Transcript Anxiety Disorders - Kelley Kline Phd

Anxiety Disorders
“The Dark side of Fear”
What is Anxiety?

The unpleasant feeling of fear or
apprehension we experience in response to
some event or situation.
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Duration & intensity of anxiety --more
severe in people with anxiety disorders than
in people without.
Anxiety Disorders:
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Phobias
 panic disorder
 generalized anxiety disorder
 obsessive-compulsive disorder
 posttraumatic stress disorder
 acute stress disorder
Comorbidity of other anxiety
disorders is high!!
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1.Symptoms of various anxiety disorders
are not disorder specific.
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2.) Cause of one disorder may be cause of
another disorder.
A. Phobias – an irrational fear out of
proportion to the danger posed by the
object or situation.
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Person knows fear is irrational, but avoids object
or situation anyway.
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Phobia may not be debilitating enough to warrant
seeking treatment.
(e.g., A fear of snakes in the city is less a problem
than in the country)
Two kinds of phobias:

1. Specific phobias - fears caused by the presence
or anticipation of a specific object or situation.
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Blood
injuries & injections
situations (planes, elevators)
animals (dogs, spiders)
natural environment (heights, water, tornadoes)
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Lifetime prevalence: 7% (men) and 16% (women).
2. Social phobias
Fear linked to the presence of other people
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Person avoids situation in which he or she could
behavior in embarrassing way.
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Speaking or performing in public
 eating in public
 Using public bathroom
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Lifetime prevalence: 11% (men) & 15% (women)
What causes phobias?
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Data show we learn phobias, they are not innate.
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We learn phobias by:
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1. Classical & operant conditioning (avoidance
learning)
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2. Modeling (observational learning)
Modeling:
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We learn phobias by observing others’ fear to
the object or event.
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Do we need to observe the person’s fear
response to the stimulus & the stimulus
itself?
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Yes!!!!
Mineka study:
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Had lab-reared monkeys view wild-reared
monkeys responses to a snake.
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A barrier was in place to block the lab-reared
monkeys from seeing the object of the wild-reared
monkey’s fear.
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Later when shown the snake, the lab-reared
monkey didn’t show fear to the snakes.

You need to see the other person’s response to the
feared stimulus & the stimulus itself for phobia
formation.
Therapy for phobias:

Systematic desensitization

Flooding
B. Generalized Anxiety Disorder (GAD)
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Symptoms:
persistent anxiety
chronic worry
focus on health/daily hassles
difficulty concentrating; irritable
tire easily; restless
Lifetime prevalence: 5% in population
 Onset: midteens; comorbidity with other anxiety
disorders & mood disorders.
Causes of GAD:

we develop GAD when confronted with painful
stimuli over which we have no control.
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Perception of not being in control may be enough
for anxiety.

we develop GAD when we misperceive events to
be out of our control & potentially threatening or
harmful.
Locus of control- we feel less anxiety
when we can control our lives.

Our “perception” of control may be more important
than “actual” control to reducing unwanted anxieties
in patients with GAD.
*Unpredictable events produce more anxiety than
predictable ones.
Patients with GAD are easily drawn to stimuli
associated with negative emotional content (traumas,
physical harm, etc.)
Worry as a tool to control emotion!!
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Patients with GAD use worry to distract
themselves from thinking about negative
events.
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Worrying keeps us from focusing on
negative emotions.
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Worrying is negatively reinforcing because
it blocks us from processing emotional
stimuli, & keeps the cycle of anxiety going.
Biological Causes of GAD
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There may be a genetic component.
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We may have a defect in the GABA system so that
fear is not brought under control.
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Benzodiazipines, which enhance the inhibitory
neurotransmitter, GABA, reduce anxiety.
Therapies for GAD
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1. Transfer global anxiety into a phobia & treat
phobia.
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*Systematic desensitization may be used if anxiety
can be linked to an identifiable source.
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2. Relaxation training
Have patients focus on relaxing during low-level
anxiety.
Treat worry!!!
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Here, therapists require that patients extend
& exaggerate their anxieties.
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Because patient remains in a fearful
situation, anxiety is believed to extinguish.
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Patient learns his or her cognitions are
illogical and unfounded.
C. Panic Disorder
attacks.
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– characterized by
Increased HR
heart palpitations
nausea
chest pain
trembling; sweating, terror
Usually physiological symptoms occur without
link to cause (with exceptions)
Lifetime prevalence: 2 % (men) & 5 % (women).
DSM-IV diagnosis:
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Recurrent uncued attacks & worry about having
attacks in the future are required.
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Is diagnosed as panic disorder with or without
agoraphobia.
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Comorbidity between panic disorder &
major depression, GAD, phobias, alcoholism, &
personality disorders is high.
What causes panic disorder?
1.There may be symptoms of an illness that leads
to panic attacks.
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(e.g., mitral valve prolapse causes heart
palpitations, dizziness, etc.)
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2. Panic may be caused by overactivity in a
nucleus in the pons called the locus ceruleus
(LC).
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In humans, a drug called Yohimbine, a drug that
stimulates the LC, can elicit panic attacks in
patients with panic disorder.
Causes (panic):
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However blocking activation in the LC has
not been found to reduce panic attacks.
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3.Creating panic attacks experimentally:
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Using hyperventilation to induce panic
attacks has produced mixed results.
Psychological theories:
Patients with panic disorder may have an autonomic
nervous system that is predisposed to be overly
active.
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People misconstrue internal bodily changes as
signals they may be in jeopardy or dying.
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With repeated exposures to attacks, patients worry
about future attacks thereby making them more
likely to occur.
Therapies for Panic disorder and agoraphobia
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Biological:
1. Antidepressants & anxiolytics can reduce
frequency of attacks.
Psychological: Barlow’s therapy (well validated):
3 components:
1. Relaxation training2. A combination of Ellis & Beck type cognitive
behavioral interventions
3. Exposure to the internal cues that trigger panic
D. Obsessive-Compulsive Disorder
(OCD):
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persistent unwanted thoughts & compulsive
behaviors that impair normal functioning.
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Lifetime prevalence: 1-2 % of general pop.
 More common in women than men
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Age of onset: early adulthood
 Males: checking rituals most common
Females: cleaning rituals most common
Components of OCD:
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1. Obsessions-intrusive & recurring thoughts & images
that appear irrational & uncontrollable to the individual
experiencing them.
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Frequency & force of thoughts always interfere with
functioning.
Fears of contamination
 Fears of expressing sexual or aggressive impulses
 hypochondria
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2. Compulsions- repetitive behaviors performed over &
over to reduce distress associated with the unwanted
thoughts.
Causes of OCD
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1. Behavioral & cognitive theories
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Compulsions are learned behaviors reinforced by
fear reduction (negative reinforcement).
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E.g., frequency of hand washing increases to reduce
or eliminate the aversive fear of dirt.
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Compulsive checking may be the result of memory
deficit.
Therapies for OCD
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Exposure and response prevention (ERP)
Victory Meyer (1966)
1.Patients with OCD expose (flooding) themselves to
situations that elicit compulsions.
 E.g., touching a dirty dish
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2. Person is instructed to refrain from performing
compulsions (extinguish anxiety & compulsions).
Treatment is partially effective in half of OCD
patients.
E. Posttraumatic Stress disorder
(PTSD)
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A traumatic event or witness to an event in which
there is perceived or actual threat of death, serious
injury, or other personal harm.
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The event must have created intense fear, horror,
or a sense of helplessness.
(May 3rd, 1999-OK)
Symptoms of PTSD fall into 3 major categories.
Symptoms in each must occur longer than 1
month.
What happens?
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1. Reexperiencing the traumatic event
 Person frequently recalls the event (has nightmares
about the event).
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2. Avoidance of stimuli associated with the event or
numbing of responsiveness
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Person tries to avoid thinking about the trauma or
encountering stimuli that will bring it to mind.
3. Symptoms of increased arousal
difficulty concentrating (sleeping), hypervigilance
PTSD: General Stats
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General prevalence: 1-3 % in the general pop.
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3% for civilians exposed to a physical attack
 20 % among people wounded in Vietnam
 50 % of all rape victims
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Women twice as likely to develop PTSD as men.
F. Acute Stress Disorder
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an individual encounters a traumatic
experience that causes problems with social
or occupational functioning for less than 1
month.