FSU CLP 4143 - Chapter 5 – Anxiety Disorders

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What is Anxiety?Condition or experience of being afraidFour types of symptomsPhysiological or Somatic Symptoms  Cognitive SymptomsBehavioral Symptoms  Emotional SymptomsWhy do we get anxious?Fight or FlightA set of physical and psychological responses that help us fight a threat or flee from it.Fight-or-Flight ResponseThe features of arousal and fear are set in motion by the hypothalamusTwo important systems activated:Autonomic Nervous System (ANS)Sympathetic NS**Parasympathetic NSEndocrine System (adrenal cortical system) – hormone releasing systemHypothalamus activates sympathetic NS first; the sympathetic NS acts directly on the smooth muscles and internal organs to produce key bodily changes.HPA AXIS: Hypothalamic pituitary axis; Hypothalamus activates the adrenal cortical system by releasing corticotropin-release factor (CRF), which signals the pituitary gland to secrete adrenocorticotropic hormone (ACTH), the body’s major stress hormone.ACTH stimulates the outer layers of the adrenal glands (adrenal cortex), releasing a group of hormones, the major one being cortisol, epinephrine, norepinephrine.Individual Differences in AnxietyPeople with one anxiety disorder are likely to have anotherPeople differ in:General level of arousal or anxiety“Trait Anxiety”Sense of which situations are threatening“State Anxiety”Situation-based (example: fear of flying)Adaptive vs. Maladaptive Fears3 QuestionsAre concerns realistic given the circumstances?Is the amount of fear in proportion to the threat?Does the concern persist in the absence of the threat?Fear vs. DiagnosisDistress & ImpairmentSevere enough to lower quality of lifeChronic and frequent enough to interfere with functioningIf fear is distressing & impairing, likely will qualify for a diagnosisWhat are Anxiety Disorders?Generalized Anxiety DisorderPanic DisorderSpecific PhobiasSocial Anxiety DisorderObsessive-Compulsive Disorder **Post Traumatic Stress Disorder **Acute Stress Disorder **Generalized Anxiety Disorder (GAD)Generalized Anxiety DisorderGAD = the “basic” anxiety disorderWorry = Key characteristicCognitive component of anxietyAnxious anticipationAnxious all the time; excessive worryPeople with GAD worry about their performance on the job, their relationships, and their health. Worry about minor issues. Focus of their worries may shift frequently, and they tend to worry about many things instead of focusing on only issues of concern.Their worry is accompanied by physiological symptoms, including muscle tension, sleep disturbances, and chronic restlessness.People with GAD feel tired much of the time, probably due to chronic muscle tension and sleep loss.Because of anxiety and worry about situations, people with GAD spend inordinate amounts of time and energy preparing for feared situations or avoiding those situations, are immobilized by procrastination and indecision, and seek reassurance from others.Prevalence & Course3-5% of general populationhighly comorbid with other anxiety disorders…and depression and substance use disorders50% onset in childhood or adolescence; begins in childhood or adolescenceCourse is chronic, but fluctuatesOften worse during times of stressWomen are at greater riskWhat Do People With GAD Worry About?How Does GAD Differ From “normal” Worry?Biological TheoriesBenzodiazepines increase the activity of GABA, a neurotransmitter that carries inhibitory messages form one neuron to another.When GABA binds to neural receptor, it prevents the neuron from firing.GABA TheoryIndividuals with GAD have deficiency in the GABA receptors, resulting in excessive firing in the limbic system (involved in emotional, physiological, and behavioral responses to threat).As a result of excessive and chronic neuronal activity, the person experiences chronic, diffuse symptoms of anxiety.Genetic TheoryBiological vulnerability to GAD is inheritedGeneral trait anxiety may increase riskCognitive TheoriesPeople with GAD think about threat constantly (conscious and unconscious levels) (Beck et al., 1994;1997)Over-predict likelihood and cost of aversive outcomesUnder-predict their ability to cope with outcomesAt the conscious level, people with GAD make a number of maladaptive assumptions, such as “It’s always best to expect the worst”; many of these assumptions reflect concerns about losing control.The unconscious cognitions of people with GAD also appear to focus on detecting possible threats in the environment.Stroop Color-Naming Task – participants presented with words printed in color on a computer screen and must say the color the word is printed in. People are slower in naming the color of words that have special significance to them (disease or failure for people with chronic anxiety) than in naming the color of non-significant words.They are paying more attention to the content of the words rather than the color.People with GAD believe worrying can help them avoid bad events by motivating them to engage in problem solving, Yet they seldom get to the problem solving.Although they are always anticipating a negative event, they tend not to think it through.They avoid visual images of what they worry about, perhaps as a way of avoiding the associated negative emotion. This avoidance prevents them from habituating to the negative emotions associated with the event or considering ways they might cope.Why do some people become vigilant for signs of threat?One theory is that they have experienced stressors or traumas that were uncontrollable and came without warning.People who have had unpredictable and uncontrollable life experiences – such as an abusive parent – also may develop chronic anxiety.The function of worry:Worry prevents bad things from happeningWorry is NEGATIVE reinforcementBiological TreatmentsBenzodiazepines (i.e. Xanax, Valium)Short termVery addictive, many side effectsTricyclic Antidepressants (Tofranil) and SSRIs (Selective Serotonin Reuptake Inhibitor) Paroxetine (Paxil)Paxil reduces anxiety better than benzodiazepinesSerotonin-Norepinephrine Reuptake Inhibitor (Venlafaxine  Effexor)Better than Buspirone in some studiesBetter than a placeboPsychological TreatmentsCognitive Behavioral Therapy (CBT)Helps people with GAD confront the issues they worry about the most; challenge their negative, catastrophizing thoughts; and develop coping strategies.Some techniques:Identify and alter negative automatic thoughtsSelf-monitor worrying“Worry time”Relaxation


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FSU CLP 4143 - Chapter 5 – Anxiety Disorders

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