ANXIETY DISORDERS

Scope of Study
1) 2) 3) 4)

5)
6) 7) 8)

Introduction to anxiety Panic Disorders Phobic disorders Obsessive-Compulsive disorders Generalized anxiety disorders Acute stress disorder and posttraumatic stress disorders Ethnic differences in anxiety disorders Case Study of anxiety disorders

Scope of Study
Anxiety disorders
Panic disorders Phobic disorders
Obsessivecompulsive disorders Generalized anxiety disorders

Acute stress disorders and posttraumatic stress disorder

Scope of Study
Treatment approaches DSM-IV-TR criteria

Thereotical perspectives
TYPES OF ANXIETY DISORDERS

One casestudy

INTRODUCTION

Introduction
Meaning of Anxiety Anxiety is generalized state of apprehension or foreboding.

Meaning of anxiety disorders Anxiety disorders is the kind of maladaptive anxiety reaction, which can cause significant emotional distress or impair the persons ability to function.

Introduction
Symptoms of anxiety 1) Physical domain *external appearance 2) Behavioral domain *avoidance behavior *dependent behavior *agitated behavior 3) Cognitive domain *thinking pattern

TYPES OF ANXIETY DISORDERS

1) PANIC DISORDERS
1.1 Definition The occurrence of repeated, unexpected panic attacks. Panic attacks are intense anxiety reactions accompanied by physical symptoms pressing heart, rapid respiration, shortness of breath, and difficulty breathing Physical symptoms are accompanied by feelings of sheer terror, sense of imminent danger, and faulty thought. *Panic attacks symptoms are akin to heart attacks

1.2 Diagnostic Features of Panic Attacks

1.3 Theoretical perspectives Factor s

Biological factors Cognitive factors

Suffocation false alarm theory

Role of nerotransmitter

Anxiety sensitivity(AS)

Gammaaminobutyric acid(GABA)

Serotonin

1.3.1

Biological Factors

1. Suffocation False alarm theory alarm model occur defect in the brains alarm Kleins model- involve respiratory sensations which triggers respiratory alarm 2. The role of neurotransmitter Gamma-aminobutyric acid (GABA) - low level of GABA lead to panic disorders Serotonin - role in regulating anxiety

1.3.2

Cognitive Factor

ANXIETY SENSITIVITY o Examining the role of fear of fear o Appears to magnify fear reactions to cues of bodily arousal o AS, their emotions or associated bodily states of arousal will get out of control, leading to harmful consequences o Avoidance of situations in which anxiety is experienced In the cognitive factor, the main root cause is faulty interpretations of bodily sensations

1.4 Treatment for Panic Disorders

Treatment approaches
Cognitive-behavioral theraphy
Coping skills for handling panic attacks Breathing retraining and relaxation training

Drug theraphy

Medication

Exposure to situations and bodily cues

1.4.1

Cognitive-Behavioral Therapy

Elements of Cognitive-Behavioral Programs for treatment of Panic Disorder Self-monitoring Exposure Development of Coping Responses

1.4.2

Drug Therapy
Clomipra mine (Anafranil)

Tricyclics imipramin e (Tofranil)

Anti depressan ts

SSRIs paroxetine (Paxil)

Alprazolam (Xanax)

Sertraline (Zoloft)

2) PHOBIC DISORDERS
2.1 Definition is a fear of an object or situation that is
Phobia

disproportionate to the threat it poses.

Fear

is anxiety experienced in response to a

particular threat.
Example: driving a car
Phobia Phobia

involve fears of the ordinary events of life is disabling when it interfere daily tasks life of

individuals.

2.2 Types of Phobic Disorders

Types
Specific disorders Social phobia Agoraphobia

2.2.1
situations.

Specific Phobias
excessive fear of a specific object or

Persistent,

E.g-fear of heights (acrophobia) fear of enclosed spaces (claustrophobia)

fear of small animals

attempt to avoid or escape the situation

significantly affect the persons lifestyle or

functioning and lead to significant distress

2.2.2
o

Social Phobias

An intense fear of social situations that they may avoid altogether or endure them only with great distress. o Common forms of social phobia like o stage fright, speech anxiety, dating fears o Anxiety lead them to escape the situations they encounters with. o Relief acts as negatively reinforces to the situation. o Social phobias will lead to several implications.

2.2.3

Agoraphobia

a fear of being out in open, busy areas. e:g, fear shopping in crowded place, crossing a bridge, using public transports, eating in restaurants and leaving home fear of places or situations that they cannot be escape if panicky symptoms or panic attacks arise in themselves two types of agoraphobia:
panic disorders with agoraphobia (PDA) - Fear of recurrent panic attacks and avoid public places agoraphobia. - Mild panicky symptoms

2.3 Theoretical Perspectives

Psychodynamic perspectives Learning perspectives

Biological perspectives
Cognitive perspectives

2.3.1
Anxiety

Psychodynamic

is a danger signals arise as a result of impulses nature that are nearing the level of conscious mind. Defense Mechanism take actionprojection. Phobic reaction as a result of projection. e:g specific phobias Phobic objects represents these

2.3.2

Learning Perspectives
Mowrers two-factor model

O. Hobart Mowrer (1948)

1)

2)

Classical Conditioning - neutral objects and situations gain the capacity to evoke fear by being paired with dangerous stimuli. - unconditioned stimulus and conditioned stimulus Operant Conditioning - negative reinforcement as a result of avoidance component of phobias - strengthen the avoidance response. - avoidance works to relieve anxiety but at a significant cost. Observational Learning - through observation from parents or significant others. - through hearing from others such as friends.

2.3.3
1)

Biological Perspectives

Genetic factors

Variations of a particular gene and different patterns of brain activity when people exposed to fearful stimuli.

Parts of brain that involved is amygdala which is an

almond shape structure in the limbic system of the

brain.
Amygdala, function as emotional computer for evaluating stimuli.

Structure of amygdala; an emotional computer which detects stimulus

Prepared Conditioning
Biological traits to acquire fears on certain types of
objects or situations

Incorporate in our ancestors who were genetically

predisposed to develop fears of potentially threatening objects

We inherited this from our ancestors.

2.3.4

Cognitive Perspectives

Factors that lead to phobias: 1) Oversensitivity to threatening cues - inherited an acutely sensitive internal alarm that leads them to become overly sensitive to threatening cues. 2) Over prediction of danger - overpredict how much fear or anxiety they will experience in the fearful situation. 3) Self-defeating thoughts and irrational beliefs - negative thinking about themselves. - irrational hold about themselves towards others.

Biological factors

Learning influences
Operant Observationa Classical l learning conditionin conditioning g

Vulnerability factors

Cognitive Biases

Increased risk potential

Phobia

A multifactorial model of phobia

2.4

Treatment Approaches

4 approaches in treatment of phobic disorders: 1) Learning-based approaches. - systematic desensitization - gradual exposure - flooding 2) Virtual Therapy - virtual reality therapy (VRT) 3) Cognitive Therapy - cognitive restructuring 4) Drug Therapy

3)

Obsessive-Compulsive Disorders

Troubled by recurrent obsessions, compulsions, or both obsessions and compulsions. It is a period of time or extent that cause marked distress, occupy more than an hour a day or significantly interfere

with normal routines such as occupational and social

functioning. Obsession- is an intrusive and recurrent thought, idea, or urge that beyond the persons ability to control. Compulsion- is a repetitive behavior or mental act the

person feels compelled or driven to perform.

Mostly compulsions fall into two categories:

- cleaning rituals
- checking rituals

Compulsion often accompany obsessions.

Compulsion will partially relieve the anxiety

created by obsessional thinking.

3.1 Theoretical Perspectives

Psychodynamic perspective obsessive-leakage of unconscious impulses into consciousness. compulsion- acts that help keep these impulse repress 2) Biological perspective -genetics: role of genes - parts of brain 1) abnormalities in brain circuitscauses by disruption in the neural pathways, changes pattern of frontal lobe activation. 2) basal ganglia-dysfunction of this region.
1)

3) Cognitive perspective-perfectionism 4) Learning perspective- as a result of operant response (negative reinforce)

3.2 Treatment Approaches

1) Exposure with response prevention (ERP)

exposure- place clients in situation that arise their

obsessive thoughts.

response prevention- effort to prevent the compulsive

behavior from occurring.

2) Cognitive-behavioral treatment program (CBT) 3) SSRI-type antidepressant drugs

increase the availability in the brain of the

neurotransmitter serotonin.

4)

Generalized Anxiety Disorders

-What???? GAD is a type of anxiety disorders involving persistent anxiety that seems to be free floating or not tied to specific situation.

People with GAD tend to be chronic worries- even

lifelong worries ( Fricchionne,2004)

Emotional distress associated with GAD interferes significantly with the people life.

Occurs with other disorders, including depression or

other anxiety disorder ( obsessive-compulsive disorder and agoraphobia)

Other features include restlessness, becoming easily

fatigue, difficulty concentrating, muscle tension and
disturbances of sleep.

GAD tend to be stable disorder in the mid teens to

mis-20s and then typically follows a lifelong course.

4.1 Theoretical Perspectives

1) Learning Perspective

-From learning perspective, generalized anxiety is

precisely; anxiety connected with almost any environment or situation.

2) Cognitive Perspective

Cognitive

perspective

emphasizes

the

role

of

exaggerated or distorted thought and belief , especially

beliefs underlie worry. They tend to perceive danger at every turn and to anticipate calamitous consequences.

3) Biological perspective

In GAD are lack of biological model, it is reasonable

to suspect irregularities in neurotransmitter activity. Neurotransmitter work on brain structures that

regulate emotional states such as anxiety and worry,

so it is possible that an over activity of these brain structures my also involved.

4.2 Treatment Approaches

1) Psychiatric drugs ( paroxetine) Help to relieve anxiety, but can not cure the underlying problem. 2) Cognitive- behavioral therapy (CBT) Therapist use combination of technique in treating GAD including training in relaxation skills, learning to substitute calming, adaptive thought for intrusive, worrisome thoughts, and learning skills of decatastrophizing (avoiding tendencies to think worst) CBT are more efficacy comparable to drug therapy.

5) Acute Stress Disorders (ASD) and posttraumatic stress disorders (PTSD)

Both involve maladaptive reactions to traumatic

stress. ASD occur in the days and week following exposure to a traumatic event. PTSD persists for months or even years or decade after the traumatic experience and may not begin until months or years after the event. Both type of stress disorder in soldiers exposed to combat, rape survivors, victim of accidents, and people who have witnessed the destruction of their home and community by natural disaster ( flood, earthquakes and tornado)

In ASD and PTSD, traumatic event involve either actual or threatened death or serious physical injury or threat to one own or another physical safety.

Factor relate to personal characteristic, people with a history of childhood sexual abuse those lacking

social support and with limited coping skills are

greater risk of suffering

trauma.

PTSD in response to

5.1 Features of traumatic stress disorders

-The symptoms or features of ASD and PTSD, Avoidance behavior Experiencing the trauma Impaired functioning Emotional numbing -Major difference in the features of ASD and PTSD is the emphasis in ASD on dissociation ( feeling of detachment from oneself or ones environment) -People with ASD may feel they are in in a daze or that world seems like a dreamlike or unreal place, and also unable to perform necessary tasks such as obtaining needed medical and legal assistance.

5.2 Theoretical Perspectives

- Anxiety becomes a conditioned response that is
elicited by exposure to trauma related stimuli.

-Through operant conditioning, person may avoid

any contact with trauma related stimuli.

- Avoidance behaviors are operant responses that

are negatively reinforced by relief from anxiety.

5.3 Treatment Approaches

1) Repeated exposure to cues and

emotions associated with trauma 2) Training in stress management 3) Training in anger management 4) Training with antidepressant drugs (sertaline)

Ethnic differences in anxiety disorders

What relationships exit between ethnicity and the prevalence of anxiety disorder?
Evidence from nationally representative sample of US adults
showed generally lower rates of some anxiety disorder among ethnic minorities.

- Anxiety disorder are not unique to our culture. Example, Panic disorder occur in many countries perhaps
even universally. However, specific features of panic attack
such as shortness of breath or fear of dying may vary from culture to culture.

CASE STUDY:
The complete Cognitive Behaviour Therapy audio series on Overcoming Social Anxiety
adapted from 2011, the anxiety network international by Thomas A. Richards, Ph.D., Psychologist

Case Study

Jim is a man in his mid-30s and he was a bright man who had associated great anxiety around these social events in public situations. He could trace his shyness and his social anxiety when in teenager years. He had married a girl he knew well from high school and had almost no other dating history. He and his wife, Lesley, had three children, two girls and a boy. After Jim married, his wife helps him taking over all of the daily and family responsibilities. Jim was able to avoid almost all social responsibility, except his own job. It was his job that bought Jim into this treatment. He had no friends of his own, except for the couples his wife knew from her work.

Years earlier, Jim had worked at a small, locallyowned record and tape store, where he knew the owner and felt a part of the family. The business was slow and manageable and he never found himself on display in front of lines of people. Several years previously, the owner had sold his business to a national record chain, and Jim found himself a lower mid-range manager in a national corporation, a position he did not enjoy because he need to communicate with client through the telephone so every time he make a call he will getting extremely anxious. So when he knew he had to perform, do something in public, or even make phone calls from work. The more time he had to worry about these situations, the more anxious, fearful and uncomfortable he felt.

Treatment
Method: Cognitive behavioral therapy (CBT)- talking Therapy. Jim was cooperative from the beginning and progressed nicely doing therapy. He took each of the practice handouts and spent time each day practicing. After completion of the behavioural group therapy, Jim had an opportunity for advancement in his company, which he now felt comfortable to take and he able to do some public speaking and respond to his employees questions.