Lecture 9- anxiety disorders and OCD

How is anxiety different to fear?

• Anxiety is associated with anticipation of future concern

• Fear is an emotional response to an immediate threat and is more associated with a fight or flight reaction

How is anxiety/arousal functional and adaptive?

It is important and helpful in shaping behaviour and avoiding aversive/dangerous stimuli

High levels of anxiety =

aversive

How does the autonomic ‘fight-or-flight’ response occur in fear/anxiety?

• Perception of threat triggers sympathetic nervous system

• Stress hormones trigger and maintain variety

What stress hormones are involved in fight-or-flight?

• Epinephrine

• Norepinephrine

• Cortisol

How does resolution of threat impact the nervous system in fight-or-flight?

• Reduction in sympathetic nervous system

• Increases parasympathetic nervous system

Symptoms of fight-or-flight

• Sweat

• Blood flow to muscles increases

• Heart rate increases

• Breathe more rapidly (increased respiration)

• Light headedness/dizziness

• Nausea

• Trembling or shaking

• Tense muscles

• Dry mouth

• Desire to urinate

• Release of blood sugar (glucose) and fats

Describe anxiety disorders?

• Differ from normal feelings of anxiousness

• Involve excessive fear or anxiety

• Fear or anxiety out of proportion to the situation

• Significant impact on functioning

• Typically lead to avoidance of stimuli/situations which impacts psychosocial functioning

What % of adults experience an anxiety disorder at some point in their life?

30%

What are some common anxiety disorders?

• Specific phobia

• Panic disorder

• Social phobia/social anxiety disorder

• Generalised anxiety disorder (GAD)

• Agoraphobia

• PTSD (no longer classified as an anxiety disorder in DSM-5)

Describe specific phobia

• Marked fear or anxiety about a specific object or situation

• Exposure to stimuli elicits an intense fear response

Describe panic disorder

• Recurrent unexpected panic attacks

• Persistent concern or worry about additional panic attacks or their consequences

• Significant maladaptive change in behaviour related to the attacks

Describe social phobia/social anxiety disorder

• Persistent fear and avoidance of social and performance situations

• Fears typically concern potential negative evaluation by others as a result of anxiety symptoms or social performance

Describe generalised anxiety disorder (GAD)

Chronic, persistent and excessive anxiety and worry about a number of events or activities that individuals find difficult to control

Describe agorophobia

• Fear of being in situations where escape may be difficult or embarrassing

• Or help may not be available in the event of panic symptoms

• e.g using public transport, in a crowd, being outside the home alone

How does PTSD develop? When do symptoms begin?

• Develops in some people after extremely traumatic events, such as combat, assault, an accident, or natural disaster

• Symptoms typically begin within 3 months after trauma

What symptoms are associated with PTSD?

• Intrusion

• Avoidance

• Negative altercations in cognitions and mood

• Hyperarousal

What are some common cognitive symptoms of fear/anxiety?

• Fears of:

  • Losing control

  • Impending death or injury

  • Negative evaluation by others

  • ‘going crazy’

• Thinking about matters outwith focus of threat may become more difficult

• Hyper-vigilance

• Threat-related imagery/memories

• Impaired reasoning processes

What are some common behavioural symptoms of fear/anxiety?

• Avoidance of threat

• Behaviours that mitigate against perceived threat (safety behaviours)

• Escape/threat

• Reassurance seeking

• Restlessness/agitation

• Freeze response

What are some common affective symptoms in fear/anxiety?

• Nervousness

• Wound-up

• Frightened

• Fearful

• Jumpy

• Jittery

• Frustrated

• Impatient

Describe anxiety disorder prevalence

• Comorbidity is common

• Often chronic and will not display spontaneous remission of symptoms

• Specific phobia has the highest prevalence

• OCD has the lowest prevalence

What % of individuals with an anxiety disorder meet criteria for two or more disorders?

40-80%

What is the prevalence of OCD?

0.1-2.3%

Describe the Mowrer two factor theory of phobia

• Discrete learning events leading to conditioned fear response

• Classical and operant conditioning

• Phobias are initially acquired through classical conditioning (associating a stimulus with an unpleasant experience)

• Then maintained through operant conditioning (avoidance behaviour being negatively reinforced)

What is a panic attack?

An abrupt surge of intense fear or discomfort that reaches a peak within minutes

What are some symptoms of a panic attack?

• Pounding heart

• Tachycardia (rapid heart rate)

• Palpitations

• Sweating

• Trembling or shaking

• Experience of choking

• Shortness of breath

• Fears of losing control, dying, or ‘going crazy’

• Pain or discomfort in chest

• Tingling sensations

• Nausea

• Dizziness

• Light headedness

• Feelings of being detached from self

• Hot flashes or chills

What % of the population will experience an occasional, unexpected panic attack sometime in their life?

28%

What is the cognitive model of panic disorder?

Panic attacks result from the catastrophic misinterpretation of the normal physical reaction to fear or worry/the bodily sensations

What is the lifetime prevalence of social anxiety disorder?

12%

When does the onset of social anxiety disorder occur?

• Adolescence

• Around 15 years old

Why do those with social anxiety disorder fear potential negative evaluation by others?

• Believe negative evaluation will result in negative social consequences

• So they engage in a variety of behaviours to prevent/minimise this

• Non-occurrence of social catastrophe attributed to performance of behaviours

What are some cognitive maintenance factors of social anxiety disorder?

• Information and interpretation bias

• Interpret performance significantly more critically

• Show self-focussed attention

• Indulge in excessive post-event processing of social events

What are obsessions?

• Recurrent, unwanted, intrusive thoughts, images or impulses that cause distress/interference

• e.g thoughts, images, or impulses which are blasphemous, aggressive, religious, sexual

• Experienced as beyond a persons’s ability to control

What are compulsions?

• Repetitive behaviour that an individual feels driven to perform

• In response to an obsession or according to rules which must be applied rigidly

• Aimed at reducing distress/anxiety or to prevent some dreaded event from happening

• Not connected in a realistic way with what they are designed to neutralise or prevent

Give some examples of compulsions

• Compulsive checking (e.g of doors and windows)

• Compulsive washing (to prevent contamination and infection)

• Superstitious ritualised movements or thoughts (e.g counting backwards until a thought has gone)

• Systematic arranging of objects

• Compulsive hoarding

What is the lifetime prevalence of OCD?

2-6%

When does the onset of OCD occur?

• Begins gradually

• In adolescence or early adulthood

What features of OCD are similar across cultures?

• Age of onset

• Sex ratio

• Types of obsessions/compulsions

What does it mean that obsessions are ego-dystonic?

• The content of the obsession is alien/inconsistent with values

• Not within their control

• Not the kind of though they would expect to have

• It is argued that obsessions which threaten self-view are more likely to capture attention