anxiety, OCD, trauma, stressor

Panic disorder

• Anxiety disorder

• Recurrent episodes of panic

• Unexpected attacks

• Anxiety reactions & physical symptoms

Panic attacks

Extreme form of anxiety

Anxiety disorder

• Psychological disorder

• Anxiety is prominent feature

• Encompasses many physical features, cognitions, & behaviours

Prevalence

Overall number of cases of a disorder existing in a population during a given period of time

Etiology

Cause or origin

Panic disorder DSM criteria

• Recurrent unexpected panic attacks w/ 4+ symptoms

• Persistent concern or worry about additional panic attacks

• Not bc of substance abuse or another medical condition

• Not another mental disorder

Agoraphobia

Fear of places & situations where it might be difficult or embarrassing to escape

Agoraphobia DSM criteria

• Marked anxiety of 2+ situations

• Fears or avoids these situations

• Situations evoke fear or anxiety

• Situations are actively avoided, require companion, or endured w/ intense fear/anxiety

• Out of proportion to actual danger

• Feelings are persistent

• Causes clinically significant distress or impairment

• Not better explained by another mental disorder

Generalized anxiety disorder (GAD)

• Persistent feelings of anxiety

• Not triggered by any specific object, situation, or activity

• Uncontrollable worrying key feature

Generalized anxiety disorder DSM criteria

• Excessive anxiety & worry

• Difficulty controlling worry

• Symptoms

• Clinically significant distress or impairment

• Not bc of substance or medical condition

• Not another mental disorder

Symptoms of generalized anxiety disorder

• Restlessness, being keyed up or on edge

• Easily fatigued

• Difficulty concentrating, mind going blank

• Irritability

• Muscle tension

• Sleep disturbance

Fear

Feeling of anxiety & agitation in response to stimulus

• Sympathetic nervous system activity

• Tendencies to avoid feared object

Phobic disorders

• Persistent fears of objects or situations that are disproportionate to the threats they pose

• Not out of touch w/ reality, generally recognize that fears are excessive or unreasonable

Types of phobic disorders (2)

• Specific phobia

• Social anxiety disorder

Specific phobias

Persistent, excessive fears of specific objects or situations

• Often begin in childhood

Acrophobia

Fear of heights

Claustrophobia

Fear of enclosed spaces

Subtypes of specific phobia (5)

• Animal type

• Natural environment

• Blood-injection-injury type

• Situational type

• Other types

DSM criteria specific phobia

• Marked fear or anxiety

• Immediate fear response

• Avoidance or endurance w/ intense fear

• Out of proportion

• Persistent

• Clinically significant distress or impairment

• Not another mental disorder

Social anxiety disorder

• Excessive fear of engaging in behaviours that involve public scrutiny

• Excessive fear of neg. evaluations from others

• Roots may begin in childhood

Separation anxiety disorder

• Childhood disorder

• Extreme fears of separation from parents or others whom the child is dependent on

• Development typically follows stressful life event

Obsessive-compulsive disorder (OCD)

• Recurrent obsessions/compulsions

• Marked distress

• Significantly interfering w/ normal routines or functioning

Obsession

• Intrusive, unwanted, & recurrent thought, image, or urge

• Beyond person’s ability to control

Compulsion

• Repetitive behaviour or mental act person feels compelled/driven to perform

• Often occur in response to obsessional thoughts

• Frequent/forceful enough to interfere w/ daily life or cause significant distress

two types of compulsions

• Checking rituals

• Cleaning rituals

Adjustment disorders

• Maladaptive reaction to identified stressor that develops within a few months of the onset of the stressor

• Impaired functioning

• Signs of emotional distress

DSM criteria for adjustment disorder

• Emotional or behavioural symptoms

• Distress or impairment

• Not another disorder

• Not bereavement

• Resolution of symptoms

Acute stress disorder (ASD)

• Traumatic stress reaction occurring in the days & weeks following exposure to traumatic event

• Extreme anxiety & dissociation

Dissociation

Feelings of detachment from oneself or environment

Posttraumatic stress disorder (PTSD)

• Impaired functioning following exposure to traumatic experience

• Experiences problems for at least 1 month

Ways traumatic events may be re-experienced

• Intrusive memories

• Recurrent disturbing dreams

• Feeling the event is recurring

PTSD & hippocampus

• PTSD may damage hippocampus & make it smaller

• Smaller hippocampus may be a sign that a person is vulnerable or more likely to develop PTSD after traumatic experience

Anxiety from psychodynamic perspective

• Danger signal that threatening impulses of sexual or aggressive nature are nearing the level of awareness

• Ego stems this by mobilizing its defence mechanisms

Anxiety & behavioural perspective

• Anxiety disorders acquired through process of conditioning & learning

Two-factor model

Operant & classical conditioning involved in the acquisition of phobic responses

• Classical conditioning - fear component

• Operant conditioning - avoidance component

Prepared conditioning

People may be genetically prepared to acquire phobic responses more readily to certain classes of stimuli than to others

• Fear of large animals, snakes, heights, strangers

Extinction

Gradual weakening or elimination of response

Cognitive perspectives & anxiety

Certain cognitions/thoughts/beliefs can heighten anxiety

• Self-defeating/irrational beliefs

• Oversensitivity to threats

• Anxiety sensitivity

• Misattributions of panic sensations

Anxiety & oversensitivity to threat

Overly sensitive internal alarm system to cues of threat

Anxiety sensitivity

Fear of fear

• Fear that one’s emotions or states of bodily arousal will get out of control & lead to harmful consequences

Misattributions of panic sensations

Assume that panic attacks involve catastrophic misinterpretations of bodily sensations like heart palpitations, dizziness, or light headedness

Biological perspective & anxiety

Genetic factors & NT contribute to anxiety disorders

Genes & environment are important

Neuroticism

• Personality trait

• Worrisome behaviour, anxious, apprehension about future, avoidance behaviour

Gamma-aminobutyric acid (GABA)

• Inhibitory NT

• Plays a role in regulating anxiety

Inhibitory NT

• tones down excess activity in the nervous system

• Prevents neurons from overly exciting their neighbours

Benzodiazepines

• Class of minor tranquilizers

• Regulate GABA receptors & enhance GABA’s calming effects

Fear network

Network of brain connections that help people regain safety & security

• Centered in amygdala

• Interactions w/ hippocampus & medial prefrontal cortex

Amygdala

Regulation of defensive emotions like fear & anger

Hippocampus

Processes of memory

Psychodynamic treatment

Foster clients’ awareness of inner sources of conflict

Humanistic treatment

Aim at helping people get in touch w/ & express their genuine talents & feelings

Biological treatment

Variety of drugs to treat anxiety disorders

Cognitive & behaviour-based treatment

Variety of techniques aimed at helping individuals confront the objects/situations that elicit their fears & anxieties

• Replacing their irrational or self-defeating thoughts

Treatment of phobic disorders

• Systematic desensitization

• Gradual exposure

• Flooding

Fear-stimulus hierarchy

• Ordered series of increasingly fearful stimuli

• Used in systematic desensitization & gradual exposure

Flooding

• Type of exposure therapy where subjects are exposed to intensely anxiety-provoking situations

• Just as effective as other techniques, may work faster

Cognitive restructuring

Replacing irrational or self-defeating thoughts & attitudes w/ rational alternatives

Treatment of agoraphobia

• Stepwise treatment

• Gradually exposing individual to increasingly fearful stimulus situations

Treatment of PTSD

• Exposure therapy

• Cognitive restructuring

Treatment of OCD

• Behaviour therapy

• Exposure therapy

• Response prevention

Response prevention

Effort to physically prevent compulsive behaviour from occurring

Treatment of generalized anxiety

• Relaxation training

• Substitution of adaptive thoughts for intrusive, anxiety-inducing thoughts

• Decatastrophizing

Decatastrophizing

Avoiding tendencies to think the worst

Treatment of separation anxiety disorder

• Coping strategies

• Strengthening child’s sense of autonomy & self-efficacy

• Targeting cognitive aspects

Treatment of panic disorder

• Training skills to handle panic attacks w/o catastrophizing

• Breathing retraining

• Exposure to related situations & bodily cues

• Training in relaxation

Physical features of anxiety

Alert system goes up

• Jumpiness

• Jitters

• Increased perspiration & heart rate

• Dizziness & nausea

Behavioural features of anxiety

• Need to escape or avoid a situation

• Agitation

• Clinginess

• Need for reassurance

Cognitive features of anxiety

• Excessive & prolonged worrying

• Overly aware of bodily sensations

• Jumbled thoughts

• Nagging thoughts

• Dread & fear

Panic attack

• Strong physical reactions

• Cardiovascular symptoms

• Feels like a heart attack

Physical symptoms of panic disorder

• Pounding heart

• Rapid respiration

• shortness of breath

• Heavy perspiration

• Dizziness

• Weakness

Selective mutism

• not initiating or reciprocating speech barring medical explanation

• Can/will speak to specific people but not to others or in certain situations

• Have the cognitive ability to speak but lots of anxiety associated w/ it