lecture 3 anxiety_disorders

8/11/2019 Lecture 3 Anxiety_disorders

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ANXIETY DISORDERS

LECTURE OUTLINE Panic and anxiety background andhistory

Etiology theoretical perspectives Types of anxiety disorders and theirtreatment Treatments


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Who is afraid of ? small insect animal, reptile speaking to a large audience speaking in front of a small group of

familiar people meeting new people attending social gatherings


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Background and history experience of anxiety cognitive,somatic, behavioural, emotional

panic discrete period of intense fear ordiscomfort (brief and intense) palpitations, shaking, chest pain, fear ofdying, going crazy, losing control anxiety negative affect, sense ofuncontrollability of future threat, self-preoccupation


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ANXIETY DISORDERS

Background and history panic attacks occur spontaneously both panic and anxiety can be normal

experiences they become maladaptive when theybecome excessive, chronic, and inabsence of any real danger


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Background and history

Prevalence 25% of population may be expected to

have an anxiety disorder at some time intheir lives Ontario Health Supplement 1-yearprevalence rates of 9% for men, 16% forwomen


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Background and history 1800s and early 1900s neuroses,Freudian perspective

1920s Watson, classical conditioningmodel, Little Albert later 1900s Eysenck neuroticism as abasic personality dimension strongemotions, moody, restless, anxious


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Etiology

Psychodynamic perspective realistic, neurotic, moral anxiety defense mechanisms origins in early parent-child relationships neurotic paradox contradicts pleasureprinciple


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Etiology

Neurotic styles Shapiro inhibition of assertion/aggression inhibition of responsibility/independence inhibition of compliance/submission inhibition of trust/intimacy


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Etiology

Biological perspective - Genetics family studies show up to 25% have an

immediate family member with an anxietydisorder twin studies - higher concordance ratesfor MZ than DZ twins genetics may operate throughbehavioural inhibition


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Etiology

Biological perspective - Neuroanatomy locus ceruleus amygdala one form of peptide (combo of amino

acids), CCK 4, related to panic; CCK 4 isfound in amygdala, hippocampus, cerebralcortex, brain stem


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Etiology

Biological perspective - Neurotransmitters norepinephrine (NE) concentrated in

locus ceruleus serotonin

dopamine in social phobia and OCD interactions serotonin affects locusceruleus (where NE is produced) and may

also influence GABA


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ANXIETY DISORDERS

Etiology Limitations of 2-factor theory cannot explain all phobias some seemto develop without conditioning

difficult to create some fears in the lab cannot explain why some stimuli aremore likely to become feared than others


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Etiology Rachmans revised theory classical conditioning modelling informational or instructionaltransmission


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Etiology Biological preparedness theory Seligman evolutionary significance ofstimuli that are easily conditioned

Bandura properties of stimulithemselves (unpredictability anduncontrollability) and the cognitive

processing that defines their threateningnature


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ANXIETY DISORDERS

Etiology Cognitive theories Bandura low perceived self-efficacy Beck experiences, beliefs, appraisals Ellis irrational beliefs, catastrophization


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ANXIETY DISORDERS

Etiology Biopsychosocial perspective emotion biology environment behaviour cognition


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ANXIETY DISORDERS

Types Specific phobia animal environmental blood, injury, injection specific situation elevators, flying other


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Types Specific phobia Diagnosticfeatures

marked and persistent fear and avoidanceof specific stimulus or situation must interfere significantly with personslife must be considered excessive orunrealistic ANS arousal


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Types Specific phobia prevalence rates from 7-11% often emerge during adolescence, usually

earlier than age 25 tend to be chronic, but may fluctuate overlife course usually assessed with self-report conditioning theories systematic

desensitization


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Systematic desensitization (SD) forspecific phobia

Wolpe (1958) reciprocal inhibition and SD

3 components of SD construction of stimulus hierarchy

progressive (deep muscle) relaxationtraining progress through the hierarchy while

practicing relaxation response


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Panic disorder - Elements recurrent, unexpected panic attacks persistent concern, preoccupation with

having another attack worry about consequences of attack

significant behaviour change in responseto attacks


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Panic disorder Other clinical features often accompanied by avoidance behaviours(agoraphobia)

possible to have agoraphobia without panicattacks onset around late adolescence, early

adulthood more women than men high rates of service utilization, poor qualityof life


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ANXIETY DISORDERS

Clarks cognitive model of panic disorder ) catastrophic misinterpretation of arousal-related bodily sensations

agoraphobia (avoidance) as way of coping


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Obsessive-compulsive disorder (OCD) -Elements

recurrent obsessions, compulsion, orboth obsessesions thoughts, images,impulses, that are persistent, markedly

distressing compulsion repetitive behavioursperformed in response to an obsession


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Obsessive-compulsive disorder (OCD) -Elements

common obsessions violence, sex,contamination, order common compulsions washing,cleaning, checking, seeking reassurance,

ordering or arranging objects cleaners vs. checkers focus on harm vs.order


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Obsessive-compulsive disorder (OCD) -Background

very rare 2.5% lifetime prevalence rate

little gender difference high overlap with depression andTourettes syndrome


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Obsessive-compulsive disorder (OCD) Psychodynamic perspective

anal fixation Does anal -retentive havea hyphen? reaction formation, undoing,displacement


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Obsessive-compulsive disorder (OCD) Treatments

Prozac - SSRIs

Exposure and response prevention


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Post-traumatic stress disorder (PTSD) Description

Person has been exposed to traumatic event

3 symptom clusters recurrent re-experiencing of event avoidance of trauma-related stimuli andnumbing increased arousal

Persists for at least 1 month after trauma


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Post-traumatic stress disorder (PTSD) Etiology

Cognitive theories

expectations and appraisals fear structure in long-term memory fear conditioning


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Generalized anxiety disorder (GAD) Description

Core feature is worrying worries areunrealistic, difficult to control, excessive Free floating anxiety Verbal thoughts rather than images as in OCD

Motor tension, vigilance, scanning What if? background of intolerance ofuncertainty


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Generalized anxiety disorder (GAD) Description

3 key features uncontrollability intolerance of uncertainty ineffective problem-solving skills


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Treatments - Pharmacotherapy

3 main drugs Xanax Paxil Zoloft

SSRIs, bezodiazepines, tricyclic anti-depressants, MAOs


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Treatments - Exposure

flooding, response prevention confrontation with anxiety-producingstimulus developing more adaptive internalrepresentations of the stimuli and their non-threatening consequences


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Treatments Cognitive restructuring

identify maladaptive cognitions challenge maladaptive cognitions develop more adaptive cognitions


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Treatments Relaxation training

decreases physiological arousal through: deep muscle relaxation positive imagery

meditation deep breathing


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Treatments Problem-solving training

What is my problem? What is my goal? What

solutions can I generate to solve theproblem? What might be the consequences ofeach solution? Try a solution

particularly relevant to GAD divides problems into manageable units


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SUMMARY both biological and psychological factorsinvolved in etiology of anxiety disorders

biopsychosocial model shift away from Freudian perspective onneuroses both biological and psychologicaltreatments for the various disorders

lecture 3 anxiety_disorders

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