Presentation on theme: "PSYC 2621 Anxiety Disorders. Anxiety is a generalized state of apprehension. Anxiety can be normal/adaptive but it can also be excessive/inappropriate."— Presentation transcript:
Historical perspectives Anxiety/dissociative/somatoform were classified as neuroses in 19th century. Identified by William Cullen with a biological origin. Freud, in the 20th century, explained it as the threatened emergence of unacceptable anxiety- evoking ideas into conscious awareness An attempt of the ego to defend itself against anxiety.
Panic Disorder Symptoms: –Recurrent panic attacks. –Intense anxiety reactions that are accompanied by physical symptoms. –Stronger bodily component than the other anxiety disorders. –Last for several minutes to hours. –Initially occurs unexpectedly (these seem more severe), later they may be cued.
DSM-IV features of Panic Attack –Involves at least 4 of the following: lasts 10 minutes repeated unexpected attacks and one must be followed for 1 month by a fear of subsequent attack. heart palpitations sweating trembling shortness of breath or smothering sensations choking sensations
Chest pains or discomfort feelings of nausea or other signs of abdominal distress feelings of dizziness, unsteadiness, lightheadedness, faintness feelings of strangeness or unrealty about one’s surroundings (derealization) or detachment from self (depersonalization) fear of losing control fear of dying.
Numbness or tingling sensations chills or hot flushes
Additional features –Usually begins in late adolescence/early adulthood. –Women experience panic attacks two or three times more often as men. –About 1% of the population can be diagnosed with panic disorder at any given time –About 3.5% have experienced panic disorder at some point in their lives.
Generalized Anxiety disorder Persistent, diffused sense of anxiety that is not triggered by any specific object, situation, or activity. Differs from panic disorder in quality.
Features Restlessness feeling “keyed up” easily fatigued difficulty concentrating or finding one’s mind going blank irritable muscle tension disturbance of sleep
Prevalence Twice as common in women as in men. Initially arises in mid-teens/mid-twenties throughout lifetime. Lifetime prevalence in the general population is about 5%. May experience depression.
Phobic Disorders Phobia means fear. Fear/anxiety are closely related. Fear is feeling some anxiety/agitation in response to a threat. Phobic disorders are persistent fears of objects/situations disproportionate to threat posed by them.
Interfere with normal routines. Phobics realize their fears are irrational. Quite common; they affect 1 in 7 adults at some point in their lives. Appear at different ages.
3 Types: –Specific Phobias: the fear of specific objects. It is associated with high levels of physiological arousal. It must impact the individual’s life. Often begins in childhood. 5 subtypes: –animal –natural environment –blood-injection-injury –situational: most frequently occurring –other
–Cont. specific phobia: Prevalence –Affects 1 in 10 people at some point in their lives –Occurs more frequently in women than men. –Social phobia The fear of social situations due to fear of judgment, humility, and embarrassment. Includes stage fright/speech anxiety. Affects more women than men.
–Cont. social phobia The roots may begin in childhood. People typically report being shy as a child. Then, social phobia tends to begin in adolescence and is chronic. –Agoraphobia The fear of places/situations where it is difficult or embarrassing to escape. May become house-bound/difficult to treat.
More common in women Begins in late adolescence or early adulthood. May occur with or without panic attacks.
Obsessive/Compulsive Disorder Obsessions are intrusive, recurrent thoughts. Compulsions are repetitive behavior or mental acts that a person are compelled to perform. Most compulsions fall into 2 categories: –checking –cleaning: relieves the anxiety of obsessions.
–Prevalence 2% to 3% of adults are affected by OCD during their lifetime. It affects men and women equally. Obsessions are difficult to distinguish from delusions.
Acute/Post-traumatic Stress Disorder A stress related disorder that arises from exposure to traumatic events. The event involves either actual/threatened death/injury/physical safety. Response can be acute acute stress d/o or prolonged PTSD
–Response involves intense fear, helplessness, horror (children may show disorganized/agitated behavior)
Features Reexperiencing the event (memories or flashbacks) Avoiding the cues connected with the incidence Numbing emotions arousal/anxiety (difficulty sleeping, angry, hypervigilance, difficulty concentrating, exaggerated startle)
Cont. Features Impairment in functioning Dissociation.
Theoretical Perspectives Psychodynamic: –Anxiety reflects: the efforts of unacceptable, repressed impulses to break into consciousness. fear as to what might happen if they do. –Phobias develop through the use of defense mechanisms of projection/displacement. For example, Freud’s description of Little Hans.
–Phobias help to contain impulses/keep person away from feared object/situation. –In GAD, conflicts remain hidden but anxiety leaks through to awareness. –In Panic D/O, unacceptable sex/aggressive impulses approach boundaries of conscious/ego must repress, generating high anxiety/panic attack. –In OCD, obsessions are leakage of unconscious impulses into consciousness, and compulsions are acts to keep impulses repressed.
Learning Mowrer’s 2-factor model. GAD is product of stimulus generalization. Panic attacks that descend out of nowhere, are triggered by unidentifiable cues. Reinforcement of O/C: compulsive behaviors are operant responses that are negatively reinforced by relief of the anxiety that is engendered by obsessional thoughts.
Cont. Learning Prepared conditioning: genetically prepared to acquire phobias. GAD: a Safety Perspective (Woody/ Rachman, 1994) –People with GAD see the world as a highly threatening place and perceive very few safe places to turn where they can feel secure. No place causes anxiety though finding a place brings some relief.
Cont. Learning PTSD (Classical Conditioning) –The trauma is the UCS and becomes associated with the sights, smells, sounds (CS) of the surroundings. –Symptoms are likely to persist when survivor avoids the CS.
Cognitive Various patterns associated with anxiety disorders. –Overprediction of fear: overpredict the amount of fear that will be experienced when exposed to feared stimuli, ie., dental fear. –Self-defeating or irrational beliefs. OCD is the tendency to exaggerate the risk of negative outcomes. –Oversensitivity to threats
Cont. Cognitive –Low self-efficacy expectancies –Anxiety sensitivity - the extent to which a person believes that their own internal anxiety will lead to harmful consequences. –Missattributions for Panic Sensations Catastrophic misinterpretations of bodily sensations.
Biological Studies show strong support for genetic influence for anxiety d/o. The evidence is most prominent for agoraphobia. Modestly prominent in GAD and Least prominent in specific phobias. There is some evidence in OCD & Panic D/O
Cont. Biological The nerotransmitter, gamma-aminobutyric acid (GABA) is implicated in anxiety d/o. –It is an inhibitory neurotransmitter. When GABA is inadequate, neurons fire excessively resulting inseizures or anxiety. Benzodiazepines enhance the calming effect of GABA. Some researchers think hyperventilation with catastrophic thinking prompt Panic attacks & agoraphobia.
TReatment Psychodynamic –Work on freeing ego from the energy put into repression. –More contemporary approaches focus on sources of anxiety that arise from current and past relationships.
Cont. Treatment Humanistic/Existential –Anxiety is the social repression of our genuine selves. –The aim is to get in touch/express genuine talents/feelings. Biological –Most common treatment is Benzodiazepines: Valuim, Tranxene, Xanax, Librium. Addictive.
Cont. Treatment –Other medications: Paxil, Zoloft, Tofranil. –OCD is usually treated with Prozac and Anafranil.
Cont. Treatment Learning-based –Systematic desensitization –Gradual exposure –cognitive restructuring –Behavioral treatment of social phobia: exposure and flooding –Behavioral treatment of PTSD, OCD, –Relaxation, GAD