ANXIETY DISORDERS
Mood Symptoms <ul><li>Tension  </li></ul><ul><li>Anxiety Anxiety </li></ul><ul><li>Fear Fear Fear Fear </li></ul><ul><li>D...
Cognitive Symptoms <ul><li>Expectation of future harm </li></ul><ul><ul><li>Fear - clear, specific danger </li></ul></ul><...
Behavioral/Somatic Symptoms <ul><li>Autonomic arousal </li></ul><ul><li>Behavior - startle, restlessness </li></ul><ul><li...
Post-Traumatic Stress Disorder (PTSD) <ul><li>Traumatic event exposure </li></ul><ul><ul><li>Death or serious injury/threa...
Post-Traumatic Stress Disorder (PTSD) <ul><li>Event is re-experienced </li></ul><ul><ul><li>Intrusive thoughts </li></ul><...
Post-Traumatic Stress Disorder (PTSD) <ul><li>Avoidance or numbing </li></ul><ul><ul><li>Avoid reminders </li></ul></ul><u...
Post-Traumatic Stress Disorder (PTSD) <ul><li>Persistent arousal </li></ul><ul><ul><li>Sleep disturbance </li></ul></ul><u...
PTSD <ul><li>Symptoms > 1 month </li></ul>
Acute Stress Disorder <ul><li>Symptoms 2 days - 1 month </li></ul>
Combat PTSD <ul><li>Goals of training </li></ul><ul><ul><li>Fighter identity </li></ul></ul><ul><ul><ul><li>Entering Vietn...
Combat PTSD Risk Factors <ul><li>Pre-morbid psychological vulnerability </li></ul><ul><ul><li>But majority of PTSD have no...
Combat PTSD Risk Factors <ul><li>More combat exposure </li></ul><ul><ul><li>Goldberg et al. (1990) - MZ twins in Vietnam <...
Combat PTSD Risk Factors <ul><li>More death exposure </li></ul><ul><li>More moral values conflict - more perceived respons...
Combat PTSD Risk Factors <ul><li>More return to non-supportive environment </li></ul><ul><ul><li>Vietnam </li></ul></ul><u...
Prevalence of PTSD <ul><li>8-15% lifetime in general population </li></ul><ul><li>20% prevalence in response to trauma </l...
Prevalence of PTSD <ul><li>Many have isolated symptoms </li></ul><ul><ul><li>68% combat veterans had frequent nightmares 5...
Treatment of PTSD <ul><li>Immediately after trauma </li></ul><ul><li>Education/reassurance regarding symptoms </li></ul><u...
Generalized Anxiety Disorder (Neurosis) <ul><li>Excessive anxiety/ worry/ anxious apprehension </li></ul><ul><ul><li>Regar...
Generalized Anxiety Disorder (Neurosis) <ul><li>Difficult to control worry - “What if?” - vague future prbs.  </li></ul><u...
Panic Disorder <ul><li>Unexpected, recurrent panic attacks </li></ul><ul><ul><li>4 in 4-week period </li></ul></ul><ul><li...
Panic Disorder <ul><ul><li>Emotional - terror, derealization/depersonalization </li></ul></ul><ul><ul><li>Cognitions - out...
Panic Disorder <ul><li>Persistent concern about future attacks </li></ul><ul><li>Worry about implications </li></ul><ul><l...
Phobic Disorders <ul><li>Persistent fear of specific situation/object </li></ul><ul><ul><li>recognize fear is excessive </...
Phobic Disorders - Agoraphobia <ul><li>Fear of marketplace - escape difficult or help unavailable </li></ul><ul><li>Avoid ...
Phobic Disorders -  Social Phobia <ul><li>Fear of situations involving potential negative evaluation by others </li></ul><...
Phobic Disorders -  Social Phobia <ul><li>15% female, 11% male </li></ul><ul><li>60% recall specific experience  </li></ul...
Phobic Disorders -  Specific Phobia <ul><li>Fear of specific stimulus </li></ul><ul><li>Avoidance or intense anxiety </li>...
Specific Phobias <ul><li>Animal - childhood </li></ul><ul><li>Inanimate objects/natural environment - any age </li></ul><u...
Obsessive Compulsive Disorder (OCD) <ul><li>Obsessions </li></ul><ul><ul><li>Recurrent, intrusive thoughts </li></ul></ul>...
Obsessive Compulsive Disorder (OCD) <ul><li>Compulsions </li></ul><ul><ul><li>Repetitive, purposeful behavior in response ...
Obsessions and Compulsions <ul><li>Cause distress </li></ul><ul><li>Consume time </li></ul><ul><li>Interfere with function...
ETIOLOGY OF  ANXIETY DISORDERS
Hereditary Influences <ul><li>MZ > DZ concordance </li></ul><ul><ul><li>Overall 35% MZ vs 10% DZ concordance </li></ul></u...
Disorder-Specific  Biological Influences <ul><li>Generalized Anxiety Disorder </li></ul><ul><ul><li>Low GABA --> Low inhib...
Disorder-Specific  Biological Influences <ul><li>Panic Disorder </li></ul><ul><ul><li>Oversensitive respiratory control ce...
Disorder-Specific  Biological Influences <ul><ul><ul><li>Challenge tests </li></ul></ul></ul><ul><ul><ul><ul><li>Sodium-la...
Disorder-Specific  Biological Influences <ul><ul><ul><ul><li>Carbon dioxide inhalation --> panic if panic history </li></u...
Disorder-Specific  Biological Influences <ul><li>Obsessive-Compulsive Disorder </li></ul><ul><ul><li>Serotonin dysregulati...
Psychological Etiology <ul><li>Psychoanalytic theory </li></ul><ul><ul><li>Objective anxiety - threat from external world ...
Psychological Etiology <ul><ul><li>Neurotic anxiety </li></ul></ul><ul><ul><ul><li>Unconscious conflict threatens consciou...
Psychological Etiology <ul><ul><ul><li>Wish to harm son --> neurotic anxiety --> door checking </li></ul></ul></ul>
Psychological Etiology <ul><li>More uncontrollable stressful life events </li></ul><ul><li>Previous anxiety disorder + str...
Behavioral Explanation <ul><li>Classical conditioning </li></ul><ul><ul><li>Little Albert </li></ul></ul><ul><ul><ul><li>R...
Behavioral Explanation <ul><ul><li>Extinction should occur rapidly, but phobias persist </li></ul></ul><ul><ul><ul><li>Why...
Behavioral Explanation <ul><ul><ul><li>Mowrer two-factor theory </li></ul></ul></ul><ul><ul><ul><ul><li>Classical conditio...
Questions for Behavioral Account <ul><li>Selectivity of phobias </li></ul><ul><ul><li>Why spider but not lamb phobia? </li...
Questions for Behavioral Account <ul><ul><li>Prepared classical conditioning </li></ul></ul><ul><ul><ul><li>Natural select...
Questions for Behavioral Account <ul><li>Susceptibility to phobias </li></ul><ul><ul><li>Physiological vulnerability (high...
Cognitive Explanation <ul><li>Threat-enhancing cognitive set </li></ul><ul><ul><li>Expect threat in environment </li></ul>...
Threat-Enhancing  Cognitive Set <ul><li>“ They discussed the priest’s convictions” </li></ul><ul><li>“ The men watched as ...
Questions for Cognitive Explanation <ul><li>Causality? </li></ul><ul><li>Does not explain spontaneous anxiety </li></ul><u...
TREATMENT OF ANXIETY DISORDERS
Biological Treatments <ul><li>Benzodiazapines </li></ul><ul><ul><li>Generalized Anxiety Disorder and Phobias </li></ul></u...
Problems With Benzodiazapines <ul><li>Side Effects </li></ul><ul><li>Psychological and Physical Dependence </li></ul><ul><...
Antidepressants <ul><li>Panic, Agoraphobia, OCD </li></ul><ul><li>Anafranil </li></ul><ul><li>Effective for 50% OCD patien...
Surgery for OCD <ul><li>Cingulotomy </li></ul><ul><ul><li>partially cut cingulate gyrus </li></ul></ul><ul><ul><li>connect...
Psychological Treatments <ul><li>Commonality = confrontation of fear </li></ul><ul><li>Cognitive-Behavior Therapy </li></u...
Behavioral Treatments <ul><ul><li>Extinction of anxiety through exposure and development of incompatible responses </li></...
Psychological Treatment Effectiveness <ul><li>Review of Panic Disorder studies </li></ul><ul><ul><li>75-95% panic-free aft...
Psychological Treatment Effectiveness <ul><li>OCD </li></ul><ul><ul><li>Exposure + response prevention </li></ul></ul><ul>...
Psychological Treatment Effectiveness THE END
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Anxiety Disorders

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Anxiety Disorders

  1. 1. ANXIETY DISORDERS
  2. 2. Mood Symptoms <ul><li>Tension </li></ul><ul><li>Anxiety Anxiety </li></ul><ul><li>Fear Fear Fear Fear </li></ul><ul><li>Dread Dread Dread Dread </li></ul><ul><li>Panic Panic Panic Panic </li></ul><ul><li>!!!! T E R R O R !!!! </li></ul>
  3. 3. Cognitive Symptoms <ul><li>Expectation of future harm </li></ul><ul><ul><li>Fear - clear, specific danger </li></ul></ul><ul><ul><li>Anxiety - unknown, diffuse danger </li></ul></ul><ul><li>Lack of Concentration </li></ul><ul><li>Self-focused preoccupation </li></ul>
  4. 4. Behavioral/Somatic Symptoms <ul><li>Autonomic arousal </li></ul><ul><li>Behavior - startle, restlessness </li></ul><ul><li>Avoidance </li></ul>
  5. 5. Post-Traumatic Stress Disorder (PTSD) <ul><li>Traumatic event exposure </li></ul><ul><ul><li>Death or serious injury/threat </li></ul></ul><ul><ul><li>Reaction of intense fear, helplessness, horror </li></ul></ul>
  6. 6. Post-Traumatic Stress Disorder (PTSD) <ul><li>Event is re-experienced </li></ul><ul><ul><li>Intrusive thoughts </li></ul></ul><ul><ul><li>Dreams </li></ul></ul><ul><ul><li>Flashbacks </li></ul></ul><ul><ul><li>Triggers </li></ul></ul>
  7. 7. Post-Traumatic Stress Disorder (PTSD) <ul><li>Avoidance or numbing </li></ul><ul><ul><li>Avoid reminders </li></ul></ul><ul><ul><li>Detachment/diminished interest </li></ul></ul><ul><ul><li>Foreshortened future </li></ul></ul>
  8. 8. Post-Traumatic Stress Disorder (PTSD) <ul><li>Persistent arousal </li></ul><ul><ul><li>Sleep disturbance </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Hypervigilance/exaggerated startle </li></ul></ul><ul><li>Impairment in functioning </li></ul>
  9. 9. PTSD <ul><li>Symptoms > 1 month </li></ul>
  10. 10. Acute Stress Disorder <ul><li>Symptoms 2 days - 1 month </li></ul>
  11. 11. Combat PTSD <ul><li>Goals of training </li></ul><ul><ul><li>Fighter identity </li></ul></ul><ul><ul><ul><li>Entering Vietnam soldiers </li></ul></ul></ul><ul><ul><ul><ul><li>19.2 years old </li></ul></ul></ul></ul><ul><ul><li>Shut down feelings </li></ul></ul><ul><ul><li>Dehumanize enemy </li></ul></ul><ul><li>Clash with realities of war </li></ul>
  12. 12. Combat PTSD Risk Factors <ul><li>Pre-morbid psychological vulnerability </li></ul><ul><ul><li>But majority of PTSD have no pre-morbid history </li></ul></ul>
  13. 13. Combat PTSD Risk Factors <ul><li>More combat exposure </li></ul><ul><ul><li>Goldberg et al. (1990) - MZ twins in Vietnam </li></ul></ul><ul><ul><ul><li>No combat exposure 8-12% PTSD </li></ul></ul></ul><ul><ul><ul><li>Combat exposure 16-31% PTSD </li></ul></ul></ul>
  14. 14. Combat PTSD Risk Factors <ul><li>More death exposure </li></ul><ul><li>More moral values conflict - more perceived responsibility </li></ul><ul><li>Less identification with unit/leader </li></ul>
  15. 15. Combat PTSD Risk Factors <ul><li>More return to non-supportive environment </li></ul><ul><ul><li>Vietnam </li></ul></ul><ul><ul><ul><li>Rapid Homecoming </li></ul></ul></ul><ul><ul><ul><li>Social rejection </li></ul></ul></ul>
  16. 16. Prevalence of PTSD <ul><li>8-15% lifetime in general population </li></ul><ul><li>20% prevalence in response to trauma </li></ul><ul><ul><li>20% Combat PTSD </li></ul></ul><ul><ul><li>11-80% range </li></ul></ul>
  17. 17. Prevalence of PTSD <ul><li>Many have isolated symptoms </li></ul><ul><ul><li>68% combat veterans had frequent nightmares 5 years later </li></ul></ul>
  18. 18. Treatment of PTSD <ul><li>Immediately after trauma </li></ul><ul><li>Education/reassurance regarding symptoms </li></ul><ul><li>Discuss details of incident (exposure) </li></ul><ul><li>Identify and process areas of impact </li></ul>
  19. 19. Generalized Anxiety Disorder (Neurosis) <ul><li>Excessive anxiety/ worry/ anxious apprehension </li></ul><ul><ul><li>Regarding several events/activities </li></ul></ul><ul><ul><li>> 6 months </li></ul></ul>
  20. 20. Generalized Anxiety Disorder (Neurosis) <ul><li>Difficult to control worry - “What if?” - vague future prbs. </li></ul><ul><li>Autonomic arousal </li></ul><ul><li>Impairs functioning </li></ul><ul><li>6.6% females 3.6% males </li></ul>
  21. 21. Panic Disorder <ul><li>Unexpected, recurrent panic attacks </li></ul><ul><ul><li>4 in 4-week period </li></ul></ul><ul><li>Panic attacks - sudden onset, peak within 10 minutes </li></ul><ul><ul><li>Physical - shortness of breath, heart races, chest pain, dizzy/faint </li></ul></ul>
  22. 22. Panic Disorder <ul><ul><li>Emotional - terror, derealization/depersonalization </li></ul></ul><ul><ul><li>Cognitions - out of control </li></ul></ul><ul><ul><ul><li>die or go crazy </li></ul></ul></ul>
  23. 23. Panic Disorder <ul><li>Persistent concern about future attacks </li></ul><ul><li>Worry about implications </li></ul><ul><li>Avoidant behaviors </li></ul><ul><li>With or without agoraphobia </li></ul><ul><li>4% lifetime prevalence </li></ul>
  24. 24. Phobic Disorders <ul><li>Persistent fear of specific situation/object </li></ul><ul><ul><li>recognize fear is excessive </li></ul></ul><ul><li>Avoid object/situation </li></ul><ul><li>Interfere with functioning or distress about phobia </li></ul>
  25. 25. Phobic Disorders - Agoraphobia <ul><li>Fear of marketplace - escape difficult or help unavailable </li></ul><ul><li>Avoid situations or insist on companion </li></ul><ul><li>7% female, 3.5% male lifetime prevalence </li></ul>
  26. 26. Phobic Disorders - Social Phobia <ul><li>Fear of situations involving potential negative evaluation by others </li></ul><ul><li>Avoidance or intense anxiety </li></ul><ul><li>Interferes with functioning or distress about phobia </li></ul>
  27. 27. Phobic Disorders - Social Phobia <ul><li>15% female, 11% male </li></ul><ul><li>60% recall specific experience </li></ul><ul><ul><li>+ 13 % vicarious experience </li></ul></ul>
  28. 28. Phobic Disorders - Specific Phobia <ul><li>Fear of specific stimulus </li></ul><ul><li>Avoidance or intense anxiety </li></ul><ul><li>Interfere with functioning or distress about phobia </li></ul><ul><li>16% female, 7% male </li></ul>
  29. 29. Specific Phobias <ul><li>Animal - childhood </li></ul><ul><li>Inanimate objects/natural environment - any age </li></ul><ul><li>Illness/injury - onset middle age </li></ul>
  30. 30. Obsessive Compulsive Disorder (OCD) <ul><li>Obsessions </li></ul><ul><ul><li>Recurrent, intrusive thoughts </li></ul></ul><ul><ul><li>Experienced as inappropriate (ego-dystonic) </li></ul></ul><ul><ul><li>Cause distress </li></ul></ul><ul><ul><li>Themes - contamination, violence </li></ul></ul><ul><ul><li>Attempt to ignore/neutralize </li></ul></ul>
  31. 31. Obsessive Compulsive Disorder (OCD) <ul><li>Compulsions </li></ul><ul><ul><li>Repetitive, purposeful behavior in response to obsessions or rules </li></ul></ul><ul><ul><li>Designed to prevent discomfort </li></ul></ul><ul><ul><li>Anxiety if don’t perform </li></ul></ul><ul><ul><ul><li>No pleasure, but tension release </li></ul></ul></ul><ul><ul><li>Common - cleaning, counting, checking </li></ul></ul>
  32. 32. Obsessions and Compulsions <ul><li>Cause distress </li></ul><ul><li>Consume time </li></ul><ul><li>Interfere with functioning </li></ul><ul><li>Begin in adolescence </li></ul><ul><li>2.5% lifetime prevalence </li></ul><ul><li>Males = females </li></ul>
  33. 33. ETIOLOGY OF ANXIETY DISORDERS
  34. 34. Hereditary Influences <ul><li>MZ > DZ concordance </li></ul><ul><ul><li>Overall 35% MZ vs 10% DZ concordance </li></ul></ul><ul><ul><li>OCD 68% MZ vs 15% DZ </li></ul></ul><ul><ul><li>Agoraphobia - 39% MZ </li></ul></ul><ul><ul><li>Generalized anxiety disorder - 30% MZ </li></ul></ul>
  35. 35. Disorder-Specific Biological Influences <ul><li>Generalized Anxiety Disorder </li></ul><ul><ul><li>Low GABA --> Low inhibitory neuron activity --> high neuronal activity in limbic system </li></ul></ul><ul><ul><li>High arousal can enhance conditioning </li></ul></ul><ul><ul><li>Anxiolytics increase GABA and decrease anxiety </li></ul></ul>
  36. 36. Disorder-Specific Biological Influences <ul><li>Panic Disorder </li></ul><ul><ul><li>Oversensitive respiratory control center in brain stem </li></ul></ul><ul><ul><ul><li>Minor oxygen debt (high CO 2 ) </li></ul></ul></ul><ul><ul><ul><ul><li>--> false alarm re suffocation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>--> panic </li></ul></ul></ul></ul>
  37. 37. Disorder-Specific Biological Influences <ul><ul><ul><li>Challenge tests </li></ul></ul></ul><ul><ul><ul><ul><li>Sodium-lactate infusion (converted to CO 2 ) --> </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Panic history --> 54-90% panic attack </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Panic history --> 5-36% panic to placebo </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>No panic history --> 0-25% panic </li></ul></ul></ul></ul></ul>
  38. 38. Disorder-Specific Biological Influences <ul><ul><ul><ul><li>Carbon dioxide inhalation --> panic if panic history </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hyperventilation --> panic if panic history </li></ul></ul></ul></ul><ul><ul><ul><li>Antidepressants --> increase 5-HT --> inhibits respiratory control center --> decrease panic </li></ul></ul></ul>
  39. 39. Disorder-Specific Biological Influences <ul><li>Obsessive-Compulsive Disorder </li></ul><ul><ul><li>Serotonin dysregulation </li></ul></ul><ul><ul><ul><li>Antidepressants (SSRIs) effective for 50% OCD </li></ul></ul></ul><ul><ul><ul><li>Dogs on Prozac </li></ul></ul></ul><ul><ul><li>Minimal brain damage </li></ul></ul><ul><ul><li>Higher activity in orbitalfrontal cortex </li></ul></ul>
  40. 40. Psychological Etiology <ul><li>Psychoanalytic theory </li></ul><ul><ul><li>Objective anxiety - threat from external world </li></ul></ul><ul><ul><li>Moral anxiety - unconscious fear of punishment by superego </li></ul></ul>
  41. 41. Psychological Etiology <ul><ul><li>Neurotic anxiety </li></ul></ul><ul><ul><ul><li>Unconscious conflict threatens consciousness --> neurotic anxiety --> defense mechanisms and symptoms --> reduce anxiety (primary gain) and interpersonal reward (secondary gain) </li></ul></ul></ul>
  42. 42. Psychological Etiology <ul><ul><ul><li>Wish to harm son --> neurotic anxiety --> door checking </li></ul></ul></ul>
  43. 43. Psychological Etiology <ul><li>More uncontrollable stressful life events </li></ul><ul><li>Previous anxiety disorder + stress --> relapse </li></ul>
  44. 44. Behavioral Explanation <ul><li>Classical conditioning </li></ul><ul><ul><li>Little Albert </li></ul></ul><ul><ul><ul><li>Rat (neutral stimulus) paired with noise (unconditioned stimulus) --> startle, cry (UCR) </li></ul></ul></ul><ul><ul><ul><li>Rat (conditioned stimulus) --> fear (conditioned response) </li></ul></ul></ul>
  45. 45. Behavioral Explanation <ul><ul><li>Extinction should occur rapidly, but phobias persist </li></ul></ul><ul><ul><ul><li>Why? </li></ul></ul></ul><ul><ul><ul><ul><li>Avoid feared stimulus --> reward --> maintain phobia </li></ul></ul></ul></ul>
  46. 46. Behavioral Explanation <ul><ul><ul><li>Mowrer two-factor theory </li></ul></ul></ul><ul><ul><ul><ul><li>Classical conditioning initiates phobia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Operant conditioning maintains phobia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Stimulus generalization and vicarious conditioning also contribute to initiation and maintenance </li></ul></ul></ul></ul>
  47. 47. Questions for Behavioral Account <ul><li>Selectivity of phobias </li></ul><ul><ul><li>Why spider but not lamb phobia? </li></ul></ul><ul><ul><li>Why dark but not electric outlet phobia? </li></ul></ul>
  48. 48. Questions for Behavioral Account <ul><ul><li>Prepared classical conditioning </li></ul></ul><ul><ul><ul><li>Natural selection favored specific fears </li></ul></ul></ul><ul><ul><ul><li>Evolutionally prepared stimuli: </li></ul></ul></ul><ul><ul><ul><ul><li>Fear conditioning occurs rapidly </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Fear extinction occurs slowly </li></ul></ul></ul></ul>
  49. 49. Questions for Behavioral Account <ul><li>Susceptibility to phobias </li></ul><ul><ul><li>Physiological vulnerability (higher neurological activity) </li></ul></ul><ul><ul><li>Lack of rewarding history with stimuli </li></ul></ul><ul><ul><li>Threat-enhancing cognitive set </li></ul></ul>
  50. 50. Cognitive Explanation <ul><li>Threat-enhancing cognitive set </li></ul><ul><ul><li>Expect threat in environment </li></ul></ul><ul><ul><li>Selective attention to threats </li></ul></ul><ul><ul><li>Selective recall of threats </li></ul></ul>
  51. 51. Threat-Enhancing Cognitive Set <ul><li>“ They discussed the priest’s convictions” </li></ul><ul><li>“ The men watched as the chest was opened” </li></ul><ul><li>“ The doctor examined little Emma’s growth” </li></ul><ul><li>Interpret neutral stimuli as threatening </li></ul>
  52. 52. Questions for Cognitive Explanation <ul><li>Causality? </li></ul><ul><li>Does not explain spontaneous anxiety </li></ul><ul><li>How do cognitive sets develop? </li></ul>
  53. 53. TREATMENT OF ANXIETY DISORDERS
  54. 54. Biological Treatments <ul><li>Benzodiazapines </li></ul><ul><ul><li>Generalized Anxiety Disorder and Phobias </li></ul></ul><ul><ul><li>Valium, Xanax </li></ul></ul><ul><ul><li>Increase GABA --> Increase inhibitory neuron activity </li></ul></ul><ul><ul><li>70% individuals show symptom reduction </li></ul></ul>
  55. 55. Problems With Benzodiazapines <ul><li>Side Effects </li></ul><ul><li>Psychological and Physical Dependence </li></ul><ul><li>Anxiety returns when stop meds </li></ul>
  56. 56. Antidepressants <ul><li>Panic, Agoraphobia, OCD </li></ul><ul><li>Anafranil </li></ul><ul><li>Effective for 50% OCD patients </li></ul>
  57. 57. Surgery for OCD <ul><li>Cingulotomy </li></ul><ul><ul><li>partially cut cingulate gyrus </li></ul></ul><ul><ul><li>connects lower brain structures with orbitalfrontal cortex </li></ul></ul><ul><ul><li>effective in 50% </li></ul></ul>
  58. 58. Psychological Treatments <ul><li>Commonality = confrontation of fear </li></ul><ul><li>Cognitive-Behavior Therapy </li></ul><ul><ul><li>Challenge threat-magnifying cognitive sets </li></ul></ul>
  59. 59. Behavioral Treatments <ul><ul><li>Extinction of anxiety through exposure and development of incompatible responses </li></ul></ul><ul><ul><ul><li>Systematic Desensitization </li></ul></ul></ul><ul><ul><ul><ul><li>Progressive muscle relaxation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Exposure to fear hierarchy </li></ul></ul></ul></ul>
  60. 60. Psychological Treatment Effectiveness <ul><li>Review of Panic Disorder studies </li></ul><ul><ul><li>75-95% panic-free after 3 months of CBT </li></ul></ul><ul><li>Generalized Anxiety Disorder </li></ul><ul><ul><li>CBT more effective than Valium </li></ul></ul><ul><ul><li>CBT + Valium most effective </li></ul></ul>
  61. 61. Psychological Treatment Effectiveness <ul><li>OCD </li></ul><ul><ul><li>Exposure + response prevention </li></ul></ul><ul><ul><ul><li>50% patients improve </li></ul></ul></ul><ul><ul><ul><li>= effectiveness vs. medications </li></ul></ul></ul>
  62. 62. Psychological Treatment Effectiveness THE END
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