Psychology Exam 2: Generalized Anxiety Disorder

Nonpathological anxiety

• Worries perceived as manageable

• Worries may be put off if more pressing matters arise

• Everyday worries less likely to be accompanied by physical symptoms

Problematic Anxiety

• Worry is out of proportion to:

  • Actual likelihood of event

  • Impact of actual event

• more pervasive and pronounced

• has a longer duration

• significantly interferes with functioning

• frequently occurs without precipitants

• The worry itself is distressing

DSM-5: Generalized Anxiety Disorder Criteria

• Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities

• Difficult to control the worry

• Associated with 3+ symptoms (at least some symptoms present more days than not for 6 + months)

  • Restlessness, keyed up, on edge

  • Easily fatigued

  • Difficulty concentrating, mind goes blank

  • Irritability

  • Muscle tension

  • Sleep disturbance

• Distress and impairment

• Not better explained by another disorder

What do people with GAD worry about?

• Everyday, routine life circumstances

• Possible job responsibilities

• Health and finances

• Health of family members

• Minor matters (doing chores, being late for an appointment)

Do the worries associated with GAD stay the same over time?

• Nope! the focus of the worry can shift from one concern to another

• “free floating anxiety”

What is some additional information about GAD?

• 12-Month Prevalence (US): 3%

• Lifetime Prevalence (US): 9%

• Gender: More females than males (2:1)

• Age of Onset (US): Median 30 (large range)

• Genetics: 1/3 of the risk is genetic

What are believed to be cognitive causes of GAD?

• Maladaptive assumptions- likely to interpret situations as dangerous, overreact, and/or experience fear.

• Metacognitive Theory- “worry about worry”.

• Intolerance of Uncertainty Theory- Any possibility of negative occurrence= it is likely. Worry to find “correct solutions, restore certainty.

• Avoidance theory- greater bodily arousal (HR, respiration), worrying reduces these by distracting from the unpleasant feelings (quick and maladaptive).

• Examples of each on slideshow!!!

What are cognitive treatments of GAD?

• Changing Maladaptive Assumptions

  • Point out irrational assumptions

  • Suggest more appropriate assumptions

  • Assign homework to practice challenging and modifying

• Focusing on Worrying

  • Triggers of worry

  • Misconceptions about worrying

  • Try more constructive ways of dealing with anxiety

    • Productive vs. Unproductive worrying

• Acceptance and Commitment Therapy

  • Aware of thoughts

  • Accept as events of mind

  • Less upset and affected by them

What are believed to be biological causes of GAD?

• GABA

  • Inhibitory messages (neuron stops firing)

  • May have problems with anxiety feedback system involving GABA

    • There may be too few GABA receptors?

    • GABA receptors may not properly capture the NT?

  • It is correlational!- may not necessarily be the cause

What are biological treatments for GAD?

• Antianxiety medications (Benzodiazapines)

  • Binds to neuron receptor sites specific to GABA, and increase ability of GABA to bind with them

  • SIGNIFICANT ISSUES WITH BENZOS!

    • Rebound anxiety when stopped

    • Physically dependent (ie. addictive)

    • Dangerous when mixed with other drugs/alcohol

• Antidepressants

  • First line pharmacological treatment for GAD

  • Specifically SSRIs or SNRIs

  • Well tolerated, fewer risks, effective

What is the DSM-5 Criteria for panic disorder ?

• Recurrent unexpected panic attacks (4+ panic symptoms)

• At least 1 attack has been followed by 1 month (or more) of the following:

  • Persistent worry/concern about additional panic attacks OR their consequences

  • Significant maladaptive change in behavior related to the attacks (i.e. avoidance)

• Not attributable to physiological effects of substances or other medical conditions

• Not better explained by another mental disorder

What is some additional information about panic disorder?

• 12 month prevalence (US): 3%

• Lifetime prevalence (US): 5%

• Gender: females > males (2:1)

• SES: poor>wealthy (50% higher)

• Race/Ethnicity: highest for non-Hispanic White Americans

• Age of Onset (US): 20-24 years old

• Environment: Most report identifiable stressors in months before first panic attack

• Genetics: MZ= 31%, DZ= 11%

What are the 3 categories that worry or concern fall into for panic disorder?

• Physical

• Social

• Mental functioning

What are believed to be biological causes of panic disorder?

• Norepinephrine

  • panic related to increased norepinephrine

• Amygdala

  • Processes emotional information

  • Sets “alarm and escape” response into motion

  • Brain circuit probably functions improperly

    • This is a different circuit than the one responsible for worry-dominated anxiety

    • Possible: inherited hyperactive panic circuitry in the brain

What are biological treatments for panic disorder?

• Antidepressant drugs

  • Prevent or reduce panic attacks

  • Some improvement in 80% of patients

  • Requires maintenance therapy

• Benzodiazepines (ie. Xanax)

  • Indirectly affect norepinephrine

  • Potential issue with psychological treatment

What are causes for panic disorder in the cognitive perspective?

• Experience more frequent and intense bodily sensations than others

• Anxiety Sensitivity

  • Tendency to focus on internal sensations

  • Assess them as potentially harmful

  • Research: Biological Challenge Tests- produce sensations that mimic panic. Those with panic disorder become more upset than those without

• Maladaptive Beliefs

  • specifically about physiological events

  • losing control, can return at any time

  • fear the worst dangerous

What is the treatment for panic disorder in the cognitive perspective?

• Cognitive- Behavioral Treatment: Panic Control Treatment (PCT)

  • 1. education- normalize and demystify

  • 2. skill building- breathing, muscle relaxation. Identify and evaluate cognitions

  • 3. Exposure to internal cues- breath through a straw, spinning in a chair, running up stairs

  • 4. Research on Improvement- 80% are free of panic after PCT, 13% are free of panic in control group

What is the DSM-5 Criteria for Agoraphobia?

• Marked fear or anxiety in 2 + of the following situation:

  • using public transportation

  • being in open spaces

  • being in enclosed places

  • standing in line or being in a crowd

  • being outside of home alone

• Fears or avoids these situations because of that:

  • escape might be difficult

  • help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms

• Agoraphobic situation almost always provoke fear or anxiety

• are actively avoided, require presence of a companion, or endured with intense fear/anxiety

• Fear and anxiety is out of proportion to actual danger posed by the situation

• is persistent (6+ months)

• causes significant distress or impairment

• If another medical condition- clearly excessive

• Not better explained by symptoms of another mental disorder

What is the course of Agoraphobia like?

What is some additional information about agoraphobia?

• 12 month prevalence (US): 1%

• Lifetime Prevalence (US): 1.3%

• Gender: females > males (2:1)

• SES: poor > wealthy

• Age of Onset (US): < 30 years old for 2/3 diagnosed

• Effectiveness of Exposure Treatment: 70% find it easier to be in public places, improvement persists for years (may have relapses). 46% seek treatment

What is the DSM-5 Criteria for Social Anxiety disorder?

• Marked fear or anxiety about one or more social situations in which the individuals is exposed to possible scrutiny by others (ex. on slides)

• Fears they will act in a way (or show anxiety symptoms) that will be negatively evaluated

• Social situations almost always provoke fear or anxiety

• are avoided or endured with intense fear or anxiety

• Fear or anxiety is out of proportion to the actual threat posed

• Fear, anxiety, or avoidance is persistent (6+ mos)

• causes significant distress or impairment

• Not better explained by symptoms of another disorder

• If another medical condition is present, fear is unrelated or excessive

Examples associated with criteria for Social Anxiety disorder:

• Criteria A: Social interactions- Having a conversation, meeting new people. Being observed- Eating or drinking. Performing in front of others- giving a speech

• Criteria B: Will be humiliating or embarrassing, will lead to rejection or offend others, concerned they will be judged as anxious, weak, or crazy

• Criteria C: May have anticipating anxiety for in advance of upcoming situations

• Criteria D: Extensive Avoidance- not going to parties, refusing school. Subtle avoidance- over preparing for a speech, limiting eye contact, wearing heavy makeup

What are specifiers and associated features of social anxiety disorder?

• Specifiers- performance only (fine in other settings)

• Associated features- inadequately assertive or excessively submissive OR highly controlling in conversation (less common). May show rigid body posture, inadequate eye contact, speak in an overly soft voice

What is some additional information about social anxiety disorder?

• 12 month prevalence (US): 7%

• Lifetime Prevalence (US): 12%

• Gender: 1:1, may be more females than males (1.5:1)

• SES: poor > wealthy

• Race/Ethnicity: Non-Hispanic White> African, Hispanic, or Asian Americans

• Age of Onset (US): Median 13 years old, 75% between 8 and 15 years old

• Genetics: 1st degree relatives 2 to 6 times more likely to have Social Anxiety Disorder

• Only 12% of shy people meet diagnostic criteria for social anxiety disorder

What are causes of Social Anxiety Disorder?

• Specific psych Vulnerability- learn that social evaluation can be dangerous

• Beliefs and expectation that work against them:

  • Must perform perfectly in social situations.

  • View self as socially unskilled/inadequate.

  • Always in danger of behaving incompetently in social situations.

  • Inept behaviors lead to terrible consequences.

  • Believe no control over feeling of anxiety in social situations

• Beliefs lead to:

  • Avoidance behaviors

  • Safety behaviors

• After social situation:

  • Repeatedly review details of event

  • Overestimate how poorly things went

  • Overestimate what negative results may happen

What are some treatments for social anxiety disorder?

• Exposure therapy

  • Group therapy is a part of this

• Cognitive Therapy

  • Modify maladaptive thoughts/beliefs

• Social Skills Training

  • Improve social skills (and confidence!)

• 40% seek treatment