Session 8: Anxiety

Physical symptoms of anxiety

Increase in arousal ( heart rate, sweating, butterflies in stomach, more blood to muscles) in preparation for flight/ fight

When does anxiety become a problem?

- Danger is imagined

- Anxiety is out of proportion to the danger, is persistent, and disabling

- Worrying about normal aspects of daily life or no identifiable trigger

- Panic attacks

- Prolonged and affects functioning

Anxiety is often experienced concurrently with ___ (60%)

Depression

Anxiety disorders

A group of mental disorders characterized by feelings of anxiety and fear

List some anxiety disorders

- Generalised Anxiety Disorder

- Obsessive Compulsive Disorder

- Social phobia

- Post-traumatic stress disorder

- Panic disorder

- Specific phobias

Generalised Anxiety Disorder

• An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal

• Feeling anxious most days for at least several weeks at a time, and usually for at least 6 months

Three main features of Generalised Anxiety Disorder (GAD)

• Excess worrying, difficulty concentrating, sleeping

• Muscle tension, inability to relax, feeling on edge

• Palpitations, breathlessness, trembling/shaking, dry mouth, sweating

What are the two types of phobia?

- Social = agoraphobia, social anxiety disorder

- Specific = e.g., dental, fear of needles/injections

Phobia

Phobias are a disruptive fear that is severe enough to induce distress and/or interfere with the patient’s job or social life, thus leading to avoidance of the stimuli.

Panic disorder

• Recurrent attacks of sudden, severe anxiety

• May lead to avoidance of certain situations

• Persistent fear of having another attack

Panic attack

Episodic attacks lasting around 10 minutes typically, palpitations/chest pain/shortness of breath/choking sensations/feeling dizzy.

Obsessive Compulsive Disorder (OCD)

• Uncontrolled intrusive and irrational thoughts (obsessions)

• Ritualised behaviors to relieve the distress/anxiety or to “stop” harm (compulsions)

What causes some anxiety disorders?

• Unique to individuals - traumatic experiences

• Genetics

• Neurotransmitters, neurobiology

• Conditioning

• Cognitive distortions and cognitive bias

___ history is a predisposing factor to developing anxiey disorders

Family

What are the two major pathways for fear processing in the brain?

1) Cerebral cortex = slow

2) Amygdala = fast

The ___ seems more active in anxious individuals

Amygdala

What neurobiological differences can be observed in the brain of individuals with anxiety?

- Amygdala more active

- Inadequate suppression by prefrontal cortex (PFC)

- Reduced GABA

Operant conditioning

a type of learning in which behavior is strengthened if followed by a reinforcer or diminished if followed by a punisher

Give an example of negative reinforcement which exacerbates anxious behaviours or thoughts?

- Avoidance of circumstances where they are likely to confront their fear

- Escaping from situations where they are confronted with that fear

Treating patient with suspected/known GAD

- Identification & assessment that does not solely rely on number, severity & duration of symptoms

- Psychoeducation, monitoring

Treating patient with GAD that has not shown improvement after psychoeducation & active monitoring

- Low-intensity interventions: Individual non-facilitated and facilitated self-help

- Psychoeducational groups

- Self-help groups

Patient with marked functional impairment due to GAD that has not responded to low-intensity interventions

- CBT

or

- Applied relaxation

or

- Drug treatment (SSRI)

or

- Combined approach

Patient with complex, treatment-resistant GAD and very marked functional impairment +/- high-risk of self-harm

- Referral to community mental health services/specialist services

Initial low-intensity interventions (self-care strategies) for anxiety

Sleep hygiene, smoking/drug cessation, alcohol reduction, self-help, exercise

What are 'high-intensity' treatments for anxiety?

- CBT

- Medications = SSRIs

What is 'combined' approach to treating anxiety?

- Psychological therapies AND SSRIs

Complex, treatment-refractory GAD and very marked functional impairment or high risk of self-harm

Referral to specialist services

What is one type of intervention for OCD specifically?

Exposure-response prevention

What tool is used to identify anxiety disorders in patient?

GAD-2

- If GAD is >3 = continue to GAD-7 for assessment of severity

- If GAD is <3 = ask 'Do you find yourself avoiding places or activities and does this cause you problems?’

If yes, consider GAD