mental health(anxiety)

7/26/2019 mental health(anxiety)

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Anxiety Disorders


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Copyright 2009 John Wiley & Sons, NY 2

Anxiety vs. Fear

AnxietyApprehension about a future threat

Fear Response to an immediate threat

Both involve physiological arousal Sympathetic nervous system

Both can be adaptive Fear triggers flight or fight

ay save life

Anxiety increases preparedness oderate levels improve performance


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Anxiety Disorders

!S"#$"%R Specific and social phobias &anic disorder and agoraphobia

'enerali(ed anxiety disorder )bsessive compulsive disorder &osttraumatic stress disorder

ost common psychiatric disorders

*+, report anxiety symptoms -.essler et al/0 *1123 ost common are phobias


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Table 5.1 Summary of MajorAnxiety Disorders


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Phobias

!isruptive fear of a particular ob4ect orsituation Fear out of proportion to actual threat

A5areness that fear is excessive ust be severe enough to cause distress orinterfere 5ith 4ob or social lifeAvoidance

%5o types6

Specific Social


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Panic Attac

A discrete period in 5hich there is the sudden

onset of intense apprehension0 fearfulness0 or

terror0 often associated 5ith feeling of

impending doom/ !uring these attac7s0symptoms such as shortness of breath0

palpitations0 chest pain or discomfort0 cho7ing

or smothering sensations0 and fear of goingcra(y or losing control are present/

6


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S!eci"c Phobia

8n5arranted0 excessive fear of specific

ob4ect or situation

Sna7es0 blood0 flying0 spiders0 etc/

How likely are you to be bitten by a spider?

ost specific phobias cluster around a fe5

feared ob4ects and situations -%able 2/93

%rigger or feared ob4ect is avoided or

endured 5ith intense anxiety

:igh comorbidity of specific phobias


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Agoraphobia

#s anxiety about0 or avoidance of0 places or

situations from 5hich escape might be difficult

-or embarrassing3 or in 5hich help may not be

available in the event of having a &anic Attac7

or panic"li7e symptoms/

8


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Table 5.2 Words Used to Describe Highly Unlikely Phobias

Fear Phobia

Anything ne Neopho!i"

Asy##etri$"l things Asy##etripho!i"

%oos %i!liopho!i"

Chil'ren (e'opho!i"

)"n$ing Choropho!i"

*nglishness Anglopho!i"

+"rli$ Alli#pho!i"

(e"nt !tter sti$ing to the roo- o- the #oth Ar"$hi!tyropho!i"

.e$hnology .e$hnopho!i"

/i$e /sopho!i"

(se'os$ienti-i$ ter#s ellenopho!i"

Source:)r"n -ro# www.phobialist.com1


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Table 5.3Types of Specific Phobias

Type of Phobia Sorce of Fear !ssociated "haracteristics

Ani#"l Ani#"ls e1g1, sn"es, inse$ts +ener"lly !egins 'ring $hil'hoo'

N"tr"l eniron#ent Aspe$ts o- the n"tr"l eniron#ent

e1g1, stor#s, heights, "ter

+ener"lly !egins 'ring $hil'hoo'

%loo', ine$tion, inry %loo', inry, ine$tions, or other

in"sie #e'i$"l pro$e'res

Cle"rly rns in -"#ilies

Sit"tion"l Spe$i-i$ sit"tions e1g1, p!li$

tr"nsport"tion, tnnels, !ri'ges,

ele"tors, -lying, 'riing, $lose' sp"$es

.en's to !egin either in $hil'hoo' or in

#i'20s1

ther e"r o- $hoing, -e"r o- $ontr"$ting "n

illness, et$1 $hil'ren:s -e"rs o- lo'

son's, $lons, et$1

;

Copyright 2009 John Wiley & Sons, NY


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1 minutes

Accompanied by at least ? other symptoms6 S5eating0 nausea0 labored breathing0 di((iness0 heart palpitations0

upset stomach0 lightheadedness0 etc/

)ther symptoms may include6 Depersonalization

Derealization

Fear of going cra(y0 losing control0 or dying


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23

&rognosis 5orse 5hen agoraphobia is

present

$ li d A i


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Post Traumatic StressDisorder &PTSD'

%hree categories of symptoms 6>/ Re"experiencing the traumatic event

Gightmares0 intrusive thoughts0 or images

*/ Avoidance of stimuli e/g/0 Refuse to 5al7 on street 5here rape occurred Nubing

!ecreased interest in others !istant or estranged from others 8nable to experience positive emotions

9/ #ncreased arousal #nsomnia0 irritability0 hypervigilance0 exaggerated startle

response %ends to be chronic -&er7onigg et al/0 *1123

Acute Stress Disorder


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Copyright 2009 John Wiley & Sons, NY 2+3


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/is Factors0 Personality

Behavioral inhibition %endency to be agitated0 distressed0 and cry in

unfamilar or novel settings )bserved in infants as young as ? months ay be inherited

&redicts anxiety in childhood and social anxiety inadolescence

Geuroticism React 5ith negative affect @in7ed to anxiety and depression -de'raaf et a/0 *11*3

&sychophysiological reactivity in firefighters predicteddevelopment of &%S! -'uthrie D Bryant0 *1123


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/is Factors0 *o#nitive

Belief that one lac7s control over environment

ore vulnerable to developing anxiety disorder

Childhood trauma or punitive parenting may foster beliefs

Amount of control during trauma may influence 5hetheranxiety disorder 5ill develop -ine7a D Linbarg0 *11K3

Attention to threat

%endency to notice negative environmental cues

Selective attention to signs of threat


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tiolo#y of S!eci"c Phobias

Conditioning

o5rerMs t5o"factor

model

&airing of stimulus 5ith

aversive 8CS leads tofear -Classical

Conditioning3

Avoidance maintained

though negative

reinforcement -)perant

Conditioning3


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Copyright 2009 John Wiley & Sons, NY 3 orry th"t > #ight h"e " he"rt

"tt"$1

>t s$"res #e hen > -eel -"int1

>t s$"res #e hen > -eel ?sh"y@ tre#!ling1

Source:(eterson & eiss,


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tiolo#y of A#ora!hobia

Fear"of"fear hypothesis -'oldstein DChambless0 >K+3


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tiolo#y of $AD

'ABA system deficits Bor7ovecMs cognitive model6

orry reinforcing because it distracts fromnegative emotions and images

Allo5s avoidance of more disturbing emotions e/g/0 distress of previous trauma

Avoidance prevents extinction of underlyinganxiety

#ndividuals 5ith 'A! less able to identify their

o5n negative feelings -ennin et al/0 *11*3

tiolo#y of (*D0


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#yeurobiolo#ical Factors

)C! symptoms common in certain

neurological disorders

:untingtonMs chorea

:yperactive regions of the brain6 )rbitofrontal cortex

Caudate nucleus

Anterior cingulate

@oss of neuronal function and underlying

biochemical abnormality -NOcel et al/0 *11K3

tiolo#y of (*D0


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Panic and A#ora!hobia

Cognitive Behavioral %herapy -CB%3 #ncrease patientMs a5areness of thoughts

that ma7e physical sensations threatening

&atient learns to challenge and changemaladaptive beliefs

CB% also effective for agoraphobia %reatment enhanced 5hen spouse or

significant other stops catering to partnerMsavoidance/

Psycholo#ical Treatment of


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$AD

Relaxation training

Cognitive Behavioral methods

Challenge and modify negative thoughts

#ncrease ability to tolerate uncertainty orry only during scheduled times

Focus on present moment

Psycholo#ical Treatment of(*D


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(*D


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PTSD


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