Download Anxiety! - neuropsychII

Anxiety
Karen Crowley, Laura Simandl,
Vickie Remmelzwaal
Background
• Anxiety
– A normal reaction to stress
– Helps one cope
– Anxiety can become excessive and irrational, which
leads to a disorder
• Five main types of Anxiety Disorders
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Generalized Anxiety Disorder
Obsessive Compulsive Disorder (OCD)
Panic Disorder
Post-Traumatic Stress Disorder (PTSD)
Social Phobia (or Social Anxiety Disorder)
Background
• Anxiety Disorders are the most common
mental illness in America
• Women suffer from anxiety and stress
almost twice as much as men
• Anxiety disorders cost the U.S. over $42
billion a year
• People with Anxiety Disorders are 3-5
times more likely to go to the doctor than
non-sufferers
Background
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Emotional/Psychological
Symptoms
Feeling restless or on edge
Avoidance
Irritability
Confusion
Behavioral problems (especially
in children and adolescents)
Nervousness and jumpiness
Self-consciousness and
insecurity
Fear that you are dying or going
crazy
Strong desire to escape
Physical Symptoms
• Heart palpitations or racing
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heartbeat
Chest pain
Hot flashes or chills
Cold and clammy hands
Stomach upset or queasiness
Frequent urination or diarrhea
Shortness of breath
Sweating
Dizziness
Tremors, twitches, and jitters
Muscle tension or aches
Headaches
Fatigue
Insomnia
Neurobiology
• Progress of understanding anxiety in
children lags behind understanding
anxiety in adults
– obstacles in the study of children such as
recruitment, lack of assessment tools, and
ethical problems involving the use of research
techniques and technologies
Neurobiology
• Brain activates neurophysiological responses to
increase survival when a threatening cue is
present
Neurobiology
• Anxiety disorders originate from an increased arousal in
the limbic system
– specific patterns of neuronal activity result in the actual
sensation of anxiety
– Amygdala, which is in the limbic system, plays a central role in
fear and anxiety and is involved in the expression and
acquisition of conditioned fear
Neurobiology – Predictive Signs
• Thousands of gene products that, if abnormal, could
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result in altered functioning of the neurotransmitter and
neuroanatomical regions involved in regulating anxiety
Positive relationship between neurological abnormalities
at age 7 and later affective disorders in adolescence
Amygdala is well developed at birth, and develops before
the hippocampus completes its development
– early traumatic experiences may leave their traces in the
amygdala as emotional memories
– may lead to an emotional response of anxiety without the
cognitive memory of the trigger
Neurobiology
• Physiological differences have been found
between inhibited and uninhibited children
– Behavioral inhibition is a temperament that
predisposes 20% of children to be highly reactive to
unfamiliar situations or people
– higher heart rates, decreased heart rate variability,
increased tension in the vocal chords, and increased
salivary cortisol levels
– EEG measurements have shown greater activity in the
right amygdala as neural activity in the amygdala is
transmitted to the frontal lobes
Neurobiology – Specific Links
• Panic Disorder
– Serotonin
– Hereditary
– Decreased blood flow in frontal cortex
• OCD
– Serotonin
– Heredity
– Brain Damage
Neuroimaging
• Role of the GABA A Receptor in Anxiety
• Benzodiazepine receptors
• Benzodiazepine agonist
increases sensitivity of
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GABA-binding site
reduces anxiety
Benzodiazepine antagonist
reduces sensitivity of
GABA-binding site
increases anxiety
Suggesting: A secretion of a neuromodulator that blocks
the binding site at the GABA A receptor or a diminished
number of benzodiazepine receptors are the cause of
Anxiety Disorders
Benzodiazepines are often used to treat anxiety, but
they can have intolerable side effects and be addictive
Neuroimaging
• Brain imagining techniques such as PET,
fMRI show altered patterns of brain
activity in a number of anxiety disorders
• Altered regional cerebral blood flow,
metabolism or oxygenation
Neuroimaging
• Patients with Simple phobia, OCD, PTSD: Share
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cerebral blood flow alterations in medial
orbitofrontal cortex (OFC), rostral anterior
cingulate cortex (rACC), inferior frontal cortex,
and insula
Patients with OCD: Exhibit specific alterations in
blood flow or metabolism within the basal
ganglia
Patients with Panic Disorder: Differential brain
metabolism in hippocampus, rACC, and OFC
Implications for School
Psychologists
• Many children with anxiety disorders do not
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receive treatment
Benefits of school-based treatment
– School psychologist can play active role in educating
administrators and teachers to recognize symptoms
and understand prevalence
– Many commonly feared situations occur in school
setting
– Less stigma in school-based help than in clinicallybased therapy
– Opportunities for prevention abound
Rationales for School-Based
Prevention Efforts
• Many children with anxiety disorders get ignored
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because of internalizing nature of behaviors and
because of co-occuring disorders such as
depression and ADHD
Childhood anxiety disorders often continue into
adulthood if left untreated
School Problems include academic
underachievement, school attendance issues,
difficulties interacting with teachers, and peers
Cognitive Behavioral Therapy
• General CBT techniques
– Relaxation skills, Cognitive restructuring, Problem
solving and Graded exposures
• Adaptations for specific childhood disorders
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Separation Anxiety Disorder
Social Phobia
Generalized Anxiety Disorder
Selective Mutism
Implications for future
• More research is needed on effectiveness and
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adaptability of programs for preschool age
children
More research is needed on effectiveness of
interventions across cultural, ethnic and
socioeconomic groups
School psychologists need to take an active role
in implementing prevention efforts in their
schools
References
Barrett, P. & Turner, C. (2001). Prevention of anxiety symptoms in primary school children: preliminary results from a
universal school-based trial. British Journal of Clinical Psychology, 40, 399-410.
Carlson, N. (2005). Foundations of Physiological Psychology: 6th ed
Boston: Allyn & Bacon.
Cummins, T. K., & Ninan, P. T. (2002). The neurobiology of anxiety in children and
adolescents. International Review of Psychiatry, 14, 114-128.D’Amato, R., Fletcher-Janzen, E., & Reynolds,
C. (2005). Handbook of School
Neuropsychology. Hoboken, NJ: Wiley.
Fisher, P.H., Maisa-Warner, C. & Klein, R. (2004.) Skills for social and academic success: a school-based intervention
for social anxiety disorder in adolescents. Clinical Child and Family Psychology Review, 7, 241 – 249.
Gosch, E. A. & Flannery-Schroeder, E. (2006). Principles of cognitive-behavioral therapy for anxiety disorders in
children. Journal of Cognitive Psychotherapy: An International Quarterly, 20, 247 -262.
Gray, R. M., Jordan, C. M., Ziegler, R. S., & Livingston, R. B. (2002). Two sets of twins with selective mutism:
neuropsychological findings. Child Neuropsychology, 8, 41-51.
Grover, R.L., Hughes, A.A., Bergman, R.L. & Newman Kingery, J. (2006). Treatment modifications based on
childhood anxiety diagnosis: demonstrating the flexibility in manualized treatment. Journal of Cognitive
Psychotherapy: An International Quarterly, 20, 275-286.
References
Helpguide. (2006). Retrieved June 1, 2007, from Web site:
http://www.helpguide.org/mental/anxiety_types_symptoms_treatment.htm.
Hirshfeld-Becker, D. R. & Biederman, J. (2002). Rationale and principles for early intervention for children at risk for
anxiety disorders. Clinical Child and Family Psychology Review, 5, 161-172.
Liberzon, I., Phan, K.L., Khan, S., & Abelson, J.L. (2003). Role of the GABA A receptor in anxiety: Evidence from
animal models, molecular and clinical psychopharmacology, and brain imaging studies. Current
Neuropharmacology, 1, 267-283.
National Institute of Mental Health. (2007). Retrieved June 1, 2007, from Web site:
http://www.nimh.nih.gov/healthinformation/anxietymenu.cfm
Perry, B. D. (1998). Aspects of anxiety disorders in children. In C. E. Coffey, & R. A.
Brumback (Eds.), Textbook of Pediatric Neuropsychiatry. Washington, DC:
American Psychiatric Press, Inc.
Tillfors, M. (2004). Why do some individuals develop social phobia? A review with emphasis on the neurobiological
influences. Nord J. Psychiarty, 58, 267-276.
Tomb, M. & Hunter, L. (2004). Prevention of anxiety in children and adolescents in a school setting: the role of
school-based practitioners. Children and Schools, 26, 87-101.