Transcript Anxiety Disorders - Rockhurst University

Anxiety Disorders in the DSM
 An unpleasant feeling of fear and apprehension.
 Clinical anxiety is often grossly disproportionate
to its recognizable stimulus or free floating if the
stimulus is unknown to the patient.
 Two common features:
– Excessive Worry: about things that are either unlikely to
happen or, if they did happen, would be much more
manageable than the individual predicts.
– Physical tension - feeling “uptight” or “high strung”
Phobias
 A fear and/or avoidance of an object,
activity, or situation that the individual
knows is out of proportion to the actual
danger posed.
 DSM-IV Phobias:
– Specific Phobia
– Social Phobia
– Agoraphobia
DSM-IV Criteria For Specific Phobia
 Marked or persistent fear that is excessive or
unreasonable, cued by a specific object or situation
 Exposure to the phobic stimulus invariably provokes an
immediate anxiety response
 The person realizes the fear is excessive or
unreasonable (except in children)
 The phobic situation is avoided or endured with intense
distress
 Phobia interferes with the person’s functioning
 If under 18 years - duration > 6 months
Etiology of Phobias
 Psychoanalytic - defense against anxiety produced
by repressed id impulses
 Avoidance-Conditioning Model - involves both
classical and operant conditioning
 Preparedness Theory
 Modeling - vicarious learning
 Cognitive Theories - increased attention to
negative stimuli and alarming predictions
 Social Skills Deficits in Social Phobia
 Autonomic Liability
Treatment of Phobias
 Systematic Desensitization - in vivo
exposure an important addition
 Cognitive Approaches - there is no evidence
that eliminating irrational beliefs alone,
without exposure, reduces phobias
 Biological Approaches - anxiolytics benzodiazepines are addicting and produce
severe withdrawal syndrome - relapse
common
Childhood Fears and Social Withdrawal
 Anxiety disorders are the most common
disorders of childhood
 School Phobia - two types:
– separation anxiety
– true fear of school
 Social Phobia - elective mutism
 Treatment - exposure with encouragement
Characteristics of Panic Disorder
 Sudden and often inexplicable attack of a host of
jarring symptoms
 Strong urge to escape and reach safety
 Depersonalization and derealization
 Fear of losing control, going crazy, or dying
 The beginning of the attack is “out of the blue”
with no obvious outside cause
 Agoraphobia - a cluster of fears centering on public
places and being unable to escape or find help
should the individual become incapacitated
Etiology of Panic Disorder
 Biological Theory - overactivity in the
noradrenergic system - hyperventilation
 Psychological Theory of Panic Disorder patients misinterpret physiological
symptoms in a catastrophic way
 Psychological Theory of Agoraphobia - due
to fear-of-fear
 Extreme Fear of Losing Control
Components of Panic Disorder Treatment
1. Re-education about the physical symptoms of
anxiety and fear, to correct misinterpretations
of them as being harmful
2. Training in methods for reducing physical
tension, by breathing retraining or relaxation
3. Repeated exposure to feared and avoided
physical situations
4. Repeated exposure to feared and avoided
sensations
Generalized Anxiety Disorder
Chronic, uncontrollable worry about several
life circumstances. Must clearly interfere
with day-to-day functioning.
Motor Tension
Autonomic Hyperactivity Vigilance
trembling, twitching
shortness of breath
keyed up
muscle tension, aches
tachycardia
easily startled
restlessness
shortness of breath
insomnia
easy fatigability
sweating
irritability
dizziness/lightheaded
nausea and diarrhea
flushes (hot flashes) or chills
Etiology of GAD
 Cognitive theory emphasizes the perception of
not being in control as a central characteristic
of all views of anxiety
 GAD clients are more inclined to interpret
ambiguous stimuli as threatening and to rate
ominous events as likely to occur to them.
 Worry as negatively reinforcing - it distracts
patients from even more negative emotions
 Defect in GABA system
Three Pervasive Themes in Worry
 Perfectionism - worry about making
mistakes or things not proceeding in just the
right way
 Responsibility - worry that if you do not
worry then a negative event may actually
happen, making you responsible
 A Sense of Uncontrollability - worry as a
means of gaining control
Obsessive-Compulsive Disorder
 Persistent and uncontrollable thoughts or compulsion
to repeat certain acts again and again, causing
significant distress and interference with everyday
functioning
 Obsessions - intrusive and recurring thoughts,
impulses, and images that come unbidden to the mind
and appear irrational and uncontrollable to the client
 Compulsion - repetitive behavior or mental act that
the person is driven to perform to reduce the distress
caused by obsessional thoughts or to prevent some
calamity
Etiology of OCD
 Psychoanalytic - Due to harsh toilet
training,person is fixated at anal stage.
 Behavioral - operant escape-responses,
memory, active attempts to suppress
thoughts
 Biological Factors - OCD is caused by a
neurotransmitter coupled to serotonin
Treatments for OCD
 Victor Meyer - Exposure plus response
prevention
 Research has shown some improvement in
OCD with serotonin reuptake inhibitors and
tricyclics
 REBT - OCD results from an irrational belief
that one must never make a mistake
 Regardless of the treatment modality, OCD
patients are rarely cured
Posttraumatic Stress Disorder (PTSD)
 An extreme response to a severe stressor,
including increased anxiety, avoidance of
stimuli associated with the trauma, and a
numbing of emotional responses.
 The etiology in partially assumed in the
definition - traumatic event(s)
 Distinguished from Acute Stress Disorder in
DSM-IV
Major Symptoms of PTSD
 Reexperiencing the traumatic event -
nightmares, difficulty during
“anniversaries,” upset by stimuli associated
with the event (e.g., thunder)
 Avoidance of stimuli associated with the
event or numbing of responsiveness decreased interest in others, estrangement
 Symptoms of increased arousal insomnia, low concentration, exaggerated
startle response
Treatment of PTSD
 Emotional and Behavioral Stabilization
 Trauma Education
 Stress Management
 Trauma Focus
 Relapse Prevention
 Follow-up and Maintenance