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March 31 Anxiety Disorders


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March 31 Anxiety Disorders

  1. 1. Anxiety Disorders
  2. 2. Physiology of Anxiety <ul><li>Fearful stimuli </li></ul><ul><li>The sympathetic nervous system (the brain and the spinal cord) releases hormones - adrenaline, noradrenaline, and cortisol. </li></ul><ul><li>Fight or flight response: enlarged pupils, increased heart rate, and sweat </li></ul><ul><li>Increased anxiety helps a person to prepare for appropriate course of action </li></ul>
  3. 3. Why stress can be harmful to health? <ul><li>Alarm </li></ul><ul><li>Resistance: release of cortisol </li></ul><ul><li>Exhaustion: the release of too much cortisol </li></ul>
  4. 4. Anxiety Disorder <ul><li>Panic Disorder (with or without Agoraphobia) </li></ul><ul><li>Obsessive Compulsive Disorder </li></ul><ul><li>Posttraumatic Stress Disorder </li></ul><ul><li>Acute Stress Disorder </li></ul><ul><li>Specific Phobia </li></ul><ul><li>Social Phobia </li></ul><ul><li>General Anxiety Disorder </li></ul>
  5. 5. Warm-up questions <ul><li>Have you ever had panic attacks? </li></ul><ul><li>What do you know about the following disorders? Do you know any one who has been diagnosed with any of them? </li></ul><ul><ul><li>Panic attack disorder </li></ul></ul><ul><ul><li>Obsessive compulsive disorder </li></ul></ul><ul><ul><li>Post-traumatic stress disorder </li></ul></ul>
  6. 6. Panic Disorder <ul><li>Occurrence of repeated , unexpected panic attacks. </li></ul><ul><ul><li>Characteristics of Panic attacks </li></ul></ul><ul><ul><ul><li>Cardiac </li></ul></ul></ul><ul><ul><ul><li>Respiratory </li></ul></ul></ul><ul><ul><ul><li>Gastrointestinal symptoms </li></ul></ul></ul><ul><ul><ul><li>Fear of loss of cognitive control </li></ul></ul></ul><ul><ul><ul><li>Other sensations </li></ul></ul></ul><ul><ul><li>What other physical illnesses are these symptoms associated with? </li></ul></ul>
  7. 7. Clinical diagnosis <ul><li>Must experienced repeated, unexpected panic attacks </li></ul><ul><li>At least a month of persistent fear of subsequent attacks </li></ul><ul><li>Worry about the consequences (going crazy) </li></ul><ul><li>Significant change in behavior </li></ul><ul><li>Onset: late adolescence to mid-30s </li></ul>
  8. 8. Panic attacks and Panic Disorder <ul><li>Panic Attack Questionnaire (Self-report) </li></ul><ul><li>Clinical interview for DSM-IV </li></ul><ul><ul><li>Questions: </li></ul></ul><ul><ul><ul><li>What are some of the surprising findings about panic attacks experienced by university students? </li></ul></ul></ul><ul><ul><ul><li>What are the findings in the study by McCabe and Blankstein (2000)? </li></ul></ul></ul><ul><ul><ul><li>According to a study by Cox et al, 1991,What were the similarities and differences between the outpatients diagnosed with panic disorder and York University students who had experienced panic attacks? </li></ul></ul></ul><ul><ul><ul><li>Do you agree that there’s a continuity between clinical and subclinical panic attacks? </li></ul></ul></ul><ul><li>See handout, “Panic attacks and panic disorder in Canadian University Students” </li></ul>
  9. 9. Panic disorder with agoraphobia <ul><li>Agoraphobia </li></ul><ul><ul><li>an excessive fear of being in public places in which escape may be difficult or unavailable. </li></ul></ul>
  10. 10. Etiology <ul><li>Biological + psychological factors </li></ul><ul><ul><li>Minor body sensations </li></ul></ul><ul><ul><li>Perceived threats & anxiety </li></ul></ul><ul><ul><li>Brain activation; adrenaline and cortisol production; physical sensation intensified </li></ul></ul><ul><ul><li>Misattributions of bodily sensation; greater threats (I’m having a panic attack; I’m having a heart attack) </li></ul></ul>
  11. 11. Psychological Explanation of Panic Disorders <ul><li>Anxiety sensitivity </li></ul><ul><ul><ul><li>“ the fear of fear” </li></ul></ul></ul><ul><ul><ul><li>Risk factor </li></ul></ul></ul><ul><ul><ul><li>Anxiety sensitivity index (ASI) (60 items) </li></ul></ul></ul><ul><ul><li>Studies on ASI and perception (Stewart, et al, 1998) </li></ul></ul><ul><ul><ul><li>Males with high scores selectively process word cues reflecting social and psychological threat </li></ul></ul></ul><ul><ul><ul><li>Females with high scores selectively process word cues involving physical threat </li></ul></ul></ul><ul><ul><li>Studies on ASI and memory (McCabe 1999) </li></ul></ul><ul><ul><ul><li>High ASI scorers were more likely to recall words about threats compared to low ASI scorers (who remember more positive words) </li></ul></ul></ul>
  12. 12. Treatments for Panic Disorder <ul><li>Cognitive behavioral approach </li></ul><ul><ul><li>Cognitive behavioral treatment (CBT) </li></ul></ul><ul><ul><ul><li>Behavior component </li></ul></ul></ul><ul><ul><ul><li>Cognitive component </li></ul></ul></ul><ul><ul><li>Self-monitoring </li></ul></ul><ul><ul><li>Breathing retraining: Breathing slowly and deeply from the abdomen </li></ul></ul>
  13. 13. Obsessive Compulsive Disorder <ul><li>Recurrent obsessions </li></ul><ul><li>Recurrent compulsions </li></ul><ul><li>Or both </li></ul><ul><ul><li>Vicious cycle </li></ul></ul><ul><ul><ul><li>intrusive thoughts compulsive rituals obsessive thoughts </li></ul></ul></ul>
  14. 14. Biological explanation of OCD <ul><li>Biological </li></ul><ul><ul><li>Genetic influence </li></ul></ul><ul><ul><li>Brain circuit </li></ul></ul><ul><ul><li>fMRI results </li></ul></ul><ul><ul><ul><li>abnormal patterns of activation in parts of the brain; leading to failure to inhibit repetitive behavior (Schwartz 1998) </li></ul></ul></ul>
  15. 15. Psychological explanation of OCD <ul><li>Cognitive </li></ul><ul><ul><li>Catastrophizing thoughts </li></ul></ul><ul><li>Personality </li></ul><ul><ul><li>Perfectionism </li></ul></ul><ul><li>Learning theory </li></ul><ul><ul><li>Compulsive behavior provides partial relief of anxiety. Because of this reduction of anxiety, compulsive behavior is reinforced. </li></ul></ul>
  16. 16. OCD Treatments <ul><li>Behavior technique </li></ul><ul><ul><li>Exposure and Response Prevention </li></ul></ul><ul><ul><ul><li>Exposure </li></ul></ul></ul><ul><ul><ul><li>Response prevention </li></ul></ul></ul><ul><ul><ul><ul><li>Results: Break the cycle </li></ul></ul></ul></ul><ul><li>Cognitive technique </li></ul><ul><li>*** CBT has as much benefits as drug therapy, but the results are more long-lasting. </li></ul>
  17. 17. Post-traumatic Distress Disorder PTSD <ul><li>Prolonged maladaptive reaction to traumatic experience </li></ul><ul><li>Traumatic event </li></ul><ul><ul><li>“Actual or threatened death, serious injury; threats to physical integrity of others.” </li></ul></ul><ul><ul><li>“The person’s response involved intense fear, helplessness, or horror.” </li></ul></ul><ul><ul><li>Examples: </li></ul></ul>
  18. 18. PTSD Symptoms <ul><li>Avoidance behavior </li></ul><ul><li>Re-experience the trauma </li></ul><ul><li>Impaired functioning </li></ul><ul><li>Heightened arousal </li></ul><ul><li>Emotional numbing </li></ul>
  19. 19. PTSD Treatments <ul><li>CBT </li></ul><ul><ul><li>Repeated exposure to cues associated with trauma; </li></ul></ul><ul><ul><li>Repeatedly talk about the traumatic experience; </li></ul></ul><ul><ul><li>Re-experience the emotional aspects of the trauma; </li></ul></ul><ul><ul><li>Visit related slides or films; </li></ul></ul><ul><ul><li>Visit the scene of traumatic events; </li></ul></ul><ul><ul><li>Cognitive restructuring </li></ul></ul><ul><li>Stress management skills (self-relaxation) </li></ul><ul><li>Anger management skills </li></ul><ul><li>EMDR (Eye Movement Desensitization and Reprocessing) </li></ul>