Understanding Anxiety Disorders: Symptoms, Types, Causes, and Treatments - Prof. Brenda Je, Study notes of Abnormal Psychology

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Anxiety Disorders Chapter 7 Experience of Anxiety • Both panic and anxiety can be “normal” experiences & adaptive in some circumstances • Become __________ when excessive, chronic, & occur in the absence of any real danger • Not a loss of contact with reality • Aware of illogical behavior, but can’t _____ Anxiety Disorders • Panic Disorder (2-3% lifetime prevalence) • Generalized Anxiety Disorder (5%) • Phobias (15%) Agoraphobia Social phobia Specific phobia • Obsessive-Compulsive Disorder (1-2.5%) • Post-traumatic Stress Disorder (8%) Prevalence • 19 million Americans have Anxiety Disorder’s (NIMH, 2000) • All anxiety disorders are more common among females than males -- except ______ • GAD may be overdiagnosed in children Panic Attacks In each anxiety disorder _______ can (but do not always) occur… • Prevalence: although most who experience PA’s wouldn’t meet criteria for a disorder, panic attacks are quite common; one study found 25- 33% one year prevalence rate among college students Generalized Anxiety Disorder (GAD)  Excessive anxiety & worry about a number of events or activities (e.g. work/ school performance)  Occurs more days than not, for at least 6 months  The person finds it difficult to control the worry  Physiological symptoms (3 or more required) • restlessness or feeling keyed up or on edge • being easily fatigued • difficulty concentrating • irritability • muscle tension • sleep disturbances  Anxiety or symptoms cause clinically significant distress or impairment in functioning Panic Disorder v GAD • PD usually experiences more severe anxiety • GAD more likely to worry over minor & major life events • GAD less extreme physiological reactions, but more persistent Phobias Strong persistent, and unwarranted fear of some specific object or situation Phobic person experiences extreme anxiety or panic attacks when confronted with phobic stimulus Attempts to avoid the phobic object or situation interfere significantly with life 3 subcategories of phobias are listed in the DSM IV: • Agoraphobia • Social phobia • Specific phobia Thoughts reported by individuals with social phobia Duration Patient Age (in years) Idiosyncratic Negative Belief 1 27 A I'll shake constantly, and people will think that I’m an alcoholic, 2 29 7 I'll look anxious, and people will think that I'm stupid. 3 34 i I'll babble a lot, and everyone will think that I’m nervous. 4 44 27 I'll blush, and people will think that I’m anxious. 5 22 2 I'll look very tense, and people around will stare at me. 6 18 4 I'll sweat heavily, and everyone will think that I'm nervous. 7 25 8 I'll go red, and people will think that I’m anxious. 8 43 24 I'll tremble uncontrollably, and people will think that | have Parkinson's disease. Source: From Wells & Papageorgiou (1999).  Phobias: Specific Phobia • Marked and persistent fear that is excessive or unreasonable about a specific object or situation • Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response – sometimes panic attack • The person recognizes that the fear is excessive or unreasonable • The phobic situation(s) is avoided or else is endured with intense anxiety or distress Phobias: Specific Phobia cont’d • Phobia interferes significantly with the person’s normal routine, occupational (or academic) functioning, or social activities or relationships • Specific Phobias are divided into 5 types – Animal Type (spiders, snakes) – Natural Environment Type (thunder, water) – Blood-injection/Injury Type (blood, shots) – Situational Type (fire drills, elevators) – Other (vomiting, contracting an illness) Common Obsessions/Compulsions 40 35 30 25 20 15 10 Percent Contamination Harm Exactness Checking Cleaning/ Repeating washing Obsessions Compulsions Source: Data from Foa & Kozak (1995).  Anxiety Disorders Etiology & Treatment 1. Biological Models • Biological Predisposition: most anxiety disorders have higher concordance for monozygotic vs. dizygotic twins; efficacy of drug treatment • Biological predisposition for fear reactions may be due to sensitized autonomic nervous system (ANS) – Biological challenge tests • Amygdala (fear network) plays a central role in emotions - has connections with other brain sites (brain stem, cortex) - may play role in conditioned fear response 3. Cognitive-Behavioral Models • Panic results from misinterpretation of bodily symptoms – Panic prone people may be very sensitive to bodily sensations – High degree of “anxiety sensitivity” • Focus on bodily sensations • Unable to assess them logically • Interpret them as potentially harmful • Anxiety Sensitivity Index Neurotransmitter theories Kindling model Suffocation false alarm theory – Poor regulation of norepinephrine, serotonin, and perhaps GABA and CCK in the locus ceruleus and limbic systems, causes panic disorder – Poor regulation in the locus ceruleus causes panic attacks, stimulates and kindles the limbic system, lowering the threshold for stimulation of diffuse and chronic anxiety – The brains of people with panic disorder are hypersensitive to carbon dioxide and induce the fight-or-flight response with small increases in carbon dioxide Panic Disorder: Etiology Genetic Theories Cognitive Theories – Disordered genes put some people at risk for panic disorder – People prone to panic attacks (1) pay very close attention to their bodily sensations, (2) misinterpret these sensations, and (3) engage in snowballing, catastrophizing thinking Panic Disorder continued Panic Disorder: CBT Treatment Clients are taught relaxation and breathing exercises. The clinician guides clients in identifying the catastrophizing cognitions they have about changes in bodily sensations. Clients practice using their relaxation and breathing exercises while experiencing panic symptoms in the therapy session. Panic Disorder & CBT, cont’d The therapist will challenge clients’ catastrophizing thoughts about their bodily sensations and teach them to challenge their thoughts for themselves The therapist will use systematic desensitization techniques to gradually expose clients to those situations they most fear while helping them to maintain control GAD: Etiology People with GAD pay unusually close attention to threatening cues – Faced with stressful events such as exams or job interviews, people with GAD are likely to interpret them as threatening, dangerous, to overreact, and to experience fear. – “Danger microscope” Phobia: Treatment Behavioral 1) Systematic desensitization 2) Modeling 3) Flooding Biological Reduce symptoms of anxiety generally so that they do not arise in the feared situation Cognitive-Behavioral Helps clients identify and challenge negative, catastrophizing thoughts about feared situations OCD: Etiology • Compulsive behaviors reduce anxiety (negative reinforcement) • Individuals with OCD may not trust their memory and judgment & feel compelled to confirm they actually performed the behavior or performed it “correctly” • OCD patients have 2 cognitive characteristics – Probability bias (belief thought increases chance of happening) – Morality bias (belief thought is as bad as actual behavior) Biological: Serotonin-enhancing drugs like Paxil, Prozac Exposure: Flooding / Systematic Desensitization – Construction of stimulus hierarchy – Most effective when in vivo (in real life, rather than imagined) Response prevention – blocking avoidance behaviors – prevented from performing rituals OCD: Treatment