Slide 1Anxiety vs. fearExampleAnxiety disordersAnxiety disorderDSM-5 Checklist: GADGeneralized Anxiety disorderGAD explanationsGAD ExplanationsGeneralized anxiety disorderGeneralized anxiety disorderPhobic DisordersDsm-5 checklist: Specific PhobiaSpecific phobiaSpecific phobiaSpecific phobiaDsm-5 checklist social phobiaSocial phobiaSocial phobiaSocial PhobiaDsm-5 checklist panic disorderPanic disorderPanic disorderPanic disorderPanic Disorder explanationsPanic disorderDsm-5 checklist oCDObsessive Compulsive disorderObsessive compulsive disorderObsessive compulsive disorderOCD ExplanationsObsessive compulsive disorderObsessive compulsive disorderObsessive compulsive disorder•P S YC 3 0 6 • 2 / 5 / 1 5 - 2 / 1 0 / 1 5ANXIETY DISORDERSANXIETY VS. FEAR•Fear is a state of alarm in response to a serious threat to one’s well-being•Anxiety is a state of alarm in response to a vague sense of danger/anticipating a future threat•Same physiological features:•Breathing fast, sweating, tensing up•Sure, fear/anxiety can be useful•Prepare us for fight/flight when threatened•For some people, its too severe and too frequent or is triggered too easily•This results in anxiety or anxiety-related disordersEXAMPLE•Rapport/alliance/relationship is the best predictor of a positive therapeutic response in all therapy models!!!ANXIETY DISORDERS•Most common disorder in the US•18% of adults suffer from an anxiety disorder each year while 29% develop a disorder throughout their lifetime•Only 1/5 of individuals seek treatment•Societal Impact•$42 billion in health care, lost wages and lost productivityANXIETY DISORDER•Comorbidities•Another anxiety disorder•Depression•Earlier in life:•More comorbidity •More impaired•MOST COMMON TO HAVE 2 ORMORE DISORDERSDSM-5 CHECKLIST: GADGeneralized Anxiety DisorderA. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The individual finds it difficult to control the anxietyC. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6Imonths):1. Restlessness or feeling keyed up or on edge.2. Being easily fatigued.3. Difficulty concentrating or mind going blank.4. Irritability.5. Muscle tension.6. Sleep disturbance.D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.E. Not caused by a substance.F. Not better explained by another disorder.GENERALIZED ANXIETY DISORDER•Excessive anxiety under most circumstances and worry about practically anything•“free-floating” anxiety•“danger” isn’t a factor•Prevalence:•2.9% in general community of US•Women 2:1•More common with European descent•Development:•Appears in adolescence•Peaks in middle ageGAD EXPLANATIONSSOCIOCULTURAL•People faced with truly dangerous social conditions are more likely to experience GAD•poverty= most powerful societal stressorResearch:•Although poverty and social pressures influence the development of GAD other factors are more important•Most people that live in a dangerous environment don’t have GAD, difficult to explain whyPSYCHODYNAMIC•All children experience anxiety and use defense mechanism to help control it•Psychoanalysts trace anxiety back to the parent-child relationshipResearch: •People with GAD do use defense mechanisms•Children who were severely punished for id impulses do develop more anxiety later in lifeGAD EXPLANATIONShumanistic•When people stop looking at themselves honestly and acceptingly•Lack of ‘unconditional positive regard’ in childhood leads to harsh self-standards or ‘conditions of worth’ •Threating self-judgments cause anxiety and set the stage for GADCOGNITIVE•Since excessive worry is inherently cognitive, there is a lot of cognitive theory on GAD•Albert Ellis: basic maladaptive assumptions lead people to behave in inappropriate ways•It is a necessity for humans to be loved by everyone•It is catastrophic when things are not as I want them•Aaron Beck: people with generalized anxiety disorder constantly hold silent assumptions •“A situation or a person is unsafe until proven to be safe” •“It is always best to assume the worst”GENERALIZED ANXIETY DISORDERCOGNITIVE TREATMENT•Changing maladaptive assumptions•Ellis’ rational emotive therapy (RET)•Point out irrational assumptions•Suggest more appropriate assumptions•Assign homework•Limited research, but current findings are positive•Breaking down worry•Psychoeducation about worrying and GAD•Assign self-monitoring of bodily arousal and cognitive responses•Clients become skilled at identifying worry and misguided attempts at control by worrying•CBT PMR exampleGENERALIZED ANXIETY DISORDERBIOLOGICAL•GAD is caused by biological factors•Family pedigree studies:•15% of relatives vs. 6% in general population•GABA•Benzodiazapines reduce anxiety•Benzodiazapine receptors (in neurons) ordinarily receive gamma-aminobutyric acid (GABA) •GABA causes a neuron to stop firing messages•Problems in feedback systemsTreatment•Antianxiety and Antidepressant drugs•relaxation Training: Physical relaxation leads to psychological relaxation•Used with biofeedback: use feedback from electrical signals from the body to train people to control physiological processesPHOBIC DISORDERS•Persistent and unreasonable fears of particular objects, activities, or situations•avoid the object or situation as well as thoughts about it•More intense and persistent•Greater avoidance•Distress that interferes with functioning •Most phobias technically are categorized as “specific” there are also two broader kinds: social phobia and agoraphobiaDSM-5 CHECKLIST: SPECIFIC PHOBIASpecific PhobiaA. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). B. The phobic object or situation almost always provokes immediate fear or anxiety.C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.E. The fear,