Anxiety Disorders I. introduction Anxiety Disorders Involve preoccupation with-and/or- A persistent, maladaptive avoidance of anxiety-provoking thoughts or situations Defined by negative emotional responses The most common type of mental disorderDefinitions Fear – physiological and emotional response to a real, immediate danger  Anxiety - More general physiological and emotional response to a vague sense of threat or danger Involves anticipation of future danger Worry – Sequence of negative, emotional thoughts concerned with future threats “self-talk” Worry: Is it always a bad thing?1. Quantitative  How often does the person worry and about how many things?2. Qualitative What is the person worrying about?○ Negative content○ Less controllable○ Less realisticAnxiety disorders: Generalized Anxiety Disorder Phobias Specific Phobias Social Phobia (with or without agoraphobia) Panic Disorder Obsessive Compulsive Disorder Acute Stress Disorder and Post-Traumatic Stress Disorder (next class)Comorbidity  High comorbidity between anxiety disorders High comorbidity with depression and substance use Differences among groups… Gender : Higher in females than males (except OCD) Age : Lower prevalence among the elderly Culture : Some differences with respect to stressors, descriptions, and symptoms Epidemiological Summary of Anxiety Disorders Is there a genetic component to anxiety disorders?A. SymptomsB. EtiologyC. Treatment Generalized Anxiety Disorder (GAD) A. SymptomsGeneralized Anxiety Disorder (GAD) Symptoms Excessive worry about many events & activities (free-floating anxiety) Worry is uncontrollable Leads to significant distress/impairment > 6 months duration of symptoms At least 3 of 6 physical symptoms:○ Restlessness○ Easily fatigued○ Poor concentration○ Irritability○ Muscle tension○ Sleep disturbanceB. EtiologyFactors Contributing to GAD Sociocultural Perspective More likely to develop in people who are facing societal conditions that are trulydangerous Cognitive Perspective (Ellis and Beck) GAD is primarily caused by basic irrational assumptions Interpret stressful events as dangerous and threatening because of these assumptions People with GAD worry in an attempt to predict and prevent negative events. New Wave Cognitive Theories Metacognitive Theory (Wells) People with GAD implicitly hold both positive and negative attitudes toward worry Intolerance of uncertainty theory Difficulty accepting that life is uncontrollable and uncertain  Avoidance theory (Borkovec) People with GAD have higher bodily arousal and worrying serves to reduce this arousal Biological Perspective Increased rate of GAD in relatives (15% vs. 6% of general population) suggests biological basis GABA inactivity may contribute to a state of excitability C. Treatment Cognitive Therapies Changing maladapive assumptions Focusing on worrying Relaxation training Is CT or Relaxation more efficacious for treating GAD?--Borkovec & Costello (1993) 3 conditions Cognitive Behavioral Therapy (CBT) Applied Relaxation (AR) Non-directive control (ND) Active vs. control differed at post-treatment 1-year follow-up results: more CBT clients (58%) met high end state criteria than AR clients (38%) Anti-anxiety drugs BiofeedbackPhobias Specific phobias Social PhobiaSpecific Phobia:A. Symptoms Fear in presence or anticipation of a specific stimulus Exposure leads to immediate fear response Fear is persistent, narrowly-defined, excessive and/or irrational Avoidance of feared stimuli > 6 month duration of symptomsSubtypes Situational Natural Environment Blood-injection injury Animal OtherSocial Phobia Symptoms Fear and avoidance of social situations Performance or interpersonal categories FEAR OF NEGATIVE SOCIAL EVALUATION Exposure leads to immediate fear response Person avoids phobic situation Recognize that fear is unreasonable > 6 month duration of symptomsCulture and Social Phobia Social phobia found across cultures Symptom expression affected by culture Taijin kyofu sho Japanese form Fear of embarrassing othersB. EtiologyTheories of why phobias develop Behavioral Perspective  Two Factor Theory 1) Classical conditioning creates fear2) Operant conditioning maintains fear Through avoidance of the feared situation Classical Conditioning:○ UCS ] UCR○ CS + UCS ] UCR○ CS ] CR ○ Stimulus generalization Operant conditioning:○ Avoiding stimulus = Relief from anxiety = negative reinforcement Behavioral-Evolutionary Perspective Modeling Preparedness TheoryB. EtiologyTreatments for Specific Phobias Systematic Desensitization In-vivo Covert Flooding Modeling  Systematic Desensitization Patients taught to relax as gradually exposed to fear Steps:1. Relaxation Training2. Creating an Anxiety Hierarchy3. Exposure to each level of the hierarchy Sample Hierarchy for Fear of HeightsTreatments for Social Phobia Antidepressant medication Exposure therapy Cognitive therapy Cognitive Behavioral Group Therapy (Heimberg) Cognitive Therapy (Clark) Social skills trainingPanic DisorderA. SymptomsPanic Disorder Symptoms Recurrent, unexpected panic attacks With > 1 month of: Worry about future panic attacks Concern about consequences of panic attacks Change in behavior due to the attacks Panic attack  Abrupt, discrete period of intense fear or discomfort, peaking within 10 min. Must include at least 4 of 13 other signs and symptoms. ○ Somatic – heart palpitations, sweating, nausea, tingling in hands or feet, shortness of breath, hot/cold flashes, trembling, feeling of choking, chest pain, feeling faint, ○ Cognitive – thinking you are dying, losing control or going crazy, or feeling detached from unself Cued vs. uncued Subtypes  With or Without Agoraphobia Agoraphobia  Persistent, excessive, irrational fear of places where escape is difficult Avoid situations that may trigger panic attackB. EtiologyFactors Contributing to Panic Disorder Biological Perspective (2 theories)1) Changes in norepinephrine activity in the midbrain (locus ceruleus)2) Role of brain circuits—brain areas triggering each other to