Download Abnormal Psych

Chapter 7
Anxiety Disorders
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Fears of People with Anxiety
Disorders



Severe enough to lower the quality of life
Chronic and frequent enough to interfere with
functioning
Out of proportion to the dangers that they
truly face
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Symptoms of Anxiety
Chapter 7
Somatic
Emotional
Cognitive
Behavioral
Goosebumps emerge
Muscles tense
Heart rate increases
Respiration accelerates
Respiration deepens
Spleen contracts
Peripheral blood vessels
dilate
Liver releases
carbohydrates
Bronchioles widen
Pupils dilate
Perspiration increases
Adrenaline is secreted
Stomach acid is inhibited
Salivation decreases
Bladder relaxes
Sense of dread
Terror
Restlessness
Irritability
Anticipation of
harm
Exaggerating of
danger
Problems in
concentrating
Hypervigilance
Worried, ruminative
thinking
Fear of losing
control
Fear of dying
Sense of unreality
Escape
Avoidance
Aggression
Freezing
Decreased
appetitive
responding
Increased
aversive
responding
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Panic Disorder Theories
• Neurotransmitter theories
– Poor regulation of norepinephrine, serotonin, and perhaps GABA and
CCK in the locus ceruleus and limbic systems, causes panic disorder
• Kindling model
– Poor regulation in the locus ceruleus causes panic attacks,
stimulates and kindles the limbic system, lowering the threshold
for stimulation of diffuse and chronic anxiety
• Suffocation false alarm theory
– The brains of people with panic disorder are hypersensitive to
carbon dioxide and induce the fight-or-flight response with small
increases in carbon dioxide
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Locus Ceruleus


The locus ceruleus is studied in relation to clinical
depression, panic disorder, and anxiety.
Psychiatric research has documented that enhanced
noradrenergic postsynaptic responsiveness in the
neuronal pathway (brain circuit) that originates in the
locus ceruleus and end in the basolateral nucleus of
the amygdala is a major factor in the
pathophysiology of most stress-induced fear-circuitry
disorders and especially in posttraumatic stress
disorder (PTSD).
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
GABA

The brain's principal inhibitory
neurotransmitter, g-amino-butyric acid
(GABA), along with serotonin and
norepinephrine, is one of several
neurotransmitters that appear to be involved
in the pathogenesis of anxiety and mood
disorders.
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
CCK

Cholecystokinin - is a peptide hormone of
the gastrointestinal system responsible for
stimulating the digestion of fat and protein

In humans, it has been suggested that CCK
administration causes nausea and anxiety
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Panic Disorder Theories, continued
• Genetic Theories
– Disordered genes put some people at risk for panic disorder
• Cognitive Theories
– People prone to panic attacks (1) pay very close attention to
their bodily sensations, (2) misinterpret these sensations, and (3)
engage in snowballing, catastrophizing thinking
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Kindling Model of Panic Disorder
Poor regulation in locus ceruleus
Panic Attacks
Lowers threshold for chronic anxiety in limbic system
Chronic anxiety increases likelihood
of dysregulation
in locus ceruleus
Panic Attacks
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Biological Treatments

Tricyclic antidepressants
–
Increase levels of norepinephrine and a number of other
neurotransmitters
• Serotonin reuptake
Increase levels of serotonin
• Benzodiazepines
–
–
Chapter 7
Suppress the central nervous system and influence functioning in
the GABA, norepinephrine, and serotonin neurotransmitter systems
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Cognitive-Behavioral Therapy
1. Clients are taught relaxation and breathing
exercises.
2. The clinician guides clients in identifying the
catastrophizing cognitions they have about
changes in bodily sensations.
3. Clients practice using their relaxation and breathing
exercises while experiencing panic symptoms in
the therapy session.
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Cognitive-Behavioral Therapy,
continued
4. The therapist will challenge clients’ catastrophizing
thoughts about their bodily sensations and teach
them to challenge their thoughts for themselves
5. The therapist will use systematic desensitization
techniques to gradually expose clients to those
situations they most fear while helping them to
maintain control
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Phobic Disorders
Agoraphobia
Fear of places where help might not
be available in case of an emergency
Specific Phobias
Fear of specific objects, places or
situations
 Animal type
 Natural environment type
 Situational type
 Blood-injection-injury type
Social Phobia
Chapter 7
Fear of being judged or embarrassed
by others
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Treatment of Phobias
Behavioral
1)
2)
3)
Cognitive-Behavioral
Systematic desensitization
Modeling
Flooding
Helps clients identify and
challenge negative,
catastrophizing thoughts
about feared situations
Biological
Reduce symptoms of anxiety
generally so that they do not
arise in the feared situation
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Generalized Anxiety Disorder
(GAD)







Excessive anxiety and worry
Difficulty in controlling the worry
Restlessness or feeling keyed-up or on edge
Easily fatigued
Difficulty concentrating
Irritability
Muscle tension and sleep disturbance
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
GAD Theories

Psychodynamic Theories
–
–
Realistic anxiety - fear of real-world events
Neurotic anxiety - the unconscious worry that
we will lose control of the id's urges, resulting in
punishment for inappropriate behavior.
– Moral anxiety - a fear of violating our own moral
principles
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
GAD Theories (cont.)



Humanistic and Existential Theories
– Conditions of worth and existential anxiety
Cognitive Theory
Biological Theories
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Obsessions (as defined by DSM-IV-TR)




Recurrent and persistent thoughts, impulses, or
images that are experienced intrusive and
inappropriate and that cause anxiety or distress
Thoughts, impulses, or images that are not simply
excessive worries about real life problems
Thoughts, impulses or images that the person
attempts to ignore or suppress or to neutralize with
some other thought or action
Obsessive thoughts, impulses or images that the
person recognizes are a product of his or her own
mind
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Compulsions
(as defined by DSM-IV-TR), continued


Repetitive behaviors (such as hand washing,
ordering, checking) or mental acts (such as praying,
counting, repeating words silently) that the person
feels driven to perform in response to an obsession
or according to rules that must be applied rigidly
Behaviors or mental acts that are aimed at
preventing or reducing distress or preventing some
dreaded event or situation; however, these
behaviors or mental acts are not connected in a
realistic way with what they should prevent
Chapter 7
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Treatments for OCD
• Biological Treatments
– Serotonin-enhancing drugs like Paxil, Prozac
• Cognitive-behavioral Treatments
– Expose the client to obsessions until anxiety
about obsessions decreases, prevent
compulsive behaviors and help the client
manage anxiety that is aroused. For example,
systematic desensitization may be used to help
a person with a germ obsession gradually
materials.
Chapter 7 tolerate exposure to “dirty”
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.