Anxiety Disorders

Specific Phobia - main criteria

4 criteria

1. intense fear of some object or situation

2. avoidance of the phobic stimulus

3. sx. persist for at least 6 months

4. fear causes significant distress or impairment

Specific Phobia - main categories

1. injury or blood or injection

2. situations

3. animals

   • most common

4. natural environment

5. “other”

Direct Experience - Behavioral Etiology

• = avoidance conditioning

• Mowrer’s 2 factory theory

  • fear is established via classical conditioning

  • avoidance is then maintained by operant conditioning

Experiencing a false alarm - Behavioral Etiology

An unexpected panic attack in a specific situation may cause a phobia.

• pair a stimulus with an unrelated panic attack

Modeling or vicarious learning - Behavioral Etiology

• phobic response is learned via observation of others

Information transmission - Behavioral Etiology

• just being warned about a potential danger is sufficient

Specific Phobia - Genetics

• genetics is a shared factor

• hard to tell if environment or genetics is why family members share phobias

• blood-injection phobia is the most heritable; may be tied to the vasovagal response

Systemic Desensitization

• used for specific phobias

• most effective

• essentially is counter conditioning

3 steps

1. learning relaxation

2. create an anxiety hierarchy

3. exposure to feared stimulus

Modeling

• specific phobias

• can be either

  • symbolic = watching

  • participant = watch and then participate

Flooding

• specific phobias

• exposure the person all at once

• not the ideal option

Specific Phobia - Drug Therapy

• use benzodiazepines or SSRIs

• relax but don’t take away the fear

Social Anxiety Disorder

a persistent, irrational fear linked to the presence of other people, fear of embarrassment or humiliation NOT a fear of people

common behaviors avoided

• public speaking

• eating

• using public bathrooms

• meeting new people

• interacting with authority figures

Behavioral Conditioning

• SAD

• similar to specific phobias

Biological Preparedness

• SAD

• we are prepared to feel fear, anger, critical or rejecting people

• those with SAD remember critical expressions more

• great activation in the amygdala

Biological Infant Temperament

• SAD

• some infants have inhibition traits (severe shyness)

  • more agitated

  • cry more frequently

Cognitive - SAD etiology

• high standard for their performance

• negative beliefs about consequences

• in their own head, ignore others

• partake in “avoidance” and “safety” behaviors

  • avoid stressful situations

  • avoid eye contact

  • use your phone so you don’t have to talk to people

Exposure

• SAD

• practice participating in events that cause anxiety

Social Skills Training

• SAD

• practice using social skills

Cognitive restructuring

• SAD

• identify negative thoughts, challenge and replace it

• PD

• relabel physical feelings and negative thoughts

Medication - SAD

• benzodiazepines and SSRIs

  • prefer SSRIs as benzos just take the edge off

• high risk of relapse when ceasing medication especially if they haven’t practiced exposure and structuring

SAD treatment

• social skills training

• exposure

• medication

• cognitive restructuring

Panic Disorder

Unforeseen (uncued), repeated panic attacks that cause significant distress/impairment such as concern about having more or avoiding situations.

Panic Attack Sx

Need at least 4

• heart palpitations

• inability to catch breath

• sweating

• nausea

• chills/hot flashes

Biological Causes of Panic Disorder

1. mitral valve prolapse

   • interpret feeling of blood flow as panic

2. locus coeruleus

   • panic due to changes in NE activity in the LC (major brain region for NE)

     • Messes with fight or flight

   • stimulation of the amygdala stimulates the LC

3. genetics

   • runs in families

Cognitive Behavioral Etiology PD

3 main factors

1. attributions

   • less likely for PD if associate panic with specific stressors

2. how fearful they are of body situations

   • measure with Anxiety Sensitivity Index

3. importance of control

   • lack control = increase PD

Positive Feedback Loop

• negative thoughts increase body sensations which increases negative thoughts and so on

Medication PD

1. benzodiazepines

   • addictive

   • relapse

   • some try to self-medicate with alcohol

2. antidepressants

   • SSRIs (paxil & prozac)

Panic Control Therapy

• PD

• create “mini” panic attacks and then use cognitive restructuring to relabel physical sensations

Relaxation and Breathing Techniques

• PD

Generalized Anxiety Disorder

For 6+ months, excessive worry about various daily issues, causing significant distress or impairment in functioning.

GAD Sx

3+

1. restlessness

2. feeling on edge

3. easily fatigued

4. difficulty concentrating

5. irritability

6. muscle tension

7. sleep disturbances

• can’t control worry

• avoidance behavior

• indecisive

Metacognitive Therapy

• GAD

• hold + and - beliefs about worrying but believe the + outweigh the -

  • positives

    • superstitious (worry=it won’t happen)

    • avoid deeper emotions

    • coping and preparation

  • negatives

    • greater sense of danger

    • intrusive thoughts

    • worry about worrying

Intolerance of uncertainty theory

• GAD

• can’t tolerate not knowing if something bad will happen so they focus on finding “correct” solutions

GAD Medications

1. PCP gives benzos to help “calm their nerves”

   • PROBLEM! it’s addictive and doesn’t address worrying therefore have relapses

2. Buspirone

   • more effective at decreasing worry than benzos and not a sedative or addictive

3. antidepressants

   • more effect at decreasing worry than benzos

   • take a while to kick in

Relaxation training/biofeedback

• learn how to relax specific muscle groups

• use electrodes to learn how to control things such as HR

CBT

• GAD

• teach clients to tolerate uncertainty

  • schedule worry sessions

  • mindfulness