Anxiety DisordersAnxiety Disorders

Thomas G. Bowers, Ph.D.

Penn State Harrisburg

Anxiety DisordersAnxiety Disorders

• Anxiety • Subjective distress, fear, apprehension• Elevated heart rate, rapid breathing, • Highly similar to fearfulness, but thought to be

irrational or unrealistic

Types of Anxiety DisordersTypes of Anxiety Disorders

Phobias

Fear mediated avoidance, thought to be unrealisticSome examples– claustrophobia

Fear of closed spaces– agoraphobia

Fear of public places– acrophobia

Fear of heights

Types of Anxiety DisordersTypes of Anxiety Disorders

Phobias

Some other examples– Specific phobias

Specific unwanted fears– Social phobia

Relatively common

Types of Anxiety DisordersTypes of Anxiety Disorders

Panic Disorder

Sudden and often unexpected attack of anxiety symptoms

Heart palpitations, nausea, choking, dizziness, trembling, apprehension, even terror

Often associated with stress

Types of Anxiety DisordersTypes of Anxiety Disorders

Generalized Anxiety Disorders

Persistent anxiety, chronic, uncontrollable worry

“Free floating”

Types of Anxiety DisordersTypes of Anxiety Disorders

Obsessive-Compulsive Disorder

Persistent and uncontrollable thoughts and feelings of a compulsion to repeat certain acts

Depression also often noted

Types of Anxiety DisordersTypes of Anxiety Disorders

Posttraumatic Stress Disorder (PTSD)

Introduced in 1980 (DSM-III)

Earlier conceptions:

1. “Shell shock” (WWI and WWII)

2. “Combat neurosis” (Korea)

3. Noted in Civil War

Types of Anxiety DisordersTypes of Anxiety Disorders

Posttraumatic Stress Disorder (PTSD)

Extreme response to severe stressor

Increased anxiety, avoidance of stimuli associated with trauma, numbing of emotional responses

Types of Anxiety DisordersTypes of Anxiety Disorders

Acute Stress Disorder (ASD)

New to DSM IV

Recovery in about one month

Types of Anxiety DisordersTypes of Anxiety Disorders

PTSD symptoms

1. Re-experiencing the traumatic event

2. Avoidance of the stimuli associated with the event or a numbing of responsiveness

3. Increased arousal

Etiology of Anxiety Etiology of Anxiety DisordersDisorders

• Varied theoretical views

• Psychoanalytical theories– Anxiety in general represents repressed id

impulses– The repressed impulses are displaced to

object with some symbolic connection– Represents neurotic level of adjustment

Etiology of Anxiety Etiology of Anxiety DisordersDisorders

• Behavioral theories– Anxiety is learned– Avoidance conditioning - classical

conditioning to a previously neutral stimulus condition

– Little Albert Case - conditioned by Watson and Rayner to develop a fear of a white rat

Etiology of Anxiety Etiology of Anxiety DisordersDisorders

• Behavioral theories– Avoidance conditioning can not account for

all of anxiety, however– Modeling theories - vicarious or

observational learning

Etiology of Anxiety Etiology of Anxiety DisordersDisorders

• Cognitive Behavioral Theories– Some patterns of thoughts (as worry) may

be maintained by avoiding even less pleasant emotions

– Uncontrollable environmental conditions also could contribute to misperception

Etiology of Anxiety Etiology of Anxiety DisordersDisorders

• Biological Views– There may be genetic components to

neuroticism– benzodiazepines (also known as minor

tranquilizers) are effective in treating anxiety

– Linked with inhibitory neurotransmitter GABA (gamma-aminobutyric acid)

Etiology of Anxiety Etiology of Anxiety DisordersDisorders

• Biological Views– Linked with inhibitory

neurotransmitter GABA (gamma-aminobutyric acid)

– Increase in GABA levels yields decreased anxiety

Treatment of Anxiety Treatment of Anxiety DisordersDisorders

• Analytical– Long relationship, ‘reparent,’ resolve

fundamental issues

• Behavioral – Desensitization for phobic concerns– Flooding

Treatment of Anxiety Treatment of Anxiety DisordersDisorders

• Cognitive behavioral– Interpretation, reformulation of thought

process– Gradual approximation of behaviors– Modeling– Social support

Treatment of Anxiety Treatment of Anxiety DisordersDisorders

• Biological – benzodiazepines– Use of minor

tranquilizers as Valium, Librium, more recently BuSpar

– Some dependence liability

Treatment of Anxiety Treatment of Anxiety DisordersDisorders

• Biological – Antidepressants as selective serotonin

reuptake inhibitors (SSRI)– Also effective treating depression