Chapter 5 Anxiety, Trauma, & Stress-Related, & Obsessive-Compulsive-Related Disorders

Nature of Anxiety and Fear Anxiety – The Future-Oriented Mood State Apprehension about future danger or misfortune Somatic symptoms of tension Fear – The Present-Oriented Mood State Immediate fight or flight response to danger or threat Involves abrupt activation of the sympathetic nervous system Anxiety and Fear are Normal Emotional States

Panic Attacks Abrupt experience of intense fear or discomfort Abrupt experience of intense fear or discomfort Several physical symptoms (e.g., breathlessness, chest pain) Fear as an alarm response Two types Expected Unexpected

Causes of Anxiety Disorders Biological Genetic Vulnerability Anxiety and brain circuits Depleted levels of GABA Psychological Freud’s views Behavioral and Cognitive Views Anxiety and fear are learned responses Catastrophic thinking and appraisals play a role Early Childhood Contributions Social Contributions Stressful life events trigger vulnerabilities

Generalized Anxiety Disorder: The “Basic” Anxiety Disorder Shift from possible crisis to crisis Worry about minor, everyday concerns (Job, family, chores, appointments) Problems sleeping Persists for 6 months or more

Prevalence of Generalized Anxiety Disorder Affects about 3.1% (in a year) to 5.7% (in a lifetime) of the general population Tends to more common in women Onset is often insidious, beginning in early adulthood Very prevalent among the elderly Tends to run in families

Treatment of Generalized Anxiety Disorder Benzodiazapines (i.e. Valium, Xanax) – Often Prescribed Antidepressants (i.e. Paxil & Effexor) Psychological interventions – Cognitive- Behavioral Therapy Combined treatments – Acute vs. Long- Term Outcomes

Panic Disorder and Agoraphobia Experience of unexpected panic attack Develop anxiety, worry, or fear about another attack Many develop agoraphobia Prevalence of panic disorder Affects about 2.7% (in a year) & 4.7% (in a lifetime) of the general population Onset is often acute, median between 20 and 24 years of age 75% of individuals with agoraphobia are female Causes of panic disorder - Combination of psychological, biological, & social

Treatment of Panic Disorder Medication Treatment SSRIs (e.g., Prozac and Paxil) are preferred drugs Relapse rates are high following medication discontinuation Psychological and Combined Treatments Cognitive-behavior therapies are highly effective No evidence that combined treatment produces better outcome Best long-term outcome is with cognitive-behavior therapy alone

Social Phobia Extreme and irrational fear in social/performance situations Often avoid social situations or endure them with great distress Prevalence of Social Phobia Affects about 6.8% (in a year) & 12.1% (in a lifetime) of the general population Onset is usually during adolescence

Social Phobia Causes Biological and evolutionary vulnerability Conditioning and modeling (i.e. socially anxious parents) Psychological Treatment Cognitive-behavioral treatment Cognitive-behavior therapies are highly effective Medication Treatment SSRIs Paxil, Zoloft, and Effexer – Are FDA approved

Posttraumatic Stress Disorder (PTSD) Main etiologic characteristics Trauma exposure and response Reexperiencing (e.g., memories, nightmares, flashbacks) Avoidance Emotional numbing and interpersonal problems Markedly interferes with one's ability to function PTSD diagnosis – Only after 1 month post-trauma Additional categorizations: Acute Stress Disorder & Delayed Onset

Prevalence and Treatment of PTSD Prevalence & Causes of PTSD - Approximately 3.5% (in a year) & 6.8% (in a lifetime)of the general population - Physical violence, accidents, & sexual assault are most common traumas Treatment -Cognitive-behavior therapies (CBT) are highly effective CBT may include graduated or massed (e.g., flooding) imaginal exposure SSRIs have shown to be helpful

Obsessive-Compulsive Disorder (OCD) Obsessions - Intrusive and nonsensical thoughts, images, or urges Compulsions - Thoughts or actions to neutralize thoughts Vicious cycle of obsessions and compulsions Cleaning and washing or checking rituals are common Prevalence of OCD Affects about 1% (jn a year) & 1.6%-2.3% (in a lifetime) of the general population

Causes & Treatment of Obsessive- Compulsive Disorder (OCD) Causes of OCD Learning that some thoughts are dangerous/unacceptable Thought-action fusion -- The thought is similar to the action Medication Treatment SSRIs Psychological Treatment ERP (exposure & ritual prevention) is most effective

Body Dysmorphic Disorder Preoccupation with imagined defect in appearance Often display ideas of reference for imagined defect Suicidal ideation and behavior are common

Body Dysmorphic Disorder Seen equally in males and females Onset usually in early 20s Most remain single Treatment Treatment parallels that for obsessive compulsive disorder (comorbid with OCD 10% of the time) Medications (i.e., SSRIs) that work for OCD provide some relief Exposure and response prevention is also helpful Plastic surgery is often unhelpful