differences mood or emotion? time orientation? physiological response? anxiety vs. fear:

biological vulnerability polygenic traits of neuroticism/ negative affect/behavioral inhibition vulnerability: anxiety or depression neurochemicals (GABA, 5-HT, NE, CRF)

psychological vulnerabilities Generalized Psychological Vulnerability - sense of uncontrollability - had unpredictable relationship w/ parents - had overprotective parents = never learn they can control events Specific Psychological Vulnerability - “_____ is dangerous” is learned by: Classical conditioning Operant conditioning Information transmission

generalized anxiety disorder 6 mo+ of uncontrollable worry to many issues 3+ of: restlessness, fatigue, poor concentration, irritable, muscle tension, sleep probs distress or impairment CRITERIA NOTE Chronic & excessive worry over minor events Constant state of apprehension/upset Difficult to make decisions & doubts if decision is right -work -finances -illness

generalized anxiety disorder prevalence 3% 2:1 sex ratio onset yrs (but most “always been this way”) prognosis: chronic

generalized anxiety disorder biological & generalized psych vulnerabilities ETIOLOGY autonomic restrictors but increased muscle tension preferentially direct attention to threatening cues interpret ambiguous info in a threatening way ASSOCIATED FEATURES

generalized anxiety disorder TREATMENT cognitive therapy & relaxation techniques medication - benzodiazepines (AKA anxiolytics) - antidepressants

benzodiazepines Valium Librium Xanax Klonopin Also used for sleeping pills & anti-seizure meds

panic attack inappropriate fear response CRITERIA 4+ of: heart palpitations, sweating, shaking, short of breath, choking, chest pain, nausea, dizzy, derealization/depersonalizaiton, fear of losing control, fear of dying, chills/heat, numbness/tingling

panic attack cued – conditioned to external cues uncued – conditioned to interoceptive cues situationally predisposed

panic disorder CRITERIA recurrent panic attacks 1+ for 1 mo+: - concern about future attacks or consequences - sig behavioral change (avoidance of external or internal cues)

panic disorder prevalence 3% 2:1 sex ratio 50-70% will experience a serious depression 1 st attack usually after highly distressing life event

panic disorder ETIOLOGY Biological Vulnerability to panic attack General Psycholgical Vulnerability panic is not in my control, something bad will happen STRESSOR triggers PANIC ATTACK Specific Psychological Vulnerability Classical conditioning of either -Interoceptive cues - exteroceptive cues

panic disorder PRESCRIBED MEDICATION benzodiazepines & antidepressants (relapse rates high 50-90% when meds stopped) COGNITIVE-BEHAVIORAL THERAPY cued: systematic desensitization uncued: induce interoceptive sensations + cognitive restructuring of perceived control + distraction from sensations TREATMENT educate about panic attacks practice relaxation

agoraphobia CRITERIA anxiety about situations where: - hard to access help - escape difficult/embarrassing

specific phobia CRITERIA 6+ mo persistent, excessive, irrational fear of an object of situation anxiety/fear on exposure avoided or endured w/ intense anxiety insight that phobia is irrational

specific phobia 9% prevalence 4:1 sex ratio prognosis: chronic over 75% have multiple phobias

specific phobia ETIOLOGY -Direct trauma experience (classical/operant cond) -Classical conditioning during panic attack -Vicarious experience -Information transmission NOTE -phobia is reinforced (avoidance = decreased anxiety) -protective factor: previous experience w/ object -prepared learning TREATMENT systematic desensitization

social phobia CRITERIA fear of social/performance situations anxiety/fear upon exposure insight that fear is irrational avoidance behavior impairs functioning

social phobia 7% prevalence 1: 1 sex ratio ETIOLOGY -Direct experience of a social trauma -Classical conditioning during panic attack -Vicarious experience NOTE -Prepared learning for social disapproval -Interpret ambiguous social info as negative -Self-preoccupied w/ bodily responses -Overestimate others’ detection of their anxiety

social phobia -cognitive-behavioral therapy (CBT) -social skills training TREATMENT PSYCHOTHERAPY PRESCRIBED MEDICATION antidepressants

OCD CRITERIA recurrent & persistent thoughts/images associated behaviors compelled to perform (can be mental or physical acts) insight to how irrational distress, consumes 1+ hr/day, or impairs functioning

ocd obsessions repetitive, unwelcome thoughts compulsions repetitive, almost irresistible action germs something bad will happen symmetry religion #s washing counting checking touching rituals

OCD 1% prevalence sex ratio varies prognosis: chronic thought-action fusion NOTE: OCD patients tend to: -be more depressed than others -have exceptionally high standards of conduct/morals -believe thoughts = actions -believe they should have perfect control over all of their thoughts & behaviors

ocd orbital frontal PFC basal ganglia cingulate abnormal activation decreases after psychotherapy or medication

PTSD CRITERIA trauma involving death, threat of death, serious injury and reaction of intense fear, helplessness, or horror persistent reexperienced 1+ for 1 month: -Intrusive recollections -Dreams -Reliving as illusions, hallucinations, or flashbacks -Avoidance of relevant stimuli -Arousal (i.e. insomnia, irritability, hypervigilance) -Distress or impairment

PTSD ACUTE STRESS DISORDER PTSD before 1 month has passed ACUTE PTSD Diagnosed 1 month after trauma CHRONIC PTSD Diagnosed if PTSD exceeds 3 months DELAYED ONSET PTSD When symptoms do not start immediately TREATMENT Revisit original trauma, relive emotions, correct assumptions