
sleeping, concentrating)
 negative
alterations of cognitions or mood
PTSD
 acute
stress disorder – PTSD symptoms
have lasted less than one month
 acute
PTSD – symptoms last between 1
and 3 months after event
 chronic
PTSD – symptoms last longer
than 3 months
 delayed
onset – few immediate symptoms
– years later
Treatment of PTSD
 Cognitive-behavioral
•
•
treatment
Exposure
Identify and correct cognitive
distortions.
 SSRI’s
(Prozac, Paxil)