Anxiety Disorders

Fear

Immediate response to a real threat. Short-lived and adaptive, helps keep us safe.

Anxiety

Focuses on future threats. Long-lasting with cognitive symptoms like tension and worry. Can be adaptive

HPA Axis

Hypothalamus detects threat → signals pituitary gland → releases ACTH → adrenal glands release cortisol & adrenaline → triggers fight or flight response

Autonomic Nervous System

Controls involuntary bodily functions like breathing and digestion. Includes:

• Sympathetic Nervous System (SNS): Activates anxiety response.

• Parasympathetic Nervous System (PNS): Calms the body.

Sympathetic Nervous System

Activates the body's alarm response during anxiety. Increases heart rate and prepares for fight or flight

Parasympathetic Nervous System

Calms the body after a threat. Slows down heart rate and restores normal function

Rumination (Cognitive component of anxiety)

Repetitive thinking about past events in a negative way.

Transient

Short-lived or temporary.: anxiety can be transient or long lived

Functional Impairment

When anxiety interferes with daily functioning, it may be considered a disorder.

Developmental Consideration

Age and developmental stage affect how anxiety manifests and is diagnosed.

Sociodemographic Factors

Anxiety is more common in women. Social factors influence prevalence and experience.

Phobia

An irrational fear of a specific object or situation that interferes with functioning.

Types of Phobias

Blood-Injury-Injection Phobia

• Parasympathetic nervous system increases rapidly shutting everything down and they faint  (vasovagal syncope)

• Situational phobia 

  • using public transport, driving through tunnels, etc

• Natural environment phobia

• Animal phobia

• other phobia

  • Other phobias are statistically rare and need to be treated differently

Trypophobia

Biological revulsion (evolutionary fear response) to clustered holes or patterns. unofficial/proposed phobia

Panic Attack

Sudden intense fear with physical symptoms (e.g., heart palpitations, dizziness, choking). Peaks within minutes.

Agoraphobia

Fear of being in situations where escape might be difficult or help unavailable. May or may not involve panic attacks. Leads to avoidance and dysfunction.

Social Isolation

Can lead to depression. Often associated with anxiety disorders.

Splashing Water Technique

Splashing water on the face signals safety to the body, activating the parasympathetic system.

Elements of Anxiety

Anxiety consists of three components:

• Physiological: Increased heart rate, shortness of breath, muscle tension.

• Cognitive: Worry, rumination, future-focused thoughts.

• Behavioral: Avoidance and safety behaviors.

DSM-5 Overview: Specific Phobia

Marked fear or anxiety about a specific object or situation. Fear is excessive and leads to avoidance or distress.

DSM-5 Overview: Panic Disorder

Recurrent unexpected panic attacks followed by persistent worry about future attacks or behavioral changes to avoid them.

DSM-5 Overview: Generalized Anxiety Disorder (GAD)

Excessive anxiety and worry on most days for at least 6 months. Difficult to control and associated with symptoms like fatigue, irritability, and sleep disturbance.

Social Anxiety Disorder (SAD)

Marked fear or anxiety about social situations where one may be judged. Often begins around age 11 and can be comorbid with depression or substance abuse.

Developmental Trajectory

Childhood fears may persist into adulthood, leading to increased dysfunction over time in SAD.

Introversion vs Social Anxiety

Introverts prefer solitude but are not fearful of social situations. SAD involves fear and avoidance due to anxiety.

Cognitive Patterns in SAD

Includes intrusive automatic negative thoughts and lack of positive feedback processing. Safety behaviors worsen anxiety.

Temperamental Factors

Behavioral inhibition in infancy (e.g., difficult temperament) may predispose individuals to SAD.

Freudian View of Anxiety

Anxiety arises from conflict between the id (instinctual desires) and ego (reality constraints).

Classical Conditioning and Phobia

Phobias can be learned through association, such as pairing a neutral stimulus (e.g., bunny) with a loud noise.

Modeling and Transmission

Fear can be internalized by observing anxious behavior in parents or through explicit instructions (information transmission).

Diathesis-Stress Model

Anxiety disorders result from a combination of genetic vulnerability and environmental stressors.

Fear of Fear

Describes panic disorder where individuals fear the physical symptoms of anxiety, believing they signal danger.

Biological Vulnerability

Genetic predisposition to negative affect or pessimism increases risk for anxiety disorders

Generalized Psychological Vulnerability

Belief that the world is uncontrollable, often learned through adverse life events

Specific Psychological Vulnerability

Specific experiences (e.g., bullying) may lead to particular anxiety disorders like SAD

Serotonin and SSRIs

Serotonin depletion or receptor dysfunction is linked to anxiety. SSRIs can help but may have side effects and are not effective for all.

Medication Limitations

Long-term use may lead to side effects or symptom relapse. SSRIs may increase suicidal thoughts in depressed patients.

GABA

Increased GABA activity reduces anxiety.

TMS (Transcranial Magnetic Stimulation)

Non-invasive technique that modulates brain activity to treat anxiety.

Psychodynamic Therapy

Includes techniques like free association and dream interpretation to uncover unconscious conflicts.

CBT for SAD

Targets automatic negative thoughts and safety behaviors. Effective in reducing symptoms.

Interceptive Exercises

Expose individuals to feared physical sensations to reduce fear response and build tolerance.

Etiology of Anxiety Disorders

Direct conditioning theory

• little albert

Observational learning

• fear comes by watching someone

Information Transmission

• explicitly told to fear

Triple Vulnerability Model

Treatments

• Biological treatments

• psychosocial perspective