Anxiety disorders: Biology and Treatment

Anxiety Disorders

Brain areas and neurotransmitters involved with GAD (biological model)

No specific brain area is involved

Excess norepinephrine

Dearth of serotonin

Medications to treat GAD (biological model)

Benziodiazapines (extremely addictive)

Buspirone

SSRIs

SNRIs

Neurotransmitters involved in panic disorder (biological model)

Too much nonepinephrine

Not enough GABA, dopamine, and serotonin

PDA

Panic Disorder and Agoraphobia

Medications to treat PDA (biological model)

Same as with GAD:

Benziodiazapines

Buspirone

SSRIs

SNRIs

Biological causes of PDA

Ratio of O2 to Co2

When you hyperventilate, you are pushing out a lot of CO2 and bringing in a lot of O2, which creates too much oxygen in your blood, which could cause a PDA episode. AND, once you notice that your heart rate increases, you start freaking out, and this escalates until the panic attack comes

Social Anxiety Disorder Brain Areas (biological model)

Dysregulation of the medial temporal lob (includes the amygdala and hippocampus)

In people with SAD, if you show them angry faces, their amygdala lights up, and they remember the times (hippocampus) when, say, they were giving a speech and a few people looked angry (which very few people would remember)

Medications for Social Anxiety Disorder

Benziodiazapines

SSRIs

SNRIs

Neurotransmitters in social anxiety disorder (biological model)

GABA, Serotonin, and Dopamine

Specific Phobias, brain areas and neurotransmitters

No specific brain area

Results partly from prepared learning

Too little GABA

Anxiety medications for specific phobias

Benziodiazapines

Specific phobia medications for exposure treatment

D-cycloserine (medication with the most research), MDMA, CBD, hydrocortisone, propranolol

Brain areas involved in OCD

Heightened activity between the thalamus, cortex, and basal ganglia (the basal ganglia, is next to your limbic system, which it is involved with habits, such as cracking your knuckles).

Neurotransmitters involved in OCD

Nonephinephrine

Serotonin

Dopamine

Medications for OCD

Benziodiazepines (work in the short-term, but not in the long)

SSRIs

SNRIs

Brain areas involved in PTSD

Areas designed to process threats are hypersensitive

Dysregulation/hypersensitivity of the hypothalamic-pituitary-adrenal gland (HPA) axis—the gland either releases too much hormone, or it releases it too sensitively

Medications used to treat PTSD

SSRIs

SNRIs

Which neurotransmitters do benzodiazepines and buspirone target?

Benzodiazepines - GABA

Buspirone - Serotonin

CBT theories for why people with GAD worry (etiology)

Worry is used to avoid mental images

Negative reinforcement

Positive beliefs about worry

Worry is used to avoid mental images

According to this model, people are more likely to worry linguistically than imaginably. Ex. if you’re worried about your loved one dying in an accident, you usually say, “how what why” sort of stuff: “How will they drive under treacherous conditions on the Henday?”

When you worry this way, there is little physiological change, but if you picture your loved one bleeding to death in a car accident, you may have a panic attack due to that imagery. Thus, a theory is that people have linguistically worry as a way to avoid the scary, graphic images

Negative reinforcement

Worrying gets negatively reinforced, as the bad stuff often doesn’t happen from worrying, so the worrying gets reinforced

Five positive beliefs about worrying

Worrying helps problem solve (which it doesn't)

Worrying lessens the emotional impact— “If I worry about it, and the bad thing happens, it won’t hurt me as significantly.”

Magical thinking—the act of worrying prevents the bad thing from happening. It’s like prayer; the act of doing it helps, or it’s supposed to help.

Worrying increases motivation

Worrying is a good personality trait (good people worry)

CBT treatment models for GAD

1. Challenge beliefs about worrying. Ex. “Why do you think being a worrier helps you?”

2. Exposure to worry-related scenarios. Ex. worrying problems often come from starting to worry about an unpleasant thought and then stopping partway through. Ideally, you should worry it through to the end, because then you can put it away.

3. Applied relaxation

GAD and the meta cognitive model

Wells argued that people’s negative (NOT positive) beliefs about worrying develop into GAD

These people feel that they have no control over their worry, and that their worry is dangerous

Meta worry

Worrying about how much you worry

Meta-cognitive treatment methods for GAD

Challenge negative beliefs about worry. Ex. “How do you know people have died from worrying?”

Exposure to intense worrying. Ex. Have the client worry in front of the therapist straight for 10 minutes, then have the therapist remind them that nothing happened from the worrying.

Exposure to worried about scenarios

CART therapy vs CBT in PDA

CART targets the breathing so you’re less likely to have a panic attack, whereas CBT targets the anxiety so that people won’t be scared when the attacks come

CBT and PDA Etiology

Learned alarms develop through conditioning and negative reinforcement

Anxiety sensitivity and catastrophic thinking

Learned alarms develop through conditioning and negative reinforcement

Worry about having another panic attack at the mall causes your body to associate the mall with a panic attack (classical conditioning), and then you avoid the mall, causing negative reinforcement

Anxiety sensitivity and catastrophic thinking

Some people are hyper aware of anxiety feelings. E.g. if you turn up the temperature in the room, people with anxiety sensitivity will notice themselves sweating first

CBT treatment for PDA

Challenge dysfunctional beliefs

Interoceptive exposure

Imaginal and in-vivo exposure—could be them imagining themselves going to the mall or riding the bus when they’re scared of those environments

Introceptive exposure

Exposure to the internal experiences and feelings of anxiety. You will sit with your client and hyperventilate with them for 30 seconds. Then, you show them that the therapist doesn’t have a panic attack from hyperventilating, so the client knows it’s not a big deal.

Social Anxiety Disorder CBT Etiology

High self-standards, fear of judgment, and negative beliefs about self

Avoidance

Safety-seeking behaviours

Social Anxiety Disorder CBT treatment methods

Cognitive restructuring (ex. If you feel when you blurt things out people stop and look at you because they’re judging you, consider that it’s possible that they weren’t thinking about you saying the wrong thing for hours, or that they stopped just to think, not to judge).

Exposure with attention on others and without use of safety behaviours (make them, say pay attention to the name and hair colour of the cashier at Tim Horton’s, in hopes to get the client out of themselves and into the moment).

CBT Etiology for Specific Phobias

True alarm: a rottweiler runs to bite you

Learned alarm: you get anxious when you hear a rottweiler bark

Vicarious learning: social modelling, e.g. if your parent avoids something, you may also

CBT treatment for SP

Graduated exposure

Virtual reality therapy: VR can work, but the problem is that it is made for video games, not therapy; hence, the quality is super poor

Flooding

CBT Etiology of OCD

Fear structures develop with excessive associations between stimuli and distress

Compulsions are repeated due to a lack of signs that the situation is safe

Fear structures

Edna Foa thought that fear structures in the brain were what caused OCD.

Ex. thinking thoughts of germs can cause thoughts of death, which causes distress.

Compulsions and lack of signs that the situation is safe

You can’t see germs, so you cannot see the germ disappearing when you wash

How to distinguish between people with child sexual OCD thoughts and paedophiles

Because a paedophile is not repulsed by the thoughts (are or aren’t?), and the OCD person doesn’t get aroused by the thoughts

Cognitive Model treatment for OCD

Inflated sense of responsibility: you are 100% responsible for locking doors, NOT your spouse

Inflated sense of serious harm: if you don’t lock the doors, someone will break in and stab you

Checking impairs meta-memory: the more you check, the less confidence you’ll have in your memory

CBT Etiology of OCD

Conditioning/reinforcement of primary emotions, and development of secondary emotions

Verbally accessible memories (VAMs) vs. Situationally accessed memories (SAMs)

Cognitive model treatments for OCD

Behavioural exercises (including contracts) to reduce responsibility. Ex. Say on Tuesday, you are responsible for the door, but on Thursday, the therapist is. The shift of responsibility brings ease.

Challenging other negative beliefs

Exposure and response prevention

Conditioning/reinforcement of primary emotions, and development of secondary emotions

1. Fear and anxiety come from classical conditioning, which is then reinforced through avoiding that fear.

2. Secondary emotions also develop, such as guilt (why was I walking down that street late at night), or disgust (he sexually assaulted me!)

VAMs vs. SAMs

VAMs—when you can very easily talk about and describe the trauma. It’s the story telling version. 

SAMs—when the situation is brought up, you have a much bigger physiological memory. It’s like your body’s memory about it.

CBT treatment methods for PTSD

Exposure to activate and modify SAMs

Cognitive restructuring to modify VAMs

Eye Movement Desensitization and Reprocessing (EMDR)

Eye Movement Desensitization and Reprocessing (EMDR)

Researchers think that it works because the client exposes themselves to the trauma via talking about it, but it’s not because of the eye and finger movements. Alex thinks that the 1-2 minute short bursts of exposure via talking may be effective.