Anxiety edith - ANXIETY DISORDERS ANXIETY Primary symptom is excessive anxiety&/or Primary debilitating attempts to avoid anxiety debilitating

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Unformatted text preview: ANXIETY DISORDERS ANXIETY Primary symptom is excessive anxiety &/or Primary debilitating attempts to avoid anxiety debilitating Anxiety is a state of alarm in response to a Anxiety vague sense of threat or danger. vague Generalized Anxiety Disorder (GAD) Generalized Characteristics of GAD: 1. “Free-floating” anxiety, chronic and persistent 2. Autonomic arousal 3. Vigilance/Scanning 4. May co-occur with specific phobias, depressive symptoms Autonomic Nervous System Sympathetic and Parasympathetic mechanisms: “automatic” responses that prepare organism for fight/flight then return to automatic” resting state. resting GAD = Hyper activation of sympathetic mechanisms Symptoms include restlessness, easy fatigue, irritability, muscle Symptoms tension, and/or sleep disturbance tension, Symptoms last at least six months CAUSES OF GENERALIZED ANXIETY DISORDER DISORDER 1. Social unrest, disruption (Sociocultural Perspective) Since race is closely tied to income and job opportunities in the Since U.S., it is also tied to the prevalence of GAD U.S., In any given year, about 6% of African Americans vs. 3.5% of In Caucasians suffer from GAD Caucasians African American women have highest rates (6.6%) 2. Psychodynamic formulation 2. a. unconscious impulses are repressed b. but, inadequate defenses to avert anxiety b. Causes of GAD (continued) Causes 3. Cognitive (Cognitive-behavioral) formulation a. anxiety exacerbated by faulty cognitive style a. b. cognitions emphasize imminent danger b. c. an initial fear response to actual threat generalizes c. and is reinforced by avoidance 4. Biological 4. malfunction of GABA neuroinhibitor mechamism - GABA receptors do not bind GABA - hyper-excitability due to failure to stop arousal hyper-excitability TREATMENT OF GENERALIZED ANXIETY DISORDER DISORDER 1. “Insight-oriented” psychotherapy generally not effective 2. Relaxation training – deep muscle relaxation (biofeedback only sometimes effective) 3. Rational-emotive therapy to confront/counteract disruptive cognitions (i.e., assumptions) 4. Self-instruction training 5. Benzodiazepines - improve functioning of GABA mechanism Cognitive therapies Cognitive Changing maladaptive assumptions Ellis’s rational-emotive therapy (RET) (described later re: social phobia) (described Teaching clients to cope Meichenbaum’s self-instruction (stress inoculation) Meichenbaum’s training training Teach self-coping statements to apply during four stages Teach of a stressful situation: of Preparing for stressor Preparing Confronting and handling stressor Coping with feeling overwhelmed Reinforcing with self-statements Phobic Disorder – Simple Phobia Phobic Definition: Excessive, unrealistic, and debilitating Definition: debilitating fear of a specific object, situation, or activity Note: Most phobias are not debilitating - coping = avoidance and suppression Causes: 1. Specific learning incident (Conditioned fear) 2. Modeling 3. Freud – displacement of anxiety re: own forbidden impulses on to “symbolic object” 4. Human predisposition: often feared objects 4. are dangerous are Treatment for Specific Phobia Treatment 1. Systematic Desensitization (developed by Wolpe) a) Teach deep muscle relaxation b) Construct fear hierarchy b) c) gradual exposure paired with relaxation c) (reciprocal inhibition) - imaginal exposure = covert desensitization - in vivo exposure – often most effective in 2. Exposure (Flooding/Implosive Therapy) - forced exposure until fear subsides 3. Modeling – vicarious conditioning 4. Psychodynamic psychotherapy – not successful Social Phobia Social Fear of social situations, being judged, scrutiny - associated with social incapacitation - often associated with lack of social skills Causes – Cognitive explanations: A) Unrealistic assumptions - Albert Ellis A) “I must be perfect” “It would be terrible if I failed” Albert Ellis identified basic irrational assumptions that plague us: It is a necessity for humans to be loved by everyone It is catastrophic when things are not as one wants them If something is dangerous, a person should be terribly concerned If and dwell on the possibility that it will occur and One should be competent in all domains to be a worthwhile person B) Disruptive automatic thoughts B) “They think I’m stupid” “I must be falling apart” C) Self-defeating cognitions “I can’t do this” Treatment of Social Phobia Treatment 1. Desensitization to arousing social situations. 2. Ellis: 2. a) identify & challenge faulty cognitions a) Point out irrational assumptions Suggest more appropriate assumptions b) homework – exposure to feared situations (Limited research, but findings are positive) 3. Beck: a) challenge automatic thoughts b) teach relaxation to replace anxiety 4. Self-instruction training Meichenbaum: social problem-solving skills - positive coping statements: “I can handle this” “What’s the first step…?”, etc. 5. Assertiveness training & social skills training Agoraphobia Agoraphobia Generalized fear of having a panic attack (fear of fear) 1. often manifested as fear of public places, open spaces, 1. leaving home leaving 2. sometimes symptoms like claustrophobia - fear inability to escape from enclosed places Causes Causes 1. usually not a clear link to a specific incident 2. maladaptive cognition = arousal interpreted 2. as onset of panic as 3. secondary gain – avoidance is reinforced Treatment of Agoraphobia Treatment 1. In vivo exposure 1. – graded exposure paired with reinforcement graded 2. Support groups – encouragement 2. 3. Family involvement – provide support and reduce secondary gain. provide Panic Disorder Panic Frequent, unpredictable panic attacks, not linked to precipitant Frequent, not - dizziness, chest pains, palpitations, sweating, dizziness, shortness of breath, faintness, etc. (“heart attack”) shortness - 4 or more attacks within a month - agoraphobia (fear of leaving safety) Causes: 1. Biological: related to norepinephrine activity - responsive to anti-depressant medication - but, also responsive to Xanax, a benzodiazapine 2. Cognitive: overinterpret arousal as signs of panic - self-fulfilling prophecy – causes attack - anxiety sensitivity – chronic illness in family as child. Treatment of Panic Treatment 1. Cognitive restructuring to reinterpret physical Cognitive symptoms symptoms 1. Interoceptive exposure 1. Anti-depressant medications Obsessive-Compulsive Disorder Obsessive-Compulsive Obsessions: 1) repeated, persistent, intrusive thoughts 1) intrusive 2) themes of: - dirt, filth, contamination - aggression, sex - religious content 3) thoughts cause anxiety Compulsions: 1) repetitive, ritualistic behaviors 2) serve to bind anxiety 3) includes: cleaning, checking, touching, counting Causes of OCD Causes 1) Biological: related to low serotonin activity - orbital frontal cortex (impulses) filtered by caudate nuclei on way to thalamus caudate - caudate nuclei rich in serotonin 2) Behavioral: anxiety reduction by compulsion reinforces the symptom reinforces 3) Psychodynamic – anal stage fixation - control themes - defenses = isolation, undoing (by compulsions), reaction formation reaction - O-C personality: over-ideational and tidy Treatment of OCD Treatment 1) Exposure and response prevention 2) Thought stopping 3) Antidepressant medications 3) (clomipramine) (clomipramine) SSRI’s SSRI’s (Serotonin-specific reuptake inhibitors) e.g., Prozac e.g., ...
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This note was uploaded on 03/31/2011 for the course PSYCH 3140 taught by Professor Staff during the Spring '11 term at Georgia State University, Atlanta.

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