chapter 6 anxiety disorders copyright © 2006 pearson education canada inc
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Chapter 6Anxiety Disorders
Copyright © 2006 Pearson Education Canada Inc.
Copyright © 2006 Pearson Education Canada Inc. 2
Overview
Most common type of abnormal behaviour 12 - 17% of adults have some form of anxiety
disorder in any given year Significant social and occupational impairment Commonalities with mood disorders - i.e., negative
emotional responses (guilt, worry) Bio-Psycho-Social are factors
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Symptoms and Associated Features
People with anxiety disorders share a preoccupation with or persistent avoidance of, thoughts or situations that provoke fear or anxiety.
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Symptoms and Associated Features
Fear - response to real, immediate danger
Anxiety– different from fear - more general and diffuse emotional reaction– low levels can be adaptive
Maladaptive anxiety– high levels of diffuse negative emotion– pessimistic thoughts and feelings– sense of uncontrollability - in future situations– shift in attention to state of self-preoccupation
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Symptoms and Associated Features
Excessive Worry– common in anxiety– relatively uncontrollable sequence of negative
thoughts and images anticipating future threats of danger
– pathological worry high quantity and negative, unrealistic content (i.e., negative
self talk
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DSM-IV-TR Approach
emphasis on description– little consideration on etiology
Eight Specific Subtypes - i.e., Panic Attack, Agoraphobia, Panic Disorder, Specific Phobia, Social Phobia,OCD, Acute Stress Disorder, Generalized Anxiety Disorder
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Panic Attack
Sudden overwhelming experience of terror involving somatic and cognitive symptoms.
Symptoms are more intense, focused, and sudden than anxiety
Symptoms include hear palpitations, sweating, dizziness, loss of control, heart attack, feeling like one is going to die
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Panic Attack: Somatic Symptoms
DSM-IV-TR requires at least 4 of 13 symptoms:– Palpitations– sweating– trembling/shaking– sensations of shortness of breath/smothering – feelings of choking– chest pain/discomfort – nausea– feeling dizzy/light-headed– derealization or depersonalization– fear of losing control/going crazy– fear of dying– tingling/numbness of extremities– chills/hot flushes
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Panic Disorder
recurrent unexpected panic attackspersistent concern about additional
attacks for one monthwith or without agoraphobia
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Phobias
persistent, excessive, unrealistic fear of a specific object/situation
avoidance behaviour
Specific Phobia: • fear of specific objects or situations• For example: public speaking, elevators, animals etc.
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Specific Phobia
• Fear of specific objects or situations• For example: public speaking, elevators, animals etc.
• Types: Animal Type, Natural/Environmental, Blood-Injection, Situational Type, Other
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Agoraphobia
Agoraphobia: • fear of public spaces• fear becomes more intense as the distance between the
person and his/her familiar surrounding increases• fear is more intense when the individual when avenues
of escape are perceived to be closed off• For Example: crowded rooms, streets• Can accompany panic disorder
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Social Phobia
fear of social situations – performance anxiety– interpersonal interactions
rooted in fear of negative evaluationsmost common fears - speaking in public,
dealing with authority, using public washroom (Stein et al., 2000)
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Obsessive-Compulsive Disorder (OCD)
presence of obsessions or compulsions or both
attempts to suppress thoughts or impulsesWhat amount of specific behaviour defines
abnormality?
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Obsessions and Compulsions
OBSESSIONS – repetitive thoughts, images, impulses– obsessions are unwelcome - come “out of the blue”– person realizes their unreasonable nature (not delusional)– themes of usually unacceptable such as: sex, violence, contamination
COMPULSIONS– behavioural responses to obsessions (“tension reduction”)– repetitive behaviours, rituals (e.g., hand-washing, checking)– mental acts (counting)– individual often attempts to reduce performing the compulsion– considered by the person to be senseless or irrational
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Generalized Anxiety Disorder (GAD)
excessive, uncontrollable worry majority of days than not for at least 6 monthsaffective, cognitive, & somatic symptomssymptoms include: feeling on edge, fatigued,
difficulty concentrating, irritability, muscle tension, poor sleep patterns
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Historical Perspective
Freud’s etiological description:– psychological conflicts– biological impulses
focus on sex and aggression
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Prognosis for Anxiety Disorders
chronic conditions
individual differences in recovery
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Epidemiology
Gender - higher prevalence in females
Age - lower prevalence in the elderly
Cross-cultural studies– similar prevalence rates– different symptom patterns
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Etiology of Anxiety Disorders:Social Factors
Stressful (dangerous) life events
Childhood abuse/neglect
Insecure attachment
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Etiology of Anxiety Disorders:Psychological Factors
preparedness through evolution
observational learning
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Etiology of Anxiety Disorders:Cognitive Factors
perceived control versus helplessnessClark’s “catastrophic misinterpretation” anxiety sensitivity
– focus on threat-related stimuli paradox of thought suppression
– “try to not think of a white bear”
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Etiology of Anxiety Disorders:Biological Factors
strong genetic component– family and twin studies
two genetic factors identified– GAD/major depression– panic disorder/phobias
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Etiology of Anxiety Disorders:Biological Factors
neuroanatomy – thalamus-amygdala circuit – OCD: caudate nucleus/orbital prefrontal
cortex/anterior cingulate cortex
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Psychological Interventions
Systematic Desensitization involves teaching relaxation techniques, then
presenting items of the fear hierarchy while the patient is in the relaxed state
Direct exposure (in vivo) works better than imagined ones in most cases
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Psychological Interventions
Flooding involves exposure to most frightening stimuli
rather than working from the least to most frightening
Has shown high success rates
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Psychological Interventions
Relaxation and Breathing
involves teaching the client to alternate between relaxing and tensing muscle groups while breathing slowly and deeply
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Exposure and Response Prevention
prolonged exposure to the situation that increases anxiety with prevention of the person’s typical compulsive response
used primarily with OCD
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Cognitive Therapy and CBT
similar to treatment used in depression identify maladaptive cognitions and beliefs
and try to reconstruct mental sets
Virtual Reality Therapy
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Biological Interventions I
antianxiety medications– Benzodiazapines (Valium, Xanax)– Serious side effect: sedation.
withdrawal, addiction
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Biological Interventions II
Antidepressant medications – SSRIs (Prozac, Zoloft, Paxil)
preferred – less side effects– tricyclics OK but serious side effects– clomipramine for OCD
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Case Study: Panic Disorder with Agoraphobia
Johanna Schneller – freelance writer describes debilitating panic attacks
– nausea, dizziness, shortness-of-breath, feelings of doom, and fear of escape
– progressive fear of leaving her home
negative effects of life– relationships– employment
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