Post on 21-Dec-2015
Nature of Anxiety and Fear
Differences between Anxiety and Fear Normal Emotional States?
Roller Coaster Ride Driving on the freeway Taking a test
Yerkes-Dodson Law
Characteristics of Anxiety Disorders
Pervasive and persistent symptoms of anxiety and fear Excessive avoidance and escape tendencies Clinically significant distress and impairment
Are the most common forms of psychopathology
Factors in Anxiety and Fear
Biological Explanation Freudian Explanation Behavioral Views Cognitive Views Social Factors Cultural Factors
Biological Factors of Anxiety and Panic
Genetic vulnerability Anxiety and brain circuits
Depleted levels of GABA Corticotropin releasing factor (CRF) and HYPAC axis Limbic (amygdala) and the
septal-hippocampal systems Behavioral inhibition (BIS) Fight/flight (FF) systems
Psychological Factors of Anxiety and Fear
Began with Freud Anxiety is a psychic reaction to fear Anxiety involves reactivation of an infantile fear situation
Behavioral and cognitive views Invokes conditioning and cognitive explanations Anxiety and fear are learned responses Catastrophic thinking and appraisals play a role
Early childhood contributions Experiences with uncontrollability and unpredictability
Social contributions Stressful life events trigger vulnerabilities
Cultural Expectations
Fig. 4-2, p. 123
Anxiety Disorders Categories
Generalized Anxiety Disorder Panic Disorder with and without
Agoraphobia Specific Phobias Social Phobia Posttraumatic Stress Disorder Obsessive-Compulsive Disorder
Generalized Anxiety Disorder
Worry About Everything Worrying is Unproductive (Interferes with
Functioning) Strong, Persistent Uncontrollable
Somatic symptoms Differ from panic (e.g., muscle tension, fatigue,
irritability)
“Do you worry excessively about minor things?”
Fig. 4-3, p. 127
Treatment of GAD
Generally Weak Benzodiazepines
Most often prescribed Offers some relief
Psychological interventions Cognitive-Behavioral Therapy
Including “exposure” to worries
Symptoms of Panic Attacks
Palpitations / Sweating Trembling / Shaking Shortness of Breath Feeling of Choking Feeling of Dying Loss of Control Derealization
Connection to?
Panic Attack
Abrupt Autonomic Surge Intense Fear or Discomfort Unexpected and Uncontrollable Absence of Actual Threat
“False Alarm”
Panic Disorder
An Unexpected Panic Attack Develop Anxiety Over:
The Next Attack or The Implications of the Attack and
Consequences Agoraphobia is Common
“Fear of the Marketplace” Consequence of Unexpected Panic Attacks Can be a separate disorder
Fig. 4-5, p. 133
Panic Disorder Treatment
Medication Treatment of Panic Disorder Benzodiazepines
Relapse and avoidance SSRIs
Preferred drugs Relapse rates are high following medication
discontinuation Psychological and Combined Treatments
Cognitive-behavior therapies seem highly effective Panic Control Treatment Graded Exposure plus Coping Skills
Combined treatments do well in the short term Some indication that CBT alone is most effective
Fig. 4-6, p. 136
Types of Specific Phobia
Natural Environment Water, spaces, storms, etc. Often more than one Peak onset about 7 years old
Animals Snakes, spiders, dogs, etc.
Blood-Injection Injury Situational
Planes, heights, etc. Separation anxiety/school phobia Others, including…
Extreme and irrational fear of a specific object or situation
Go to great lengths to avoid phobic objects Often recognize fears are unreasonable Markedly interferes with one's ability to
function
Specific Phobia Diagnosis
Fig. 4-7, p. 142
Treatment of Specific Phobias
Psychological Treatments Cognitive-behavior therapies are highly effective Graduated exposure-based exercises
Structured and consistent Systematic Desensitization Prevent Avoidance/Escape
Blood/Injection Phobia Different Actually Increase Tension to Prevent Fainting
Marked and Persistent Fear of Social or Performance Situations
Often avoid social situations or endure them with great distress
Most Common Type of Social Fear? Public Speaking
Interferes with Life Functioning
Social Phobia Diagnosis
Fig. 4-8, p. 146
Treatment for Social Phobia
Medication Treatment of Social Phobia Antidepressants
Tricyclics and MAO Inhibitors SSRIs
Paxil, Zoloft, Effexor FDA approved High relapse rates following discontinuation
Psychological Treatment Cognitive-behavioral treatment
Exposure, rehearsal, role-play in a group setting
Highly effective
Posttraumatic Stress Disorder (PTSD)
Exposure to a traumatic event War and Combat Rape and Assault Car Accidents Natural Disasters
Re-experience the event (e.g., memories, nightmares, flashbacks)
Avoidance of cues that remind person of event Emotional numbing, sleep disturbance, hyperarousal, and
interpersonal problems are common Markedly interferes with one's ability to function
Subtypes of Post Traumatic Stress
Acute Stress Disorder Immediately post-trauma
Acute PTSD 1-3 months post trauma
Chronic PTSD 3+ months post trauma
Delayed Onset PTSD Onset of symptoms 6 months or more post
trauma
Fig. 4-10, p. 153
Psychological Treatment of PTSD Cognitive-behavioral treatment
Face the Original Trauma Imaginal Reexposure Flooding Corrective Emotional Learning Virtual Reality
Increase positive coping skills and social support Cognitive-behavior therapies are highly effective Eye Movement Desensitization and Retraining (EMDR)
Controversial, but has research support
PTSD Treatment
Obsessive-Compulsive Disorder
Culmination of All Anxiety Disorders Obsessions
Intrusive Thoughts, Images, or Urges Attempts to Suppress or Eliminate
Compulsions Thoughts or Actions Attempts to Suppress the Obsessions Attempts to Obtain Relief
Most people with OCD display multiple obsessions Most Common Problem?
Cleaning and washing or checking rituals NOT the same as Obsessive-Compulsive Personality
Disorder
Fig. 4-11, p. 157
Treatment for OCD
Biological Interventions SSRIs seem to benefit up to 60% of patients
Limited extent of help Relapse is common with medication discontinuation Psychosurgery (cingulotomy) is used in extreme cases
Psychological Treatment Cognitive-behavioral therapy is most effective with OCD
Exposure and response prevention Combining medication with CBT may be no better than
CBT alone
Factors in Treating Anxiety Disorders
Biological Interventions Cognitive-Behavioral Interventions What about:
Psychoanalytic Interventions Existential Interventions Humanistic Interventions Constructivist Interventions
And, then again, what about: Social Interventions Cultural Interventions
Comorbidity
Comorbidity is common across the anxiety disorders About half of patients have two or more secondary
diagnoses Major depression is the most common secondary
diagnosis Comorbidity suggests common factors across anxiety
disorders Comorbidity suggests a relation between anxiety and
depression
pp. 162-163