Lecture 5: Anxiety and OCD Related Disorders

Anxiety

emotional state one experiences in anticipation of a future threat, and is characterized by physiological arousal, negative cognitions, and avoidance behaviors

Anxiety originated as…

an adaptive response to alert individuals that a threat was present and to encourage self-preserving behaviors

Anxiety can be both ______ and ______

adaptive

maladaptive

Anxiety is the most common mental health issue in the US and affects ___% at some point in their life

33.7

Separation Anxiety Disorder

• Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached

• 4 weeks in kids, 6 months in adults

In separation anxiety disorder _____ focus on caregivers, while _____ focus on children or partners

• children

• adults

Selective Mutism

• failure to speak in situations where expected to do so, despite comfort with the language and being able to speak fluidly in other circumstances

• at least 1 month

selective mutism is comorbid with what?

other anxiety disorders (usually social)

Who runs a greater risk of developing selective mutism

people who need to speak in a non-native language

Specific Phobia

Excessive and consistent fear of a specific object or situation and avoidance of feared stimuli

Approx. ___% of individuals fear more than one situation or object (average of __ fears)

• 75%

• 3

Specific Phobia categories

1. Natural environment

2. Animals

3. Mutilation/medical treatment

4. Situations

5. Other

Social Anxiety Disorder

• Fear and avoidance of social situations, specifically because the individual fears negative evaluation or social humiliation

• 6 months

Panic Disorder

• panic attacks are recurrent and followed by at least one month of significant fear of future panic attacks, fear of potential consequences of panic attacks, and/or a change in behavior related to the panic attacks

• more common in women, more frequent in adults

Panic attack

rush of physiological symptoms (e.g., rapid heartbeat, shortness of breath, derealization, fear of dying, etc.) that peaks within minutes

Agoraphobia

• Fear of situations in which a person may not be able to escape or get help if they experience embarrassing (e.g., vomiting) or panic-like (e.g., shortness of breath) physiological symptoms.

• Often feared situations include crowds, lines, enclosed places (e.g., movie theaters), open places (e.g., parking lot), public transportation, or being alone while out of the house

Generalized Anxiety Disorder

Uncontrollable and excessive worry about multiple topics for more days than not over a period of six months, and must experience at least three related physical symptoms (e.g., muscle tension, difficulty concentrating, being easily fatigued)

• Individuals of _____ descent tend to experience GAD more frequently

• Individuals from _____ and _____ income countries are more likely to meet criteria for GAD

• European

• developed; higher

Obsessive-Compulsive Disorder

presence of obsessions and/or compulsions

Obsessions

repetitive, intrusive thoughts, doubts, ideas, or images that cause significant anxiety or distress

Compulsions

repetitive and ritualistic behaviors (including mental acts) that reduce the anxiety caused by the obsessions

Obsessions and/or compulsion take >___ hr a day OR ____ ______ _____ in functioning

• >1 hr

• cause significant impairment

Common obsessions in OCD

1. Contamination

2. Losing control

3. Harm

4. Perfectionism

5. Unwanted sexual thoughts

6. Religious

7. Other

Body Dysmorphic Disorder

Individuals are preoccupied with perceived physical flaws that are minor or not visible to others. The preoccupation must be associated with repetitive behaviors (e.g., checking mirrors, mental acts), and cannot be better explained by an eating disorder

In BDD preoccupations consume an average of __ to _ hrs a day

3 to 8 hrs

No difference in prevalence between men and women, BUT body areas of concern tend to vary by gender:

• Women more likely concerned with their skin, breasts, thighs, and body hair

• Men more likely concerned with genitals, balding, and muscular build

Hoarding Disorder

• Difficulty discarding items resulting in significant accumulation of clutter, to the point of impairment

• More common among older adults

Trichotillomania

Compulsive urges to pull hair, resulting in hair loss, despite repeated attempts to stop

Excoriation

Skin picking that results in lesions, despite attempts to stop

Trichotillomania and Excoriation are often triggered by feelings of _____ or _____, may be preceded by an increasing sense of ____ and followed by ____

• anxiety

• boredom

• tension

• relief

Hypochondriasis

• A preoccupation with developing or having a significant illness or disease; anxiety that is out of proportion with any actual physical symptoms

• High anxiety related to health, and repetitive health-related behaviors (e.g., checking body for signs of disease,

  seeking reassurance from doctors)

Olfactory Reference Disorder

Preoccupation with the erroneous belief that one gives off a foul odor (e.g., unpleasant body odor)

_____ _____ are central to anxiety

cognitive symptoms

Cognitive biases

patterns of deviation from logical reasoning and processing

Two-factor theory

proposes that classical and operant conditioning can explain how fears develop in individuals who suffer from phobias and how avoidance and escape are maintained after the fear has developed

Classical conditioning

fear is learned when a normal fear response to a threatening stimulus becomes associated or paired with a non-threatening stimulus

Operant Conditioning

fear-related behaviors such as avoidance or rituals are learned when the behavior removes an unpleasant stimulus and results in a decrease of uncomfortable emotions and physiological sensations

The cognitive-behavioral model

consistently biased perceptions of events can lead to the distressing emotions, uncomfortable bodily sensations, and detrimental behaviors

Social cognitive theory

fear can be acquired when a fear response is witnessed within a social interaction

Amygdala

• thought to play a major role in threat detection and the acquisition of fear by operating as part of a “fear circuit” with other areas of the subcortical brain

• amygdala may become overactivated in individuals with anxiety disorders

The “defensive survival circuit”

thought to underlie behavioral and physiological responses to a perceived threat and primarily includes subcortical regions of the brain that operate unconsciously

The cognitive circuit

thought to underlie the cognitive and emotional experience of fear

Vulnerability-stress model (aka Diathesis-stress model):

susceptibility to excessive fear might be a hereditary trait, and individuals w/ this trait might be more likely to experience symptoms of anxiety/OCD when confronted by a fear-inducing stimulus.

Unhelpful thinking styles (10)

1. All or nothing

2. Mental filter

3. Jumping to conclusions

4. Emotional reasoning

5. Labelling

6. Overgeneralizing

7. Disqualifying the positive

8. Magnification (catastrophizing and minimization )

9. Shoulds

10. Personalization

Cognitive restructuring:

changing negative patterns of thinking known as cognitive distortions

CBT interventions

• mood or thought logs

• cognitive restructuring

Exposure therapy

Exposing client to a feared stimulus in a gradual way

Exposure and Response Prevention (ERP)

Clients gradually and repeatedly confront the obsessive thoughts and anxiety-provoking stimuli while not performing the compulsive behaviors normally used to alleviate anxiety in the short term

_____ is often used as a primary form of treatment

medication

Individuals w/anxiety often first seek treatment for their symptoms in ____ ___ settings

primary care

The most commonly prescribed classes of medications for anxiety disorders and OCRDs are

SSRIs and SNRIs

Imagine that a father cries every time he drops his 3 year-old daughter off at daycare because he worries that something bad will happen to her and he will not be there to help her.  This has been occurring for about 7 months. These symptoms most closely align with which disorder? 

Separation Anxiety Disorder

True or False: In order to qualify for a diagnosis of Obsessive-Compulsive Disorder, a person must experience both obsessions and compulsions.

false

answer: need obsessions and/or compulsions

True or False: There is no significant difference in the prevalence rates of Body Dysmorphic Disorder between men and women.

true

A 22-year-old resident of New York City avoids taking the subway or other forms of public transportation to get to work or to visit with friends because she worries she may not be able to get help in the event that she faints or vomits.  This person's symptoms most closely align with:

Agoraphobia

Which type of therapy is used to treat anxiety and OCD by helping clients come into contact with a feared stimulus in a gradual way?

Exposure Therapy