ch 5 anxiety and ocd disorders

anxiety

an emotional state characterized by physiological arousals, unpleasant feelings of tension, and a sense of apprehension or foreboding

anxiety disorder

maladaptive anxiety reaction which can cause significant emotional distress or impair a persons ability to function

features of anxiety disorders

1. physical features

2. behavioral features

3. cognitive features

overview of anxiety disorders

• anxiety disorders along with dissociative / somatic symptom and related disorders were classified as neuroses throughout the 19th century

• neurosis derives from roots that mean: an abnormal or diseased condition of the nervous system

• William Cullen coined the term in 18th century

• in beginning of 20th century, psychodynamic view of anxiety rose

• freud maintained that neurotic behavior stems from threatened emergence of unacceptable, anxiety evoking ideas into conscious awareness

• freuds concepts formed basis for classification systems found in first two editions of DSM

DSM recognizes following specific types of anxiety disorders:

panic disorder, phobic disorders, generalized anxiety disorder

• new categories for OCD and PTSD → obsessive compulsive and related disorders and trauma and stressor related disorders

panic disorder

characterized by repeated, unexpected panic attacks

→ attacks are intense anxiety reactions that are accompanied by physical symptoms

features of panic attacks

• stronger bodily component to panic attacks than other forms of anxiety → attacks are accompanied by feelings of terror, sense of imminent danger or impending doom

• during attacks → people tend to keenly aware of changes in their heart rates and may think they are having a heart attack

panic attack diagnosis features

• must be the presence of recurrent panic attacks that begin unexpectedly— attacks that are not triggered by specific objects or situations

• first panic attacks occur spontaneously or unexpectedly but over time they may become associated with certain situations or cues

• at least one panic attack must been followed by a period by a month that included either or both of the following features:

  • persistent fear of subsequent attacks or the feared consequences of an attack such as losing control, having a heart attack or going crazy

  • significant maladaptive change in behavior such as limiting activities or refusing to leave the house

• agoraphobia

agorapobia

excessive fear of being in public places

casual factors for panic attacks

involve a combination of cognitive and biological factors of misattributions on the one had and physiological reactions on the other

misattributions: misperceptions of underlying causes of changes in physical sensations (ex: someone may believe they are having a heart attack)

biological factors of panic disorder

• genes may create a predisposition or likelihood

• low levels of GABA in some parts of the brain (panic)

• anti-anxiety drugs like benzodiazepines target GABA receptors

• serotonin help regulate emotional states → antidepressant drugs have shown beneficial effects on some forms of anxiety

• manipulation of CO2 in blood

cognitive factors of panic disorder

• anxiety sensitivity → fear of fear itself

• influenced by genetic factors

• influenced by environmental factors

• includes ethnicity → asian and hispanic students report higher levels of anxiety sensitivity on average

• anxiety sensitivity was less strongly connected to panic attacks in these groups

treatment approaches for panic disorder

• cbt

• drug therapy: antidepressants (lexapro), benzodiazepines (xanax)

• PCT (panic control therapy)

  empirically supported treatment

  panic symptoms elicited in office

  conitions reexamined

  catastrophic misinterpretations of bodily sensations are talked about

  patients learn that sensations are controllable and not really dangerous

• breathing retraining (aims to restore CO2 lvl in blood

phobia

an excessive irrational fear

types of phobic disorders

specific phobia, social anxiety disorder, agoraphobia

specific phobia

persistant, excessive fear of a specific object or situation that is out of proportion to the actual danger these objects or situations pose

specific phobia diagnosis

• must significantly affect the persons lifestyle or functioning or cause significant distress

• oftten begin in childhood but some begin later (claustrophobia has mean onset of 20 yrs)

• effects 12.5% of population

• more common in women

social anxiety disorder

intense fear of social situations

• people with SAD may find ways to decline social invitations

• avoidance behaviors

agoraphobia features

• can be extreme to where they cannot leave the house

• might be difficult or embarrassing to escape in the event of panicky symptoms

• women are more likely to develop agoraphobia

• tends to be chronic and frequently begins in early adulthood

psychodynamic perspectives of anxiety disorders

• anxiety is a danger signal indicating that threatening impulses of a sexual or aggressive nature are near the level of awareness

• to fend off impulses the ego mobilizes its defense mechanisms

• projection: projecting a person’s own destructive impulses onto the phobic object

learning perspectives of anxiety disorders

O. Hobart Mowrer

• two factor model: incorporated roles for both classical and operant conditioning in the development of phobias

• avoidance component of phobias → negative reinforcement

  • relief from anxiety negatively reinforces the avoidance of fearful stimuli

• extinction → weakening of the conditioned response when the conditioned stimulus is repeatedly presented in the absence of the unconditioned stimulu

biological perspectives of anxiety disorders

• amygdala: produces fear response to triggering stimuli without conscious thought

  • with anxiety disorders, amygdala may become overly excitable

• prefrontal cortex (memory of safety) → amygdala (memory of fear) → fear

cognitive perspectives of anxiety disorders

• oversensitivity to threatening cues

  • “fight or flight” is overly sensitive

• overpredicition of danger

  • overpredict how much fear or anxiety they will experience in a fearful situation → fear of being scared in the situation may cause avoidance behaviors

• self-defeating thoughts and irrational beliefs

  • can heighten and perpetuate anxiety / phobic disorders

  • thoughts like “my heart is going to leap out of my chest”, “I’ll sound stupid” are examples

treatment approaches of anxiety disorders

• learning based approaches

• systematic desensitization

• gradual exposure

• flooding

• virtual reality therapy

• cognitive therapy

• cognitive restructuring

• drug therapy

systematic desensitization

• gradual process in which clients learn to handle progressively more disturbing stimuli while they remained relaxed

• fear stimulus hierarchy: about 10-20 stimuli arranged in a sequence according to their capacity to evoke anxiety

• based on assumption that phobias are learned or conditioned responses that can be unlearned

gradual exposure

• stepwise approach in which clients gradually confront the objects or situations they fear

• repeated exposure to stimulus with nothing bad happening can lead to gradual weakening of the phobic response, even to the point that it is eliminated

flooding

• form of exposure therapy in which clients begin by confronting their most difficult anxiety situations

• underlying belief is that anxiety represents a conditioned response to a phobic stimulus and can go away if individual confronts the situation without harmful consequences

virtual reality therapy

uses digital technology to help people confront fears in a safe environment

cogntive therapy

• REBT → albert ellis

  • helps with social anxiety, shows how irrational thoughts are

• seek to identify and correct dysfunctional distorted beliefs

cognitive restructuring

method where therapist helps clients pinpoint self defeating thoughts and generate rational alternatives

generalized anxiety disorder

characterized by excessive anxiety and worry that is not limited to any one object, situation, or activity

features of GAD

• excessive and uncontrollable worry

• emotional distress with GAD interferes significantly with every day life

• frequently occurs with other disorders

  • depression

  • OCD

  • other anxiety disorders

• other related features include:

  • restlessness, feeling tense, becoming easily fatigued, having difficultly concentrating, irritability; sleep disturbances, and muscle tension

theoretical perspectives in GAD & treatment approaches

• cognitive and biological perspectives converge in evidence showing irregularities in the functioning of the amygdala and in its connections to the prefrontal cortex

  • the prefrontal cortex may rely on worrying as a cognitive strategy for dealing with fear generated by an overactive amygdala

• irregularities in neurotransmitter activity

  • drugs such as benzodiazepines and antidepressants work to regulate emotional states of anxiety

  • best used in pair with therapy → CBT

obsessive compulsive disorder

troubled by recurrent obsessions, compulsions, or both, that are time consuming (lasting longer than an hour) or cause significant distress, or interfere with a person’s normal routines/occupational/social functioning

• effects 2-3% of the general populatio

obsession

recurrent, persistent and unwanted thought, urge, or mental image that seems beyond a person’s ability to control

• can be potent and persistent enough to interfere with daily life and can cause significant distress and anxiety

compulsion

repetitive behavior or mental act that a person feels compelled or driven to perform

• typically occur in response to obsessive thoughts

• frequent enough to interfere with daily life or cause distress

• most compulsions fall in two categories: cleaning rituals and checking rituals

psychodynamic perspective of OCD

• obsessions represent leakage of unconscious urges or impulses into consciousness

• compulsions are acts to keep these impulses repressed

genetic factors of OCD

• history of tic disorders → big factor

• prefrontal cortex fails to control excess neural activity from amygdala → anxiety and worry

• lower GABA levels in hippocampus → prefrontal cortex is not as good at filtering out disturbing thoughts

cognitive factors of OCD

• overly focused on thoughts

• exaggerate the risk that unfortunate events will occur

• perfectionism→ exaggerate consequences of less than perfect work

learning perspective of OCD

compulsive behaviors → operant responses negatively reinforced by anxiety relief

treatment approaches for OCD

• exposure with response prevention (ERP)

  • exposure: repeated and prolonged exposure to stimuli / situations that evoke obsessive thoughts

  • response prevention: preventing the compulsive behavior to occur

• CBT combined with ERP

  • first line treatment of OCD

• SSRI antidepressants

  • usually paired with CBT / ERP

body dysmorphic disorder

preoccupied with imagined or exaggerated physical defect in their appearance

body dysmorphic disorder features

• fear others will judge them based on flaw

• spend hours examining themselves and go extreme measures to fix defect(s)

  • surgery, skin picking

• classified in obsessive compulsive spectrum

  • obsessed with perceived defect and feel compelled to check themselves / fix themselves

• features

  • lower self esteem

  • perfectionism

  • suicidal thinking → suicide attempts

  • high comorbidity rate with depression and bipolar

body dysmorphic disorder treatment

• CBT

  • involves ERP

  • going in public and not hiding perceived defect

  • avoiding checking mirrors

• antidepressants

hoarding disorder

extreme difficulty discarding stacks of unnecessary and seemingly useless possessions → results in personal distress or in creating so much clutter a person cannot walk in the home

hoarding disorder features

• bears close relationship to OCD → includes additional features such as recurring thoughts about acquiring objects and fears over losing them

  • do not experience rituals like people with OCD

  • typically take pleasure in collecting objects and thinking about them → unlike anxiety associated with obsessions in OCD

hoarding disorder treatment

CBT