PSYC 2621

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PSYC 2621

• Anxiety Disorders

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Anxiety Disorders

• Anxiety is a generalized state of apprehension.
• Anxiety can be normal/adaptive but it can also be
  excessive/inappropriate

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Features
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Historical perspectives

• Anxiety/dissociative/somatoform were classified
  as neuroses in 19th century.
• Identified by William Cullen with a biological
  origin.
• Freud, in the 20th century, explained it as the
  threatened emergence of unacceptable
  anxiety-evoking ideas into conscious awareness
• An attempt of the ego to defend itself against
  anxiety.

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Panic Disorder

• Symptoms
• Recurrent panic attacks.
• Intense anxiety reactions that are accompanied by
  physical symptoms.
• Stronger bodily component than the other anxiety
  disorders.
• Last for several minutes to hours.
• Initially occurs unexpectedly (these seem more
  severe), later they may be cued.

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DSM-IV features of Panic Attack

• Involves at least 4 of the following
• lasts 10 minutes
• repeated unexpected attacks and one must be
  followed for 1 month by a fear of subsequent
  attack.
• heart palpitations
• sweating
• trembling
• shortness of breath or smothering sensations
• choking sensations

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• Chest pains or discomfort
• feelings of nausea or other signs of abdominal
  distress
• feelings of dizziness, unsteadiness,
  lightheadedness, faintness
• feelings of strangeness or unrealty about ones
  surroundings (derealization) or detachment from
  self (depersonalization)
• fear of losing control
• fear of dying.

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• Numbness or tingling sensations
• chills or hot flushes

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Additional features

• Usually begins in late adolescence/early
  adulthood.
• Women experience panic attacks two or three times
  more often as men.
• About 1 of the population can be diagnosed with
  panic disorder at any given time
• About 3.5 have experienced panic disorder at
  some point in their lives.

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Generalized Anxiety disorder

• Persistent, diffused sense of anxiety that is not
  triggered by any specific object, situation, or
  activity.
• Differs from panic disorder in quality.

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Features

• Restlessness
• feeling keyed up
• easily fatigued
• difficulty concentrating or finding ones mind
  going blank
• irritable
• muscle tension
• disturbance of sleep

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Prevalence

• Twice as common in women as in men.
• Initially arises in mid-teens/mid-twenties
  throughout lifetime.
• Lifetime prevalence in the general population is
  about 5.
• May experience depression.

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Phobic Disorders

• Phobia means fear.
• Fear/anxiety are closely related.
• Fear is feeling some anxiety/agitation in
  response to a threat.
• Phobic disorders are persistent fears of
  objects/situations disproportionate to threat
  posed by them.

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• Interfere with normal routines.
• Phobics realize their fears are irrational.
• Quite common they affect 1 in 7 adults at some
  point in their lives.
• Appear at different ages.

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• 3 Types
• Specific Phobias
• the fear of specific objects. It is associated
  with high levels of physiological arousal. It
  must impact the individuals life. Often begins
  in childhood.
• 5 subtypes
• animal
• natural environment
• blood-injection-injury
• situational most frequently occurring
• other

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• Cont. specific phobia
• Prevalence
• Affects 1 in 10 people at some point in their
  lives
• Occurs more frequently in women than men.
• Social phobia
• The fear of social situations due to fear of
  judgment, humility, and embarrassment.
• Includes stage fright/speech anxiety.
• Affects more women than men.

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• Cont. social phobia
• The roots may begin in childhood.
• People typically report being shy as a child.
  Then, social phobia tends to begin in adolescence
  and is chronic.
• Agoraphobia
• The fear of places/situations where it is
  difficult or embarrassing to escape.
• May become house-bound/difficult to treat.

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• More common in women
• Begins in late adolescence or early adulthood.
• May occur with or without panic attacks.

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Obsessive/Compulsive Disorder

• Obsessions are intrusive, recurrent thoughts.
• Compulsions are repetitive behavior or mental
  acts that a person are compelled to perform.
• Most compulsions fall into 2 categories
• checking
• cleaning relieves the anxiety of obsessions.

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• Prevalence
• 2 to 3 of adults are affected by OCD during
  their lifetime.
• It affects men and women equally.
• Obsessions are difficult to distinguish from
  delusions.

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Acute/Post-traumatic Stress Disorder

• A stress related disorder that arises from
  exposure to traumatic events.
• The event involves either actual/threatened
  death/injury/physical safety.
• Response can be acute ? acute stress d/o
• or prolonged ? PTSD

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• Response involves intense fear, helplessness,
  horror (children may show disorganized/agitated
  behavior)

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Features

• Reexperiencing the event (memories or flashbacks)
• Avoiding the cues connected with the incidence
• Numbing emotions
• arousal/anxiety (difficulty sleeping, angry,
  hypervigilance, difficulty concentrating,
  exaggerated startle)

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Cont. Features

• Impairment in functioning
• Dissociation.

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Theoretical Perspectives

• Psychodynamic
• Anxiety reflects
• the efforts of unacceptable, repressed impulses
  to break into consciousness.
• fear as to what might happen if they do.
• Phobias develop through the use of defense
  mechanisms of projection/displacement. For
  example, Freuds description of Little Hans.

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• Phobias help to contain impulses/keep person away
  from feared object/situation.
• In GAD, conflicts remain hidden but anxiety leaks
  through to awareness.
• In Panic D/O, unacceptable sex/aggressive
  impulses approach boundaries of conscious/ego
  must repress, generating high anxiety/panic
  attack.
• In OCD, obsessions are leakage of unconscious
  impulses into consciousness, and compulsions are
  acts to keep impulses repressed.

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Learning

• Mowrers 2-factor model.
• GAD is product of stimulus generalization.
• Panic attacks that descend out of nowhere, are
  triggered by unidentifiable cues.
• Reinforcement of O/C compulsive behaviors are
  operant responses that are negatively reinforced
  by relief of the anxiety that is engendered by
  obsessional thoughts.

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Cont. Learning

• Prepared conditioning genetically prepared to
  acquire phobias.
• GAD a Safety Perspective (Woody/ Rachman, 1994)
• People with GAD see the world as a highly
  threatening place and perceive very few safe
  places to turn where they can feel secure. No
  place causes anxiety though finding a place
  brings some relief.

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Cont. Learning

• PTSD (Classical Conditioning)
• The trauma is the UCS and becomes associated with
  the sights, smells, sounds (CS) of the
  surroundings.
• Symptoms are likely to persist when survivor
  avoids the CS.

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Cognitive

• Various patterns associated with anxiety
  disorders.
• Overprediction of fear overpredict the amount of
  fear that will be experienced when exposed to
  feared stimuli, ie., dental fear.
• Self-defeating or irrational beliefs.
• OCD is the tendency to exaggerate the risk of
  negative outcomes.
• Oversensitivity to threats

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Cont. Cognitive

• Low self-efficacy expectancies
• Anxiety sensitivity - the extent to which a
  person believes that their own internal anxiety
  will lead to harmful consequences.
• Missattributions for Panic Sensations
• Catastrophic misinterpretations of bodily
  sensations.

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Biological

• Studies show strong support for genetic influence
  for anxiety d/o.
• The evidence is most prominent for agoraphobia.
• Modestly prominent in GAD and
• Least prominent in specific phobias.
• There is some evidence in OCD Panic D/O

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Cont. Biological

• The nerotransmitter, gamma-aminobutyric acid
  (GABA) is implicated in anxiety d/o.
• It is an inhibitory neurotransmitter. When GABA
  is inadequate, neurons fire excessively resulting
  inseizures or anxiety. Benzodiazepines enhance
  the calming effect of GABA. Some researchers
  think hyperventilation with catastrophic thinking
  prompt Panic attacks agoraphobia.

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TReatment

• Psychodynamic
• Work on freeing ego from the energy put into
  repression.
• More contemporary approaches focus on sources of
  anxiety that arise from current and past
  relationships.

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Cont. Treatment

• Humanistic/Existential
• Anxiety is the social repression of our genuine
  selves.
• The aim is to get in touch/express genuine
  talents/feelings.
• Biological
• Most common treatment is Benzodiazepines
• Valuim, Tranxene, Xanax, Librium. Addictive.

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Cont. Treatment

• Other medications Paxil, Zoloft, Tofranil.
• OCD is usually treated with Prozac and Anafranil.

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Cont. Treatment

• Learning-based
• Systematic desensitization
• Gradual exposure
• cognitive restructuring
• Behavioral treatment of social phobia exposure
  and flooding
• Behavioral treatment of PTSD, OCD,
• Relaxation, GAD