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Anxiety Lecture_jm_fall09_class

Anxiety Lecture_jm_fall09_class - ANXIETY ANXIETY DISORDERS...

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Unformatted text preview: ANXIETY ANXIETY DISORDERS Overview Overview What are anxiety disorders? Frequency and Comorbidity DSM­IV Anxiety Disorders Interpretations and Treatment Paradigms What are Anxiety Disorders? What are Anxiety Disorders? Anxiety vs. Fear Continuum from normal to abnormal anxiety Key to differentiate disorders Intensity and Frequency Causes and Context Trait vs. State Anxiety Common Symptoms of Anxiety Common Symptoms of Anxiety nervousness jitteriness tension, trembling feeling tired dizziness urinating a lot heart palpitations worry, sweating sleeplessness difficulty concentrating apprehension, vigilance Facts about Anxiety Facts about Anxiety Disorders Prevalence How many people are affected? Are there gender differences? Comorbidity is extremely common Gender Comparison of Anxiety Gender Comparison of Anxiety Disorders 24 20 16 12 8 4 0 All Anxiety PTSD Panic Agora Men Social Women Phobia GAD OCD Depression versus Anxiety Depression versus Anxiety Depressed Mood Anhedonia Decreased Appetite Decreased Sleep Problems Sleep Fatigue Compulsive Rituals Agitation Phobias Problems Problems Concentrating Concentrating Indecision Worry Physical Complaints DSM­IV Anxiety Disorders Stress Disorders Stress Disorders Post­Traumatic Stress Disorder Acute Stress Disorder PTSD and ASD: What is traumatic stress? stress? Experience of an event involving actual or threatened injury or death Response of intense fear, helplessness, or horror in reaction to the event Typical symptoms for stress disorders disorders Re­experiencing the trauma Avoidance Arousal or anxiety Dissociative symptoms Depersonalization Derealization Dissociative amnesia PTSD vs. ASD Criteria PTSD PTSD: ­ Stress symptoms appear or last > 1 month after trauma ­ Re­experiencing of trauma ­ Avoidance and numbing of general responsiveness ­ Persistent symptoms of increased arousal ­ Sig. distress or impairment ASD: ­ Symptoms > 2 days and < 1 month ­ Dissociative symptoms Prevention and Treatment of PTSD Prevention and Treatment of PTSD Early intervention Psychotropic medication Psychotherapy Cognitive­behavioral approaches Eye Movement Desensitization and Reprocessing (EMDR) PHOBIAS Excessive, unreasonable fear Types of phobias Phobia may place huge limitations on everyday activities Phobias and Fears Phobias and Fears What is the difference between being afraid of something and being phobic? Phobics: Reality Check Phobics: Reality Check Phobics ‘know’ that fear is irrational Might even try to approach feared stimulus Role of classical conditioning Usually controlled if stimulus is avoided Phobias Phobias Relatively common Gender differences Age of onset Tend to be chronic Social Phobia Disabling fears of one or more specific social or performance situations Fear of negative evaluation of others and/or embarrassing actions Restriction of social life Lifetime prevalence Social Phobia Social Phobia PANIC DISORDER: PANIC DISORDER: DSM­IV­TR CRITERIA Recurrent, unexpected panic attacks At least 1 attack has been followed by 1 month of at least 1 of these: persistent concern about another attack worry about implications of attack Panic Attacks: Clinical Panic Attacks: Clinical Features Shortness of breath or feeling or being smothered Dizziness, unsteadiness, or sweating Trembling, shaking, or sweating Heart palpitations or a racing heart rate Choking, nausea, or stomach pain Numbness or tingling; flushing or chills Chest pain or discomfort Sense of “strangeness,” of being detached from oneself or one’s surroundings Fear of going crazy, losing control, or dying Agoraphobia Agoraphobia Fear of public places or unfamiliar situations in which escape may be difficult Afraid of losing control in a crowd May dread anxiety of a panic attack GENERALIZED ANXIETY GENERALIZED ANXIETY DISORDER (GAD) Intense but vague anxious apprehension “Free floating anxiety” Persistent worry that something terrible will happen Somatic complaints OBSESSIVE COMPULSIVE OBSESSIVE COMPULSIVE DISORDER (OCD) Persistent Obsessions/Compulsions Anxious Dread if Thought or Act is Prevented Do they recognize the absurdity of the obsessions or compulsions? Obsessions Obsessions Unwanted and intrusive obsessive thoughts or images Usually involve doubt, fear of harm to loved ones, fear of contamination, or one’s own aggression Compulsions Compulsions Behaviors to neutralize obsessive thoughts or images or to prevent dreaded event or situation Common compulsions: counting, checking, ordering, touching, washing OBSESSIONS/COMPULSIONS VS. OCD OBSESSIONS/COMPULSIONS VS. OCD Common for a person to have harmless obsession Certain types of compulsive behavior required for certain jobs Does it interfere with functioning at home/work? Interpretations and Interpretations and Treatment Paradigms Biological Paradigm: Why are some people anxious? Anxiety is modestly heritable ~ 25% concordance rates in MZ twins for all disorders Environmental effects unique to individuals Neuroanatomy – 2 pathways Thalamus to amygdala to hypothalamus Thalamus to visual cortex Biological Paradigm: Treatment 50 Million prescriptions per year for anxiety­related problems Tranquilizers, usually benzodiazepines (Valium, Xanax), most commonly prescribed Side effects Use of antidepressants Psychodynamic Paradigm: Why are some people anxious? Intrapsychic events and unconscious motivations Beliefs specific to phobias Beliefs specific to OCD Psychodynamic Paradigm: Treatment Uncover roots of maladaptive behavior by gaining insight into its origins Treat the symptoms or treat the cause? Cognitive Perspective: Why are some people anxious? Irrational appraisals of the feared situations Emphasis on ways in which certain thoughts and styles of thinking have undesirable behavioral effects Misinterpretation of bodily symptoms Cognitive Perspective: Treatment Therapist works to change “inner voice” of client Monitor thoughts and challenge them Reinterpretation of bodily symptoms Behavioral Perspective: Why are some people anxious? Environmental stress may lead to emotional symptoms Undesirable conditioned fear responses to stimuli Behavioral Perspective: Treatment Exposure to feared stimuli and response prevention Acceptance of internal cognitive and emotional events linked to behavior Importance of client’s trust in therapist May include relaxation and breathing retraining SYSTEMATIC DESENSITIZATION DESENSITIZATION Series of fear­arousing stimuli, gradually increased from more mild to more feared stimuli “Baby steps” Paired with relaxation Has become treatment of choice for phobias MODELING MODELING Demonstration by a therapist or former client who had the same problem Used in conjunction with systematic desensitization ...
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