Anxiety DisordersMargaretha, S.Psi., G.Dip.Psych.Universitas Airlangga, Surabaya, 2007

**OUTLINEAnxietyDefinisi & Terminologi terkaitManifestasi Karakteristik dasarEtiologiKlasifikasi dan diagnosisPhobiaPost Traumatic Stress Disorders (PTSD)PanicGeneralized Anxiety Disorders (GAD)Obsessive Compulsive Disorders (OCD)Diskusi

**Takut (fear) : ada object spesifik yang jelas menyebabkan rasa takutEx: takut terlambat takut dimarahi karena ada guru yang galakCemas (anxiety) : Kondisi cemas, takut tapi obyek tidak jelas, atau rasa takut tidak bisa dijelaskan atau dipahamiEx: takut pada ruang gelap

**Definition of AnxietyEmosi negatif yang muncul karena antisipasi kejadian mendatang yang dibayangkan akan menyakitkanSifat Anxiety patologisIntensitas rasa takut tinggi, durasi lama, dan berpengaruh pada perilakuDapat menghasilkan gejala emosi, kognitif, fisik dan perilaku

**Anxiety: Where to find itBuku psikologi abnormal: anxiety PPDGJ: neurosa, somatoform & stress (F.4) DSM: Anxiety disorders ICD: Neurotic, stress related and somatoform disordersNeurosis William Cullen Defisiensi general sistem saraf pusat (nervous system)Psychoneurosis Sigmund Freud 1900Tension seksual yang tak terlepaskan - hypochondriasisPikiran yang direpresi - phobias

**Manifestasi Anxiety PhysicalAnorexia, sakit di perut, sakit dada, mulut kering, pusing, sakit kepala, disfungsi seksual, tangan berkeringatAffectiveDari rasa gamang hingga perasaan diterorCognitivePikiran mengenai hal negatif yang dapat dialamiBehavioralMacam-macam respon yang dilakukan individu untuk mengurangi atau menghindari kecemasan

**Karakteristik dasar AnxietyEtiologi gangguan terkait dengan stressKemampuan menjelaskan realita tetap baik (intact)Memunculkan gejala-gejala penderitaan (distressing)Gangguan terjadi terus menerus/persistenTapi tidak memiliki dasar gangguan medis nyata

**Sisi positif AnxietyYerkes-Dodson law:Performance improves as a function of anxiety up to a threshold beyond which there is a fall off in performance

**Etiology Social & BiologicalSOCIALSocial factors: peristiwa traumatis, masa kecil yang sulit, kurangnya support sosial BIOGenetic, dibuktikan lewat: twin studiesKetidakseimbangan hormonal

**Etiology Psychological Personality factorsSome personality traits predispose to certain anxiety disorders avoidant, perfectionistPsycho-analytic theories - unconscious defence mechanismsPhobia - displacementOCD - reaction formation, undoingPTSD - denial, repressionCognitive theoriesBerpikir selektif dan cenderung melebih-lebihkan (selective attention and catastrophic thinking)Behaviour Perilaku yang dipelajari (learned behaviour)

**Terminologi AnxietyNeurosis William Cullen Defisiensi general sistem saraf pusat (nervous system)Psychoneurosis Sigmund Freud 1900Tension seksual yang tak terlepaskan - hypochondriasisPikiran yang direpresi - phobiasICD10 Neurotic, stress related and somatoform disorders.DSM IV Anxiety disorders

**General medical conditionscausing anxiety

Cardiovascular conditions, ex: jantungRespiratory conditions, ex: sesak napasMetabolic conditions: ex: gangguan kelenjar, diabetesNeurological conditions, ex: Traumatic brain injury

**Substances that cause anxietyMedications Antipsychotics, Antidepressants, Heavy metals, Toxins (gasoline, paint, insecticides, nerve gases, carbon monoxide, carbon dioxide), InsulinIntoxication Alcohol, Amphetamines, Caffeine, Cannabis, Cocaine, Hallucinogens, Inhalants

**PHOBIA

**Definisi Anxietas oleh karena adanya situasi/obyek yang jelas dari luar individu, yang sebenarnya pada saat ini tidak membahayakanSebagai akibatnya, individu menghindari atau dihadapi dengan rasa terancam Seringkali co-exist dengan episode depresif

**Macam Agora phobiaAnxietas timbul pada situasi berikut: banyak orang, keramaian, tempat umum, bepergian keluar rumah, bepergian sendiriSocial phobiaAnxietas muncul dan menghindari situasi sosial, di luar konteks perilaku Ex: takut dipermalukan Anxiety provoked by social or performance situationsFeared situations are avoided or endured with marked anxietyE.g., public speaking, going to parties, meeting new people, eating in publicPerson fears will act in a way that will be humiliating or embarrassing

**Specific PhobiaDitandai dengan rasa takut menetap yang excessive, irasional, karena hadirnya suatu stimulus/obyek/kondisi tertentuSpecific phobia / phobia khasAnimal: laba-laba (Arachnophobia)Natural environment : Darkness (Nyctophobia)Situational: closed place (Claustrophobia)Other: death (Thanatophobia)

**Terapi Sistematis desentisasiExposureModellingObat

**Prognosis Cukup baikDapat dimodifikasi perilakunyaRestrukturisasi kognitif

**PTSD

**PTSDRespon akibat suatu stress yang diakibatkan peristiwa traumatisMeliputi timbulnya rasa takut, hellplessnessSeperti merasakan ulang pengalaman traumatisMenghindari stimulus/ timbul penghindaran dengan cara psychological numbingMuncul respon arousalGajala timbul lebih dari 1 bulan

**Unlike other anxiety disorders, PTSD is directly tied to a traumatic incidentE.g., Torture victims, accident survivors, assault victimsMay see onset immediately after traumatic event, or may be delayed onsetSeems to be particularly likely to occur if a person cannot make sense of a trauma

**Contoh PTSD setelahBencana alamPerang Meninggalnya orang terdekatDitinggal significant othersRape Melihat pembunuhan

**TreatmentMedikamentosaPrognosis membaik 60% (moderately improved, Seligman, 1994)ExposureDisclosure / opeing up

**PANIC

**Definisi PPDGJ (F 41.0)Ditemukan adanya beberapa serangan anxietas berat, dalam masa 1 bulan, dimana:Pada keadaan secara obyektif tidak bahayaTidak terbatas pada situasi yang telah dapat diprediksikan sebelumnya (unpredictable situations)Muncul setelah membayangkan sesuatu yang mengkhawatirkan terjadi

**Panic attackCharacterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly Last several minutes, often accompanied by high physiological arousal (rapid heart rate, shortness of breath) and fear of losing controlBecome apprehensive about when next attack will occurMay lead to agoraphobia: fear of going out in public placesFear may be general or limited to certain situationsPublic transportationTunnels or bridgesCrowdsGoing out by oneself

**Treatment Obat: antianxiety drugs, antidepressanPrognosis membaik 80% (improved, Seligman, 1994)KognitifReinterpretasi gejala panic Prognosis membaik 75% (improved, Seligman, 1994)

**GAD

**GAD

Gangguan cemas menyeluruh (F 41.1) DSM-IVR criteria for GAD Excessive or ongoing anxiety and worry for at least 6 months about numerous events or activitiesDifficulty controlling the worryAt least 3 of the following symptoms: restlessness, easy fatigue, irritability, muscle tension, sleep disturbanceSignificant distress or impairment

**GADMarked by a chronic, high level of anxietythat is not tied to any specific threat Free-floating anxiety Worry constantly about yesterday's mistakes,tomorrows problems Worry about family, finances, work, personalillness more than others May see muscle tension, poor concentration,irritability, sleep disturbance, feeling on edge

**GAD : treatments by perspectivesPsychodynamic therapyFree association, Transference, Resistance17 Research shows that psychodynamic therapy (psychoanalysis) is not consistently helpful for GADCognitiveGAD is the result of dysfunctional ways of thinking about the world.Albert Ellis: Rational Emotive therapyPersons with GAD make these types of irrational assumptionsEx: It is catastrophic when things are not going the way I would like them to.Aaron BeckPeople with GAD see the world as more dangerous than it actually is It is always best to assume the worstEx: My safety depends on anticipating and preparing myself for any possible danger that might occur.Cognitive therapies for GADKeeping a journalRecognizing maladaptive, dysfunctional assumptions.Challenging old assumptions and substituting new beliefsDeveloping new coping skillsBehavioral perspective on GADGAD is learned through classical conditioning and generalization.

**Prognosis Antidepresan moderateCBT 50% improved (Roy-Byrne & Cowley, 1998)

**OCD

**Definisi Obsesi: pikiran yang berulangCompulsi: perilaku yang berulangGejala anxietas yang muncul 2 minggu berturut-turutHarus disadari sebagai pikiran sendiriTidak berhasil dilawanBukan hal yang memberikan kepuasanpengulangan

**Contoh Selalu was-was belum mengunci pintuSelalu mencuci tanganCompulsions are responses to obsessions and often reduce anxiety associated with the thoughts in the short termCommon compulsions: cleaning, counting, checking, asking for reassurance, orderingUsually has onset during adolescence

**Treatment CBTBehavior therapyDrug therapy: serotoni inhibitionPrognosis: 40-60% moderate (Foa, 1998)

**Diskusi 1Mr. A menyaksikan teman karibnya meninggal karena kecelakaan motor 6 minggu yang lalu.Setelah itu ia mengalami mimpi buruk setiap malam, sulit tidur, dan selalu terbayang-bayang kecelakaan ituIa jadi takut mengendarai motor, bahkan timbul kecemasan ketika melihat jalan rayaIa juga tidak lagi bisa menunjukkan afeksi pada pacarnya, dan pacarnya juga merasa sejak kecelakaan itu ia menjadi orang yang sangat mudah terkejut dan sering marah-marah

**Diskusi 2Mrs. B c/o a long h/o episodes of anxiety, racing heart, sweating, CP, and fears that she is having a MI and will die. These last 30 minutes and are unexpected. She c/o anxiety while inmalls and traveling alone to new places for fear of having another attack. Despite a negative medical w/u, she still worries about having a MI during anattack.

**Diskusi 3Ms. D has a chief c/o worrying about everything for the last year. She also c/o frequent headaches, fatigue and insomnia secondary to the anxiety.These symptoms have worsened to the point where she has been distracted and making mistakes at work.

**Diskusi 4Dr. E memiliki riwayat sejak kecil takut berbicara di depan kelas Ia selalu takut jika ia akan melakukan hal yang salah di depan orang banyak, lalu dipermalukan Oleh karena itu ia selalu menghindari komunikasi dengan rekan profesionalnya, namun akhir-akhir ini ia merasa perilaku ini akan memperngaruhi negatif karir akademisnya