Prepared by: Ashlea R. Smith, Ph.D. Argosy University – Phoenix Second Edition This multimedia product and its contents are protected under copyright law

Prepared by: Ashlea R. Smith, Ph.D. Argosy University –

Phoenix

Second Edition

This multimedia product and its contents are protected under copyright law. The following are prohibited by law:-any public performance or display, including transmission of any image over a network;

-preparation of any derivative work, including the extraction, in whole or in part, of any images; -any rental, lease, or lending of the program.

Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Anxiety Disorders

Chapter 4


Chapter Outline

What Is Anxiety?

What Are the Anxiety Disorders?

The Etiology of Anxiety Disorders

The Treatment of Anxiety DisordersCopyright © 2012 by Pearson Education, Inc. All rights reserved.

What Is Anxiety?

A common emotion characterized by physical symptoms, future-oriented thoughts, and escape or avoidance behaviors-Occurs when people encounter a new situation or anticipate a life-changing event

-Usually is time-limited and ends when the event is over


Fight-or-Flight ResponseActivation of the SNS triggered by fear

or stress-Sympathetic nervous system (SNS): increases

heart rate and respiration allowing body to perform at peak efficiency

-Allows you to use all available resources to escape

-Parasympathetic nervous system (PNS): slows down the heart rate and respiration, thus returning the body to a resting state


Fight or flight response…


Figure 4.1 The Sympathetic and the

Parasympathetic nervous system

Adapted from Lilienfeld, et al., Psychology: From Inquiry to Understanding (p.121). Pearson/Allyn and Bacon. Copyright © 2009 Pearson Education, Inc. Reprinted by permission of Pearson Education, Inc.

Just how it works…

What if the snake strikes me and it’s poisonous?

You are walking on a path at a

local park and all of a sudden you

see a snake slither out in front of you.

Figure 4.2: The Elements of Anxiety

As soon as you see the snake, your

heart starts racing and your breathing increases (body’s

response).

You scream for help or run in the other direction.


Figure 4.3 Negative Reinforcement Increases Avoidance Behavior and Anxiety


Normal Anxiety vs. Abnormal Anxiety

Things to consider:Feeling anxious occasionally is normalFunctional impairmentDevelopmental age

Cognitive development, not actual chronological age

Sociodemographic factors Sex, race/ethnicity, and SES)

Women and men seek treatment at equal rates if fear is severe


Table 4.1 Typical Fears at Different Developmental

Ages


What Are the Anxiety Disorders?

Group of disorders characterized by heightened physical arousal, cognitive distress, and behavioral avoidance of feared objects/situations/events

-Panic Attacks

-Panic Disorders and Agoraphobia

-Generalized Anxiety Disorder

-Social Phobia

-Specific Phobia

-Obsessive Compulsive Disorder

-Post-traumatic Stress Disorder

-Separation Anxiety Disorder

How does comorbidity relate to anxiety disorders?

57% of people diagnosed with one anxiety disorder also have another

anxiety disorder or depression.


The “Facts” about Anxiety Disorders

31.2% of American adults will suffer at some point in their lives

Most common disorder among all age groupsOnset is around age 11 years oldEqually distributed among Hispanics, non-

Hispanic blacks, and non-Hispanic whitesSignificant economic burden: $42.3 billion Frequent comorbidity issues


Fact Or Fiction?

Panic attacks tend to only occur in people diagnosed with a panic disorder.

Fact or fiction?

No. Actually, 28.3% of adults report having had a panic attack, but only 4.7% of adults have

panic disorder.

Generalized Anxiety Disorder (GAD) is found to be more common in individuals from lower socioeconomic status (SES).

Fact or fiction?

Yes, because populations from lower SES have more legitimate things to worry about, such as unsafe

living conditions, lower income, poor health care, and more medical conditions.


Panic Attacks

Discrete period of intense fear and physical arousal, which develops abruptly

Symptoms peak in about ten minutes-Somatic and cognitive symptoms

-Common occurrence

Three types of attacks-Situationally-bound attacks

-Situationally-cued attacks

-Uncued attacks

Remember, as many as 28.3% of adults report having had a panic attack, although only 4.7% of

adults have panic disorder.


Panic Disorder With or Without Agoraphobia and Agoraphobia Without Panic Attacks

Panic Disorder without Agoraphobia: a person has had at least one panic attack and worries about having more

Panic Disorder with Agoraphobia: panic attacks combined with avoidance of places, where escape may be difficult or impossible.Example: shopping malls

Agoraphobia without History of Panic Disorder: intense fear and/or avoidance of public places (agoraphobia) without any past panic attacks

50% of people with panic disorder live off unemployment, disability, welfare, or social security


Generalized Anxiety Disorder (GAD)

Excessive worry about future events, past transgressions, financial status, and the health of oneself and loved ones

Lasts at least six monthsOnset late teens early adulthood (20s)Account for 12% of PCP visitsCommon in lower SES

More likely to occur in adults than children.

With the current state of the economy, do you think we will see a dramatic increase in people with reported GAD for the future?


Social PhobiaThe third most common

psychiatric disorderA pervasive pattern of

social timidity characterized by fear that the person will behave in a way that will be humiliating or embarrassing

Two subtypes: Nongeneralized (specific

subtype)

generalized subtype

Intense fear that others will detect anxiety

Social situations that create distress: speaking, eating, drinking, or writing in the presence of others, engaging in social interactions, and initiating conversations


More than 50% of people with social phobia have additional anxiety disorders.

Table 4.2 Developmental Differences in Distressful Social Situations


Real People, Real Disorders: Ricky Williams

Heisman trophy winner

1st round college draft pick for the NFL

Conducted interviews with his helmet on

Difficulty interacting with others

At times unable to leave the house to run errands

Is it easier to mask social phobia or phobias in general if you are not in the

limelight?

How would life change for you to live with a social

phobia?


Specific Phobias

Severe and persistent fears of circumscribed events, objects, or situations that led to significant disruption in areas of functioning

Four groups-Animal phobias

-Natural environment phobias

-Blood/injection/injury phobias (vasovagal syncope)

-Situational phobiasCopyright © 2012 by Pearson Education, Inc. All rights reserved.

Adapted from Stinson FS, Dawson DA, Patricia Chou S, et al. "The epidemiology of DSM-IV specific phobia in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions." Psychological Medicine, 37, 7, pp. 1047-1059, 2007 © Cambridge Journals, published by Cambridge University Press, reproduced with permission.


Figure 4.4: Vasovagal Response in Blood-Injury-Illness Phobias


Obsessive-Compulsive Disorder

A condition involving obsessions (intrusive thoughts), often combined with compulsions (repetitive behaviors), that can be extensive, time consuming, and distressful

Obsessions vs. Compulsions


Is Trichotillomania a Variant of OCD?

• Facts: Defined as repetitive hair pulling that results in noticeable hair loss, which individuals feel powerless to stop the pulling.

Let’s Examine the Evidence:

-Both are characterized by repetitive behavior that is used to decrease anxiety

-Both are associated with high rates of anxiety and depression

• -Higher rates of OCD occur in people with TTM

• -Obsessive thoughts exist in both OCD and TTM

• -Antidepressants used to treat both

• Conclusion: TTM and OCD share common features, but studies suggest differences related to treatment, symptoms, and features


Post-Traumatic Stress Disorder (PTSD)

After an event that involves actual or threatened death, serious injury, or a threat to physical integrity, emotional distress leads to avoidance of stimuli associated with the traumaPersistent symptoms of increased SNS arousal

Classic symptoms associated with PTSD


Research Hot Topic: 9/11 Trauma, Grief, PTSD, and Resilience

Experiences lived by inner city adolescents

-Stabbings

-Shootings

-Murder90% of Americans have

been exposed to trauma, but only 5 to 11% develop PTSD as a result

What are some “protective factors” that shield one from developing PTSD?

What does the word “resilience” mean?

How can we use this

information to understand

PTSD?

Exposure to trauma is not

enough to develop PTSD!


Separation Anxiety Disorder (SAD)

Severe and unreasonable fear of separation from a parent or caregiver

3 to 5% of all children sufferMore common among girls

Children from all ethnic backgrounds are equally likely to suffer from SAD

Think back to your childhood when you first started preschool or kindergarten. Do you remember experiencing some

separation anxiety from your parent or guardian?


Stop and Think!

Do animals experience separation anxiety like humans? Why or why not? How would we define the symptoms? Are there things pet owners do to cause this, or how can it be prevented?

Key PointsTennant (2003) outlined that the separation anxiety usually arises as a youngster, when a pet is “spoiled or not conditioned to accept an appropriate routine” (p. 70). He further stated that,

“the bottom line is that we actually cause the problem ourselves by misguided acts of kindness” (p. 70).

Tennant, C. (2003). Breaking Bad Habits in Dogs. Hauppauge, NY: Barron’s Educational Series, Inc.


How do anxiety disorders develop?Biology says:

-Hereditary factors

-Trait anxiety (personality traits)

-Differences in brain functioning and brain structure

-Neurotransmitters, particularly serotonin (responsible for mood, thoughts, behavior, and appetitive) and GABA (the body’s natural way to decrease anxiety, “natural valium”)

-Corticotrophin-releasing factor (CRF)

-Adrenocorticotropic hormone (ACTH)

-Temperament


Behavioral inhibition = withdrawal from people,

objects, or situations.

Figure 4.5: Stress May Affect Brain Functioning

Adapted from Biological Psychiatry, 46, Heim, C., & Nemeroff, C. "The impact of early adverse experiences on brain systems involved in the pathophysiology of anxiety and affective disorders." pp. 1509-1522, Copyright © 1999 Society of Biological Psychiatry with permission from Elsevier Science Inc.


How do anxiety disorders develop?

Freud says:-A conflict exists between the id (“childish” wants) and ego (“adult” ways of thinking)

-Sexual and aggressive impulses

-Defense mechanisms, especially repression and displacement, result in phobias

-Little Hans



Behavioral theories -Learned behavior; one becomes classically conditioned

-Vicarious learning theory

-Information transmission


Figure 4.7: The Fear of Fear Model



Cognitive theories -Information is processed differently, leading to the development of anxiety

-Aaron Beck and maladaptive thoughts

-Fear of Fear model

-One is hypersensitive to bodily sensations

-Anxiety sensitivity

-Distorted cognitions or “faulty beliefs”


Quick Recap

1. _____ is a pervasive pattern of social timidity characterized by fear that the person will behave in a way that will be humiliating or embarrassing. (a) Generalized anxiety disorder

(b) Panic disorder

(c) Social phobia

(d) Obsessive-compulsive disorder


Quick Recap

2. ______consists of intrusive thoughts and repetitive behaviors that are extensive, time consuming, and distressful. (a) Post-traumatic stress disorder

(b) Separation anxiety disorder

(c) Obsessive-compulsive disorder

(d) Specific phobia


Biological Treatment Options

Medication-Use of Selective Serotonin Reuptake Inhibitors (SSRIs) for the depletion of serotonin in the neural synapses (Prozac, Luvox, and Zoloft)

-Use of Benzodiazepines to allow GABA to transmit nerve signals more effectively, which reduces anxiety (Valium and Xanax)


Figure 4.8: How SSRIs Work


Biological Treatment Options

Psychosurgery-Only considered if a patient has failed to benefit from medication and therapy

-Cingulotomy: more common option, involves inserting thin probes into the portion of the brain called the cingulate bundle where the probes burn selective portions of the brain tissue

-Capsulotomy: gamma knife surgery (form of radiation treatment) which makes precise lesions in the brain tissue without opening the skull


Psychological Treatment Options

Psychodynamic-Uses free association and dream interpretation as a reflection of the patient’s experience in the “outside world”

-Little knowledge of the effectiveness of treatment

-Interpersonal Psychotherapy (IPT) targets interpersonal disputes and conflicts, interpersonal role transitions, and complicated grief reactions for social phobias, PTSD, and panic disorder



Behavioral-Well-researched approach

-Exposure: a client faces fears to get over them

-Exposure therapy

-Imaginal exposure

-70% improve after this treatment, with remission rates of 93% after two years and 62% after ten years, excluding combat-related PTSD

-Virtual reality exposure

-Social skills training (SST)Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Research HOT Topic: Virtual Reality Therapy

Behavior therapy most effective with some element of exposure

Patient fitted with a head-mounted display that has screens for eye, earphones, and a device that tracks movement

Used to treat specific phobias

Sounds, noises, and vibrations are added

Now being used with veterans


What are your thoughts on the use of this technology?


Cognitive Behavioral Therapy (CBT)-Well-researched approach

-Exposure in combination with cognitive restructuring to change negative cognitions

-Hypothesis testing (to see whether this “worst thing” actually happens)

-Generate positive coping cognitions to counteract the negative thoughts

-70% of patients improve

-Relaxation training and biofeedbackCopyright © 2012 by Pearson Education, Inc. All rights reserved.

I Object or Accept! What are your thoughts?

“Our society rewards people who deal with stress by working harder and faster to

produce more in a shorter time” (Davis, M., Eshelman, E. R., & McKay, M. (2000). The Relaxation & Stress Reduction

Workbook, 5th Ed. Oakland, CA: New Harbinger Publications, Inc., p. 9)

In essence, do you think as a society we are fostering the

development of anxiety disorders as a means to cope?

Does this relate to formulating theories about anxiety

disorders? Why or why not?


Reviewing Learning Objectives

1. Anxiety consists of three parts: physiological, cognitive, and the behavior.

2. Anxiety is a common occurrence. However, to be diagnosed, the fear or anxiety must cause impairment.

3. When considering the expression of anxiety, it is important to assess one’s cognitive maturity, gender, race/ethnicity, age, and SES, as well as sociocultural implications.

4. Many different types of anxiety disorders exist, such as panic disorder, GAD, OCD, phobias, PTSD, and SAD.


Reviewing Learning Objectives

5. Anxiety disorders can develop in many different ways, but it is becoming clear that neuroanatomical and neurochemical alterations lead to anxiety disorders.

6. The most appropriate approach to understanding the etiology of the disorder is to take into account a biopsychosocial approach including biological and psychological/environmental factors.

7. Anxiety disorders can be treated through the use of medication or behavioral or cognitive behavioral interventions.


Documents

Prepared by: Ashlea R. Smith, Ph.D. Argosy University – Phoenix Second Edition This multimedia product and its contents are protected under copyright law