1. Wk. 10 Anxiety Disorders
Who me, worry?

2. Anxiety’s Components: Regehr & Glancy p. 202
“…can have an adaptive function…”
“…a diffuse, unpleasant and vague experience of apprehension”
“…physical symptoms such as headache, perspiration, heart palpitations, general restlessness, difficulty sleeping and gastric discomfort.”

3. Along with Depression…
The problem that’s most commonly presented to ‘helping professionals’
80% of presenting problems are either anxiety or depression

4. Characteristics of Anxiety Disorders: DSM V
Intense and prolonged feelings of fear & distress that occur out of proportion to the actual threat or danger
Interferes with normal daily functioning
Strong ‘somatic’ symptoms:
‘we feel it in the body’

5. Prevalence: Regehr & Glancy p. 203
In any one year period….
9% of men
16% of women
Lowest age of onset:
Median age of 11 yrs
(vs. 30 years for mood disorders)
Significant childhood issue

6. Students…a sudden concern*
“50% of 1600 University of Alberta students identified feeling ‘overwhelming’ anxiety in the past year.” (2012 Study)
At McMaster University, “50.2% stated that they were overwhelmed with anxiety.”
*Regehr & Glancy, p.203

7. Examples of Anxiety Disorders Listed in DSM V
Separation Anxiety Disorder
PTSD
Specific Phobia
Social Anxiety Disorder (Social Phobia)
Panic Disorder
Panic Attack Specifier
Agoraphobia
Generalized Anxiety Disorder
Substance/Medication-Induced Anxiety Disorder
Anxiety Disorder Due to Another Medical Condition

8. Separation Anxiety Disorder
Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached
Relates to separation from home or attachment figures
Worry about well-being or death of attachment figures
Worry about untoward events to themselves

9. Specific Phobia, Social Phobia, Agoraphobia
Specific Phobia – object or situation provokes immediate fear or anxiety (e.g. flying, heights, animals, seeing blood)
Social Phobia (Social Anxiety Disorder)- marked fear or anxiety about one or more social situations; having a conversation, meeting unfamiliar people, being observed (e.g. eating, giving a speech)
Agoraphobia – marked fear about specific situations (e.g.using public transportation, being in open spaces or closed spaces, standing in line or in a crowd, being outside of the home alone)

10. DSM V: Panic Disorder and Panic Attack Specifier
Symptoms may include:
Symptoms…
Heart palpitations
Sweating
Trembling
Shortness of breath
Choking feeling
Chest pain
Abdominal stress
Dizziness, fainting
De-realization
Fear of losing control, going crazy
Fear of dying
Numbing, tingling
Chills, hot flashes
People show up in Emerg, thinking it’s a heart attack

11. DSM V: Generalized Anxiety Disorder Indicators
Excessive worry & anxiety typically lasting 6 months or more (general guide – this is flexible)
Person finds it difficult to control worry
Impaired social/occupational functioning
Not caused by drug use, medical condition
Plus 3 or more of:
Restlessness, on edge
Easily fatigued
Poor concentration
Irritable
Muscle tension
Sleep disturbance

12. Causes of Anxiety* High stress environments
Learned response to experiences/trauma
Disrupted biological responses
Fight or flight biological syndrome
Genetics:
Panic Disorder: 1st degree relatives = 7x increased risk
Phobias: 1st degree relative = 6-9x greater risk
*Regehr & Glancy,

13. Text: Anxiety evolved to protect us…
“…when acute threats were encountered, biological adaptations served as protective mechanisms…”
“…Respiration and blood pressure increased, oxygen and energy shifted to large muscles away from the immune, digestive and reproductive systems.”

14. Model: General Adaptation Syndrome
1. Alarm, mobilization, body prepares
2. Stress response drops, body normalizes
3. Exhaustion, if stress is unrelenting
Panic Attack:
Process disrupted, significant autonomic arousal to relatively minor threats
Regehr & Glancy

15. Social-Environmental Factors
Child living in violent household can be in heightened state of arousal, anticipating when violence might erupt
“The chaotic nature of these environments means the child cannot reliably predict when the violent parent might erupt, or when he or she might be kind, and nurturing.”
Regehr & Glancy

16. A Learned Behaviour? Example:
Teenager bullied in high school, develops rational (adaptive) fear of some students
…then fear generalizes to other situations (maladaptive)
person sees themselves as not socially competent and avoids social situations outside school

17. Pairs: So….
What kinds of fears, phobias, excessively uncomfortable situations do you suffer from/in?
Dimensional Concept: Where does it fit on the spectrum from mild to severe?
To what degree does it affect your ‘functioning’?
Do you consider yourself to have a mental illness re: DSM V, Rosenhan’s model? o

18. Strange phobias ?
Allodaxaphobia - Fear of the opinions of other people.
Barophobia - Fear of gravity.
Chromophobia - Fear of colours.
Euphobia - Fear of hearing good news.
Francophobia - Fear of France or French culture.
Genuphobia - Fear of knees.
Hippopotomonstrosesquippedaliophobia - Fear of long words.
Japanophobia - Fear of the Japanese.
Optophobia - Fear of opening one's eyes.
Plutophobia - Fear of wealth.
Selenophobia - Fear of the moon.
Uranophobia - Fear of heaven.

19. 3 Groups of Symptoms* Physiological:
Racing heart, shallow breathing, trembling etc.
Cognitive:
Fearful thoughts, beliefs, preoccupation with the threat
Behavioural:
Avoidance of triggering situations, safety behaviours, checking, hypervigilance
*Regehr & Glancy,
p. 207

20. ‘Cognitive Triad’: Where do we intervene?
Cognitive/Thoughts
Event:
Failed test in
SSW
Behaviour
Physiology/
Feelings

21. Cognitive Therapy: Distorted Thinking
Boarding an airplane…
Catastrophic, ‘Primitive’ Voice:
This plane will crash
Rational, Mature Voice:
Driving cars is more dangerous than flying
Goal: strengthen Rational Voice

22. ‘De-catastrophizing’
Catastrophic/Primitive Voice:
“People will notice how embarrassed I am”
Rational/Mature Voice:
“So what if people notice? Most won’t, and those who do will likely be understanding.’

23. Carry 1st Alert Cards One side: Catastrophic Response
Other side: Rational Response
Before entering situation, review card to strengthen Rational Response
Plagued with catastrophic thoughts: challenge them, review evidence

24. Problem…therapy costly
“Psychotherapy…should be a front-line treatment for anxiety and depression – which also constitute more than 80% of all psychiatric diagnoses.”
May 2015 Series, Globe and Mail, Open Minds: How to Build a Better Mental Health Care System
Research evidence shows therapy is best treatment for anxiety
Psychologists & social workers/therapists not included in Canadian public health care system
Long wait lists for psychotherpists, usually fee-for-service

25. Therapeutic Interventions
Meds: Paxil, Valium etc (addictive, also once stopped, symptoms return)
Progressive relaxation/Yoga
Mindfulness Breathing Exercises
Systematic Desensitization (CBT)
Family-based CBT

26. Anxiety…Key Points
Very Common: esp. for women (1 in 6 have it to some degree)
Within the realm of everyday, ‘normal’ experience
Somatic symptoms
Often combines with Depression
Occurs globally: cultural differences in reported symptoms
Risk goes up for other mental health disorders
Self-medication
>Alcohol ‘works well’
> Risk of addiction
>Risk of Concurrent Disorder

27. Where are we on the spectrum?
Mild=========Moderate=======Severe
Adaptive…………………………Maladaptive
Is our anxiety commensurate with the situation?