Download - TOPIC 5 ANXIETY DISORDERS
TOPIC 5ANXIETY DISORDERS
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Anxiety disorder
Anxiety is a generalized state of apprehension
The focus of anxiety is more internal than external
It seems to be a response to a vague or unrecognized danger
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Anxiety is a physiological, behavioral and psychological reaction all at once
Therefore intervention programs in general should focus on:
- to reduce physiological reactivity- to eliminate avoidance behavior - to change subjective reaction
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Free-floating anxietyAnxiety that comes out of blue
Situational Anxietyanxiety arises only in response to a specific situation but it is unrealisticsituational anxiety will eventually become phobic when you start to avoid the situation
Anticipatory anxietythinking about one particular situation
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Anticipatory anxiety is closely associated with the way you are thinking.
With panic disorder, thoughts are generally focused on worrying about having a panic attack in a situation that will result in embarrassment, extreme discomfort, a heart attack or even worse.
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Different types of anxiety disorders defined by DSM-IV-TR
Panic disorders Agoraphobia Social Phobia Generalized Anxiety Disorder Obsessive Compulsive Disorder Post Traumatic Stress Disorder
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Panic Disorder
Characterized by sudden episodes of acute apprehension or intense fear that occur “out of blue” without any apparent
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Symptoms of panic disorder- Shortness of breath or a feeling of being smothered - Heart palpitations – pounding heart or accelerated heart rate - Dizziness, unsteadiness- Trembling or shaking- Feeling of choking - Sweating - Nausea or abdominal distress- Feeling of unreality- Numbness or tingling in hands and feet- Hot and cold- Chest pain or discomfort - Fears of going crazy or losing control - Fear of dying
Panic Disorder
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Your symptoms would be diagnosed as panic disorders if:
You have had two or more panic attacks
At least one of these attacks has been followed by one month (or more) of persistent concern about having another panic attack.
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The panic doesn’t occur because you are thinking about, approaching or actually entering a phobic situation
It happens spontaneously and unexpectedly for no apparent reason
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The causes of panic disorder
Heredity
chemical imbalances in the brain personal distress
major life changes may trigger the onset of panic attacks
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TreatmentMedication antidepressant drugs such as tofranil and paxil
Personal wellness program regular exercise daily practice of deep relaxation good nutrition a shift in attitude to a calmer and easy-going
approach
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Generalized Anxiety Disorder Characterized by persistent feelings of
anxiety that are not triggered by any specific object, situation or activity
GAD having at least three of the following six symptoms - Restlessness- Being easily fatigued- Difficulty concentrating - Irritability- Muscle tension - Difficulties with sleep
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No specific phobias associated with GAD but it is sustained by basic fears
- Fear of losing control- Fear of not being able to cope- Fear of failure- Fear of rejection- Fear of death and disease
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Phobic Disorders
The word phobia derives from the Greek phobos meaning fear
Phobic disorders are irrational fears of objects or situations
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Specific Phobias Persistent and excessive fears of specific
objects or situations
The DSM-IV groups specific phobias within 5 subtypes
- Animal Type- Natural Environment Type - Blood Injection Injury Type- Situational Type - Other Type
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Social Phobia
Fear of embarrassment or humiliation in situations where you are exposed to the scrutiny of others
Typically your concern is that you will say or do something that will cause others to judge you as being anxious, weak, crazy or stupid
The most common - Fear of Public Speaking
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Agoraphobia The word agoraphobia means fear of open
spaces / market places
Afraid of being in situations from which escape might be difficult or unavailable
Fear of embarrassment plays a key role
The most common feature of agoraphobia is anxiety about being far away from home or far from a “safe person”
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Agoraphobia appears to be engendered by panic disorder
Different level of agoraphobia
- mild case- moderate case- severe case
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Obsessive Compulsive Disorder
Obsessions are recurring ideas, thoughts, images or impulses
Compulsions are repetitive behaviors or behaviors or rituals that you perform to dispel the anxiety brought up by obsessions
Obsessions may occur by themselves without necessarily being accompanied by compulsions
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The most common compulsions include washing, checking and counting
Obsessive compulsive disorder is often accompanied by depression
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Post Traumatic Stress Disorder
The essential feature of post traumatic stress disorder is the development of disabling psychological symptoms following a traumatic event
The traumatic event involves either actual or threatened death or serious physical injury or threat to one’s own or another’s physical safety
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Symptoms of PTSD
Repetitive, distressing thoughts about the event Nightmares related to the event Flashbacks so intense that you feel or act as though the trauma
were occurring all over again An attempt to avoid thoughts or feelings associated with the
trauma An attempt to avoid activities or external situations associated
with the trauma Emotional numbness Feeling of detachment or estrangement from others Losing interest in activities that used to give you pleasure Persistent symptoms of increased anxiety, such as difficulty
falling or staying asleep, difficulty concentrating
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To receive a diagnosis of PTSD, these symptoms need to have persisted at least 1 month
Less than 1 month’s duration, the appropriate diagnosis is “acute stress disorder”
In addition, the disturbance must be causing you significant distress, interfering with social, vocational or other important areas of your life
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Theoretical Perspectives Psychodynamic perspective
- anxiety disorders are viewed as neurosis- the anxiety experienced in neurosis reflects;
1 – the efforts of unacceptable, repressed impulses to break into consciousness
2 – fear as what might happen if they do
Stress on the roles of defense mechanisms
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Phobias develop through the use of defense mechanism of projection and displacement
A phobic reaction is believed to represent the projection of the person’s own threatening impulses onto the phobic object.
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Learning Perspectives
Anxiety disorders are acquired through conditioning
Phobia - Classical conditioning- Operant conditioning - Observational learning – modeling
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Generalized anxiety- a product of stimulus generalization
Obsessive compulsive disorder- compulsive behavior are operant responses that are negatively reinforced by relief of the anxiety that is engendered by obsessional thoughts
PTSD - classical conditioning 28
Cognitive PerspectivesOverprediction of fear Irrational beliefsOversensitivity to threatsAnxiety sensitivityMisattribution for panic sensationLow self-efficacy expentancies
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Biological Perspectives
Genetic Factors
Neurotransmitter - Gammaaminobutyric acid (GABA)
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TREATMENT FOR ANXIETY DISORDERS
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The specific treatment approach depends on the type of anxiety disorder and its severity. But in general, most anxiety disorders are treated with cognitive-behavioral therapy, medication, or some combination of the two.
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SYSTEMATIC DESENSITIZATION
Systematic desensitization is a technique which is used to help people manage and eventually conquer phobias
An individual learn to handle progressively more disturbing stimuli while they remain relaxed
About 10 – 20 stimuli are arranged in a hierarchy (fear stimulus hierarchy)
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Assumption (Joseph Wolpe, 1958) – maladaptive anxiety responses, like other behaviors are learned or conditioned. They can be unlearned by conterconditioning.
Advantages of systematic desensitization are:- enhance self-efficacy expectancies- lower catecholamine levels- help people overcome phobias through a stepwise approach of actual exposure to the phobic stimuli
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The procedures of systematic desensitization
1. Begins with the collection of a history of the patient’s problem
2. The problem is explained to the patient3. Explain the rationale of systematic
desensitization4. Train the patient with relaxation
techniques5. Establish an anxiety hierarchy6. Imagery desensitization
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Phobia About Driving on Freeways
1. Watching from a distance as cars drive past on the freeway
2. Riding in a car on the freeway with someone else driving 3. Driving on a freeway the distance of one exit with a
friend sitting next to you at a time when there is a little traffic
4. Driving the distance of one exit with a friend when the freeway is busier
5. Repeat step 3 alone6. Repeat step 4 alone
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7. Driving the distance of two exits with a friend sitting next to you at a time when there is little traffic
8. Driving the distance of two exits with a friend sitting next to you at a time when there is moderate traffic
9. Repeat step 7 alone10. Repeat step 8 alone
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Phobia about giving presentation
1. Preparing a talk which you don’t give2. Preparing a talk and delivering it in front of one friend3. Preparing a talk and delivering it in front of three friend4. Giving a brief presentation to three or four people at work who
you know well5. Same as Step 4 but a longer presentation6. Giving a brief presentation to 10 -15 people 7. Same as Step 6 but a longer presentation8. Giving a brief presentation to 3 or 4 strangers9. Same as step 8 but a longer presentation10. Giving a brief presentation to 10 – 15 strangers 11. Giving a brief presentation to 50 strangers
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Cognitive Techniques
Rational restructuring Much maladaptive behavior is determined by the assumptions people make about the world
In this rational restructuring, argument or discussion may be used in an attempt to get patients to see the irrationality of their belief
The therapist may attempt to teach them to modify their internal sentences
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Rational Emotive Therapy (RET) Ellis (1962)
RET aims to change behavior by altering the way the patient thinks about things
ABC – Beliefs (B) about activating events or situations (A) that determine the problematic emotional or behavioral consequences (C)
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Behavioral Treatment of Social PhobiaFlooding Method (exposure therapy)
Behavioral Treatment of AgoraphobiaExposure Therapy - gradual exposure to fear-inducing stimuli
Behavioral Treatment to PTSDExposure Therapy
Behavioral Treatment for OCDExposure with response prevention
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Complementary treatments for anxiety disorders Exercise – Exercise is a natural stress buster and anxiety reliever.
Research shows that as little as 30 minutes of exercise three to five times a week can provide significant anxiety relief. To achieve the maximum benefit, aim for at least an hour of aerobic exercise on most days.
Relaxation techniques – When practiced regularly, relaxation techniques such as mindfulness meditation, progressive muscle relaxation, controlled breathing, and visualization can reduce anxiety and increase feelings of relaxation and emotional well-being.
Biofeedback – Using sensors that measure specific physiological functions—such as heart rate, breathing, and muscle tension—biofeedback teaches you to recognize the body’s anxiety response and learn how to control them using relaxation techniques.
Hypnosis – Hypnosis is sometimes used in combination with cognitive-behavioral therapy for anxiety. While you’re in a state of deep relaxation, the hypnotherapist uses different therapeutic techniques to help you face your fears and look at them in new ways.
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