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Welcome to Unit 5:
Anxiety Disorders
Class Business
 Grading
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**Conditional enrollment**
Readings:
• Chapter 4
• Chapter 7, pages 263-270 and 284-292
• The Numbers Count
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Reminders:
• Writing and APA Style
• http://owl.english.purdue.edu/owl/resource/560/01/
Anxiety
 What
is anxiety?
Anxiety
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Anxiety: A state characterized by
negative affect, bodily tension, arousal
and apprehension about the future.
Is anxiety always a bad thing?
Fear
 Fear:
Distress about a specific dangerous
object or situation. It is caused by need
for immediate action and is usually shortlived.
 Protects us by triggering the “fight or flight”
response.
Anxiety Disorders
 All
anxiety disorders can be thought of as
extremely exaggerated versions of normal
feelings such as fear, anxiety and panic.
Case Study: Neal

Neal is a 32 year-old IT specialist. He reports
that for the past 18 months he constantly feels
keyed-up, and unable to relax. He worries about
everything, from his health, to the economy, to
whether he is a good enough husband. He feels
emotionally and physically exhausted. Even
though he is worn out, he can’t sleep. He often
spends hours in bed at night ruminating about
possible disasters or things he might have done
to offend people at work. He is having problems
focusing at work, and is afraid he is going to be
fired because of it.
Generalized Anxiety Disorder
(GAD)

DSM-IV Criteria:
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Excessive anxiety & worry most days for at least 6
months, related to numerous areas of life.
Difficult to control the worry.
3 or more symptoms:
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Restlessness/feeling “keyed up”
Easily fatigued
Problems concentrating, mind going blank
Muscle tension
Sleep problems
Prevalence of GAD
 Past-year
prevalence is about 2%.
 Lifetime prevalence is about 5%.
 More common in women than men.
 Rate is 2x higher in very low income
groups.
Course of GAD
 Gradual
onset typically in late teens or
early adulthood.
 Tends to be persistent if not treated.
Etiology of GAD

Mildly heritable.
 May be related to chronic activation of the
behavioral inhibition system (BIS).

The BIS causes us to freeze, feel anxious and
nervously evaluate the environment to find the threat.
“Kindling Effect”: Groups of neurons that fire
often have lower activation thresholds, and fire
more easily in the future.
 Fear leads to fear.

Treatment of GAD
 Cognitive-Behavioral
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Therapy (CBT):
Superior to medication, long lasting effects.
Learn to identify and control anxious thoughts.
Progressive muscle relaxation.
Case Study: Ally

Ally is a 42 year-old preschool teacher. In the
last year she has been experiencing “spells” that
last about 10 minutes. She gets short of breath,
her heart races, she feels dizzy, her fingers and
toes tingle and she experiences fear that she is
losing her mind. They “come out of the blue.”
She went to the emergency room during her last
spell because she thought she was having a
heart attack. The doctor said she was
healthy, and referred her to see a
therapist.
Panic Attacks

DSM-IV Criteria:
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Discrete period of intense fear/discomfort with four or
more symptoms that develop quickly and peak within
ten minutes.
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Heart palpitations/racing heart
Sweating
Trembling/shaking
Shortness of breath/feeling like choking
Chest pain
Nausea
Dizziness, lightheadedness
Derealization (feelings of unreality) or depersonalization (being
detached from oneself)
Fear of losing control/going crazy
Fear of dying
Numbness/tingling
Chills or hot flushes
Agoraphobia
 Literally
“fear of the marketplace.”
 Agoraphobia is fear and avoidance of
situations where it would be perceived to
be unsafe to have a panic attack.
Panic Disorder
 DSM-IV
Criteria:
 Recurrent unexpected panic attacks.
 At least 1 attack followed by 1 month of at
least 1 symptom:
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Persistent concern about having other
attacks.
Worry about implications/consequences of
attack.
Significant change in behavior related to the
attacks.
Prevalence of Panic Disorder
 Lifetime
Prevalence is 3.5%
 12-month prevalence is 2.3%
 More common in women, especially with
agoraphobia.
 Men likely to cope with alcohol.
 Prevalence similar across U.S. ethnic
groups.
Course of Panic Disorder
 Onset
in early adulthood, mean age is
25-29.
 Panic attacks don’t usually occur before
puberty.
Etiology of Panic Disorder
 Due
to an interaction of psychological and
biological factors.
 Some people are genetically predisposed
to panic—they have an easily triggered
“fight or flight response”.
 Seem to be more likely to catastrophically
interpret bodily sensations.
Etiology of Panic Disorder
 Upon
the experience of such panic,
psychological factors determine whether
they expect subsequent attacks.
 Agoraphobia is socially or culturally
determined after someone has a panic
attack.
Treatment of Panic Disorder
 Psychological
Treatment:
 Panic Control Therapy
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Highly effective (80-100% panic free after
12 weeks!)
Purposeful induction of panic.
Cognitive therapy.
Breathing exercises, progressive muscle
relaxation.
Gradual exposure to agoraphobic
situations.
Case Study: Lucy

Lucy is a 19 year-old college student. Two
months ago, she was raped by her ex-boyfriend
in a car after a football game. Since the rape,
she can’t stop thinking about what happened.
She has nightmares about it, and sometimes
feels as though she is in the back of the car
again. Whenever she sees a car like the one
her ex-boyfriend drives she experiences
paralyzing fear. She finds that he is having
trouble sleeping, and constantly feels on edge,
like she needs to be scanning the room for men
who might try to harm her.
PTSD Criteria
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Exposure to a traumatic event where:
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Person saw, experienced or was
confronted with events that involved actual
or threatened death or serious injury, or a
threat to physical integrity of self or others.
AND
Person felt fear, helplessness or horror.
PTSD Criteria
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The event is repeatedly re-experienced
in 1 or more ways:
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Intrusive memories, thoughts, images
Nightmares
Re-living the experience
Intense physical or physiological distress
when exposed to cues that remind of
event.
PTSD Criteria
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Persistent avoidance of stimuli
associated with the trauma.
Numbing of general responsiveness
Persistent increased arousal (problems
sleeping, irritability/anger,
hypervigilance, exaggerated startle
response, etc.)
All symptoms must last more than 1
month.
PTSD

About 8% of people will experience
PTSD.
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Most cases are due to combat or sexual
assault.
PTSD may last from months to a
lifetime.
Etiology of PTSD
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Trauma.
May be a genetic vulnerability to anxiety
that  risk for PTSD.
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This vulnerability is more important when
the trauma is less severe.
Treatment of PTSD
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Psychotherapy is most effective
treatment.
Therapy generally focuses on reliving
and describing traumatic events and
experiencing feelings about it.
Case Study: Mike
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Mike is a 39 year-old landscaper. He often worries
about the possibility that his wife and children will be
killed in a car accident. He can’t help thinking horrible
thoughts about it, often imagining how their dead bodies
would look. Whenever he has these thoughts, he recites
three “Hail Mary” prayers and performs a discreet finger
tapping ritual. If he does not say the prayers perfectly or
tap his fingers evenly and without error he has to start
over, or else his family may be killed. Sometimes, if the
thoughts are especially bad, he also has to recite all of
the prime numbers backward from 100, 100 times. He
often spends hours each day doing these rituals.
OCD Criteria
 Characterized
by obsessions or
compulsions (often both).
 Causes distress, is time-consuming (1
hr/day or more), or interferes with daily
functioning.
Obsessions
 Obsessions
are nonsensical thoughts,
images or urges that the person tries to
resists or eliminate.
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Contamination
Impulses
Sexual ideas
Somatic (bodily) concerns
Need for symmetry
Compulsions
 Compulsions
are thoughts or actions used
to suppress obsessions and provide relief
from them.
 Also can be due to rigid internal rules,
often to prevent a dreaded event.

May be behaviors (like hand-washing,
checking) or mental (like counting, praying
etc.)
Demographics
 Lifetime
prevalence about 3%.
 More common in adult women, but in kids
more common in boys.
 Age of onset is adolescence to mid-20’s.
 Onset is usually gradual but may be
sudden after a trauma (such as rape).
 Typically a chronic disorder.
Etiology of OCD
 Certain
people more likely to be anxious.
 People with OCD more likely to have
anxious relatives.
 Early experiences teaches certain
thoughts are dangerous/unacceptable.
 Seems to be related to fundamentalist
religious beliefs.
Psychosocial Treatment of OCD
 Exposure
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and response-prevention
Based on the idea of “reality testing.”
Questions or comments?