Anxiety Disorders and Obsessive Compulsive Disorders

Anxiety Disorders

• Panic disorder

• Agoraphobia

• Generalized anxiety disorder

• Obsessive-compulsive disorder

• Social anxiety disorder

• Separation anxiety

• Selective mutism

Panic Attack

• Experience of recurring, unexpected panic attacks in a person's lifetime.

• At least one of these attacks has been followed by a 1-month period in which the individual worries about having additional attacks or their implications (e.g., having a heart attack), and/or the individual has changed his or her behavior in a maladaptive way (e.g., avoiding situations that may provoke panic sensations).

Agoraphobia

Life time symptoms:

• Becoming isolated or detached

• Feeling afraid of being alone

• Overdependence on others

• Being afraid of losing control in public

• Avoiding places that may be difficult to escape from

• Refusing to leave the house

Intervention: Symptom management

Generalized Anxiety Disorder (GAD)

All of the below features must be present in order to make a proper diagnosis of GAD:

1. Excessive anxiety and worry, occurring more days than not for at least 6 months, concerning a number of events;

2. The individual finds it difficult to control the worry;

3. The anxiety and worry are associated with at least three of the following six symptoms (only one item required in children):

   1. Restlessness, feeling keyed up or on edge.

   2. Being easily fatigued

   3. Difficulty concentrating

   4. Irritability

   5. Muscle tension

   6. Sleep disturbance

Social Phobia (Social Anxiety Disorder)

A.  A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.

B.  Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack.  

C.  The person recognizes that this fear is unreasonable or excessive.

D.  The feared situations are avoided or else are endured with intense anxiety and distress.

E.  The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

F.  The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months.

G. The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder.

Obsessive-compulsive Disorder

Obsessions:

• Recurrent and persistent thoughts, impulses, or images that are intrusive and cause marked anxiety or distress; but are not excessive worries about real-life problems;

• The person attempts to ignore, suppress or neutralize these thoughts, impulses, or images;

• The person is aware that the obsessional thoughts, impulses, or images are a product of his or her own mind, as opposed to delusional in nature

Compulsions:

• Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession;

• The behaviors or mental acts are directed at preventing or reducing distress or a dreaded event or situation;

• These behaviors or mental acts may not always be associated with the content of the obsessional theme. For example, if the theme is Contamination, the ritual may involve mental rehearsal or counting;

• The symptoms of OCD are not the result of another psychiatric disorder present or caused by a medical condition or substance abuse

Separation Anxiety

Extreme anxiety of an individual that is related to separation from others to who the person is attached” (APA, 2013)

• Anxiety must be inappropriate for developmental stage

• For this diagnosis to be made at least three signs of excessive anxiety must be demonstrated at times when the individual faces separation from an important figure

 Symptoms must be persistent over at least 4 weeks for children or 6 months for adults

Symptoms:

• Excessive distress when thinking about or experiencing a separation from major people in one's life

• Worry about losing these people or about unlikely events (kidnapped)

• Refusal to participate in activities away from home

• Excessive fear of being alone

• And/or frequent nightmares or physical complaints when separation occurs

Selective mutism

• Unwillingness to speak in certain settings

• No clear reason (such as hearing impairment) that results in the inability to produce speech

• To some extent a choice by the individual

Criteria

• Repeated failure to speak in a setting where speech is expected

• The individual speaks in other settings

• Failure to speak interferes with function

• Failure to speak is not the result of language different

• Disturbance lasts at least 1 month

Role of OT

What can you do?

•Teach/educate stress management strategies

•Establish a balanced work/leisure schedule

•Incorporate physical activity

•Promote/establish a sleep routine

•Teach relaxation techniques

•Teach coping strategies/skills

•Promote leisure exploration/return to meaningful occupations

Intervention Strategies

• Social Skills Training

• Coping Skills

• Problem Solving

• Stress management techniques

  • relaxation

  • deep breathing

  • progressive muscle relaxation

  • Guided Imagery

  • Autogenics

Teaching social skills

1. Assess to determine the social skills deficits

2. Discuss the need for social skills

3. Select a social skill

4. Teach the social skill (preferably in the natural setting where they would typically be used)

5. Practice the skill (generalize the social skills to other situations)

6. Over teach!!!!!

7. Pause, review, and reflect

Before you can help someone improve their social skills, they need to understand why these skills are important.

Brainstorm a list of social skills that would be necessary as a student was to progresses through grade school?