1. Nature of Anxiety and Fear  Differences between Anxiety and Fear  Normal Emotional States?  Roller Coaster Ride  Driving on the freeway  Taking a test

2. Yerkes-Dodson Law

3. Characteristics of Anxiety Disorders  Pervasive and persistent symptoms of anxiety and fear  Excessive avoidance and escape tendencies  Clinically significant distress and impairment  Are the most common forms of psychopathology

4. Factors in Anxiety and Fear  Biological Explanation  Freudian Explanation  Behavioral Views  Cognitive Views  Social Factors  Cultural Factors

5. Biological Factors of Anxiety and Panic  Genetic vulnerability  Anxiety and brain circuits  Depleted levels of GABA  Corticotropin releasing factor (CRF) and HYPAC axis  Limbic (amygdala) and the septal-hippocampal systems  Behavioral inhibition (BIS)  Fight/flight (FF) systems

6. Psychological Factors of Anxiety and Fear  Began with Freud  Anxiety is a psychic reaction to fear  Anxiety involves reactivation of an infantile fear situation  Behavioral and cognitive views  Invokes conditioning and cognitive explanations  Anxiety and fear are learned responses  Catastrophic thinking and appraisals play a role  Early childhood contributions  Experiences with uncontrollability and unpredictability  Social contributions  Stressful life events trigger vulnerabilities  Cultural Expectations

7. Fig. 4-2, p. 123

8. Anxiety Disorders Categories  Generalized Anxiety Disorder  Panic Disorder with and without Agoraphobia  Specific Phobias  Social Phobia  Posttraumatic Stress Disorder  Obsessive-Compulsive Disorder

9. Generalized Anxiety Disorder  Worry  About Everything  Worrying is Unproductive (Interferes with Functioning)  Strong, Persistent  Uncontrollable  Somatic symptoms  Differ from panic (e.g., muscle tension, fatigue, irritability)

10. “Do you worry excessively about minor things?”

11. Fig. 4-3, p. 127

12. Treatment of GAD  Generally Weak  Benzodiazepines  Most often prescribed  Offers some relief  Psychological interventions  Cognitive-Behavioral Therapy  Including “exposure” to worries

13. Symptoms of Panic Attacks  Palpitations / Sweating  Trembling / Shaking  Shortness of Breath  Feeling of Choking  Feeling of Dying  Loss of Control  Derealization  Connection to?

14. Panic Attack  Abrupt Autonomic Surge  Intense Fear or Discomfort  Unexpected and Uncontrollable  Absence of Actual Threat  “False Alarm”

15. Panic Disorder  An Unexpected Panic Attack  Develop Anxiety Over:  The Next Attack or  The Implications of the Attack and Consequences  Agoraphobia is Common  “Fear of the Marketplace”  Consequence of Unexpected Panic Attacks  Can be a separate disorder

16. Fig. 4-5, p. 133

17. Panic Disorder Treatment  Medication Treatment of Panic Disorder  Benzodiazepines  Relapse and avoidance  SSRIs  Preferred drugs  Relapse rates are high following medication discontinuation  Psychological and Combined Treatments  Cognitive-behavior therapies seem highly effective  Panic Control Treatment  Graded Exposure plus Coping Skills  Combined treatments do well in the short term  Some indication that CBT alone is most effective

18. Fig. 4-6, p. 136

19. Types of Specific Phobia  Natural Environment  Water, spaces, storms, etc.  Often more than one  Peak onset about 7 years old  Animals  Snakes, spiders, dogs, etc.  Blood-Injection Injury  Situational  Planes, heights, etc.  Separation anxiety/school phobia  Others, including…

20.  Extreme and irrational fear of a specific object or situation  Go to great lengths to avoid phobic objects  Often recognize fears are unreasonable  Markedly interferes with one's ability to function Specific Phobia Diagnosis

21. Fig. 4-7, p. 142

22. Treatment of Specific Phobias  Psychological Treatments  Cognitive-behavior therapies are highly effective  Graduated exposure-based exercises  Structured and consistent  Systematic Desensitization  Prevent Avoidance/Escape  Blood/Injection Phobia Different  Actually Increase Tension to Prevent Fainting

23.  Marked and Persistent Fear of  Social or Performance Situations  Often avoid social situations or endure them with great distress  Most Common Type of Social Fear?  Public Speaking  Interferes with Life Functioning Social Phobia Diagnosis

24. Social Phobia  Causes?  Biological vulnerability  Direct conditioning, observational learning, information transmission

25. Fig. 4-8, p. 146

26. Treatment for Social Phobia  Medication Treatment of Social Phobia  Antidepressants  Tricyclics and MAO Inhibitors  SSRIs  Paxil, Zoloft, Effexor FDA approved  High relapse rates following discontinuation  Psychological Treatment  Cognitive-behavioral treatment  Exposure, rehearsal, role-play in a group setting  Highly effective

27. Posttraumatic Stress Disorder (PTSD)  Exposure to a traumatic event  War and Combat  Rape and Assault  Car Accidents  Natural Disasters  Re-experience the event (e.g., memories, nightmares, flashbacks)  Avoidance of cues that remind person of event  Emotional numbing, sleep disturbance, hyperarousal, and interpersonal problems are common  Markedly interferes with one's ability to function

28. Subtypes of Post Traumatic Stress  Acute Stress Disorder  Immediately post-trauma  Acute PTSD  1-3 months post trauma  Chronic PTSD  3+ months post trauma  Delayed Onset PTSD  Onset of symptoms 6 months or more post trauma

29. Fig. 4-10, p. 153

30.  Psychological Treatment of PTSD  Cognitive-behavioral treatment  Face the Original Trauma  Imaginal Reexposure  Flooding  Corrective Emotional Learning  Virtual Reality  Increase positive coping skills and social support  Cognitive-behavior therapies are highly effective  Eye Movement Desensitization and Retraining (EMDR)  Controversial, but has research support PTSD Treatment

31. Obsessive-Compulsive Disorder  Culmination of All Anxiety Disorders  Obsessions  Intrusive Thoughts, Images, or Urges  Attempts to Suppress or Eliminate  Compulsions  Thoughts or Actions  Attempts to Suppress the Obsessions  Attempts to Obtain Relief  Most people with OCD display multiple obsessions  Most Common Problem?  Cleaning and washing or checking rituals  NOT the same as Obsessive-Compulsive Personality Disorder

32. Fig. 4-11, p. 157

33. Treatment for OCD  Biological Interventions  SSRIs seem to benefit up to 60% of patients  Limited extent of help  Relapse is common with medication discontinuation  Psychosurgery (cingulotomy) is used in extreme cases  Psychological Treatment  Cognitive-behavioral therapy is most effective with OCD  Exposure and response prevention  Combining medication with CBT may be no better than CBT alone

34. Factors in Treating Anxiety Disorders  Biological Interventions  Cognitive-Behavioral Interventions  What about:  Psychoanalytic Interventions  Existential Interventions  Humanistic Interventions  Constructivist Interventions  And, then again, what about:  Social Interventions  Cultural Interventions

35. Comorbidity  Comorbidity is common across the anxiety disorders  About half of patients have two or more secondary diagnoses  Major depression is the most common secondary diagnosis  Comorbidity suggests common factors across anxiety disorders  Comorbidity suggests a relation between anxiety and depression

36. pp. 162-163