Exam II Study Guide 2 2 12 Chapter 5 Anxiety Disorders What is anxiety Anxiety The condition experience of being afraid The immediate fearful reaction to a perceived threat Anxious anticipation Evolutionary alarm system prepares our bodies for fight or flight What are the four types of symptoms associated with anxiety Four Types of Symptoms 1 Physiological or somatic Symptoms 2 Cognitive Symptoms 3 Behavioral Symptoms 4 Emotional Symptoms When is anxiety considered adaptive vs maladaptive Adaptive vs Maladaptive Fears 3 questions 1 Are concerns realistic given the circumstances 2 3 Does the concern persist in the absence of the threat Is the amount of fear in proportion to the threat Fear vs Diagnosis Distress Impairment Severe enough to lower quality of life Chronic and Frequent enough to interfere with functions Insight varies Anxiety Disorders Maladaptive FEAR or something or another especially likely to differ cross culturally How does culture play a role in anxiety disorders Context Environment influences the CONTENT of fears Types of Anxiety Disorders Specific phobias Social Anxiety Disorder Generalized Anxiety Disorder GAD Panic Disorder Post Traumatic Stress Disorder Obsessive Compulsive Disorder Generalized Anxiety Disorder GAD What two factors should be considered when making an anxiety diagnosis Diagnostic Criteria Anxiety and worry occurring more days than not for at least 6 months About a number of events or activities Worry is difficult to control o Worry defined as cognitive component of anxiety anxious anticipation Associated with 3 of the following more days than not for the past 6 months o Restlessness or feeling keyed up or on edge o Easily fatigued o Difficulty concentrating or mind going blank o Irritability o Muscle tension o Sleep disturbance Focus is not confined to features of Axis I disorders Impairment or distress Not due to substance use GMC or does not occur exclusively during mood psychotic or pervasive developmental disorders What is the prevalence and course of GAD Prevalence and Course 3 5 of general population Highly comorbid with other anxiety disorders Also associated with depression and substance use disorders 50 report onset in childhood or adolescence Course is chronic but fluctuating and often worse during times of stress Women are at greater risk How is GAD explained by Cognitive theory Cognitive Theory People with GAD think about threat constantly Beck et al 1994 1997 The function of worry o worry is an attempt at suppression of negative images Borkovec et al 1990 avoidance o Wells Butler 1997 GAD folks have 2 competing ideas about worry Worry prevents bad things from happening Worrying is dangerous to your health What are the psychological treatments Psychosocial Treatment Cognitive Behavioral Therapy CBT o Some techniques Therapists work with client to identify and alter negative automatic thoughts Self monitor worrying and schedule worry time o Relaxation Techniques i e progressive muscle relaxation deep breathing How is GAD explained by Biological theory Biological Theories GABA Theory o Genetic Theory o Biological vulnerability to GAD is inherited What are the biological treatments Biological Treatments Benzodiazepines i e Xanax Valium Short term relief from anxiety o o Very addictive many side effects Tricyclic Antidepressants Tofranil and SSRIs Paxil o Paxil reduced anxiety better than benzodiazepines Serotonin Norepinephrine Reuptake Inhibitor Effexor o Better than placebo 2 7 12 PTSD and Related Stress Disorders Individuals with GAD have deficiency in GABA receptors resulting in excessive firing in the limbic system 3 Kinds of Stress Disorders Axis I Anxiety Disorders Posttraumatic Stress Disorder o o Acute Stress Disorder Axis I Adjustment Disorder Events that Induce PTSD Combat and War related Traumas o Combat fatigue syndrome Shell Shock Tornadoes floods earthquakes fires Physical emotional sexual Common Traumatic Events Car accidents sudden deaths of loved ones Disasters o Abuse o o o DSM V will change definition o Response involving fear helplessness or horror DSM V will drop this requirement horror Traumatic event is reexperienced in 1 of the following ways Know the diagnostic criteria for the 3 stress disorders and the 3 categories of symptoms of PTSD PTSD Diagnostic Criteria Exposed to trauma with both of the following present Event involved actual or threatened death serious injury or threat to physical integrity of self or others Intrusive images thoughts or perceptions o o Distressing dreams o Active of feeling as if the traumatic event were occurring o Distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic even o Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the trauma Avoidance of stimuli associated with the trauma and numbing of general responsiveness as indicated by 3 of the following Inability to recall important aspects of trauma Efforts to avoid thoughts feelings or conversations o o Avoid activities people or places o o Diminished interest of participation in significant activities o Detachment or estrangement from others o Restricted range of affect o Sense of shortened future Persistent symptoms of increased arousal as indicated by 2 of the following Irritability or outburst of anger o Difficulty falling or staying asleep o o Difficulty concentrating o Hypervigilance o Exaggerated startle response Duration more than 1 month Impairment or Distress Specify If o Acute 3 months o Chronic 3 months o With delayed onset onset 6 months after the stressor How does acute stress disorder differ from PTSD acute stress disorder lasts from 2 days 4 weeks max Acute Stress Disorder Diagnostic Criteria Witnessed event fear helplessness response 3 dissociative symptoms numbing derealization depersonalization dissociative amnesia 1 symptoms of reexperiencing trauma Avoidance of stimuli Symptoms of anxiety or increased arousal difficulty sleeping irritability poor concentration hypervigilance etc Distress or impairment Duration 2 days minimal to 4 weeks maximum occurs within 4 weeks of the trauma Not due to substances GMC other mental illness NOTE DIFFERENCES IN DURATION BETWEEN PTSD AND ACUTE STRESS DISORDER PTSD w delayed onset Adjustment Disorders Consists of emotional and behavioral symptoms E g depressive symptoms anxiety symptoms and or antisocial behaviors Also on Axis I but not categorized with depression or
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