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Chapter 4 anxiety disorders


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Chapter 4 anxiety disorders

  1. 1. Anxiety and the Anxiety Disorders Chapter 4
  2. 2. Defining Anxiety And Anxiety Disorders <ul><li>Anxiety </li></ul><ul><li>An unpleasant emotion characterized by a general sense of danger, dread, and physiological arousal </li></ul>
  3. 3. Common Components of Anxiety
  4. 4. Anxiety Disorders <ul><li>Trait Anxiety </li></ul><ul><li>An individual’s tendency to respond to a variety of situations with more or less anxiety </li></ul><ul><li>State Anxiety </li></ul><ul><li>An individual’s level of anxiety at a specific time </li></ul>
  5. 5. Classifying Anxiety Disorders ( DSM-IV-TR)
  6. 6. Anxiety Disorders <ul><li>Generalized Anxiety Disorder </li></ul><ul><li>Chronic, pervasive, and debilitating nervousness </li></ul><ul><li> Chronic (>6 months), pervasive anxiety </li></ul><ul><ul><li>Difficulty controlling the anxiety </li></ul></ul><ul><ul><li>The anxiety includes three or more of the following: </li></ul></ul><ul><ul><li> Restlessness </li></ul></ul><ul><ul><li> Fatigue </li></ul></ul><ul><ul><li> Difficulty concentrating </li></ul></ul><ul><ul><li> Irritability </li></ul></ul><ul><ul><li> Muscle Tension </li></ul></ul><ul><ul><li> Sleep disturbance </li></ul></ul>
  7. 7. Anxiety Disorders <ul><li>Panic Disorder </li></ul><ul><li>Panic attacks that cause ongoing distress or impairment </li></ul><ul><li>Panic attack </li></ul><ul><li>Discrete episode of acute terror in the absence of real danger </li></ul><ul><li>Criteria for Panic Disorder </li></ul><ul><li>Episodes of intense panic (panic attacks) </li></ul><ul><li>Persistent concern about having additional attacks, worry about the consequences of an attack, or changes in behavior because of the attack </li></ul>
  8. 8. Anxiety Disorders <ul><li>A Panic Attack Cycle </li></ul>
  9. 9. Anxiety Disorders <ul><li>Criteria for Panic Disorder </li></ul>
  10. 10. Anxiety Disorders <ul><li>Phobias </li></ul><ul><li>An intense, persistent, and irrational fear and avoidance of a specific object or situation </li></ul>
  11. 11. Anxiety Disorders <ul><li>Types of Phobias </li></ul><ul><li>Social phobia </li></ul><ul><li>Agoraphobia </li></ul><ul><li>Specific phobia </li></ul>
  12. 12. Anxiety Disorders <ul><li>Social Phobia </li></ul><ul><li>A phobia in which fears are focused on social situations or other activities where there is a possibility of being observed and judged </li></ul><ul><li>Example: </li></ul><ul><li>Stage Fright </li></ul>
  13. 13. Anxiety Disorders <ul><li>Agoraphobia </li></ul><ul><li>A fear of wide open spaces or crowded places </li></ul>
  14. 14. Anxiety Disorders <ul><li>Specific phobias </li></ul><ul><li>Any phobia that is not a social phobia or agoraphobia </li></ul><ul><li>Four common types: </li></ul><ul><li> animals </li></ul><ul><li> natural environment </li></ul><ul><li> blood/injection/injury </li></ul><ul><li> situational </li></ul>
  15. 15. Anxiety Disorders <ul><li>Obsessive-Compulsive Disorder </li></ul><ul><li>An anxiety disorder in which distressing and unwanted thoughts lead to compulsive rituals that significantly interfere with daily functioning </li></ul><ul><li>Obsessions </li></ul><ul><li>Unwanted and upsetting thoughts or impulses </li></ul><ul><li>Compulsions </li></ul><ul><li>Irrational rituals that are repeated in an effort to control or neutralize the anxiety brought on by obsessional thoughts </li></ul>
  16. 16. Anxiety Disorders <ul><li>Criteria for Phobias </li></ul>
  17. 17. Anxiety Disorders <ul><li>Obsessive-Compulsive Disorder </li></ul>
  18. 18. Anxiety Disorders
  19. 19. Anxiety Disorders <ul><li>Postraumatic and Acute Stress Disorders </li></ul><ul><li>Trauma </li></ul><ul><li>An emotionally overwhelming experience in which there is a real or perceived possibility of death or serious injury to oneself or a loved one </li></ul>
  20. 20. Anxiety Disorders <ul><li>Acute stress disorder </li></ul><ul><li>Significant posttraumatic anxiety symptoms that occur within one month of a traumatic experience. </li></ul><ul><li>Posttraumatic stress disorder </li></ul><ul><li>Significant posttraumatic anxiety symptoms occurring more than one month after a traumatic experience </li></ul>
  21. 21. Anxiety Disorders
  22. 22. Anxiety Disorders Diagnostic Criteria for Posttraumatic Stress Disorder (continued)
  23. 23. Anxiety Disorders
  24. 24. Anxiety Disorders <ul><li>Advantages and Limitations of the DSM-IV-TR Anxiety Disorder Diagnoses </li></ul><ul><ul><li>Comorbidity </li></ul></ul>The presence of two or more disorders in one person, or a general association between two or more different disorders.
  25. 25. Anxiety Disorders
  26. 26. Anxiety Disorders <ul><li>Classification in Demographic Context </li></ul><ul><li>Age </li></ul><ul><li>Separation Anxiety Disorder (SAD) </li></ul><ul><li>Gender </li></ul><ul><li>Disproportionate rates of anxiety disorders in women have noted that traditional female gender roles have not typically emphasized assertion and self-sufficiency — skills that are important for overcoming anxiety. </li></ul><ul><li>Class </li></ul><ul><li>People living in poor urban environments are at increased risk for developing PTSD. </li></ul>
  27. 27. Anxiety Disorders <ul><li>Cultural and Historical Relativism </li></ul><ul><li>Latinos </li></ul><ul><li> nervios = GAD </li></ul><ul><li> ataque de nervios = panic attack </li></ul><ul><li>Chinese </li></ul><ul><li> Shenjing shuairuo is similar to anxiety and mood disorders symptoms. </li></ul><ul><li>Japanese </li></ul><ul><li> Taijin kyofusho is an anxiety disorder recognized in Japan characterized by worry that one’s body or aspects of one’s body will be displeasing or offensive to others </li></ul>
  28. 28. Explaining and Treating Anxiety Disorders <ul><li>Biological Components </li></ul><ul><li>The Autonomic Nervous System </li></ul><ul><li>sympathetic nervous system </li></ul><ul><li>parasympathetic nervous system </li></ul><ul><li>flight-or-fight response </li></ul>
  29. 29. Explaining and Treating Anxiety Disorders <ul><li>Limbic System </li></ul><ul><li> amygdala </li></ul><ul><li> hippocampus </li></ul><ul><li> hypothalamus </li></ul>
  30. 30. Explaining and Treating Anxiety Disorders <ul><li>Neurotransmission </li></ul><ul><li>Gamma-aminobutyric acid (GABA) </li></ul><ul><li>Norepinephrine </li></ul><ul><li> locus coeruleus </li></ul><ul><li>Serotonin </li></ul>
  31. 31. Explaining and Treating Anxiety Disorders <ul><li>Autoimmune Disorders </li></ul><ul><li>basal ganglia </li></ul><ul><li>Genetic factors </li></ul>
  32. 32. Explaining and Treating Anxiety Disorders <ul><li>Biological Interventions </li></ul><ul><li> Barbiturates </li></ul>Benzodiazepines
  33. 33. Anxiety Disorders <ul><li>Biological Interventions </li></ul><ul><li>Panic Disorder and Agoraphobia </li></ul><ul><li>SSRIs </li></ul><ul><li> prozac, zoloft, paxil </li></ul><ul><li>Tricyclics </li></ul><ul><li> tofranil, elavil, and sinequan </li></ul>
  34. 34. Anxiety Disorders <ul><li>Biological Interventions </li></ul><ul><li>Obsessive-Compulsive Disorder </li></ul><ul><li>SSRIs </li></ul><ul><li>benzodiazepines and neuroleptics to augment </li></ul>neuroleptic
  35. 35. Anxiety Disorders <ul><li>Biological Interventions </li></ul><ul><li>Post Traumatic Stress Disorder </li></ul><ul><li> SSRIs </li></ul><ul><li> Wellbutrin (bupropion) </li></ul>
  36. 36. Anxiety Disorders <ul><li>Biological Interventions </li></ul><ul><li>Social Phobias </li></ul><ul><li>SSRIs </li></ul><ul><li>Beta-blockers </li></ul>
  37. 37. Anxiety Disorders <ul><li>Biological Interventions </li></ul><ul><li>Generalized Anxiety Disorder </li></ul><ul><li>Paxil </li></ul><ul><li> Azaspirones </li></ul>Effexor BuSpar
  38. 38. Anxiety Disorders <ul><li>Behavioral Components </li></ul><ul><li>Classical conditioning </li></ul><ul><li> Little Albert (Watson & Raynor) </li></ul>
  39. 39. Anxiety Disorders <ul><li>Behavioral Components </li></ul><ul><li>Classical conditioning </li></ul><ul><li>temporal contiguity </li></ul><ul><li>negative reinforcement </li></ul><ul><li>extinction </li></ul><ul><li>prepared conditioning </li></ul>
  40. 40. Anxiety Disorders <ul><li>Behavioral Components </li></ul><ul><li>Operant conditioning </li></ul><ul><li> Modeling </li></ul>
  41. 41. Anxiety Disorders <ul><li>Behavioral Components </li></ul><ul><li>principle of multiple causality </li></ul><ul><li>preceding variables </li></ul><ul><li>latent inhibition </li></ul><ul><li>accompanying variables </li></ul><ul><li>postevent variables </li></ul>
  42. 42. Anxiety Disorders <ul><li>Behavioral Interventions </li></ul><ul><li>Phobias </li></ul><ul><li>systematic desensitization </li></ul><ul><li>in vivo desensitization </li></ul><ul><li>covert desensitization </li></ul><ul><li>relaxation training </li></ul><ul><li>fear hierarchy </li></ul><ul><li>flooding </li></ul>
  43. 43. Anxiety Disorders <ul><li>Behavioral Interventions </li></ul><ul><li>Panic Disorder </li></ul><ul><li> systematic desensitization </li></ul><ul><li>in vivo desensitization </li></ul><ul><li>covert desensitization </li></ul><ul><li>interoceptive exposure </li></ul>
  44. 44. Anxiety Disorders <ul><li>Behavioral Interventions </li></ul><ul><li>Obsessive-Compulsive Disorder </li></ul>exposure and response prevention covert response prevention
  45. 45. Anxiety Disorders <ul><li>Behavioral Interventions </li></ul><ul><li>Post Traumatic Stress Disorder </li></ul><ul><li>prolonged imaginal exposure </li></ul>
  46. 46. Anxiety Disorders <ul><li>Cognitive Components </li></ul><ul><li>Cognitive schemas </li></ul>
  47. 47. Anxiety Disorders <ul><li>Cognitive Components </li></ul>
  48. 48. Anxiety Disorders <ul><li>Cognitive Interventions </li></ul>
  49. 49. Anxiety Disorders <ul><li>Psychodynamic Components </li></ul><ul><li>Freud </li></ul><ul><li>repression </li></ul>
  50. 50. Anxiety Disorders <ul><li>Psychodynamic Components </li></ul><ul><li>Phobias </li></ul><ul><li>displacement </li></ul><ul><li>Oedipus complex </li></ul><ul><li>projection </li></ul>
  51. 51. Anxiety Disorders <ul><li>Psychodynamic Components </li></ul><ul><li>isolation of affect </li></ul><ul><li>undoing </li></ul>Cheat on wife Buy wife a mink coat
  52. 52. Anxiety Disorders <ul><li>Psychodynamic Interventions </li></ul><ul><li>resistance </li></ul><ul><li>transference </li></ul>
  53. 53. Anxiety Disorders <ul><li>Humanistic and Existential Components </li></ul><ul><li>maladaptive emotional scheme </li></ul><ul><li> A humanistic term for patterns of thought and feeling that emerge around salient emotional experiences (usually in childhood) and are activated in similar situations during adulthood. </li></ul>
  54. 54. Anxiety Disorders <ul><li>Humanistic and Existential Interventions </li></ul><ul><li>development of a strong therapeutic alliance that allows for the recognition and exploration of painful emotional experiences </li></ul>
  55. 55. Anxiety Disorders <ul><li>Multiple Causality in Anxiety Disorders </li></ul><ul><li>Integrated cognitive and behavioral approaches </li></ul><ul><li>Cognitive-psychodynamic overlap </li></ul><ul><li>Combined behavioral-biological </li></ul>
  56. 56. Anxiety Disorders <ul><li>Connection Between Mind and Body </li></ul><ul><li>HPA axis </li></ul><ul><li>Brain changes in PTSD </li></ul><ul><li>Brain changes after behavioral interventions for OCD </li></ul>
  57. 57. Anxiety Disorders <ul><li>Case Vignettes </li></ul><ul><li>Arthur (panic disorder) </li></ul><ul><li>Greg (obsessive-compulsive disorder) </li></ul>