Transcript Chapter 6 Anxiety Disorders

Chapter 6
Anxiety Disorders
Copyright © 2006 Pearson Education Canada Inc.
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
Copyright © 2006 Pearson Education Canada Inc.
2
Symptoms and Associated Features

People with anxiety disorders share a
preoccupation with or persistent avoidance
of, thoughts or situations that provoke fear
or anxiety.
Copyright © 2006 Pearson Education Canada Inc.
3
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
Copyright © 2006 Pearson Education Canada Inc.
4
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
Copyright © 2006 Pearson Education Canada Inc.
5
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
Copyright © 2006 Pearson Education Canada Inc.
6
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

Copyright © 2006 Pearson Education Canada Inc.
7
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
Copyright © 2006 Pearson Education Canada Inc.
8
Panic Disorder
recurrent unexpected panic attacks
 persistent concern about additional
attacks for one month
 with or without agoraphobia

Copyright © 2006 Pearson Education Canada Inc.
9
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.
Copyright © 2006 Pearson Education Canada Inc.
10
Specific Phobia
•
•
•
Fear of specific objects or situations
For example: public speaking, elevators, animals etc.
Types: Animal Type, Natural/Environmental, BloodInjection, Situational Type, Other
Copyright © 2006 Pearson Education Canada Inc.
11
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
Copyright © 2006 Pearson Education Canada Inc.
12
Social Phobia

fear of social situations
–
–
performance anxiety
interpersonal interactions
rooted in fear of negative evaluations
 most common fears - speaking in public,
dealing with authority, using public
washroom (Stein et al., 2000)

Copyright © 2006 Pearson Education Canada Inc.
13
Obsessive-Compulsive Disorder (OCD)

presence of obsessions or compulsions or
both
attempts to suppress thoughts or impulses
 What amount of specific behaviour defines
abnormality?

Copyright © 2006 Pearson Education Canada Inc.
14
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
Copyright © 2006 Pearson Education Canada Inc.
15
Generalized Anxiety Disorder (GAD)
excessive, uncontrollable worry
 majority of days than not for at least 6
months
 affective, cognitive, & somatic symptoms
 symptoms include: feeling on edge,
fatigued, difficulty concentrating, irritability,
muscle tension, poor sleep patterns

Copyright © 2006 Pearson Education Canada Inc.
16
Historical Perspective
 Freud’s
–
–
etiological description:
psychological conflicts
biological impulses
focus on sex and aggression
Copyright © 2006 Pearson Education Canada Inc.
17
Prognosis for Anxiety Disorders
 chronic
conditions
 individual
differences in recovery
Copyright © 2006 Pearson Education Canada Inc.
18
Epidemiology

Gender - higher prevalence in females

Age - lower prevalence in the elderly

Cross-cultural studies
–
–
similar prevalence rates
different symptom patterns
Copyright © 2006 Pearson Education Canada Inc.
19
Etiology of Anxiety Disorders:
Social Factors

Stressful (dangerous) life events

Childhood abuse/neglect

Insecure attachment
Copyright © 2006 Pearson Education Canada Inc.
20
Etiology of Anxiety Disorders:
Psychological Factors

preparedness through evolution

observational learning
Copyright © 2006 Pearson Education Canada Inc.
21
Etiology of Anxiety Disorders:
Cognitive Factors
perceived control versus helplessness
 Clark’s “catastrophic misinterpretation”
 anxiety sensitivity

–

focus on threat-related stimuli
paradox of thought suppression
–
“try to not think of a white bear”
Copyright © 2006 Pearson Education Canada Inc.
22
Etiology of Anxiety Disorders:
Biological Factors

strong genetic component
–

family and twin studies
two genetic factors identified
–
–
GAD/major depression
panic disorder/phobias
Copyright © 2006 Pearson Education Canada Inc.
23
Etiology of Anxiety Disorders:
Biological Factors
 neuroanatomy
–
–
thalamus-amygdala circuit
OCD: caudate nucleus/orbital prefrontal
cortex/anterior cingulate cortex
Copyright © 2006 Pearson Education Canada Inc.
24
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
Copyright © 2006 Pearson Education Canada Inc.
25
Psychological Interventions
Flooding

involves exposure to most frightening stimuli
rather than working from the least to most
frightening

Has shown high success rates
Copyright © 2006 Pearson Education Canada Inc.
26
Psychological Interventions
Relaxation and Breathing

involves teaching the client to alternate between
relaxing and tensing muscle groups while
breathing slowly and deeply
Copyright © 2006 Pearson Education Canada Inc.
27
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
Copyright © 2006 Pearson Education Canada Inc.
28
Cognitive Therapy and CBT
similar to treatment used in depression
 identify maladaptive cognitions and beliefs
and try to reconstruct mental sets


Virtual Reality Therapy
Copyright © 2006 Pearson Education Canada Inc.
29
Biological Interventions I
 antianxiety
medications
Benzodiazapines (Valium, Xanax)
– Serious side effect: sedation.
withdrawal, addiction
–
Copyright © 2006 Pearson Education Canada Inc.
30
Biological Interventions II
 Antidepressant
medications
SSRIs (Prozac, Zoloft, Paxil)
preferred – less side effects
– tricyclics OK but serious side effects
– clomipramine for OCD
–
Copyright © 2006 Pearson Education Canada Inc.
31
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
Copyright © 2006 Pearson Education Canada Inc.
32