PS 280 10 Anxiety Disorders

8/8/2019 PS 280 10 Anxiety Disorders

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ANXIETY DISORDERS

LECTURE OUTLINE Panic and anxiety ± background and

history

Etiology ± theoretical perspectives

Types of anxiety disorders and their

treatment

Treatments



ANXIETY DISORDERS

Who is afraid of ? small insect

animal, reptile

speaking to a large audience

speaking in front of a small group of

familiar people

meeting new people

attending social gatherings



ANXIETY DISORDERS

Background and history experience of anxiety ± cognitive,

somatic, behavioural, emotional

panic ± discrete period of intense fear or discomfort (brief and intense)

palpitations, shaking, chest pain, fear of

dying, going crazy, losing control

anxiety ± negative affect, sense of

uncontrollability of future threat, self-

preoccupation



ANXIETY DISORDERS

Background and history panic attacks occur spontaneously

both panic and anxiety can be ³normal´

experiences

they become maladaptive when they

become excessive, chronic, and in

absence of any real danger



ANXIETY DISORDERS

Background and historyPrevalence

25% of population may be expected to

have an anxiety disorder at some time intheir lives

Ontario Health Supplement ± 1-year

prevalence rates of 9% for men, 16% for women





ANXIETY DISORDERS

EtiologyPsychodynamic perspective

realistic, neurotic, moral anxiety

defense mechanisms

origins in early parent-child relationships

neurotic paradox ± contradicts pleasureprinciple





ANXIETY DISORDERS

EtiologyBiological perspective - Genetics

family studies show up to 25% have an

immediate family member with an anxietydisorder

twin studies - higher concordance rates

for MZ than DZ twins

genetics may operate through

behavioural inhibition



ANXIETY DISORDERS

EtiologyBiological perspective - Neuroanatomy

locus ceruleus

amygdala

one form of peptide (combo of amino

acids), CCK4, related to panic; CCK4 isfound in amygdala, hippocampus, cerebral

cortex, brain stem



ANXIETY DISORDERS

EtiologyBiological perspective - Neurotransmitters

norepinephrine (NE) ± concentrated in

locus ceruleus

serotonin

dopamine in social phobia and OCD interactions ± serotonin affects locus

ceruleus (where NE is produced) and may

also influence GABA



BEHAVI AL - ACTOR THEORY

Cl i l iti i ( l )

R

CS CR

Oper t iti i (Ski er)

SD behavi r Rei f r er



ANXIETY DISORDERS

Etiology ± Limitations of 2-factor theory cannot explain all phobias ± some seem

to develop without conditioning

difficult to create some fears in the lab

cannot explain why some stimuli are

more likely to become feared than others





ANXIETY DISORDERS

Etiology ± Biological preparedness theory Seligman ± evolutionary significance of

stimuli that are easily conditioned

Bandura ± properties of stimulithemselves (unpredictability and

uncontrollability) and the cognitive

processing that defines their threateningnature



ANXIETY DISORDERS

Etiology ± Cognitive theories Bandura ± low perceived self-efficacy

Beck ± experiences, beliefs, appraisals

Ellis ± irrational beliefs, catastrophization



ANXIETY DISORDERS

Etiology ± Biopsychosocial perspective emotion

biology

environment

behaviour

cognition



ANXIETY DISORDERS

Types ± Specific phobia animal

environmental

blood, injury, injection

specific situation ± elevators, flying

other



ANXIETY DISORDERS

Types ± Specific phobia ± Diagnosticfeatures

marked and persistent fear and avoidance

of specific stimulus or situation must interfere significantly with person¶s

life

must be considered excessive or unrealistic

ANS arousal



ANXIETY DISORDERS

Types ± Specific phobia prevalence rates from 7-11%

often emerge during adolescence, usually

earlier than age 25

tend to be chronic, but may fluctuate over

life course

usually assessed with self-report

conditioning theories systematic

desensitization



ANXIETY DISORDERS

Systematic desensitization (SD) for specific phobia

Wolpe (1958) ± reciprocal inhibition and SD

3 components of SD

construction of stimulus hierarchy

progressive (deep muscle) relaxationtraining

progress through the hierarchy while

practicing relaxation response



ANXIETY DISORDERS

Panic disorder - Elements recurrent, unexpected panic attacks

persistent concern, preoccupation with

having another attack

worry about consequences of attack

significant behaviour change in responseto attacks



ANXIETY DISORDERS

Panic disorder ± Other clinical features often accompanied by avoidance behaviours

(agoraphobia)

possible to have agoraphobia without panicattacks

onset around late adolescence, early

adulthood

more women than men

high rates of service utilization, poor quality

of life



ANXIETY DISORDERS

Clark¶s cognitive model of panic disorder ) catastrophic misinterpretation of arousal-

related bodily sensations

agoraphobia (avoidance) as way of coping





ANXIETY DISORDERS

Obsessive-compulsive disorder (OCD) -Elements

recurrent obsessions, compulsion, or

both obsessesions ± thoughts, images,

impulses, that are persistent, markedly

distressing compulsion ± repetitive behaviours

performed in response to an obsession



ANXIETY DISORDERS

Obsessive-compulsive disorder (OCD) -Elements

common obsessions ± violence, sex,

contamination, order common compulsions ± washing,

cleaning, checking, seeking reassurance,

ordering or arranging objects cleaners vs. checkers ± focus on harm vs.

order



ANXIETY DISORDERS

Obsessive-compulsive disorder (OCD) -Background

very rare ± 2.5% lifetime prevalence rate

little gender difference

high overlap with depression and

Tourette¶s syndrome



ANXIETY DISORDERS

Obsessive-compulsive disorder (OCD) ±Psychodynamic perspective

anal fixation ± ³Does anal-retentive have

a hyphen?´ reaction formation, undoing,

displacement





ANXIETY DISORDERS

Obsessive-compulsive disorder (OCD) ±Treatments

Prozac - SSRIs

Exposure and response prevention



ANXIETY DISORDERS

Post-traumatic stress disorder (PTSD) ±Description

Person has been exposed to traumatic event

3 symptom clusters

recurrent re-experiencing of event

avoidance of trauma-related stimuli and

numbing

increased arousal

Persists for at least 1 month after trauma



ANXIETY DISORDERS

Post-traumatic stress disorder (PTSD) ±Etiology

Cognitive theories

expectations and appraisals

fear structure in long-term memory

fear conditioning



ANXIETY DISORDERS

Generalized anxiety disorder (GAD) ±Description

Core feature is worrying ± worries are

unrealistic, difficult to control, excessive

³Free floating´ anxiety

Verbal thoughts rather than images as in OCD

Motor tension, vigilance, scanning

³What if?´ ± background of intolerance of

uncertainty



ANXIETY DISORDERS

Generalized anxiety disorder (GAD) ±Description

3 key features

uncontrollability intolerance of uncertainty

ineffective problem-solving skills



ANXIETY DISORDERS

Treatments - Pharmacotherapy3 main drugs

Xanax

Paxil

Zoloft

SSRIs, bezodiazepines, tricyclic anti-depressants, MAOs



ANXIETY DISORDERS

Treatments - Exposure

flooding, response prevention

confrontation with anxiety-producing

stimulus

developing more adaptive internal

representations of the stimuli and their non-threatening consequences



ANXIETY DISORDERS

Treatments ± Cognitive restructuring

identify maladaptive cognitions

challenge maladaptive cognitions

develop more adaptive cognitions



ANXIETY DISORDERS

Treatments ± Relaxation training

decreases physiological arousal through:

deep muscle relaxation

positive imagery

meditation deep breathing



ANXIETY DISORDERS

Treatments ± Problem-solving training

What is my problem? What is my goal? What

solutions can I generate to solve theproblem? What might be the consequences of

each solution? Try a solution

particularly relevant to GAD divides problems into manageable units



ANXIETY DISORDERS

SUMMARY

both biological and psychological factors

involved in etiology of anxiety disorders ±

biopsychosocial model

shift away from Freudian perspective on

³neuroses´

both biological and psychological

treatments for the various disorders

Documents

PS 280 10 Anxiety Disorders