Abnormal Psych Chapter 5 Anxiety Disorders 07 05 2014 What is Anxiety Condition or experience of being afraid Four types of symptoms o Physiological or Somatic Symptoms Cognitive Symptoms o Behavioral Symptoms Emotional Symptoms Why do we get anxious o Fight or Flight threat or flee from it Fight or Flight Response A set of physical and psychological responses that help us fight a o The features of arousal and fear are set in motion by the hypothalamus o Two important systems activated Autonomic Nervous System ANS Sympathetic NS Parasympathetic NS Endocrine System adrenal cortical system hormone releasing Hypothalamus activates sympathetic NS first the sympathetic NS acts directly on the smooth muscles and internal organs to produce key system 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 Anxiety People with one anxiety disorder are likely to have another People differ in o General level of arousal or anxiety Trait Anxiety o Sense of which situations are threatening State Anxiety Situation based example fear of flying Adaptive vs Maladaptive Fears 3 Questions o Are concerns realistic given the circumstances o Is the amount of fear in proportion to the threat o Does the concern persist in the absence of the threat Fear vs Diagnosis Distress Impairment o Severe enough to lower quality of life o Chronic and frequent enough to interfere with functioning If fear is distressing impairing likely will qualify for a diagnosis What are Anxiety Disorders Generalized Anxiety Disorder Panic Disorder Specific Phobias Social Anxiety Disorder Obsessive Compulsive Disorder Post Traumatic Stress Disorder Acute Stress Disorder Generalized Anxiety Disorder GAD Generalized Anxiety Disorder o GAD the basic anxiety disorder o Worry Key characteristic Cognitive component of anxiety Anxious anticipation o Anxious all the time excessive worry o People 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 o 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 Course o 3 5 of general population o highly comorbid with other anxiety disorders and depression and substance use disorders o 50 onset in childhood or adolescence begins in childhood or adolescence o Course is chronic but fluctuates Often worse during times of stress o Women are at greater risk What Do People With GAD Worry About of Patients 40 80 70 60 50 30 20 10 0 350 300 250 200 150 100 50 0 Family Money Work Illness How Does GAD Differ From normal Worry Worry Time Min GAD Patients N 60 Controls N 36 Biological Theories o Benzodiazepines 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 Group firing GABA Theory Individuals 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 o Genetic Theory Biological vulnerability to GAD is inherited General trait anxiety may increase risk Cognitive Theories o People with GAD think about threat constantly conscious and unconscious levels Beck et al 1994 1997 Over predict likelihood and cost of aversive outcomes Under predict their ability to cope with outcomes At 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 o 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 to think it through Although they are always anticipating a negative event they tend not 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 o 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 o The function of worry Worry prevents bad things from happening Worry is NEGATIVE reinforcement Biological Treatments o Benzodiazepines i e Xanax Valium Short term Very addictive many side effects o Tricyclic Antidepressants Tofranil and SSRIs Selective Serotonin Reuptake Inhibitor Paroxetine Paxil Paxil reduces anxiety better than benzodiazepines o Serotonin Norepinephrine Reuptake Inhibitor Venlafaxine Effexor Better than Buspirone in some studies Better than a placebo Psychological Treatments o Cognitive Behavioral Therapy CBT Helps people with GAD confront the issues they worry about the most challenge their negative catastrophizing
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