2. ANXIETY DISORDERS

3. Anxiety vs. Fear  anxiety: (future oriented) negative affect, bodily tension, and apprehension about the future  fear: (reaction to current danger) immediate alarm in response to danger – initiates flight or fight response

4. Phobias unrealistic fear of a specific situation, activity, or object

5. Types of specific phobias  Blood-Injection-Injury  Situational Phobia  Natural Environment Phobia  Animal Phobia  Other phobias

6. Common Phobia Treatments  systematic desensitization: combines relaxation with exposure invivo imaginal virtual reality  http://www.youtube.com/watch?v=JK-vVMMN43Y http://www.youtube.com/watch?v=JK-vVMMN43Y  flooding: expose individual directly to feared stimulus

7. Social Phobia DSM criteria:  Extreme shyness and fear in social situations  focus is on situation in which the person is exposed to unfamiliar people or to possible scrutiny by others  person fears will be humiliated or embarrassed  Avoidance or endure with extreme distress  Impairment  Rule out cause by other disorder

8. Social Phobia: Treatment

9. Social Phobia: Treatment (cont.)  Psychological Cognitive-behavioral treatment  Exposure  Skill building  Group settings

10. PANIC

12. Panic Disorder  At least one of the panic attacks is followed by at least a month of (a) persistent fear of having another attack, or (b) a significant maladaptive change in behavior following the attacks.  The disturbance is not better understood by the physiological effects of a substance or medical condition.  The disturbance is not better understood by another psychological condition.

13. Panic Disorder with Agoraphobia (PDA)  agoraphobia : fear of being away from a safe place

14. Development of Panic Disorder Step 1 Real Stressor Step 2 Step 3 Fear of Having Another Attack Step 4 Increased Attention to Body Step 5 More Fear

15. Summary The fear of having another panic attack just makes you more frightened. This “fear of your fear” increases the chances of future attacks. Solution

16. Treatment for Panic Disorder: 1) Imipramine (tricyclic antidepressant) 2) SSRIs 3) Exposure and relaxation training 4) Panic control treatment

17. Example Interoceptive Exposure Exercises

18. generalized anxiety disorder

19. GAD Symptoms  continuous feelings of anxiety; experienced across situations  continues for at least 6 months and is uncontrollable more days than not  involves muscle tension, fatigue, irritability, difficulty sleeping

20. GAD Treatment  anxiolytics: drugs that reduce anxiety  Benzodiazepines  anti-depressants  cognitive-behavioral treatment  relaxation training

21. Obsessive Compulsive Disorder and Related Disorders

22. DSM-V Criteria for OCD  Presence of obsessions or compulsions (or both)  the person recognizes that the obsessions or compulsions are excessive or unreasonable (not required for children)  they cause marked distress, are time-consuming (more than 1 hour per day), or interfere with the person’s functioning

23. DSM-V Criteria for Obsessions  recurrent and persistent thoughts, impulses, or images  experienced as intrusive and inappropriate  cause marked anxiety or distress  the thoughts are not simply excessive worries about real-life problems  the person attempts to ignore or suppress the thoughts  the person recognizes that the thoughts are a product of his or her own mind (not imposed from outside)

24. DSM-V Criteria for Compulsions  Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly  Behaviors are aimed at preventing or reducing distress, or preventing some dreaded event or situation. However, behaviors not connected in a realistic way with what they are designed to prevent, or are clearly excessive

25. OCD : Compulsions  Four major categories Checking Ordering Arranging Washing/cleaning http://www.youtube.com/watch?v= zC2G6lf9fCs&list=PLYL4hYoJA9GcHQt 1Cf1owyPUbs-L2QOjN&index=9

26. Treatment of OCD  SSRI ’ s  Exposure and response prevention  How does it compare to medication?  Psychosurgery (cingulotomy)

27. Obsessive Compulsive Related Disorders  Hoarding Disorder.  Hair-Pulling Disorder.  Excoriation Disorder.  Body Dysmorphic Disorder.

28. Post Traumatic Stress Disorder

29. PTSD  exposure to traumatic event  traumatic event is reexperienced (e.g., recollections, dreams, flashbacks)  try to avoid stimuli associated with the trauma  symptoms of increased arousal (e.g., problems sleeping, concentrating)  negative alterations of cognitions or mood

30. PTSD  acute stress disorder – PTSD symptoms have lasted less than one month  acute PTSD – symptoms last between 1 and 3 months after event  chronic PTSD – symptoms last longer than 3 months  delayed onset – few immediate symptoms – years later

31. Treatment of PTSD  Cognitive-behavioral treatment Exposure Identify and correct cognitive distortions.  SSRI’s (Prozac, Paxil)