Dr. Hassan Sarsak, PhD, OT 1

Anxiety used interchangeably with stress. Stressor is an external pressure that is brought to bear on the individual. Anxiety: vague diffuse apprehension that is associated with feelings of uncertainty and helplessness. Anxiety: unpleasant emotional, cognitive, behavioral, or physical experience of stress (Cara, E & MacRae, A. (2005).pg.196. Anxiety usually is considered a normal reaction to an anticipation of danger or threat to biological integrity or self-concept. 2

 Fear: intellectual appraisal of a threatening stimuli  Stress: a state of disequilibrium that occurs when there is a disharmony between demands occurring within an individual’s internal or external environment and his/her ability to cope with those demands.  Fear usually is considered a normal reaction to a realistic danger or threat to biological integrity or self-concept. 3

 Anxiety in ancient Greek lies in the word root angh meaning “to press tight” and “to be heavy with grief”, the Latin word anxietas means “troubled mind”  Synonyms in English anxiety is described using many vocabularies including worry, edginess, panic, fright, alarm, terror, jitters, jumpiness, and uneasiness.  It is linked to our primitive fight flight response. 4

5  Anxiety disorders are the most common of all psychiatric illnesses and result in a considerable functional impairment and distress.  Affect 4-5% of the population  More common in women (girls) than in men (boys) 2:1 ratio. (same as what?! Major Depression)  more common in low socioeconomic and minority.  It affects all age groups including children

 Anxiety is considered normal if???  Anxiety is considered abnormal if: 1. It is too much severe in relation to the anticipated danger. 2. Long-term response occurs (beyond the potential danger) 3. Impaired intellectual, occupational, and social functions 4. Psychosomatic effect arouse 6

 Often begin in childhood, but may develop at anytime  Post traumatic stress disorder and acute stress disorder follow the stressful event  Prevalence and prognosis vary with the specific disorder 7

 Emotional:  Physiological:  Cognitive:  Behavioral: See Cara, E & MacRae, A. (2005). table 8 pg

 The degree of impact varies with the severity of and type of anxiety disorder  Reaction may vary from temporary discomfort to severely avoidant and paralyzing behavior: Anxiety can range from mild feelings of uneasiness to immobilizing terror 9

10  Discrete periods of intense fear or discomfort, in which 4 or more symptoms develop abruptly and reach peak within 10 minutes, followed, at least once, by concern for recurrence  This disorder is characterized by recurrent panic attacks, with unpredictable onset, and manifest by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort.

 At least 4 of the 13 symptoms must be present to identify the presence of panic disorder. If fewer than 4 symptoms are present, the individual diagnosed as having a limited- symptom attack  Palpitation or accelerated heart rate  Sweating  Trembling or shacking  sensation of shortening of breath or smothering  Feeling of chocking  Chest pain or discomfort  Nausea or abdominal stress  Feeling dizzy, unsteady, lightheaded, or faint (pale)  Derealization, or depersonalization?!(from the last lec.)  Fear of losing control or going crazy  Fear of dying  Paresthesias (numbness or tingling sensation)  Chills or hot flashes 11

12  Characterized by chronic, persistent, unrealistic, and excessive unfocused anxiety and worry. The symptoms should exist for 6 months or longer.  GAD symptoms (7 symptoms) must cause clinically significant distress or impairment in functions(table 8-1). What are these symptoms?*  Depression symptoms and somatic complains may combined with this disorder.

 There are many etiological implications for panic disorder and GAD: psychoanalytic theory, cognitive theory, and biological aspects. 13

14 1. Agoraphobia with panic disorder history * Characterized by symptoms of panic disorder and the individual experiences a fear of being in places or situations from which escape might be difficult or in which help might not be available in the event that a panic attack should occur. example: being outside the home alone. 2. Agoraphobia without history of panic disorder Less common than no 1.

15 3. Social phobia: excessive fear of situations in which a person might do something embracing or be evaluated negatively by others that may lead to avoidance. 4. Specific phobias: marked, persistent, excessive or unreasonable fear in the presence or in anticipating an encounter with a specific object or situation leading to avoidant behavior.  There are 5 subtypes of the most common specific phobias: animal type (afraid of certain animals), natural-environment type (afraid of storms), blood-injection-injury type, situational type (afraid of flying, heights,…), other type.

16  OCD is characterized by recurrent obsessions (unwanted ideas) or compulsions (repetitive behavior to reduce anxiety) that are severe enough to be time consuming or to cause marked distress or significant impairment.

17  Defined as the persistent re-experiencing (duration of disturbance is for more than one month) of an extremely traumatic event that produces symptoms of increased arousal (difficulty falling asleep, irritability, anger, etc).  PTSD is also defined as the development of characteristic symptoms following exposure to an extreme traumatic stressor involving a personal threat to physical integrity or physical integrity of others.  symptoms: high level of anxiety, nightmares, symptoms of depression, symptoms should present for more than one month (otherwise it is called acute stress disorder).  Other symptoms?

 It is similar to PTSD; however, it immediately follows the event.  In addition the symptoms do not persist beyond one month.  Similar to “situational anxiety” 18

 Trait anxiety: enduring personality style that manifests persistent anxiety  Anticipatory: predictive anxiety in response to future actual or imagined situation  Acute: time limited anxiety that diminishes with the resolution of the problem (situational anxiety).  Chronic: anxiety that persist, developing around new stressors after immediate problems are resolved.  Free floating: generalized anxiety, which may be vague in origin.  Clinical: disruption in function due to anxiety 19