Anxiety & Obessive-Compulsive Disorders

The main difference between fear and anxiety

fear reflects an adaptive state for dealing with real threat or danger; anxiety is a chronic fear sensation not clearly associated with any specific stimulus

Fear

Subjective experiences of apprehension

• dread, fright, a desire to flee

Behavioral manifestations

• flight, fight, freeze

Physiological responses

• change in heart rate, sweating

Anxiety

Reflects a sense of worry, concern, or apprehension, involving emotional and physiological experiences

Gender differences in anxiety disorders

Diagnostic Bias

Women seek treatment more often

Men may underreport symptoms

Women may have greater exposure to trauma

There may be biological differences between men and women

Criteria for Generalized Anxiety Disorder Diagnosis

Has anxiety and worry about multiple things for 6 months or more; worry is ongoing, disproportionate, and difficult to control. Has at least 3 symptoms of poor concentration, irritability, edginess, muscle tension, fatigue, and sleep problems — PIEMFS

GAD Biological Causes

Some hereditary risk, possible GABA defiency, overactive fear circuit, amygdala and insula may be overactive, and less regulation from the prefrontal cortex and anterior cingulate cortex

GAD Cognitive-Behavioral Specific Types (2)

Maladaptive assumptions and Intolerance of uncertainty

Maladaptive assumption

A cognitive-behavioral part of GAD where you see things as more threatening than they actually are

Intolerance of uncertainty

A cognitive-behavioral part of GAD with difficulty dealing with the possibility that something bad could happen, even if it is very unlikely

Medications for GAD

Benzodiazepines and SSRIs

Therapy for GAD

Rational-emotive therapy & Mindfulness

Rational-emotive therapy

a therapy for GAD that changes irrational thoughts and behaviors by identifying them and replacing them with more realistic thoughts and healthier behaviors

Therapy of Mindfulness

A therapy for GAD that accepts worries rather than trying to eliminate them by teaching people to focus on the present, observe their thoughts and feelings without judging them, and accepting worries without reacting to them.

Specific Phobia & Criteria

fear of a certain object or situation - persistent, disproportionate fear, lasts 6+ months, exposure to it is immediate fear, person avoids it, and causes distress

Agoraphobia

Fear of situations where escape may be difficult, or help may not be possible

Agoraphobia - the person has anxiety in two or more of . . .

Public transportation, open spaces, enclosed spaces, crowds/lines, and being outside home for 6+ months

Social Anxiety Disorder

Fear of social situations, unfamiliar people, being watched or judged, acting embarrassingly — can cause avoidance of group situations or safety behaviors

Causes of Phobias

Hereditary, two-factor theory (classical & operant conditioning), and modeling

Hereditary cause of Phobias

some fears may have survival advantages, such as fear of animals, darkness, or heights

Two-factor Theory Cause of Phobia

Classical Conditioning = fear is learned by association

Operant Conditioning = avoiding the fear reduces anxiety, which reinforces avoidance

Modeling Cause of Phobia

learning fear by watching other people

What is the best treatment for a phobia and what two things follow under this type of therapy?

Exposure therapy

(1) systematic desensitization

(2) flooding

Systematic desensitization

A type of exposure therapy where you are exposed to your phobia/fear while staying relaxed

Flooding

A type of exposure therapy where you are intensely exposed to the feared object or situation on repeat

Panic Attack Criteria

Rapid onset, increased heart rate, shaking, shortness of breath, and fear of dying

Cued = triggered by something

Uncued = happens unexpectedly

Panic Disorder Criteria

Recurrent and unexpected for one month or more, the person has anxiety about future attack OR dysfunctional behavior changes like avoidance or safety behaviors.

Causes for a Panic Disorder

Biological, Cognitive, and Behavioral

Biological cause for a Panic Disorder

Hereditary, oversensitive fear network, low GABA activity, and a greater sensitivity to caffeine

Cognitive cause for a Panic Disorder

Anxiety Sensitivity - a person interprets normal physical sensations as dangerous or threatening, which can trigger or worsen a panic attack.

Behavioral cause for a Panic Disorder

Panic becomes a conditioned response to internal or external cues/stimuli

Avoidance and learned fear—a person may learn to fear certain situations or physical sensations after experiencing a panic attack and then avoid them, which reinforces the fear

panic attack in a crowded store → avoiding crowd → avoidance reduces anxiety temporarily → fear becomes stronger over time

Treatments for a Panic Disorder (medications & therapy)

Medications: Benzodiazepines, SSRIs & SNRIs

Therapy: Cognitive Behavioral Therapy (CBT), Cognitive restructuring, and exposure to feared internal OR external stimuli

OCD Obsessions

Repeated thoughts, urges, and images. Thoughts are unwanted, difficult to control, and usually cause anxiety/distress

OCD Compulsions

Repeated behaviors, mental acts, are performed to reduce anxiety, or prevent something feared

Washing - checking - praying - counting

OCD Criteria

Obsession, compulsion or BOTH

More than 1 hour per day OR significant distress/impairment

OCD Causes

Hereditary risk, personal history of abuse, hyperactive brain circuit, thought-action fusion, two-factor theory/negative reinforcement

• Germs - anxiety - handwashing - anxiety decreases - handwashing is reinforced

OCD Treatments

Medications: SSRIs

Exposure and response prevention (ERP), and cingulotomy

ERP

Expose the person to the obsession while preventing the compulsive behavior - an OCD treatment

Body Dysmorphic Disorder

A defect in appearance, defect is slight or imaginary, repetitive behaviors/thoughts about appearance, causes distress or dysfunction, and can involve muscle dysphoria

Hoarding Disorder

Unable to discard possessions, significant distress when getting rid of things, can involve magazines, junk mail, notes, and receipts

Trichotillomania Disorder

Hair pulling

Excoriation Disorder

Skin picking

Treatment: habit reversal therapy

Cingulotomy a treatment for OCD

A rare surgical treatment for severe, treatment-resistant OCD that involves making small lesions in the cingulate cortex to disrupt brain circuits involved in OCD symptoms.