Anxiety Anxiety DisordersDisorders

How much do you know?How much do you know?

• Anxiety QuizAnxiety Quiz

What is Anxiety?What is Anxiety?•Refers to a general state of Refers to a general state of

dread or uneasiness that dread or uneasiness that occurs in response to a occurs in response to a vague or imagined danger.vague or imagined danger.

•It differs from fear, which It differs from fear, which is a response to a real is a response to a real danger or threat.danger or threat.

What does anxiety look What does anxiety look like?like?

•Physical signs and symptoms:Physical signs and symptoms:–Feelings of panic, dread, Feelings of panic, dread, horror, and terrorhorror, and terror

–Rapid heartbeat, shortness of Rapid heartbeat, shortness of breath, tremblingbreath, trembling

–Uncontrollable taking over of Uncontrollable taking over of avoidant thoughtsavoidant thoughts

DSM-IV Classifies Anxiety DSM-IV Classifies Anxiety Disorders to include:Disorders to include:

•Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder

•Phobic DisordersPhobic Disorders

•Panic Disorders

•Generalized Anxiety Generalized Anxiety DisorderDisorder

•Stress DisordersStress Disorders

Obsessive Compulsive Obsessive Compulsive Disorder Disorder

We’ll cover this in depth later!We’ll cover this in depth later!

Medication TherapyMedication Therapy(Antidepressants)(Antidepressants)

PhobiasPhobias•12 percent of 12 percent of

American’s are afflictedAmerican’s are afflicted

•Most common Most common psychiatric illness in psychiatric illness in women and the second women and the second most common in men most common in men over ages 25over ages 25

•Categorized into three Categorized into three groupsgroups

3 Main Groups of Phobias 3 Main Groups of Phobias Include:Include:

•Specific (simple) PhobiaSpecific (simple) Phobia

•Social PhobiaSocial Phobia

•AgoraphobiaAgoraphobia

Specific (simple) PhobiaSpecific (simple) Phobia(view cartoons/view phobia wkshts)(view cartoons/view phobia wkshts)

•Most common phobiasMost common phobias

•Produce intense fear of a Produce intense fear of a particular object or situation, particular object or situation, that is in fact relatively safe.that is in fact relatively safe.

–ClaustrophobiaClaustrophobia–ArachnophobiaArachnophobia–ZoophobiaZoophobia

The Origin of PhobiasThe Origin of Phobias

•PsychoanalyticPsychoanalytic–Phobias are defenses against Phobias are defenses against the anxiety produced by the anxiety produced by repressed impulses of the IDrepressed impulses of the ID

–The anxiety is displaced onto The anxiety is displaced onto some situation or object that is some situation or object that is symbolically related to the ID.symbolically related to the ID.

The Origin of PhobiasThe Origin of Phobias

•SociobiologistsSociobiologists–Suggest the Suggest the roots of roots of phobias are phobias are carried in our carried in our genes.genes.

The Origin of PhobiasThe Origin of Phobias•BehavioristsBehaviorists

– Phobias are learned via:Phobias are learned via:–classical conditioning (little classical conditioning (little Albert),Albert),

–operant conditioning operant conditioning (reinforcing staying home for a (reinforcing staying home for a child from school),child from school),

–vicarious learning (observation),vicarious learning (observation),–or Mowrer’s two-factor modelor Mowrer’s two-factor model

Two Factor ModelTwo Factor Model

Social PhobiaSocial Phobia(view cartoons)(view cartoons)

•Characterized by a Characterized by a persistent fear of persistent fear of social situations in social situations in which one might be which one might be exposed to the close exposed to the close scrutiny of others and scrutiny of others and may be humiliated or may be humiliated or embarrassedembarrassed

What do social phobias look What do social phobias look like?like?

•Feel all eyes are on themFeel all eyes are on them

•Fear eating out or using public Fear eating out or using public restroomsrestrooms

•Fear talking on the phone or writing Fear talking on the phone or writing in front of othersin front of others

•Fear speaking in public and datingFear speaking in public and dating

•Find blushing painfully Find blushing painfully embarrassingembarrassing

The Origin of Social The Origin of Social PhobiaPhobia

•Related to feelings of Related to feelings of inferiority and low self-inferiority and low self-esteemesteem

AgoraphobiaAgoraphobia•Fear of being alone in public places Fear of being alone in public places

from which there is no easy escape.from which there is no easy escape.•Shopping MallShopping Mall•Movie TheatreMovie Theatre•ElevatorElevator•Buses, Trains, AirplanesBuses, Trains, Airplanes

•Agoraphobics commonly experience Agoraphobics commonly experience panic attacks & avoidant behaviors.panic attacks & avoidant behaviors.

The Origins of The Origins of AgoraphobiaAgoraphobia

•No apparent causeNo apparent cause

When can a phobia be When can a phobia be diagnosed?diagnosed?

•When the When the irrational fear irrational fear leads to avoidance leads to avoidance behaviors (not behaviors (not leaving home) that leaving home) that interferes with the interferes with the affected person’s affected person’s normal life.normal life.

How can a phobia be How can a phobia be treated?treated?

•Exposure TreatmentExposure Treatment (Foa & (Foa & Kozak 1986)Kozak 1986)– Patient is exposed to the Patient is exposed to the phobic stimulusphobic stimulus

– Flooding (an extreme version of Flooding (an extreme version of exposure) is where a person is exposure) is where a person is immersed in the fear until the immersed in the fear until the fear itself fades away.fear itself fades away.

How can a phobia be How can a phobia be treated?treated?

•Counter-ConditioningCounter-Conditioning (Watson 1924)(Watson 1924)

– Client is trained to substitute Client is trained to substitute a relaxation response for the a relaxation response for the fear responsefear response

HOW???HOW???

Through a process of: Through a process of: Systematic DesensitizationSystematic Desensitization

(Wolpe 1958)(Wolpe 1958)

•Step 1: train the patient to relax Step 1: train the patient to relax (biofeedback)(biofeedback)

•Step 2: create a scale of anxiety to Step 2: create a scale of anxiety to the stimulusthe stimulus

•Step 3: begin to expose the client Step 3: begin to expose the client to small level of stimulus with to small level of stimulus with relaxation and progress to larger relaxation and progress to larger levels of stimulus (cope with levels of stimulus (cope with modeling)modeling)

                                                                                                                                         

Post Traumatic Stress Post Traumatic Stress DisorderDisorder

•An extreme or traumatic An extreme or traumatic event that one see, event that one see, experience, or learn about experience, or learn about which causes intense fear, which causes intense fear, helplessness, and horror.helplessness, and horror.

•Event involves actual or Event involves actual or threatened death or serious threatened death or serious injury, or threats of harm to injury, or threats of harm to oneself and others.oneself and others.

                                                  

PTSD ExamplesPTSD Examples::•Physically attacked- domestic Physically attacked- domestic

violence or rapeviolence or rape•Injured in a serious car, plane, Injured in a serious car, plane,

or train accidentor train accident•Hurt or traumatized by a Hurt or traumatized by a

natural disasternatural disaster•Told about the sudden, Told about the sudden,

unexpected death of a loved unexpected death of a loved oneone

•A soldier views a horrific war A soldier views a horrific war scenescene

How does PTSD work?How does PTSD work?

•Acute stress of a Acute stress of a traumatic event causes traumatic event causes chemical reactions in the chemical reactions in the brain that produce anxiety brain that produce anxiety provoking emotions and provoking emotions and physical symptoms.physical symptoms.

How common is PTSD?How common is PTSD?•In the past is was believed In the past is was believed

only soldiers who suffered only soldiers who suffered from “battle fatigue” or from “battle fatigue” or “shell shock” had PTSD“shell shock” had PTSD

•Currently, we are recognizing Currently, we are recognizing more scenarios.more scenarios.

•1 of every 13 Americans will 1 of every 13 Americans will get PTSD at some point in get PTSD at some point in their life. More of the victims their life. More of the victims are women.are women.

Why more women Why more women sufferers?sufferers?

•Studies conclude that women Studies conclude that women are more likely to experience are more likely to experience a lot more different traumatic a lot more different traumatic events:events:–RapeRape–Sexual MolestationSexual Molestation–Neglect by parentsNeglect by parents–Physical abuse in childhood Physical abuse in childhood and adulthoodand adulthood

Signs & Symptoms of Signs & Symptoms of PTSDPTSD

•The symptoms of this condition The symptoms of this condition are not all in your head or are not all in your head or imaginaryimaginary

•The symptoms must last for The symptoms must last for more than one month, must more than one month, must cause personal distress in daily cause personal distress in daily life, and you must have a life, and you must have a certain number of them in certain number of them in order to be diagnosed with order to be diagnosed with PTSD.PTSD.

                           

Signs & Symptoms of Signs & Symptoms of PTSDPTSD

– 1. Re-experiencing (1 or more)1. Re-experiencing (1 or more)•Frequent upsetting Frequent upsetting memories/images about the memories/images about the eventevent

•Distressing dreams repeatedlyDistressing dreams repeatedly•Acting as if the event were Acting as if the event were happening againhappening again

•Emotional pain when seeing Emotional pain when seeing things associated with the eventthings associated with the event

•Physical reactions of shakiness, Physical reactions of shakiness, chills, increased heart ratechills, increased heart rate

–2. 2. Avoidance and numbing (3 or more)Avoidance and numbing (3 or more)•Avoid conversation about eventAvoid conversation about event•Avoid activities or people in the Avoid activities or people in the eventevent

•Not being able to remember Not being able to remember important details about the eventimportant details about the event

•No longer enjoying activities you No longer enjoying activities you once enjoyedonce enjoyed

•Feelings of detachment Feelings of detachment •Belief that important life goals will Belief that important life goals will not be fulfillednot be fulfilled

–3. Hyper arousal (2 or 3. Hyper arousal (2 or more)more)

•Problems falling and Problems falling and staying as asleepstaying as asleep

•Angry outbursts and Angry outbursts and irritablenessirritableness

•Problems concentratingProblems concentrating

•Feeling “overly alert”Feeling “overly alert”

•Being “overly startled”Being “overly startled”

When do these When do these symptoms occur?symptoms occur?

•Usually start to appear Usually start to appear within several weeks of the within several weeks of the traumatic eventtraumatic event

•However, some people may However, some people may not have them for months not have them for months or ears after the traumatic or ears after the traumatic eventevent

PTSD & the possibility of PTSD & the possibility of other conditionsother conditions

•Anxiety Anxiety

•DepressionDepression

•Self-medication: Self-medication: alcohol & drugsalcohol & drugs

Treatment of PTSDTreatment of PTSD•Suggested therapy is a type Suggested therapy is a type

of psychotherapy called of psychotherapy called Cognitive Behavioral TherapyCognitive Behavioral Therapy (CBT)(CBT)

                                               

Treatment of PTSDTreatment of PTSD

•CBT-CBT- is used to treat PTSD is used to treat PTSD (and other disorders) by (and other disorders) by focusing on helping the focusing on helping the client learn to understand client learn to understand the condition better and to the condition better and to deal with it, while medicating deal with it, while medicating (Zoloft) the patient.(Zoloft) the patient.