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Anxiety Disorders WEB Anxiety as a Normal and an Abnormal Response • Some amount of anxiety is “normal” and is associated with optimal levels of functioning. • Only when anxiety begins to interfere with social or occupational functioning is it considered “abnormal.” The Fear and Anxiety Response Patterns • • • • Fear Panic Anxiety Anxiety Disorder The Bell Curve An Important Law- The Yerkes Dodson Law Another Bell CurveCourtesy of Our Good Buddies Yerkes-Dodsen Phobic Disorders • 1. 2. 3. Phobias Specific phobias Social phobia Agoraphobia Specific Phobias Specific Phobias • Psychosocial causal factors • Genetic and temperamental causal factors • Preparedness and the nonrandom distribution of fears and phobias • Treating specific phobias Social Phobia • General characteristics Fear of being in social situations in which one will be embarrassed or humiliated Social Phobia • Interaction of psychosocial and biological causal factors – Social phobias as learned behavior – Social fears and phobias in an evolutionary context – Preparedness and social phobia Social Phobia • Interaction of psychosocial and biological causal factors – Genetic and temperamental factors – Perceptions of uncontrollability – Cognitive variables Panic Disorder With and Without Agoraphobia • • • • Panic disorder Panic versus anxiety Agoraphobia Agoraphobia without panic Panic Disorder • • • • Prevalence and age of onset Comorbidity with other disorders Biological causal factors The role of Norepinephrine and Serotonin Panic and the Brain Panic Disorder • Genetic factors • Cognitive and behavioral causal factors • Interoceptive fears Panic Disorder: The Cognitive Theory of Panic Panic Disorder: The Cognitive Theory of Panic • Perceived control and safety • Anxiety sensitivity as a vulnerability factor for panic • Safety behaviors and the persistence of panic • Cognitive biases and the maintenance of panic Treating Panic Disorder and Agoraphobia • Medications • Behavioral and cognitive-behavioral treatments Generalized Anxiety Disorder • General characteristics • Prevalence and age of onset • Comorbidity with other disorders Generalized Anxiety Disorder: Psychosocial Causal Factors • The psychoanalytic viewpoint • Classical conditioning to many stimuli • The role of unpredictable and uncontrollable events • A sense of mastery: immunizing against anxiety Generalized Anxiety Disorder: Biological Causal Factors • Genetic factors • A functional deficiency of GABA • Neurobiological differences between anxiety and panic Obsessive-Compulsive Disorder • Obsessions- repetitive unwanted ideas that the person recognizes are irrational • Compulsions- repetitive, often ritualized behavior whose behavior serves to diminish anxiety caused by obsessions Obsessive-Compulsive Disorder • • • • Prevalence and age of onset Characteristics of OCD Types of compulsions Comorbidity with other disorders Obsessive-Compulsive Disorder: Psychosocial Causal Factors • • • • Psychoanalytic viewpoint Behavioral viewpoint The role of memory Attempting to suppress obsessive thoughts Obsessive-Compulsive Disorder: Biological Causal Factors • Genetic influences • Abnormalities in brain function • The role of serotonin Post-Traumatic Stress Disorder • Critical Component – Symptoms occurs AFTER a traumatic stressor Symptoms Categories • Intrusive – – – – – distressing recollections dreams flashbacks psychological trigger reactions physiological trigger reactions Symptoms Categories • Avoidance – – – – – – – avoid thoughts, feelings or discussions avoid activities, places memory blocks anhedonia (without pleasure) numb alexithymia (emotions unknown) feeling of doom Symptom Categories • Hyperarousal Symptoms – – – – – sleep disturbance anger problems concentration startle response “on guard” hypervigilence Diagnoses • Acute Stress Disorder – new to DSM-IV (1994) – symptoms 2 days to 4 weeks following traumatic event • PTSD – new to DSM-III (1980) – symptoms beyond 4 weeks – delayed onset Who Is Vulnerable? • All ages • Both genders • Across Cultures and ethnic groups Some Stats Andrews, Wahlberg, Montgomery (1993) 70 60 50 40 30 Frequency 20 10 0 Black Hispanic Native American White Employment 60 50 40 30 Frequency 20 10 0 Employed Umemployed Depression 35 30 25 20 Enter Exit 15 10 5 0 Total Group Severe PTSD Moderate PTSD Types of Traumas • Natural – earthquakes – floods – fires • Human induces – war – crimes of violence Co-Morbid Diagnoses • Alcoholism – 75% for Vietnam Veterans with PTSD • Depression – 77% of firefighters with PTSD also have depression • Generalized Anxiety • Panic Attacks