Abnormal Psych Chapter 5 Anxiety Disorders

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Anxiety disorders

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Anxiety is normal response to fear.

- anxiety disorders are a group of disorders where anxiety is the primary symptom:

- anxiety is persistent 6 months and up.

- anxiety / fear is out of proportion to Danger.

- 31% of adults mat lifetime criteria for an anxiety disorders.

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Anxiety can be expressed as

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- physiological /somatic symptoms: dizziness, sweaty Palms, dry mouth, shaking, edgy feeling, muscles tense, heart rate increases, respiration accelerates.

- emotional symptoms: fearfulness and watchfulness, Terror, irritability.

- cognitive symptoms: unrealistic fears and worries, fear of dying or losing control.

- behavioral symptoms: Escape, avoidance, aggression, freezing.

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Severity of anxiety

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DSM-5 is categorically is a symptom list. And tries to incorporate dimensional perspective by using levels of disorders ( none, light, mild, moderate, severe.) By using:

1. Cross-cutting symptom measures.

2. Sorter specific severity measures.

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Some disorders (OCD)

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- obsessive compulsive disorder is now related more to other other disorders rather than anxiety.

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Specific phobias

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Marked fear of a specific object or stituation.

- object or situation is actively avoided or endured with intense fear / anxiety.

- fair is out of proportion with actual Danger.

- persistent 6 months or more and distress / impaired functioning.

Ex: spidars, blood, snake.

- very common about a 12% rate and National study.

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Social anxiety disorder / social phobia

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- fear or anxiety about one or more social situations where the individual is exposed to possible judgment / scrutiny by others.

- fears of negative evaluation (embarrassment/ humiliation)

- social situations avoided or endured with intense fear.

- specifier: performance only

- six or more months

-- 7% 12 month rate, and 12.1% lifetime rate in 2005 NCRS

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Agoraphobia

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Fears or avoid situations because Escape or help may not be available.

Fear / anxiety in two or more situations.

Typically Express in situations such as public transportation, open spaces, and close places, Thinline flash crowd, outside the home.

- out of proportion, persistent for 6 months or more, impaired functioning, distress.

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Theories about phobias

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- Behavioral: classical conditioning, operant conditioning, negative experience, then...-avoidance of situation is reinforced by decreased anxiety

- biological: genetic Heritage first degree relatives three to four times more likely to have phobias. Higher rates and female relatives.

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Phobia treatment

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- systematic desensitization: gradual exposure.

- modeling: watching someone else being unfearful of the fear.

- flooding: extreme exposure.

- psychopharmaceutical: benzodiazepines, MOA inhibitors, ssris

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DSM criteria panic disorder

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- recurrent unexpected attacks: some may be responsive to situational cues, but at least some attacks must be unexpected.

- need 4 + physiological symptoms: (pounding heart, shortness of breath, trembling shaking, sweating, chest pain, nausea, dizzy, chills) despersonlization, derealization,faer of losing control, fear of dying.

- followed by one month or more of worrying about additional attacks, changes in Behavior.

- 2 to 3% prevalence rate. Lower rates and Asians, Latin Americans, and African countries. Higher rates among non-hispanic Caucasians and American Indians in u.s. more frequent and women.

- median age of onset 20-24

- frequently seek medical care because of physical symptoms. Can provide panic attack specifier for any diagnosis.

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Panic disorder theories

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Genetic theories: disordered genes put some people at risk for panic disorder. Coordinance rate of panic attacks is 24% 4 monozygotic twins versus 11% 4 dyzygotic twins.

Physiological theories: a cognitive model - people prone to panic attacks (1) pay very close attention to their bodily Sensations, (2) misinterpret the sensations, and (3) engage in snowballing and catastrophization.

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Integrated model of panic disorder

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A model that understands the biological vulnerability, but also thinks about the psychological components / cognitive vulnerability.

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Panic treatments

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Drug therapies:

-tricyclic antidepressants (imipramine). Reduces PA in 45 to 70% of clients.

-Ssris (Prozac/ Zoloft). Some tolerate SSRI side effects better than tricyclic side effects, similar effectiveness.

-Benzodiazepine (Xanax). Effective for 55 to 75%, addictive, High relapse rates.

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Panic treatment

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Cognitive behavioral treatment:

- relaxation and breathing. Control over psychological response.

- identify Catastrophizing cognitions.

- use relaxation while experiencing panic. To increase control.

- therapist challenges unreasonable interpretations.

- systematic desensitization. Gradual exposure while maintaining control over panic. Or..

- intrusive exposure / targets learned associations between bodily cues and panic / fear.

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Generalized anxiety disorder

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Excessive anxiety and worry, more days than not, for at least 6 months.

- difficulty controlling the worry.

- need 3+ : restlessness, fatigue, difficulty concentrating, sleep disturbance, irritability, muscle tension.

•prevalence duration in co-occurrence:

- 3% population. More common in developed countries.

- many report anxious "all their lives"

- high co-morbidity with other anxiety disorders.

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Generalized anxiety disorder theories

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Biological: malfunctioning of Gaba neurotransmitter. Does not turn off fear response. Problems in brain circuits that monitor anxiety reactions prefrontal cortex, Amendola, and the interior cinghulate cortex. Modest evidence for heritability of GAD specifically stronger evidence for trait anxiety.

cognitive: role of avoidance. Worrying allows individuals to avoid arousal / fear. Difficulty tolerating uncertainty, worrying about current Solutions.

sociocultural: living in dangerous situations, poverty, prejudice and discrimination.

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Treatment for generalized anxiety disorder GAD

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- cognitive therapy techniques focus on modifying catastrophic thinking patterns and believes that worrying is serving a useful function ex: cognitive restructuring.

- behavioral techniques include relaxation training, scheduling specific time to worry, planning pleasurable activities, and controlled exposure to thoughts and situations that are being avoided.

- the purpose of these exposures is to help the person learn that they're feared outcomes do not come true, and to experience a reduction in anxiety over time.