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Class%209 - ANXIETY ANXIETY DISORDERS Overview Overview...

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Unformatted text preview: ANXIETY ANXIETY DISORDERS Overview Overview Anxiety and Fear Anxiety Disorders Panic Disorder Agoraphobia Generalized Anxiety Disorder Specific Phobias What are Anxiety and Fear? What are Anxiety and Fear? One of many systems designed to detect an , and motivate and help you to do something about it Hunger – detect “low fuel”, alter digestion, motivate eating Pain – detect tissue trauma, reflexive withdrawal, motivate escape What are “anxiety” and “fear”? What are “anxiety” and “fear”? Systems designed to: 1. Detect (perceived threat) 1. Motivate protection or defense – FIGHT or FLIGHT or FREEZE – Autonomic Nervous System 1. Facilitate or defense Fight or Flight Response Fight or Flight Response Liver releases sugar Adrenal gland releases Respiration rate increases norepinepherine Heart rate increases Vasodilatation/constriction Increased muscle tension Unnecessary body systems shut down DEFINITIONS/TERMS DEFINITIONS/TERMS Components Of Anxiety And Fear Physiological 2. Cognitive 3. Behavioral 4. Social 1. Anxiety vs. Anxiety Disorder Everyone experiences anxiety Difference? Amount of distress Amount of Interference in Important Aspects of Daily Life DISTINGUISHING DISTINGUISHING Anxiety and Fear Anxiety Future­oriented Perceive possible threat ↓ physiologic activity ↑ cognitive activity Motivates avoidance or preventative behaviors Fear Present­oriented Perceive certain threat ↑ physiologic activity ↓ cognitive activity Motivates escape or defensive behaviors Anxiety Disorders Anxiety Disorders Panic Disorder with/without Agoraphobia Generalized Anxiety Disorder Specific Phobia Social Anxiety Disorder (Social Phobia) Obsessive­Compulsive Disorder Posttraumatic Stress Disorder DSM­IV Anxiety Disorders DSM­IV Anxiety Disorders Second most prevalent class of psychological disorders over one year period Almost 25% of the population will, at some time, have an anxiety disorder The most prevalent if looking at any single point of time Over 17% of the population Panic Disorder Panic Disorder One or more panic attacks At least some unexpected or uncued Followed by at least one month of concern over having more panic attacks Panic Attack Panic Attack Feeling of imminent doom and urge to escape Plus four or more of: Heart palpitations Sweat Tremble Short of breath Chest pain/tightness Tingling sensations Fear of losing control Stomach distress Choking sensation Dizziness/lightheaded Derealization Hot flashes/Chills Fear of dying Fear of going crazy Panic Disorder Panic Disorder “Followed by at least one month of concern over having more panic attacks” Panic disorder is not only having panics 1 in 3 college students will probably have a panic attack Only 3%­5% will develop panic disorder The concern about panic attacks provokes panic attacks PANIC DISORDER PANIC DISORDER CAUSES Genetic contribution – specific and non­specific Biological and psychological vulnerabilities Anxiety Sensitivity : people who tend to attend that a physical sensation might be a panic attack Agoraphobia Agoraphobia Anxiety about being in places where escape might be difficult in the event of: An unexpected or cued panic attack Panic­like symptoms including nausea, diarrhea, etc. Situations are avoided or endured with marked distress Agoraphobia Agoraphobia Situations can include: Being outside the home alone Crowds, malls, supermarkets Arenas, theatres Buses/public transportation Driving or being a passenger in a car Etc. Generalized Anxiety Disorder Generalized Anxiety Disorder Excessive anxiety and worry, more days than not, for 6 months or more Difficult to control the worry Associated with 3 or more of: Restlessness/Keyed­up Poor Concentration Muscle Tension Fatigue Irritability Sleep Problems Generalized Anxiety Disorder Generalized Anxiety Disorder • Common worry • • • • • • • topics Minor matters Work/school Finances Family Health (own or significant other) Social relationships Community or world affairs GENERALIZED ANXIETY GENERALIZED ANXIETY DISORDER CAUSE Biological vulnerability Autonomic restrictors: low levels of autonomy Chronically tense Highly sensitive to threat Intense cognitive processing in absence of images as way to Intense avoid negative affect avoid TREATMENT Benzodiazepine Drug Treatment: minor tranquilizer. High Benzodiazepine dependency. No good treatment. dependency. Exposure to Worry Images Exposure Worry Exposure to Uncertainty Relaxation Training Specific Phobia Specific Phobia Marked and persistent fear unreasonable or excessive that is Cued by a specific object or situation Situation or object is avoided or endured with distress Specific Phobia Specific Phobia • Five broad sub­categories 1. Animal type 2. Natural environment type 3. Blood­Injury­Injection type 4. Situational Type 5. Other Type • Dogs, snakes, spiders, etc. • Storms, heights, water, etc. • Injections, medical procedures, blood • Flying, tunnels, driving, elevators, etc. • Choking, vomiting, illness, space, etc. SPECIFIC PHOBIA SPECIFIC PHOBIA CAUSE DIRECT EXPERIENCE FALSE ALARM Vicarious Observation INFORMATION TREATMENT SYSTEMATIC DESENSITIZATION FLOODING Treatment for Anxiety Disorders Treatment for Anxiety Disorders Medication SSRI, Tricyclic Antidepressant Benzodiazepine, Monoamine Oxidase Inhibitor Generally effective Fairly quick acting and easy to take Side­effects with TCA’s Addictiveness of benzo’s MAOI ­ Lethal interaction with tyramine High relapse rates after discontinuation Treatment for Anxiety Disorders Treatment for Anxiety Disorders Psychotherapy Cognitive­behavioral therapy has consistently shown to be the most effective therapy for anxiety Generally effective Low side­effect risk Low relapse after treatment – many continue to improve Slower than medication Requires hard work Treatment for Anxiety Disorders Treatment for Anxiety Disorders Cognitive Behavioral Therapy for Anxiety Education about anxiety and its symptoms Relaxation skills (sometimes) Rational thought challenging skills Graduated exposure to fear/anxiety provoking stimuli Treatment for Anxiety Disorders Treatment for Anxiety Disorders Combined Medication and CBT Only a few studies on this: Some suggest slightly better outcome Most suggest no additive effect Some suggest slightly worse outcome ...
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