Chapter 6 Anxiety Disorders Copyright © 2006 Pearson Education Canada Inc

Chapter 6Anxiety Disorders

Copyright © 2006 Pearson Education Canada Inc.

Copyright © 2006 Pearson Education Canada Inc. 2

Overview

Most common type of abnormal behaviour 12 - 17% of adults have some form of anxiety

disorder in any given year Significant social and occupational impairment Commonalities with mood disorders - i.e., negative

emotional responses (guilt, worry) Bio-Psycho-Social are factors


Symptoms and Associated Features

People with anxiety disorders share a preoccupation with or persistent avoidance of, thoughts or situations that provoke fear or anxiety.



Fear - response to real, immediate danger

Anxiety– different from fear - more general and diffuse emotional reaction– low levels can be adaptive

Maladaptive anxiety– high levels of diffuse negative emotion– pessimistic thoughts and feelings– sense of uncontrollability - in future situations– shift in attention to state of self-preoccupation



Excessive Worry– common in anxiety– relatively uncontrollable sequence of negative

thoughts and images anticipating future threats of danger

– pathological worry high quantity and negative, unrealistic content (i.e., negative

self talk


DSM-IV-TR Approach

emphasis on description– little consideration on etiology

Eight Specific Subtypes - i.e., Panic Attack, Agoraphobia, Panic Disorder, Specific Phobia, Social Phobia,OCD, Acute Stress Disorder, Generalized Anxiety Disorder


Panic Attack

Sudden overwhelming experience of terror involving somatic and cognitive symptoms.

Symptoms are more intense, focused, and sudden than anxiety

Symptoms include hear palpitations, sweating, dizziness, loss of control, heart attack, feeling like one is going to die


Panic Attack: Somatic Symptoms

DSM-IV-TR requires at least 4 of 13 symptoms:– Palpitations– sweating– trembling/shaking– sensations of shortness of breath/smothering – feelings of choking– chest pain/discomfort – nausea– feeling dizzy/light-headed– derealization or depersonalization– fear of losing control/going crazy– fear of dying– tingling/numbness of extremities– chills/hot flushes


Panic Disorder

recurrent unexpected panic attackspersistent concern about additional

attacks for one monthwith or without agoraphobia


Phobias

persistent, excessive, unrealistic fear of a specific object/situation

avoidance behaviour

Specific Phobia: • fear of specific objects or situations• For example: public speaking, elevators, animals etc.


Specific Phobia

• Fear of specific objects or situations• For example: public speaking, elevators, animals etc.

• Types: Animal Type, Natural/Environmental, Blood-Injection, Situational Type, Other


Agoraphobia

Agoraphobia: • fear of public spaces• fear becomes more intense as the distance between the

person and his/her familiar surrounding increases• fear is more intense when the individual when avenues

of escape are perceived to be closed off• For Example: crowded rooms, streets• Can accompany panic disorder


Social Phobia

fear of social situations – performance anxiety– interpersonal interactions

rooted in fear of negative evaluationsmost common fears - speaking in public,

dealing with authority, using public washroom (Stein et al., 2000)


Obsessive-Compulsive Disorder (OCD)

presence of obsessions or compulsions or both

attempts to suppress thoughts or impulsesWhat amount of specific behaviour defines

abnormality?


Obsessions and Compulsions

OBSESSIONS – repetitive thoughts, images, impulses– obsessions are unwelcome - come “out of the blue”– person realizes their unreasonable nature (not delusional)– themes of usually unacceptable such as: sex, violence, contamination

COMPULSIONS– behavioural responses to obsessions (“tension reduction”)– repetitive behaviours, rituals (e.g., hand-washing, checking)– mental acts (counting)– individual often attempts to reduce performing the compulsion– considered by the person to be senseless or irrational


Generalized Anxiety Disorder (GAD)

excessive, uncontrollable worry majority of days than not for at least 6 monthsaffective, cognitive, & somatic symptomssymptoms include: feeling on edge, fatigued,

difficulty concentrating, irritability, muscle tension, poor sleep patterns


Historical Perspective

Freud’s etiological description:– psychological conflicts– biological impulses

focus on sex and aggression


Prognosis for Anxiety Disorders

chronic conditions

individual differences in recovery


Epidemiology

Gender - higher prevalence in females

Age - lower prevalence in the elderly

Cross-cultural studies– similar prevalence rates– different symptom patterns


Etiology of Anxiety Disorders:Social Factors

Stressful (dangerous) life events

Childhood abuse/neglect

Insecure attachment


Etiology of Anxiety Disorders:Psychological Factors

preparedness through evolution

observational learning


Etiology of Anxiety Disorders:Cognitive Factors

perceived control versus helplessnessClark’s “catastrophic misinterpretation” anxiety sensitivity

– focus on threat-related stimuli paradox of thought suppression

– “try to not think of a white bear”


Etiology of Anxiety Disorders:Biological Factors

strong genetic component– family and twin studies

two genetic factors identified– GAD/major depression– panic disorder/phobias


Etiology of Anxiety Disorders:Biological Factors

neuroanatomy – thalamus-amygdala circuit – OCD: caudate nucleus/orbital prefrontal

cortex/anterior cingulate cortex


Psychological Interventions

Systematic Desensitization involves teaching relaxation techniques, then

presenting items of the fear hierarchy while the patient is in the relaxed state

Direct exposure (in vivo) works better than imagined ones in most cases



Flooding involves exposure to most frightening stimuli

rather than working from the least to most frightening

Has shown high success rates



Relaxation and Breathing

involves teaching the client to alternate between relaxing and tensing muscle groups while breathing slowly and deeply


Exposure and Response Prevention

prolonged exposure to the situation that increases anxiety with prevention of the person’s typical compulsive response

used primarily with OCD


Cognitive Therapy and CBT

similar to treatment used in depression identify maladaptive cognitions and beliefs

and try to reconstruct mental sets

Virtual Reality Therapy


Biological Interventions I

antianxiety medications– Benzodiazapines (Valium, Xanax)– Serious side effect: sedation.

withdrawal, addiction


Biological Interventions II

Antidepressant medications – SSRIs (Prozac, Zoloft, Paxil)

preferred – less side effects– tricyclics OK but serious side effects– clomipramine for OCD


Case Study: Panic Disorder with Agoraphobia

Johanna Schneller – freelance writer describes debilitating panic attacks

– nausea, dizziness, shortness-of-breath, feelings of doom, and fear of escape

– progressive fear of leaving her home

negative effects of life– relationships– employment

Documents

Chapter 6 Anxiety Disorders Copyright © 2006 Pearson Education Canada Inc