1.  anxiety disorders -  vague, negative, high arousal state, often intrusive thoughts of possible futures, helplessness.  too much of a good thing- anxiety is useful response system to threats (evolutionarily adaptive) motivate for change.  generalized anxiety disorder- 5% lifetime risk, prolonged (>6 months), vague, distress. not connected to life events. worry, vigilance, bodily tension and reactivity.  panic disorder- 1.5%, intense, relatively brief wave of feeling ‘out of control’, high arousal, sweating/shortness of breath, fear of death/losing mind, fear of future panic, associated stimuli- agoraphobia.

2.  comorbidity/overlap with depression-  over half mood disordered folks meet criteria for an anxiety disorder (an especially close link with G.A.D.)  high negative affect common to both, low positive affect more specific to depression. anxious folks also hyperaroused.  anxiety gives way to depression (future anticipation of loss vs. perceived past loss)  phobias-unlike GAD, the feared objects are known. often evolutionarily relevant- specific phobias (11%): spiders, dogs, snakes, heights, but also social (2.7%): fear of blushing and eating in public are difficult to treat.  agoraphobia (5.6%) fear of the marketplace. role of learning: event X paired with anxiety-->avoidance--> reduced anxiety. So you learn to avoid X. ~ exposure treatment.

3.  panic disorder with agoraphobia (Lundh et al., 1999)  stroop color naming task- delayed color naming for words specific to disorder but less so for threatening words (social, phobics).  automatic attention grabbing- unconscious (17ms) subliminal findings related to trait anxiety- preattentive bias for panic related words.  obsessive-compulsive disorder (2-3%) identified by Freud (1894)  thoughts and behaviors- sexual, religious, aggressive, threatened harm (symbolic nature).  obsessions-doubting, contamination, fear of aggression  compulsions-counting, ordering, checking, touching & washing.--compulsions protective against anxiety.

4.  undoing- a conflict (ambivalence) between two opposing impulses of equal strength where the second magically ‘undoes’ the first. chronic indecision [These thoughts are condensed from Shapiro (1965)].  reaction formation-reversed of repressed impulse- sympathy rather than sadistic, bashful rather than exhibitionistic  isolation of affect-isolating thoughts or behaviors so that links to other thoughts or affective context are removed. Rituals, formulas, thought stopping. akin to the repression of hysterics- separating affect from thought-thought remains. ‘living machines’: ‘I must be in love with her-- she has all the qualities I want in a wife.’  intellectual rigidity, sharp, intense focus-insensitive to the tone of social interaction.  good workers (often) more or less continuously active (even in play)-- “I should be doing _____”. tolerate no interference.  they are not delusional- they don’t say ‘I have cancer, I have been contaminated’ but ‘I’m worried I have cancer…’ (obsessional doubt and dogma). Lost capacity for conviction.

5.  post-traumatic stress disorder (1-14%)  fear, hopelessness, or horror. re-experiencing, emotional numbness, hypervigilance, startle.  risks-depression, alcohol abuse, dissociative style, inhibited withdrawn.  Treatments for many anxiety disorders:  behavioral- exposure, flooding, in-vivo, etc.  cognitive- restructuring, thought stopping, rehearsal  biological- benzodiazepines-librium,valium, -addictive  antidepressants drugs of choice now  psychosurgery (making a comeback?)