Transcript Chapter Three

Anxiety Disorders
Panic Disorder
Specific Phobias
Social Phobia
Obsessive-Compulsive Disorder (OCD)
Posttraumatic Stress Disorder (PTSD)
Generalized Anxiety Disorder (GAD)
Panic Attack
A period of intense fear or discomfort involving at least 4 of the
following symptoms that develop abruptly and peak within 10 min.
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Racing heart, pounding heart (palpitations)
Sweating
Trembling or shaking
Feeling short of breath or smothering sensations
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, & faint
Derealization or depersonalization
Fear of losing control or going crazy
Fear of dying
Numbness or tingling
Chills or hot flushes
May be expected or unexpected (“out of the blue”)
Main Diagnostic Criteria
for Panic Disorder
Recurrent unexpected panic attacks
Persistent worry about having more attacks
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Worry about the implications of the attack or its
consequences (e.g., losing control, having a heart
attack, "going crazy")
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Significant change in behavior related to the attacks
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Presence or Absence of agoraphobia
The attacks are not due to a substance or a
medical condition (thyroid problems)
Main Diagnostic Criteria
for Specific Phobia
Excessive or unreasonable fear triggered by
a specific object or situation (e.g., flying,
animals).
Exposure to the phobic stimulus invariably
provokes anxiety.
The person recognizes the fear is irrational.
The phobic situation(s) is avoided or
endured with intense anxiety.
Significant personal distress or interference
with routine.
Categories of Specific Phobias
Animal
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Dogs, spiders, snakes
Natural environment
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Water, storms, heights
Situational
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Bridges/tunnels, flying, driving, elevators, tight spaces
Blood-injection-injury
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Involves drop in blood pressure and can involve
fainting
Other
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Choking, vomiting, balloons, clowns
Main Diagnostic Criteria
for Social Phobia
Excessive fear of one or more social and performance
situations where the person is exposed to unfamiliar
people or to possible scrutiny by others.
Fear of acting in a way (or show anxiety symptoms) that
will be humiliating or embarrassing.
Exposure to the feared social situation invariably
provokes anxiety
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May take the form of a panic attack
The person recognizes the fear is excessive or
unreasonable.
The feared social or performance situations are avoided
or endured with intense anxiety
Excessive personal distress/interference in functioning
Main Diagnostic Criteria for OCD
Obsessions as defined by:
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Recurrent and persistent thoughts, impulses, or images
that are experienced as intrusive, senseless, and
inappropriate
Cause marked anxiety or distress
the thoughts, impulses, or images are not simply
excessive worries about real-life problems
the person attempts to ignore or suppress such
thoughts, impulses, or images, or to neutralize them with
some other thought or action
the person recognizes that the obsessional thoughts,
impulses, or images are a product of his or her own mind
Main Diagnostic Criteria for OCD (2)
Compulsions as defined by:
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Rituals: Repetitive behaviors (e.g., hand
washing, ordering, checking) or mental acts
(e.g., praying, counting, repeating words silently)
The person feels driven to perform the rituals in
response to an obsession, or according to
certain rules
the rituals are aimed at preventing or reducing
distress or preventing some dreaded event or
situation
The rituals either are not connected in a realistic
way with what they are designed to neutralize or
prevent or are clearly excessive
Main Diagnostic Criteria for OCD (3)
At some point during the course of the disorder, the
person has recognized that the obsessions or
compulsions are excessive or unreasonable. Note:
This does not apply to children.
The obsessions or compulsions cause marked
distress, are time consuming (take more than 1 hour
a day), or significantly interfere with the person's
routine.
With Poor insight: if, for most of the time the person
does not recognize the obsessions and compulsions are
excessive or unreasonable
Some Common Obsessions
 contamination - dirt, germs, bodily
waste, chemicals
 mistakes - locks, appliances,
paperwork, decisions
 impulses - violent, sexual, religious,
embarrassing
 order - neatness, symmetry, numbers
Uncommon Obsessions
 Contamination from people with
disabilities
 Thoughts of becoming pregnant (male)
 Crumbs of the communion wafer fell in
my underwear
 Put the baby in the oven by mistake
Some Common Compulsive Rituals
Washing/Cleaning – hand washing,
showering, toilet, inanimate objects, hand gel
Checking – locks, appliances, for assurance,
Mental rituals – praying, neutralizing, mental
reviewing
Repeating – steps, touching
Ordering/arranging – left-right balance
Causes of anxiety disorders
Biological/genetic
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General vulnerability
Negative affect
Intensity of fight/flight response
Psychological/environmental/learning
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Personal experiences (traumatic?)
Vicarious learning
Informational transmission
Persistence of anxiety disorders
Physiological
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Fight/flight response
Cognitive
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Dysfunctional beliefs and interpretations
Overestimates of probability and severity
Behavioral
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Avoidance
Safety behaviors, rituals, & safety signals
Types of Exposure Therapy
In vivo: confrontation with fear-evoking
situations
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example: party, closet, floor, driving
Imaginal: confrontation with anxiety-evoking
thoughts/doubts
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Fires, responsibility for harming a loved one
Interoceptive: confrontation with fearevoking bodily sensations
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example: dizziness, breathlessness, headache
Criteria for Fear Reduction
During Exposure Therapy
Elicit fear
Allow habituation to occur
Provide corrective information
Fear level (0-100)
Effects of Repeated and Prolonged
Exposure on Irrational fear
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10
0
Session
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10
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Time (mins)
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Sarah: Contamination OCD
Married female in her late 20s, has baby
Fears of contamination from animals (pets,
bugs)
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Will get germs and then perhaps get sick
Compulsive washing, cleaning, & changing
clothes rituals to minimize contact with
contaminants and to keep anxiety manageable
Avoidance: neighbor’s home, own baby, certain
clothes, handling food
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Asks others to touch many things
Exposure Therapy Hierarchy:
Fear of contamination from animals
Situation (SUDS)
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Office floor (40)
Floor near entry to home (45)
Neighbor’s house/couch (65)
Neighbor’s pet
Dresser where bug was found (70)
Clothes from “buggy” dresser (75)
Bugs (85)
Response Prevention: Washer
No contact with water except for 1 daily
ten-minute shower
No changing clothes during the day
No cleaning objects in the house
No use of gloves/towels to touch surfaces
No asking others to open doors, hold
baby, prepare food, etc.