Transcript Generalized Anxiety Disorder

Generalized Anxiety Disorder:
An anxiety disorder in which a person is continually
tense, apprehensive, and in a state of autonomic
nervous system arousal.
By Owen Maher
Diagnostic Criteria: DSM
• A. Excessive anxiety and worry (apprehensive
expectation), occurring more days than not for at least
months, about a number of events or activities (such as
work or school performance).
6
• B. The person finds it difficult to control the worry.
• C. The anxiety and worry are associated with 3 (or more) of
the following 6 symptoms (with at least some symptoms
present for more days than not for the past 6 months). Note:
Only one item is required in children.
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying
asleep, or restless unsatisfying sleep)
Diagnostic Criteria: DSM
• D. The focus of the anxiety and worry is not confined to
features of an Axis I disorder,
• E. The anxiety, worry, or physical symptoms cause
clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
• F. The disturbance is not due to the direct physiological
effects of a substance (e.g., a drug of abuse, a
medication) or a general medical condition (e.g.,
hyperthyroidism) and does not occur exclusively during a
Mood Disorder, a Psychotic Disorder, or a Pervasive
Developmental Disorder.
Psychoanalytic: Causes
• The psychodynamic theory of
psychology sees anxiety as an
alerting mechanism that arises when
our unconscious motivations clash
with the constraints of our conscious
mind.
–This conflict is intensified in people
with GAD.
Psychoanalytic: Treatment
• Psychotherapy
The goal of dynamic psychotherapy is to identify and
explore the causes of anxiety and what they mean to the
patient. A therapist may work with the patient on a number
of exercises, including stress evaluation and techniques to
be practiced while the patient is on his or her own.
• The goal of behavior therapy is to establish coping
strategies for anxiety. Behavior and cognitive therapy
overlap, because new behavior is only possible after a
person is able to replace irrational, anxious thoughts with
healthy ones. Methods include the following:
–
–
–
–
Biofeedback
Controlled exposure to anxiety-causing situations
Meditation
Planning relaxed events and relaxation training
Humanistic: Causes
• Theorists propose that GAD, like other
psychological disorders, arises when
people stop looking at themselves
honestly and acceptingly
– This view is best illustrated by Carl
Rogers’ explanation:
• Lack of “unconditional positive regard” in childhood
leads to “conditions of worth,” (harsh self-standards)
• These threatening self-judgments break through and
cause anxiety, setting the stage for GAD to develop
Humanistic: Treatments
• Therapy based on this model is “clientcentered” and focuses on creating an
accepting environment where clients can
“experience” themselves
• Although case reports have been positive,
controlled studies have only sometimes
found client-centered therapy to be more
effective than placebo or no therapy
Behavioral/ Learning: Causes
• Behavioral theory holds that anxiety results
from not knowing how to behave in a given
situation. The possibility of suffering negative
consequences because of inappropriate
behavior may result in hesitation and inaction.
• The anxiety may be generalized
to similar situations.
– For example, anxiety over taking a particular
test may be generalized to taking all tests in the
future.
Behavioral/ Learning: Treatments
• Much like the
psychodynami
c treatments in
that doctors try
to establish
coping
mechanisms
for patients.
Cognitive: Causes
• Theory: GAD is caused by maladaptive assumptions
– Albert Ellis identified basic irrational
assumptions:
• It is a necessity for humans to be loved by
everyone
• It is catastrophic when things are not as one wants
them
• If something is dangerous, a person should be
terribly concerned and dwell on the possibility that
it will occur
• One should be competent in all domains to be a
worthwhile person
• When these assumptions are applied to everyday life,
GAD may develop
Cognitive: Causes
• Aaron Beck is another cognitive theorist
– Those with GAD hold unrealistic silent
assumptions that imply imminent danger:
• Any strange situation is dangerous
• A situation/person is unsafe until proven safe
• It is best to assume
the worst
• My security depends on anticipating and
preparing myself at all times for any possible
danger
Cognitive: Treatment
• Two kinds of cognitive therapy:
– Changing maladaptive assumptions
• Based on the work of Ellis and Beck
– Teaching coping skills for use during
stressful situations
Biological/ Somatic: Causes
• Many people in the United States who are
diagnosed with GAD claim to have been nervous
or anxious their whole lives.
• GAD is associated with irregular levels of
neurotransmitters in the brain.
– Norepinephrine is concentrated in the locus ceruleus
(nerve cluster that lies near the brain's fourth
ventricle). Increased activity in the locus ceruleus is
associated with anxiety, and decreased activity in the
locus ceruleus diminishes anxiety. Increased levels of
GABA and serotonin seem to reduce anxiety. All of
these neurotransmitters interact during heightened
anxiety.
Bio Medical Therapy
• Medication
General anxiety disorder is treated with the
following types of drugs:
–
–
–
–
Antidepressants
Benzodiazepines
Beta-blockers
Buspirone
• Drug choice is determined by the patient's ability
to tolerate side effects and by the drug's
effectiveness in reducing symptoms.
Bibliography
• “Chapter 4- Anxiety Disorders.” Comer, Fundamentals of
Abnormal Psychology, 4e-Chapter 4: Student
Handout Answer Key.
<http://occonline.occ.cccd.edu/online/cbasile/Fund4PPT_AK_Ch04.doc>
• “Generalized Anxiety Disorder.” Copyright 2000
American Psychiatric Association.
<http://www.behavenet.com/capsules/disorders/gad.htm>
• “Generalized Anxiety Disorder.” Copyright 1998-2006,
last modified Friday Sept. 8, 2006 .
<http://www.mentalhealthchannel.net/gad/>
By Max Boomer
What is Panic Disorder
Panic disorder is when someone has very frequent Panic
Attacks and constantly worry about having another panic
attack and avoid places that may have caused one, or you
think will cause a future attack
A panic attack is a sudden burst of fear or anxiety that can
last for five-twenty minutes. Your nervous system reacts
as if you are in a life-threatening situation, whether or not
you are.
Causes of Panic Disorder
Exact causes of panic disorder are not clear, many factors
may make a panic attack more likely
Two of the most common theories are a chemical
imbalance and family history of Panic disorder
Stress and Anxiety increase chances of having a panic
attack, also how a stressful situation is handled is
important.
Prescription medications, Alcohol abuse, Drug abuse, too
much nicotine and/or caffeine, or a health condition such as
overactive Thyroid can help to trigger attacks
What happens during a Panic Attack
Panic attacks consist of hyper-tension, fear, intense anxiety
and trouble breathing
Having repeating and/or unexpected Panic Attacks is a
sign of Panic disorder.
Avoiding places that you think may cause a Panic Attack
is called Agoraphobia, which is commonly associated
with Panic disorder, many people who have Panic
disorder also have some degree of depression.
Treatment Options
Like most other medical and psychological conditions,
prescription medications are available to treat Panic
Disorder
Also, psychotherapy is an important part also. Usually
drugs will be prescribed with psychotherapy, or therapy
will be prescribed alone
Although Panic disorder can be treated, it is never
completely cured, medication and therapy will allow the
patient to resume a normal lifestyle, however relapse is
possible
Medications
Anti- Depressants are prescribed fairly often along with
serotonin inhibitors such as Prozac or Xanex
Therapy
Cognitive-Behavioral Therapy is the most popular type of
therapy used to treat Panic Disorder
This is a type of therapy in which by changing the
thoughts and behaviors of your symptoms that the
symptoms of your condition will alleviate
Bibliography
“Panic Disorder without Agoraphobia” Diagnostic and Statistical
Manual of Mental Disorders, fourth edition 1994
“Panic Attacks and Panic Disorder”
WebMD 22 February 2005 1 January 2007
<http://www.webmd.com/hw/anxiety_panic_disorders/hw53798.asp>
Phobias!
"The only thing we have to
fear is fear itself.” – Franklin
Roosevelt
A presentation by Quentin Turner
Defined




A phobia is a strong,
persistent fear of
situations, objects,
activities, or persons.
Phobias are not just
extreme fear, they are
irrational fears.
The cause of phobias
are currently
unknown.
Phobias first appear in
the adolescence and
adulthood.
Symptoms



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Causes an immediate
response of anxiety when
exposed to the object of
fear.
Compelling desire to avoid
and unusual measures
taken to stay away from
object of fear.
An impaired ability to
function at normal tasks
because of the fear.
In some cases, anxious
feelings when merely
anticipating an encounter
with what you fear.
Complications

Having a phobia may cause other
problems, including:
• Social isolation
• Depression
• Substance abuse

When a phobia starts to interfere
with your personal life and duties, it
is important to go seek medical help.
Treatment

Treatment for phobias can include but is not
limited to medication such as:
• beta blockers - work by blocking the stimulating effect
of epinephrine (adrenaline)
• antidepressants
• behavioral therapy - desensitization or exposure
therapy focuses on changing your response to the feared
object or situation
• cognitive-behavioral therapy - involves you and your
therapist learning ways you can view and cope with the
feared object or situation differently
Clinical / Specific Phobias

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
Acrophobia – fear of heights.
Claustrophobia - fear of confined
spaces.
Heliophobia — fear of sunlight.
Xenophobia — fear of strangers,
foreigners, or aliens.
Arachnophobia — fear of spiders.
Zoophobia - a generic term for
animal phobias
Social Anxiety Disorder


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
Similar symptoms of
phobias but applied to
social situations.
Intense, chronic fear of
being judged by others
and of potentially being
embarrassed or humiliated
by their own actions.
Physical symptoms of
social anxiety disorder
include excessive blushing,
sweating, trembling,
nausea, and stammering.
Panic attacks can occur
under intense fear and
discomfort as well.
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Treatment should be
sought is the anxiety
causes interference in
personal life and duties.
Social Phobia can be
treated in the same ways
as a specific phobia.
References

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http://en.wikipedia.org/wiki/Social_p
hobia#Symptoms
http://en.wikipedia.org/wiki/Phobia
http://www.mayoclinic.com/health/p
hobias/DS00272/DSECTION=1
Obsessive-Compulsive
Disorder
By: Sara Crandall
Breaking Down OCD….
•Obsessions: undesirable,
recurrent, disturbing thoughts
•Compulsions: repetitive or
ritualized behaviors
•D
isorder: Disturbs the normal
physical or mental health
A person with OCD….
•plagued by persistent,
recurring thoughts that
reflect exaggerated anxiety or
fears
Obsessions of OCD….
• Fear of dirt or germs
• Concern with order, symmetry
(balance) and exactness
• Worry that a task has been done
poorly, even when the person
knows this is not true
Obsessions of OCD
(continued)….
• Fear of thinking evil or sinful
thoughts
• Thinking about certain sounds,
images, words or numbers all the
time
• Need for constant reassurance
• Fear of harming a family member or
friend
Compulsions of OCD….
•Washing hands over and over again
(any type of grooming to be clean)
•Checking something constantly
•Not stepping on the cracks of a
sidewalk
Compulsions of OCD….
•Everything needs to be in perfect
order
•Touching something a certain way or
a certain number of times
•Need of constant reassurance and
approval
What causes OCD?
• Lack of serotonin in the brain (chemical
imbalance)
– Chemical in the brain
– Keeps from repeating behaviors over and over
• Different Brain Structure
• Not caused by family problems or
childhood experiences
• Runs in families
• Environmental Stressors
Causes of the Disorder….
• Behavioral/ Learning:
»Can be learned with in your
environment
»If you have environment stressors
»Being around someone who you look
up to who has it you can learn it
Causes of the Disorder….
• Cognitive:
»Deals with the mind
»How you think
»Mental judgment or
perception
»What your reasoning is in
your mind
How common is OCD….
• 3 million Americans ages 18 to 54 have
OCD
-2.3% of this age group had OCD
• Women and men affected equally by OCD
• 25% chance blood relative has OCD
• 70% chance identical twins will share it
Causes of the Disorder….
• Biological/ Somatic:
»Runs through the family
»If sibling has it chance
you would have it
»Runs in your families
genes
Causes of the Disorder….
•Humanistic:
»Self-confidence
»Believing in your self
»Doing what you believe
is right
How to stop OCD….
• Many people with OCD know there rituals
do not make sense
• Can’t stop because something bad might
happen to a:
-family member
-pet
-friend
-house
-personal belonging
When do you get help if you
have OCD?
• If you feel unable to keep up with
your normal appearance and behavior
• If you can’t work
• If you cut off connections with friends
and families and are unable to
socialize
• If you can’t take care of yourself and
have trouble eating, sleeping, bathing,
etc.
Ways to cope with OCD….
•Cognitive Behavioral Therapy (CBT)
•Support Groups
•Family Therapy
•See a Psychiatrist
•Avoid people who make you feel bad
•Have a healthy Life-Style
•Find a creative outlet for feelings
•Find something that relaxes you
OCD comes with a lot of
baggage….
• Obsessive-Compulsive Spectrum
Disorders and anxiety disorder:
–Hypochondrias
–Phobias
–Panic Disorders
–Social Anxiety
–Anxiety Attacks
–Depressions
–Panic Attacks
Causes of the Disorder….
• Psychoanalytic: OCD can be caused by
depression of repressed feelings from
another situation
Treatments of the Disorder….
• Psychoanalysis Therapy
(Psychodynamic Therapy): Freud’s
theory of therapeutic help
• Psychodynamic Therapy:
Therapist tries to understand the
patients symptoms at that
current moment
Treatments of the Disorder….
• Humanistic: Aim to boost selffulfillment
–Carl Roger’s
–Focus on the future
–Conscious behaviors
–Take responsibility for the actions
–Want to see growth
Treatments of the Disorder….
•Behavioral Therapy:
–Apply learning principles to eliminate
unwanted behavior
–Exposure Therapy-Joseph Wolfe
–Aversive conditioning-counter
conditioning
–Token Economy-Operant conditioning
Treatments of the Disorder….
•Cognitive Therapies:
–Teach people different
ways of thinking
–Assuming the thoughts
they think between events
–Telling them different ways
to think
Treatments of the Disorder….
•Group/ Family Therapy:
–No one feels alone
–Shows togetherness
–Family can see what the person is
going through, I that is not them
doing this it is the disorder
–Work to heal relationships
–Help family discover their role in the
family
How to treat OCD with
Medication…. Bio Medical
Therapy
• anti-depressants or other antianxiety medications:
- Prozac (fluoxetine)
- Zoloft (sertraline)
- Paxil (paroxetine)
- Luvox (fluvoxamine)
• antibiotics
Bibliography….
• “Obsessive-Compulsive Behaviors and
Disorders: Symptoms, Treatment, and
Support.” Helpguide Mental Health Issues. 6
July 2005. 23 December 2006.<http://www.
helpguide.org/mental/obsessive_compulsive
_disorder_ocd.htm>
• “Obsessive-Compulsive Disorder.” Diagnostic
criteria for 300.3 Obsessive-Compulsive Disorder.
27 December 2006.<http://www.behavenet.com
/capsules/disorders/o-cd.htm>
Bibliography….
•
•
•
“Obsessive-Compulsive Disorder Screening
Quiz.” Psych Central. 16 February
2006. 21 December 2006.
<psychcentral.com/ocdquiz.htm>
“Obsessive-Compulsive Disorder.” Family Doctor. 25
2005. 19 December 2006. <http://family
July
doctor.org/133.xml>
“Risk Factors and Causes of OCD.” Healthy
Place. 29 January 2006. 30 December 2006.
<http://www.healthyplace.com/Communitie
s/Anxiety/ocd_4.asp>
Posttraumatic
Stress
Disorder
By Emily Cumpata
POSTTRAUMATIC STRESS DISORDER
(According to DSM-IV)
When an individual
who has been
exposed to a
traumatic event
develops anxiety
symptoms,
reexperiencing of the
event, and avoidance
of stimuli related to
the event lasting
more than four
weeks.
FACTS
-PTSD is often experienced by
combat veterans, accident and
disaster survivors, and sexual
assault victims
-About 4% of those who have
experienced a natural disaster and
50% of those who have been
kidnapped, held captive, tortured, or
raped experience PTSD
-(1988) The U.S.
Centers for Disease
Control compared 7000
Vietnam combat
veterans to 7000
noncombat veterans
who served in the same
years
-Combat stress more
than doubled a
veteran’s risk of alcohol
abuse, depression, or
anxiety
-Roughly 15% of all
Vietnam veterans
reported having PTSD
symptoms
DIAGNOSTIC CRITERIA
(According to DSM-IV)
The person has been exposed to a
traumatic event in which both of the
following were present:
1. The person experienced, witnessed, or was
confronted with an event or events that involved
actual or threatened death or serious injury, or a
threat to the physical integrity of self or others
2. The person's response involved intense fear,
helplessness, or horror. (In children, this may be
expressed instead by disorganized or agitated
behavior)
DIAGNOSTIC CRITERIA
(According to DSM-IV)
The traumatic event is persistently
reexperienced in one (or more) of the
following ways :
1. Recurrent and intrusive distressing recollections of the event,
including images, thoughts, or perceptions
2. Recurrent distressing dreams of the event
3. Acting or feeling as if the traumatic event were recurring
(illusions, hallucinations, and dissociative flashback episodes,
occurring while awake or when intoxicated)
4. Intense psychological distress at exposure to internal or
external cues that symbolize or resemble an aspect of the
traumatic event
5. Physiological reactivity on exposure to internal/external cues
that symbolize or resemble an aspect of the traumatic event
DIAGNOSTIC CRITERIA
(According to DSM-IV)
Persistent avoidance of stimuli associated with
the trauma and numbing of general
responsiveness (not present before the trauma),
as indicated by three (or more) of the following:
1. Efforts to avoid thoughts, feelings, or conversations
associated with the trauma
2. Efforts to avoid activities, places, or people that arouse
recollections of the trauma
3. Inability to recall an important aspect of the trauma
4. Markedly diminished interest or participation in significant
activities
5. Feeling of detachment or estrangement from others
6. Restricted range of affect
7. Sense of a foreshortened future
DIAGNOSTIC CRITERIA
(According to DSM-IV)
Persistent symptoms of increased arousal
(not present before the trauma), as
indicated by two (or more) of the
following:
1. Difficulty falling or staying asleep 4. Hypervigilance
2. Irritability or outbursts of anger
5. Exaggerated startle
3. Difficulty concentrating
response
-Duration of the disturbance is more than 1 month
-The disturbance causes clinically significant
distress or impairment in social, occupational, or
other important areas of functioning
CAUSES
Psychoanalytic Perspective
-This perspective argues that traumatic
events shatter archaic and egotistical
fantasies which are central to the
organization of self-experience
-The unconscious meanings
of the traumatic events are
found in faulty attempts to
restore these fantasies
-The victim attaches what
actually changes the person's
experience of self to the
traumatic event
TREATMENTS
Psychoanalytic/Psychodynamic Therapy
-Dream analysis can be used to understand the affective
elements of PTSD
-There are many experimental difficulties
are associated with dream analysis, but
important discoveries have been
uncovered through this type of research
-Free association can be
used to explore the
unconscious mind of the victim
-The victim relaxes and says
whatever comes to mind, this
may reveal the event that is
affecting them
CAUSES
Humanistic Perspective
Symptoms of PTSD can include:
-Concern with humanistic
values overlaid by hedonism
(a self-indulgent devotion to
pleasure and happiness as a
way of life)
-Negative self-image
-According to humanistic psychologist Carl
Rogers, all people are basically good and are
endowed with self-actualizing tendencies
-However, PTSD victims are thwarted by an
environment that inhibits growth and prevents
them from reaching self-actualization
TREATMENTS
Humanistic Therapy
-Humanistic therapy
provides a hopeful view of
human beings and the
individual’s capacity to
reach self-actualization
-This therapeutic approach
works more effectively with
present (rather than past)
occurrences, and is
therefore not the best
option for treating victims of
PTSD
CAUSES
Behavioral/Learning Perspective
-Fear conditioning
-Anxiety has been linked with
classical conditioning of fear
-Many victims of PTSD experience
anxiety with any reminder of their
trauma
-Anxiety can be caused by any internal or external cues
that symbolize/resemble an aspect of the traumatic event
-Reinforcement helps maintain fear: if the victim
constantly is reminded of the trauma, they are more likely
to respond negatively
TREATMENTS
Behavioral Therapy
-There are two behavioral
techniques for treating PTSD:
exposure-based
procedures
anxiety management techniques
-Used when anxiety disrupts daily
functioning
-Includes relaxation training, stress
inoculation training, cognitive
restructuring, breathing retraining and
distraction techniques
-A set of techniques
involving the
confrontation of
feared situations and
is used when the
disorder involves
excessive avoidance
CAUSES
Cognitive Perspective
-Schemas provide the essential
structural base for the cognitive
components of individuals
-The person’s personality consists of
self-perpetuating patterns that are stable
aspects of an individual's mode of
engaging the world
-These two aspects influence the
expression of beliefs and symptoms
associated with traumatic event
-Victims of PTSD develop schemas, or
mental molds into which they pour their
experience
TREATMENTS
Cognitive Therapy
-Cognitive therapy involves
working with cognitions to change
schemas, emotions, thoughts,
and behaviors
Also includes:
-Learning skills for coping with
anxiety and negative thoughts
-Preparing for stress reactions
-Addressing urges to use
alcohol or drugs when trauma
symptoms occur
-Communicating and relating
effectively with people
CAUSES
Biological/Somatic Perspective
-People are genetically predisposed to
particular fears and high anxiety
-A traumatic event paired with a sensitive,
high-strung temperament can often result in
PTSD
-Certain people may be more
vulnerable physiologically and in
turn have a different response to
traumatic situations
-Fear-learning experiences can
traumatize the brain, by creating
fear circuits within the amygdala
TREATMENTS
Group/Family Therapy
-PTSD can have devastating effects on the family
and friends of the victim
-Group therapy is often an ideal therapeutic setting
-Trauma survivors are able to share their feelings
within the safety and empathy of the other survivors
-They discuss and share how they
cope with trauma-related shame,
guilt, rage, fear, doubt, and selfcondemnation
-They also prepare themselves to
focus on the present rather than the
past
TREATMENTS
Bio Medical Therapy
-Medication (along with psychotherapy) have been shown to lessen the
three major symptoms: reexperiencing, avoidance and hypervigilance
-The most widely used drug treatments for PTSD are
the selective serotonin reuptake inhibitors, such as
Prozac and Zoloft
-It may help relieve the distress and
emotional numbness caused by
trauma memories
-Currently, no particular drug has
emerged as a definitive treatment
-Medication is useful for symptom
relief, which makes it possible for
victims to participate in psychotherapy
Bibliography
• Beall, Lisa S. "Post-Traumatic Stress Disorder: a Bibliographic
Essay." 1997. 30 Dec. 2006
<http://www.lib.auburn.edu/socsci/docs/ptsd.html>.
• Jennifer, Lange T., Lange L. Christopher, and Rex B. Cabaltica.
"Primary Care Treatment of Post-Traumatic Stress Disorder."
American Family Physician. 1 Sept. 2000. AAFP. 1 Jan. 2007
<http://www.aafp.org/afp/20000901/1035.html>.
• Myers, David G. Exploring Psychology. 6th ed. New York:
Worth, 2005.
• "Posttraumatic Stress Disorder (PTSD)." DSM-IV & DSM-IV-TR.
2006. BehaveNet®. 19 Dec. 2006
<http://www.behavenet.com/capsules/disorders/ptsd.htm>.
• "Treatment of PTSD." National Center for PTSD. 20 July 2006.
United States Department of Government Affairs. 1 Jan. 2007
<http://www.ncptsd.va.gov/facts/treatment/fs_treatment.html>.