Anxiety is the condition experience of being afraid Anxiety is an immediate fearful reaction to a perceived threat Anxiety is also anxious anticipation 4 Symptoms of Anxiety Physiological or Somatic knees and toes curled in showing anxious behavior other examples are racing heart sweating shaking Behavioral Hiding behind his note cards typically associated with avoidance avoiding eye contact or being restless and fidgety Cognitive thought bubble Emotional feeling dread or shy or embarrassed Fight or Flight endocrine system Threatening situations activation of the autonomic nervous system ANS the Sympathetic nervous system fight or flight stimulates organs Parasympathetic nervous system returns body to normal Adaptive vs Maladaptive Anxiety Three Questions 1 Are concerns realistic given the circumstances 2 Is the amount of anxiety in proportion to the threat 3 Does the concern persist in the absence of the threat Typical Anxiety vs Diagnosis Distress Impairment Severe enough to lower quality of life Chronic frequent enough to interfere with functioning BUT insight varies Insight introspection when someone knows why they are anxious and how its affect ing their lives Anxiety Anxiety Disorders involve maladaptive fear Generalized Anxiety Disorder Panic Disorder Specific Phobia Social Anxiety Disorder Generalized Anxiety Disorders E G Please Lord help the ceilings not fall on me Worry Cognitive thought component of anxiety what if Most common form of anxiety Cognitive component of anxiety Anxious anticipation GAD General Anxiety Disorder the basic anxiety disorder DSM 5 criteria for GAD A Excessive anxiety and worry apprehensive expectation occurring more days than not for at least 6 months about 2 events or activities Difficult to control worry B C The anxiety and worry are associated with 3 symptoms 1 Restlessness feeling keyed up on edge 2 Being easily fatigued 3 Difficult concentrating 4 Irritability 5 Muscle tension 6 Sleep disturbance Impairment and or distress D 3 5 of general population About 2X higher prevalence in women 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 more likely more threats towards women tend to ruminate more social pressures gender roles Comorbidity having more than one disorder Cognitive Theory People with GAD think about possible threat constantly Beck et al 1994 1997 Over predict likelihood and cost of aversive outcomes Under predict their ability to cope with outcomes Ruminate on possible threats Over predict or overestimate likelihood of an event and cost of things Underestimate coping Stop task what color is it typed in individuals with GAD take longer to say red when they have concern about the word The function of worry Borkovec et al 1990 avoidance Worry is a coping strategy to avoid negative material Worry is negatively reinforcing by allowing the individual to cognitively avoid the Worrying as a way to avoid negative emotions and cope with negative events in negative affect their lives Biological Factors GABA Theory Individuals with GAD have deficiency in GABA receptors resulting in excessive firing in the limbic system GABA Inhibitory effects on neurons GAD they don t have enough GABA for neurons to stop firing Hypothalamus amygdala GAD is inherited Genetic Theory Biological vulnerability to GAD is inherited Are biological theories and cognitive theory mutually exclusive Panic Disorder Recurrent unexpected At least one panic attack has been followed by 1 month of panic attacks Persistent concern of additional attacks Worry about the implications of the attacks A significant change in behavior Panic Attack Fight or flight response to nonthreatening stimuli Can occur in the context of any anxiety disorder Discrete period of intense fear or discomfort Four or more of the fight or flight symptoms develop and peak within 10 minutes Panic attacks are NOT specific to anxiety or panic disorders Panic attacks have a lifetime prevalence rate of 22 7 Panic disorder has a lifetime prevalence rate of 4 7 Two to three times more common in women Onset varies most typical between late adolescence and mid 30s like every thing else Agoraphobia Marked fear or anxiety about two or more of the following Fears avoids situations because of thoughts that escape might be difficult or unavailable Generally occurs after one experiences panic attacks Using public transportation Being in open spaces Being in enclosed places Standing in line or being a crowd Being outside of the home alone Individuals with Panic Disorder 1 2 3 Pay close attention to bodily sensations Misinterpret bodily sensations Engage in snowballing catastrophic interpretations Bodily sensations Heart rate nausea Focus on bodily sensations and the misinterpretation increases panic and anxiety Anxiety Sensitivity Fear of anxiety related physical sensations Due to the belief that these sensations have harmful somatic psychological or social consequences AS is a risk factor for anxiety problems Elevated in those with anxiety disorders AS predicts future occurrence of anxiety symptoms and panic attacks in both adolescents and healthy adults AS linked to the development of panic disorders Higher anxiety sensitivity the more sensitive they are to panic feelings Cognitive Perspectives behaviors Safety Actions to avoid or reduce anxiety provoking situations Maintain fear by False attribution of safety Avoidance of disconfirming evidence ing panic attack Panic Disorder Model Slow down breathing sit down grab hold of something distract drink water dur Taking a Xanax Avoidance of situations causing panic e g bridges shopping malls Specific Phobia Fear or anxiety about a specific object or situation Consistent and immediate anxiety response maybe even panic attack Avoided or endured with intense anxiety distress Fear is out of proportion to actual danger Persistent Lasting 6 months Impairment and or Distress A B C D E F Anxiety Feeling queasy while climbing a tall ladder Phobia Refusing to attend your best friend s wedding because it s on the 25th floor of a hotel Specific phobias are adaptive fears expressed in a maladaptive manner Most people with one specific phobia have another 10 lifetime prevalence that s high 0 don t seek treatment Onset varies Most during childhood Some during the mid twenties 4 Categories of Specific
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