4Historical 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 awarenessAn attempt of the ego to defend itself against anxiety.
5Panic 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.
6DSM-IV features of Panic Attack Involves at least 4 of the following:lasts 10 minutesrepeated unexpected attacks and one must be followed for 1 month by a fear of subsequent attack.heart palpitationssweatingtremblingshortness of breath or smothering sensationschoking sensations
7Chest pains or discomfort feelings of nausea or other signs of abdominal distressfeelings of dizziness, unsteadiness, lightheadedness, faintnessfeelings of strangeness or unrealty about one’s surroundings (derealization) or detachment from self (depersonalization)fear of losing controlfear of dying.
8Numbness or tingling sensations chills or hot flushes
9Additional featuresUsually 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 timeAbout 3.5% have experienced panic disorder at some point in their lives.
10Generalized Anxiety disorder Persistent, diffused sense of anxiety that is not triggered by any specific object, situation, or activity.Differs from panic disorder in quality.
11Features Restlessness feeling “keyed up” easily fatigued difficulty concentrating or finding one’s mind going blankirritablemuscle tensiondisturbance of sleep
12Prevalence 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.
13Phobic 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.
14Interfere 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.
153 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:animalnatural environmentblood-injection-injurysituational: most frequently occurringother
16Cont. specific phobia: Social phobia Prevalence Affects 1 in 10 people at some point in their livesOccurs more frequently in women than men.Social phobiaThe fear of social situations due to fear of judgment, humility, and embarrassment.Includes stage fright/speech anxiety.Affects more women than men.
17Cont. social phobia Agoraphobia 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.AgoraphobiaThe fear of places/situations where it is difficult or embarrassing to escape.May become house-bound/difficult to treat.
18More common in womenBegins in late adolescence or early adulthood.May occur with or without panic attacks.
19Obsessive/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:checkingcleaning: relieves the anxiety of obsessions.
20Prevalence2% to 3% of adults are affected by OCD during their lifetime.It affects men and women equally.Obsessions are difficult to distinguish from delusions.
21Acute/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/oor prolonged PTSD
22Response involves intense fear, helplessness, horror (children may show disorganized/agitated behavior)
23Features Reexperiencing the event (memories or flashbacks) Avoiding the cues connected with the incidenceNumbing emotionsarousal/anxiety (difficulty sleeping, angry, hypervigilance, difficulty concentrating, exaggerated startle)
24Cont. FeaturesImpairment in functioningDissociation.
25Theoretical 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.
26Phobias 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.
27Learning 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.
28Cont. LearningPrepared 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.
29Cont. 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.
30Cognitive 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
31Cont. 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 SensationsCatastrophic misinterpretations of bodily sensations.
32BiologicalStudies show strong support for genetic influence for anxiety d/o.The evidence is most prominent for agoraphobia.Modestly prominent in GAD andLeast prominent in specific phobias.There is some evidence in OCD & Panic D/O
33Cont. BiologicalThe 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.
34TReatment 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.
35Cont. Treatment Humanistic/Existential Biological Anxiety is the social repression of our genuine selves.The aim is to get in touch/express genuine talents/feelings.BiologicalMost common treatment is Benzodiazepines:Valuim, Tranxene, Xanax, Librium. Addictive.
36Cont. Treatment Other medications: Paxil, Zoloft, Tofranil. OCD is usually treated with Prozac and Anafranil.
37Cont. Treatment Learning-based Systematic desensitization Gradual exposurecognitive restructuringBehavioral treatment of social phobia: exposure and floodingBehavioral treatment of PTSD, OCD,Relaxation, GAD