Anxiety and OCD

Anxiety

future-orientated mood state, fear in the absence of threat

Fear

immediate fight-or-flight in response to threats or danger

Diagnosis Requirements

High severity and distress, functional impairment, DSM-5 criteria for symptom and duration

Specific Phobia

a severe and persistent fear of a specific object or situation

Social Phobia

fear of a negative evaluation from others

Panic Disorder

recurrent, unexpected panic attacks with one month or more of worry about having another panic attack or attack consequences and maladaptive changes in behavior to avoid another panic attack

Agoraphobia

Fear of public places, often related to the dear of having a panic attack in public

Separation Anxiety

anxiety related to separation from or harm coming to a loved one

Selective Mutism

speaking in front of some but not others

Childhood Only Anxiety Disorders

Separation Anxiety and Selective Mutism

GAD

Excessive or ongoing anxiety and worry about two or more activities with symptoms present for at least 6 months

6 Symptoms for GAD (3 in adults, 1 in children)

restlessness, fatigue, poor concentration, irritability, muscle tension, sleep problems

Social Anxiety Disorder

Intense fear of being scrutinized or doing something embarrassing or humiliating in the presence of others

Social Anxiety: Generalized Type

any social situation

Social Anxiety: Performance Type

performing something in front of other people (even having to behave a certain way)

Panic Attack

intense fear accompanied by 4 or more physical symptoms

Physical Symptoms of a Panic Attack

pounding heart, trembling, shortness of breath, dizziness, fear of losing control, fear of dying

Agoraphobia Fears (at least 2 needed)

being outside of the home alone

traveling in public transportation

being in open spaces

being in stores or theatres

standing in line or being in a crowd

excess norepinephrine, overactive panic circuitry

Biological Factors of panic/physical symptoms

Underactivity of GABA and overactive fear circuitry (PFC, anterior cingulate cortex, amygdala)

Biological Factor of Worry/Cognitive Symptoms

Genetics in Anxiety

predisposition to excessive autonomic reaction to stress

Behavioral Model - Anxiety

Classical Conditioning of Fears and Phobias

Operant conditioning of avoidance behaviors

Modeling/Social Learning for kids from parents

Cognitive Model - Anxiety

Maladaptive, irrational assumptions

Negative Automatic Thoughts

Unrealistically High Standards

Misinterpretation of Bodily Sensations

Meta-Cognitive Theory

people hold negative and positive beliefs about worrying

Cognitive Behavioral Perspective

Thoughts: Inaccurate overly-threatening interpretations of events

Behaviors: Learned responses from dealing with stress and threat

Feelings: Arousal, hypersensitivity

SSRIs

Increases serotonin

SNRIs

increase serotonin and norepinephrine

Benzodiazepenes

Increases GABA

Cognitive Behavioral Therapy (CBT)

a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

Cognitive Restructuring

challenges common cognitive errors: likelihood of a negative event happening and how bad it will be

Behavioral Exposures

systematic desensitization, exposure therapy

Obsessions

intrusive, persistent, unpleasant thoughts, images, and/or impulses

Compulsions

repetitive thoughts or behaviors

DSM-5 Criteria of OCD

Prescence of obsessions, compulsions, or both

Thoughts and behaviors are irrational and excessive

Having an obsessive thought OR not doing a ritual "the right way" results in distress

Significant impairment

Not enough serotonin or glutamate

Neurotransmitters in OCD

Over excited - Cingulate Cortex, orbitofrontal cortex, amygdala, caudate nucleus, basal ganglia

Structural and Functional Abnormalities in OCD

Thought-Action Function

thinking something is just as bad/same as doing it

Cognitive Model and OCD

Thoughts are dangerous

Thought-Action Function

Inflated Sense of Responsibility

Low levels of cognitive control over thoughts

SSRIs + CBT (ERP)

Best OCD Treatment

Exposure and Response Prevention

Introduce feared stimuli in a graded way

Resist or modify rituals for extending periods of time

Learn to tolerate distress without compulsions

Targeting Obsessions

Separate obsessions and irrational behaviors from the person

Reality testing

Learning to tolerate uncertainty

OCD criteria

Prescence of obsessions, compulsions, or both

Thoughts and behaviors are irrational and excessive

Having an obsessive thought OR not doing a ritual "the right way" results in distress

Significant impairment