anxiety & OCD

the most prevalent mental disorder in the US and worldwide

anxiety disorders

12-month prevalence rate of anxiety disorders among adults in the US

19.1%

risk factors for anxiety disorders

exposure to stressful life events, the trait of behavioral inhibition, having a parent with an anxiety disorder

children with anxious parents are ___ as likely to have anxiety problems than children without anxious parents

2x

heritability estimates for anxiety disorders

30-50%

concordance rates for anxiety disorders

12-26% monozygotic, 4-15% dizygotic

separation anxiety disorder criteria

3+ symptoms for 4 weeks in children/adolescents and 6 months in adults

treatment for separation anxiety disorder

CBT that includes psychoeducation, exposure, relaxation techniques, and cognitive restructuring. most effective when combined with parent training. if there is school refusal, must treat that first.

specific phobia criteria

intense fear with avoidance, out of proportion to actual danger. 6+ months

heritability estimates for specific phobia

30-50%

brain areas involved in specific phobia

increased activity in amygdala, insula, thalamus, dorsal anterior cingulate cortex (dACC), mPFC, OFC (all responsible for emotion generation) and reduced activity in vPFC and ventral anterior cingulate cortex (vACC) (all involved in emotion and fear regulation)

Mowrer’s two-factor theory

associated with specific phobia. attributes phobic reactions to a combination of classical (neutral stimulus conditioned to elicit anxiety) and operant conditioning (learn that avoiding it avoids the anxiety).

theory that attributes phobic reactions to a combination of classical (neutral stimulus conditioned to elicit anxiety) and operant conditioning (learn that avoiding it avoids the anxiety).

Mowrer’s two-factor theory

psychosocial treatments for specific phobia

ERP alone or CBT with ERP

research on effectiveness of ERP

in-vivo > imaginal, therapist led > self-directed, virtual reality may be as effective for some types (heights, flying, small animals). effectiveness increases when combined with another intervention (e.g., PMR, like when someone faints at blood and has drop in BP).

social anxiety disorder criteria

fear/anxiety to at least 1 social situation in which they may be scrutinized by others. must fear being negatively evaluated, and as a result, either avoids or endures with intense anxiety. fear must be excessive to the actual threat and/or avoidance must be persistent (6+ months) and cause significant distress/impairment.

time frame for social anxiety disorder

6 months

first-line treatments for social anxiety disorder

CBT and antidepressants (SSRIs and SNRIs)

panic disorder criteria

recurrent, unexpected panic attacks (at least 4 symptoms) with at least 1 followed by 1+ months of fearing additional attacks or their consequences, and/or maladaptive change in behavior

number of symptoms required for panic attacks

4

timeframe for panic attacks

1 attack and 1+ month of fearing another or change in behavior.

psychosocial treatments for panic disorder

comprehensive CBT (e.g., panic control treatment, which combines relaxation + techniques for controlling symptoms)

interoceptive exposure involves exposing to physical symptoms by having them run in place

meds for panic disorder

antidepressants (SSRIs and SNRIs) are first-line. sometimes benzos.

criteria for agoraphobia

fear/anx in 2+ situations, must fear or avoid due to concerns about escape or help being unavailable. excessive to actual threat, must almost always elicit fear and be avoided, require a companion, or endured with intense fear for 6+ months and distress/impairment

treatment for agoraphobia

in vivo exposure and response prevention. usually graded exposure, but there is evidence that intense (non-graded) is effective and may have better long term effects. combining with breathing/relaxation/cognitive techniques do not significantly improve symptoms, they need to learn to tolerate fear

effectiveness of graded vs non-graded ERP for agoraphobia

usually graded is used, but research is showing that intense (non-graded) is also effective and better long-term outcomes

research on combining ERP + other techniques for agoraphobia

combining ERP with relaxation, breathing, or cognitive techniques does not significantly improve symptoms. they need to learn to tolerate high levels of fear and anxiety.

criteria for GAD

excessive worry, most days, with 3+ symptoms, for 6+ months.

difference between GAD and nonpathological anxiety

with GAD, you are unable to control the worry and more likely to have somatic symptoms

content of GAD worries based on age

kids/teens = catastrophic events and competence in school and sports

adults = health and safety

most common comorbid disorder with GAD

MDD

Borkovec’s cognitive avoidance theory

associated with GAD, posits that worry is a verbal-linguistic activity (over-intellectualize) that allows us to avoid mental imagery and the negative emotions/somatic arousal associated with images

theory that posits that worry is a verbal-linguistic activity (over-intellectualize) that allows us to avoid mental imagery and the negative emotions/somatic arousal associated with images

Borkovec’s cognitive avoidance theory

contrast avoidance model

associated with GAD, posits that people engage in chronic worry for 2 reasons: the negative emotional state generated by worry

1. allows them to avoid negative emotional contrasts (NECs) which occur when there is a sharp increase in negative emotions or a sharp decrease in positive emotions in response to a negative event

2. increases the likelihood of positive emotional contrasts (PECs) which occur when there is a sharp decrease in negative emotions when a positive event happens or the feared negative event does not happen.

in other words, chronic worry is reinforced because it decreases the likelihood of NECs and increases the likelihood of PECs

theory that says people worry because it 1) allows them to avoid a sharp increase in negative emotions or a sharp decrease in positive emotions, and 2) increases the likelihood of a sharp decrease in negative emotions when a positive event happens or when the negative event does not happen.

contrast avoidance model

intolerance of uncertainty model

associated with GAD, worry is:

1. intolerance of uncertainty: low tolerance for and strong reaction to ambiguity

2. negative problem orientation: poor problem-solving confidence and ability, especially in uncertain situations

3. positive beliefs about worry: tendency to overestimate the advantages of worrying (e.g., believe that worrying prevents bad things and distracts from disturbing thoughts)

4. cognitive avoidance of mental images: based on Borkovec’s cognitive avoidance theory and refers to use of coping strategies that facilitate avoidance of threatening images.

research supports this because these 4 things distinguish GAD vs other anxiety disorders

theory that says worry includes difficulty with ambiguity, poor problem-solving, believing that worry prevents bad things/distracts from thoughts, and cognitive avoidance theory (use of coping strategies that facilitate avoidance of threatening images)

intolerance of uncertainty model