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Chapter 5 Anxiety, Trauma, & Stress-Related, & Obsessive-Compulsive-Related Disorders Nature of Anxiety and Fear • Anxiety – The Future-Oriented Mood State – Apprehension about future danger or misfortune – Somatic symptoms of tension • Fear – The Present-Oriented Mood State – Immediate fight or flight response to danger or threat – Involves abrupt activation of the sympathetic nervous system • Anxiety and Fear are Normal Emotional States Panic Attacks – Abrupt experience of intense fear or discomfort – Several physical symptoms (e.g., breathlessness, chest pain) – Fear as an alarm response Two types Expected Unexpected Causes of Anxiety Disorders Biological Psychological • Genetic Vulnerability • Freud’s views • Anxiety and brain circuits • Behavioral and Cognitive Views • Depleted levels of GABA – Anxiety and fear are learned responses Social Contributions – Catastrophic thinking and appraisals play a role • Stressful life events trigger vulnerabilities • Early Childhood Contributions Generalized Anxiety Disorder: The “Basic” Anxiety Disorder – Shift from possible crisis to crisis – Worry about minor, everyday concerns (Job, family, chores, appointments) – Problems sleeping – Persists for 6 months or more Prevalence of Generalized Anxiety Disorder – Affects about 3.1% (in a year) to 5.7% (in a lifetime) of the general population – Tends to more common in women – Onset is often insidious, beginning in early adulthood – Very prevalent among the elderly – Tends to run in families Treatment of Generalized Anxiety Disorder – Benzodiazapines (i.e. Valium, Xanax) – Often Prescribed – Antidepressants (i.e. Paxil & Effexor) – Psychological interventions – CognitiveBehavioral Therapy – Combined treatments – Acute vs. LongTerm Outcomes Panic Disorder and Agoraphobia – Experience of unexpected panic attack – Develop anxiety, worry, or fear about another attack – Many develop agoraphobia • Prevalence of panic disorder – Affects about 2.7% (in a year) & 4.7% (in a lifetime) of the general population – Onset is often acute, median between 20 and 24 years of age – 75% of individuals with agoraphobia are female • Causes of panic disorder - Combination of psychological, biological, & social Treatment of Panic Disorder • Medication Treatment – SSRIs (e.g., Prozac and Paxil) are preferred drugs – Relapse rates are high following medication discontinuation • Psychological and Combined Treatments – Cognitive-behavior therapies are highly effective – No evidence that combined treatment produces better outcome – Best long-term outcome is with cognitive-behavior therapy alone Social Phobia – Extreme and irrational fear in social/performance situations – Often avoid social situations or endure them with great distress Prevalence of Social Phobia – Affects about 6.8% (in a year) & 12.1% (in a lifetime) of the general population – Onset is usually during adolescence Social Phobia • Causes – Biological and evolutionary vulnerability – Conditioning and modeling (i.e. socially anxious parents) • Psychological Treatment – Cognitive-behavioral treatment – Cognitive-behavior therapies are highly effective • Medication Treatment – SSRIs Paxil, Zoloft, and Effexer – Are FDA approved Posttraumatic Stress Disorder (PTSD) – Main etiologic characteristics Trauma exposure and response – Reexperiencing (e.g., memories, nightmares, flashbacks) – Avoidance – Emotional numbing and interpersonal problems – Markedly interferes with one's ability to function – PTSD diagnosis – Only after 1 month post-trauma – Additional categorizations: Acute Stress Disorder & Delayed Onset Prevalence and Treatment of PTSD • Prevalence & Causes of PTSD - Approximately 3.5% (in a year) & 6.8% (in a lifetime)of the general population - Physical violence, accidents, & sexual assault are most common traumas • Treatment -Cognitive-behavior therapies (CBT) are highly effective – CBT may include graduated or massed (e.g., flooding) imaginal exposure – SSRIs have shown to be helpful Obsessive-Compulsive Disorder (OCD) – Obsessions - Intrusive and nonsensical thoughts, images, or urges – Compulsions - Thoughts or actions to neutralize thoughts – Vicious cycle of obsessions and compulsions – Cleaning and washing or checking rituals are common Prevalence of OCD – Affects about 1% (jn a year) & 1.6%-2.3% (in a lifetime) of the general population Causes & Treatment of ObsessiveCompulsive Disorder (OCD) • Causes of OCD – Learning that some thoughts are dangerous/unacceptable – Thought-action fusion -- The thought is similar to the action • Medication Treatment – SSRIs • Psychological Treatment – ERP (exposure & ritual prevention) is most effective Body Dysmorphic Disorder – Preoccupation with imagined defect in appearance – Often display ideas of reference for imagined defect – Suicidal ideation and behavior are common Body Dysmorphic Disorder – Seen equally in males and females – Onset usually in early 20s – Most remain single • Treatment – Treatment parallels that for obsessive compulsive disorder (comorbid with OCD 10% of the time) – Medications (i.e., SSRIs) that work for OCD provide some relief – Exposure and response prevention is also helpful – Plastic surgery is often unhelpful