• Anxiety Disorders

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• Anxiety Disorders

Anxiety Disorders

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Several distinguishable disorders:

common characteristic is that anxiety is

major symptom and/or underlying cause

1. Phobic Disorder (phobias):

Intense fear triggered by specific

object (class of objects) or situation(s)

The fear is irrational (out of all proportion

to actual threat)

Provokes strong urge to flee or avoid

P recognizes that the fear is irrational


3 major types of phobias:

A) Specific phobias (specific objects or

non-social situations)

e.g., cats, balloons, snakes, heights

B) Social phobias

Basic underlying fear: of “performing” in

social situations

e.g., fear of eating in public (4%)

e.g., fear of speaking to strangers (5%)

e.g., fear of speaking in public (8%)


C) Agoraphobia:

Fear of public places (esp. places from

which quick exit (“escape”) would be

difficult or embarrassing)

Most agoraphobics have history of panic

attacks (this is underlying fear)


Treatment for phobias

1) Some form of exposure therapy:

gradual exposure to the anxiety-provoking

objects or situations

e.g. systematic desensitization

Sometimes combined with

2) Cognitive-behavioral therapy

- Identifying and changing negative, distorted

thoughts [e.g., negative predictions; focusing on failures vs. successes)

- Learning adaptive skills for coping with

feared situation

- e.g., public speaking skills

NB. Cognitive-behavioral therapy may be used alone


3) Use of medication

Tranquilizers or antidepressant medications

(e.g. Paxil)

Can be effective, but

High relapse rate (50-75%) when drug

discontinued

If P continues medication (esp. tranquilizers),

increasing dosage may be required (=

“tolerance”)


2) Panic Disorder (4%)

Characterized by intense, often “out-of- theblue”

surges of anxiety = panic attacks

Sense of terror, heart pounding, choking sensation

Dizziness, trembling, faintness

(Unlike phobic anxiety..), quite unpredictable

>>> worry about when/where next attack will

occur (= secondary/anticipatory anxiety)

Causes?:

Not clearly established; however,

Evidence that some people predisposed by

genetic makeup to be more at risk of

developing the disorder (runs in families)


Some evidence of abnormal functioning in

brain’s fear and arousal “circuitry” (surges of

activity, would normally only occur in

response to perceived threat)

Treatments:

Cognitive-behavioral therapy

Medication (antidepressants, tranquilizers)

Psychotherapy and medication may be used in

combination

Recent study: After 1 yr of combined

psychotherapy and medication, 30-50% of

patients symptom-free


3) Obsessive-Compulsive Disorder (OCD)

[Imitate /Describe- using Jack Nicholson char in As Good As It Gets & boy in Phil Donahue

video]

http://www.youtube.com/watch?v=n4g8m0AwbXA&feature=related

Compulsion: strong urge to engage in some

action or “ritual” (in very specific way, or

specific number of times)

Often related to obsessive thought

Obsession: Troublesome, recurring thought

that causes anxiety-

e.g., will get sick,; make someone else sick; left

door of house unlocked..


Causes of OCD?

Not fully understood; but appears to have some

biological basis:

About 50% patients respond well to antidepressant

medications

Studies have revealed abnormal functioning in

several brain regions, incl. Basal ganglia (involved

in motor behavior/impulse control)

[Interestingly, involved in control of ritualized behavior in other animal species) ]

Treatments:

Antidepressant medications (Chlomipramine and SSRIs)

Exposure Therapy


Post-traumatic Stress Disorder (PTSD)

-Man in Haiti sees his family and neighbours crushed....

-Woman is raped..

-A soldier sees his buddy’s head blown off.and other horrors in Afghanistan

-A child is repeatedly abused

-A teenager wounded in severe car accident in which 2 friends are killed

-A POW is repeatedly tortured

>> Can lead to PTSD

P has been confronted with event involving threat

death/ serious injury/ threat to self or others

>> response of intense fear /helplessness/ horror


Following the traumatic event (but sometimes

not until months afterwards) some people:

show signs of irritability, depression, difficulty

concentrating

have difficulty sleeping

intense nightmares

during day, thoughts about event intrude

vivid flashbacks

P becomes hypersensitive to stimuli related to the

event [describe Stroop test with word list]

Some researchers have characterized PTSD as a

disorder of memory -- inability to forget

Recent study (2010 Janovic & Ressler) has found that Ss

with PTSD deficient in developing “conditioned

inhibition response”- related to extinction

Problem may involve inability to inhibit fear responses


Will everyone who experiences

psychological trauma develop PTSD?

No

Studies of POWs subjected to torture:

Incidence ranged from 20% to 67%

Study of survivors of car wrecks: PTSD

victims were not consistently those in most

severe crashes:

General conclusion: Some people more

vulnerable than others to developing

PTSD


What underlies susceptibility?

Personality factors:

includes tendency to brood

Genetic/biological basis?:

Goenijian et al. (2008) studied survivors

of 1988 Armenian earthquake

Degree to which people genetically related was

strong predictor of whether or not had developed

PTSD (heritability 41%)


Gilbertson et al (2002) studied Vietnam

war vets with PTSD who were identical

twins

Had reduced hippocampal volume (smaller

than average)

But other twin (had not been in the war, did not

have PTSD) had smaller hippocampus as well

Hippocampus known to play important role

regulating level of cortisol (stress hormone)

Reduced hippocampus size may render P more

vulnerable to stress

Note: Some data suggests high levels of stress

may damage hippocampal neurons

Reduced hippocampal volme may be both

cause and effect in PTSD


Treatments for PTSD

Exposure therapy

Drug treatments:

D-Cycloserine useful as adjunct to

exposure therapy (speeds up extinction)

Propranolol (inhibits effects of adrenalin in

brain) can reduce incidence of PTSD if

administered within hours of the trauma

Prozasin (also an adrenergic antagonist) reduces severity of

nightmares and other symptoms, improves

sleep


4) Generalized Anxiety Disorder

Anxiety, worry is pervasive and chronic

P often imagines “worst-case” outcomes

Treatment:

Medication (tranquilizers)

Psychotherapy

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