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Anxiety Disorder
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Three Components of Anxiety
Physical symptoms
Cognitive component Behavioral component
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Physiology of Anxiety: Physical
System
Perceived danger
Brain sends message to autonomic nervous system
Sympathetic nervous system is activated (all or nonephenomena)
Sympathetic nervous system is the fight/flight system
Sympathetic nervous system releases adrenaline andnoradrenalin (from adrenal glands on the kidneys).
These chemicals are messengers to continue activity
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Parasympathetic Nervous System
Built in counter-acting mechanism for the
sympathetic nervous system Restores a realized feeling
Adrenalin and noradrenalin take time todestroy
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Cardiovasular Effects
Increase in heart rate and strength of heartbeat tospeed up blood flow
Blood is redirected from places it is not needed (skin,fingers and toes) to places where it is more needed(large muscle groups like thighs and biceps)
Respiratory Effects-increase in speed and dept ofbreathing
Sweat Gland Effects-increased sweating
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Behavioral System
Fight/flight response prepares the body for
action-to attack or run When not possible behaviors such as foot
tapping, pacing, or snapping at people
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Cognitive System
Shift in attention to search surroundings for
potential threat Cant concentrate on daily tasks
Anxious people complain that they are easilydistracted from daily chores, cannot
concentrate, and have trouble with memory
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U Shaped Function of Anxiety
Useful part of life
Expressed differently at various age levels
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Generalized Anxiety Disorder
Unfocused worry
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Generalized Anxiety Disorder:
Diagnostic Criteria
Excessive anxiety or worry occurring more
days than not for atleast 6 months
about anumber of events or activities
Difficulty controlling worry
3 of 6 symptoms are present for more days
than not:restlessness, easily fatigued, difficultyconcentrating, irritability, muscle tension, sleepdisturbance
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Generalized Anxiety Disorder
(GAD): Prevalence
~ 4% of the population (range from 1.9% to
5.6%) 2/3 or those with GAD are female in developed
countries
Prevalent in the elderly (about 7%)
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Generalized Anxiety Disorder:
Genetics
Familial studies support a genetic model (15% of therelatives of those with GAD display it themselves-base
rate is 4% in general population)
Risk of GAD was greater for monozygotic female twinpairs than dizygotic twins.
The tendency to be anxious tends to be inherited
rather than GAD specifically
Heritability estimate of about 30%
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Generalized Anxiety Disorder:
Neurotransmitters
Finding that benzodiazepines provide relief
from anxiety (e.g. valium) Benzodiazepine receptors ordinarily receive
GABA (gamma-aminobutyric acid)
GABA causes neuron to stop firing (calms
things down)
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Generalized Anxiety Disorder:
Neurotransmitters
Getting Anxious
Hypothesized Mechanism:
Normal fear reactions
Key neurons fire more rapidly
Create a state of excitabilitythroughout the brain and body
perspiration, muscle tensionetc.
Excited state is experiences asanxiety
Calming Down
Feedback system is triggered
Neurons release GABA
Binds to GABA receptors oncertain neurons and orders
neurons to stop firing
State of calm returns
GAD: problem in this feedbacksystem
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GABA Problems?
Low supplies of GABA
Too few GABA receptors GABA receptors are faulty and do not capture
the neurotransmitter
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Generalized Anxiety Disorder:
Cognitions
Intense EEG activity in GAD patients reflecting intensecognitive processing: low levels of imagery
Worrying is a form of avoidance
They restrict their thinking to thoughts but do notprocess the negative affect
Worry hinders complete processing of more disturbingthoughts or images
Content of worry often jumps from one topic to anotherwithout resolving any particular concern
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Generalized Anxiety Disorder:
Treatment
Short term-benzodiazepine (valium)
Cognitive Therapy (focus on problem)
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Phobia: Diagnostic Criteria
Marked & persistent unreasonable fear of
object or situation Anxiety response
Unreasonable
Object or situation avoided or endured withdistress
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Differential Diagnosis of Specific
Phobia
Vs. SAD: not related to fear of separation
Vs. Social Phobia: not related to fear of asocial situation or fear of humiliation
Vs. Agoraphobia: fear not related to closedplaces
Vs. PTSD: fear not related to a specific pasttraumatic event
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Phobias: Types
Specific phobias
Blood-Injection Injury phobias
Situational phobia
Natural environment phobia
Animal phobia
Pa-leng (Chinese) colpa daria (Italian) Germs
Choking phobia..
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What are your fears???
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Developmentally Normal FearsAge Normal Fear
Birth- 6 Months Loud noises, loss of physical support,rapid position changes, rapidlyapproaching other objects
7-12 Months Strangers, looming objects, unexpectedobjects or unfamiliar people
1-5 Year Strangers, storms, animals, dark,
separation from parents, objects,machines loud noises, the toilet
6-12 Year Supernatural, bodily injury, disease,burglars, failure, criticism, punishment
12-18 Performance in school, peer scrutiny,
appearance, performance
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Normal Rituals and Behaviors
Even some ritualistic behaviors are normal
Any rituals?
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Phobias: Prevalence
Fears are very prevalent
Phobias occur in about 11% of the population More common among women
Tends to be chronic
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Etiology of Phobias: Genetics
31% of first degree relatives of phobics also
had a phobia (compared to 11% in the generalpopulation)
Relatives tended to have the same type ofphobia
Not clear if transmission is environmental orgenetic
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Specific Phobia: Behavioral
Perspective
Case of Little Albert
Two-factor model:
Acquisition-classicalconditioning
Maintenance-operantconditioning
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Specific Phobia: Behavioral Perspective
Classical conditioning
Modeling Stimulus generalization
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Specific Phobia: Behavioral-Evolution
Perspective (Preparedness)
Discussion Section Topic
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Specific Phobia: Cognitive
Perspective
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Specific Phobia: Social and
Cultural Factors
Predominantly female
Unacceptable in cultures around the world formen to express fears
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Specific Phobia: Treatment
Systematic Desensitization
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Social Phobia
Fearful apprehension
Social situations
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Social Phobia: Diagnostic Criteria
Marked or persistent fear in one or more socialor performance situations
Exposure to fear situation is associated withextreme anxiety
Person recognizes that fear is excessive or
unreasonable Feared social and performance situations are
avoided or endured with intense anxiety
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Social Phobia: Prevalence
13% of the general population
About equally distributed in males and females,however, males more often seek treatment
Usually begins around age 15
Equally distributed among ethnic groups
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Etiology Social Phobia: Emotions
Temperament and Biological Theories (Kagan)
Behaviorally inhibited children 2 remained inhibited atage 7 and 12 (see video)
Biological preparedness
We are prepared to fear rejecting people Social phobics more likely to foucs on critical facial
experessions
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Biological Basis of Temperament
Kagan proposed temperamental differencesrelated to inborn differences in brain structure
and chemistry:He found inhibited children have:
Higher resting heart rates
Greater increase in pupil size in response tounfamiliar
Higher levels of cortisol (released with stress)
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Temperament and Anxiety
Disorders
Inhibited temperament: risk factor in socialphobia
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Kagans Temperamental/Biological
Theory and Prevention
Early identification of at risk children
Parental training Avoid overprotecting
Encourage children to enter new situations
Help kids to develop coping skills
Avoid forcing the child
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Encouraging Shy Children: helpful
hints
Use rewards
Arrange dont push No nagging
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Social Phobia: Treatment
Cognitive-Behavioral Therapy
Assess which social
situations are problematic Assess their behavior in
these situations
Assess their thoughts inthese situations
Teaches more effectivestrategies
Rehearse or role playfeared social situations in agroup setting
Medication
Tricyclic antidepressants
Monoamine oxidase inhibitors SSRI (Paxil) approved for
treatment
Relapse is common withmedications are discontinued