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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

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

17. 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