Chapter 5 - Anxiety DisordersPANIC DISORDER• Description - with &without Agoraphobia• PD w/o Agora - panic attacks

- feeling of imminent death- numerous symptoms

(racing heart, sweating, dizziness)- “out of blue”- fear another attack

• PD w/Agora - avoid certain situations

- embarrassment, lack of help

- Rare

- More in women

Tx implications?

involve spouse, decrease aid

Possible Causes • Psychodynamic:

- anxiety from sexual/aggressive impulses leaking• Cognitive:

- Hypersensitive to internal states

- Misinterpret symptoms

- Perceive danger

Behavioral: Classical conditioning

• Panic attack (US) -> fear (UR)

• Associate place (CS) with panic attack

• Public place (CS) -> fear (CR)

(embarrassment, lack of assistance)

Agoraphobia = stimulus generalization (all places like 1st place)

Biological

• genetic sensitivity – overactive BAS

• hyperventilation causes symptoms

Panic Treatment

Psychodynamic

• Uncover conflict

Cognitive

• Breathing retraining & relaxation

• Self-statements & reappraisal of fears

Biological

• Mild tranquilizers (Xanax)

Behavioral

• Systematic desensitization

• Barlow: gradual exposure to panic symptoms until fear decreases

Phobias

Description

• Fear specific object or situation

• No threat or threat is exaggerated

• Common fears, but heightened

• Phobia = impairs your life

Specific Phobias

• fear of specific situation/object

• animal, nature (childhood)

• blood-injection-injury

• ~11%

Social Phobia

• fear of being judged/embarrassed in social situations

• 3-13%

Agoraphobia

• fear situations/public places

• something bad might happen

• fear panic but no actual attacks

• avoid situation

Possible Causes

Psychodynamic

• Projection of own impulses onto object

• Avoid object to reduce anxiety& keep impulse out of awareness

Cognitive

• Catastrophize

Behavioral: Mowrer’s 2-Factor Theory

• 1st = fear is classically conditioned

• 2nd = fear maintained by operant conditioning

- avoid situation = avoid punishment

(negative reinforcement)

• Preparedness

- biologically prepared to fear certain stimuli harmful to ancestors

- harder to unlearn these phobias

Treatment • Best is behavioral (esp. specific phobia)

- Exposure to feared situation/object- Learn that it is not so frightening- Extinguish link of CS -> CR- Imaginal vs. in vivo exposure- Gradual (systematic) or flooding- Relax vs. not during exposure

Obsessive-Compulsive Disorder(OCD)

Description

• Anxiety if do not perform certain actions

Anxiety from certain thoughts

• Actions are pointless, often embarrassing

• Obsessions

- meaningless, troublesome thoughts that cannot stop

• Compulsions

- meaningless acts person feels forced to repeat

Possible Causes

Psychodynamic

• Obsessions = unconscious impulses

• Compulsions = behaviors that keep impulses unconscious

Cognitive

• Irrational beliefs: perfectionism & seeking approval of others

Behavioral

• Obsessions -> anxietycompulsions reduce anxiety

• Modeling

Treatment

• Systematic desensitization + response prevention

- Expose to thoughts and prevent behavior

- Tolerate thoughts until anxiety decreases

• Medication — SSRIs

Post-Traumatic Stress Disorder(PTSD)

Description

• Extreme anxiety related to specific trauma

• Trauma is “outside the normal range of human experience”

Symptoms

• Intrusive thoughts: reliving event

• Avoid reminders

• Emotional numbness

• Hypervigilance

• Dissociation - detachment from self & surroundings

1.Acute Stress Disorder

- lasts a few weeks

2.Post-Traumatic Stress Disorder

>1 month

Possible Causes

Cognitive

• Appraising threat as extremely traumatic

Biological

• Sympathetic NS

Behavioral

• Classical conditioning - environment becomes conditioned stimuli for PTSD response

• Stimulus generalization - cues that resemble original situation trigger PTSD

Treatment

• Systematic Desensitization

- progressive exposure, imaginal or in vivo

• Flooding

- imagine worst-case scene

- multiple times until anxiety decreases

• Disagreement about flooding for trauma

Generalized Anxiety Disorder (GAD)

Description

• continual anxiety over everything

• “catch-all” vs. true disorder

Possible Causes

Cognitive

• General tendency to catastrophize, perceive threat

Behavioral

• Worrying modeled/reinforced

Biological

Genetic predisposition + decreased GABA

• GABA = inhibits firing

• Less GABA=more firing

Treatment

Behavioral

• Relaxation exercises (deep breathing, progressive muscle)

Cognitive

• Discover & retrain automatic thoughts

Biological

• Medications to stimulate GABA