HD 3700 1st Edition Lecture 18Outline of Last LectureI. R.D. Laing’s revolutionary approachII. Subtypes of SCZIII. Hamlet’s speech to the playersIV. Prelim Study GuideOutline of Current Lecture: Anxiety and Everyday LifeI. “Normal Anxiety” and common ways of coping with itII. Obsessive-Compulsive Disorder and its neuro-anatomical circuit.III. The range of anxiety disordersIV. Hamlet and HoratioCurrent LectureI. “Normal Anxiety” and common ways of coping with it- The role of anxiety in everyday life: anxiety is a necessary part of everyday lifeo Big changes generate anxiety—going to college, break up, etc.- Anxiety as a motivator: not much difference between anxiety and excitement, heart beat increases - Anxiety as an inhibitor—the mind is associative, the speed / range of associationscan be constricted / limited by anxiety, boring people have a constricted range of associations- Anxiety and temperament—you can categorize people by temperament, some people have a depressive style, some have a manic style, some have an anxious style- Anxiety and early experience—orphans, children who were traumatized in early childhood tend to have high anxiety, cortisol levels and the way that the brain organizes itself gets set up in early experience - Anxiety and defenseso Defenses are always fueled by anxiety!!! o If something makes you anxious, you will associate to it easilyo Defenses are ways of distorting/suppressing associations- Some of the defenses against anxiety in everyday lifeo Magical thinking—wearing same underwear on game dayo Obsessionso Compulsions—checking that you locked the door multiple timeso Perfectionismo Rumination—thinking about it over and over and overo Dissociation—just not letting yourself think about ito Eating disorders—are really anxiety disorders, with a distorted componento Drugs, alcohol- Three component model of anxietyo Potential stressors: failures, personal losses, frightening events, time pressure, insultso Stressor perceived as a threato Bodily effects: automatic emergency response, shallow breathing, pounding heart, tense muscles, sleep disturbances, fatigue, psychosomatic illnesso Upsetting thoughts: anger, fears, preoccupations, self-doubts, negative self-talk, repeated “danger” thoughts, worry about body reactions and healtho Ineffective behavior: escape, avoidance, indecision, aggression, inflexible responses, poor judgment, inefficiency, drug useII. Obsessive Compulsive Disorder- Obsessions: preoccupation with…o Dirt, germs, environmental toxinso Something terrible happeningo Symmetry, order, exactnesso Excessive praying or religious concerno Bodily wastes or secretionso Forbidden, aggressive, or perverse sexual thoughtso Fear you might harm others or yourselfo Lucky or unlucky numberso Intrusive nonsense words, sounds, or music- Compulsionso Ritualized hand washing, bathingo Repeating ritualso Checkingo Rituals to remove contact with contaminantso Ordering or arrangingo Countingo Hoarding or collecting ritualso Rituals of clearning- An important distinctiono Many, if not most people, who struggle with anxiety (and many, if not most people struggle with anxiety) find themselves thinking obsessively or doing some things compulsively. o These symptoms can cause enough distress to send someone into therapy to work on the sources of the anxiety.o However, Obsessive-Compulsive Disorder (OCD) is much more severe, is related to Tourette’s Syndrome, schizophrenia, and other developmental-brain disorders.- Diagnostic criteriao Obsessions are: recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distresso Compulsions are defined by: repetitive behaviors or mental acts that the person feels driven to perform in response to an obsessions or according to rules that must be applied rigidly The behaviors or mental acts are aimed at prevention or reducing distress or preventing some dreaded event of situation, however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive- OCD as a “movement disorder”o The theory goes like this: there is a pathway between the orbitofrontal cortex (where your thoughts and feelings generate) and the cingulum embedded in the cingulate gyrus which in turn activates the caudate nucleus(which runs your “automatic” body movements). With OCD, this pathway is unmodulated so that thoughts can set off compulsive movements … o …. and feelings, aroused by the amygdala, can also contribute to the system by setting off compulsive thoughts and fears.- OCD brain scanso Pathways between thinking and action appear to be dismodulatedIII. Range of anxiety disorders- Types of anxiety disorderso Phobiaso Generalized Anxiety Disordero Panic Attackso Panic Disordero Panic Disorder with Agoraphobiao Social Anxiety Disordero Obsessive Compulsive Disordero Eating Disorders Anorexia, Bulimiao Body Dysmorphic Disordero Post Traumatic Distress Disorder- Prevalenceo Close to SCZ, because Segal thinks it is also an organic brain disordero A lot of people have these disorders and don’t tell anyoneo Anxiety Disorders (panic, OCD,PTSD, GAD, social phobia, phobias): 18.1% of the general populationo Panic Disorder 2.7%o Obsessive Compulsive Disorder: 1%o Post Traumatic Stress Disorder: 3.5%o Generalized Anxiety Disorder: 3.1%o Social Phobia: 6.8%- Generalized Anxiety Disordero Generalized anxiety disorder (GAD) is much more than the normal anxietypeople experience day to day. It's chronic and exaggerated worry and tension, even though nothing seems to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety.o People with GAD can't seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. People with GAD also seem unable to relax. They often have trouble falling or staying asleep. Their worries are accompanied by physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability, sweating, or hot flashes. They may feel lightheadedor out of breath. They may feel nauseated or have to go to the bathroom frequently. Or