Psych 2510 – Trull Chapter 5: Anxiety DisordersAnxiety disorders involve excessive worry, anxiety, or fear. - Worry: concern about future threato Thinking - Anxiety: emotional state that occurs as a threatening event draws near o Anxiety is composed of three parts:  Physical feelings – arousal  Thoughts Behaviors- Fear: intense emotional state that occurs as a threat is imminent or actually occurringDSM-5- Anxiety disorderso Panic disorder, agoraphobia, social anxiety, specific phobia, generalized anxiety disorder- Obsessive Compulsive-related Disorderso Obsessive Compulsive disorder, body dysmorphic disorder (not the same as eating disorder) - Trauma-related Disordero Post-traumatic stress disorder, acute stress disorderAnxiety Disorders: Features Panic attacks - Involve:o Intense physical feelings: heart racing, sweating, and dizzinesso Thoughts that one will lose control, go crazy, or die. - Panic attacks may be uncued (abrupt onset) - Situationally predisposedo Some situations cause more than others - Situationally boundo Every time you are in a certain situation, will have a panic attack Panic disorder: refers to regular uncued panic attacks and worry about the consequences of these attacks. - People with panic disorder may also have agoraphobia, or avoidance of situations where a panic attack mightoccur.Video: a profile of panic disorder.Social phobia: refers to intense and ongoing fear of potentially embarrassing situations - Situationally bound attacks- EX: being around others, eating around others, speaking in front of others 1Psych 2510 – Trull Specific phobia: refers to excessive, unreasonable fear of an object or situation- Examples:o Animals Not fears of dangerous animals (ex: bears) o Natural environment Storms, tornadoes, etc. o Blood-injection-injury Needles, hospitals o Situational  Enclosed spaces, fear of flying Generalized anxiety disorder: refers to extreme levels of persistent, uncontrollable worry (e.g. 6 months)- At least 3 of the following: o Restlessnesso Fatigueo Concentration problemso Irritability o Muscle tensiono Sleep problems2Obsessive-compulsive disorder- Presence of obsessions: troublesome and recurring thoughtso Doubto Need for ordero Aggressive impulses o Sexual images - Presence of compulsions: Physical or mental acts performed in response to an obsession to lessen distresso Checkingo Organizingo Countingo Hand washing Posttraumatic stress disorder: refers to constant re-experiencing of a traumatic event through images, memories, nightmares, flashbacks, illusions, or other ways.- Traumatic event - Intrusion symptoms: memories, images, dreams- Avoidance of thoughts/places/behaviors associated with trauma - Negative alterations in cognition and mood- Increased physiological arousal: hyper-vigilance, trouble sleeping, irritability, startle- Symptoms for generally 1 month Acute stress disorder: refers to short-term anxiety and dissociative symptoms following a traumaVideo: Darwin, a profile of posttraumatic stress disorder. Separation anxiety disorder: refers to children with excessive worry about being away from home or from close family members. The disorder may be associated with school refusal behavior. Anxiety Disorders: Epidemiology- Anxiety disorders are common to the general population and especially females. - Many anxiety disorders develop at age 19-31 years. - Anxiety disorders are often associated with other anxiety disorders, depression, and substance abuse.- Prevalence rates are high Anxiety Disorders: CausesBiological Risk Factors - Several brain areas have been implicated in anxiety disorderso Amygdala Evaluation of threat/experience of fear Strong negative emotions Arousal Startleo Septal-hippocampal regions Part of the brain associated with assisting person in response to threat EX: flight or fight o These are both associated with physical arousal, emotion, and memories surrounding fearful and anxiety provoking stimuli - Neurotransmitter systems o Serotonino Norepinephrineo Cortisol – threat Released with stress o GABA – inhibits nerve cells related to anxiety - Other brain areas are specific to certain anxiety disorderso Anterior cingulate  in obsessive-compulsive disorder o Locus coeruleus  panic disorderEnvironmental Risk Factors- Preparedness: evolutionary influences o Anxiety may be influenced by evolutionary processes o Some avoidance behaviors seem adaptive in certain contexts.- Cognitive risk factors: exaggerated danger, catastrophize o Distorted thinking about the dangerousness of various stimulio Assumptions that something bad will happeno Assumptions of terrible consequenceso Assumptions that others can easily notice one’s anxiety- Anxiety sensitivity: refers to fear of the potential dangerousness of one’s own internal sensations suchas dizziness and increased heart rate.o Over-sensitive to physiological sensations associated with anxiety - Family factors/modelingo Over controllingo Affectionlesso Overprotectiveo Rejectingo Demanding parentso Parents may also model anxiety-based responses or induce anxiety by maltreating their childreno People can learn aspects of fear and anxiety through direct experience, information transfer, orreinforcement for fear of strangers or other stimuli.- Cultural factors influence the development of anxiety disorderso Particularly in people more commonly exposed to neighborhood or mass traumasAnxiety Disorders: PreventionPreventing anxiety involves: - Building ability to control situations that might lead to anxiety- Education about dangerous and non-dangerous situations- Changing negative thoughts- Coping better with stress- Practicing skills in real-life situationsInterviews, self-report questionnaires, and observations - Used to collect information about people with anxiety disorders because of the internal nature of the symptoms.Physiological assessment of anxiety disorders consist of:- Determining heart rate- Muscle tension- Sweat gland activity- Other symptoms to measure their severityAnxiety Disorders: TreatmentEffective treatment for anxiety disorders addresses:- Unpleasant physical feelings- Negative thoughts- Avoidant behaviorsBiological treatment - Medicationso EX: benzodiazepines (Xanax) and antidepressants (SSRI)o Problem with benzo. Is easily abused and addictive  Cannot be mixed with alcohol  Not effective long term b/c not able to overcome the emotions Psychological treatments - Often begin