Chapter 5 1 Anxiety is a condition experience of being afraid It can be an immediate fearful reaction to a perceived threat but it can also be anxious anticipation 2 The four types of symptoms associated with anxiety are physiological behavior cognitive and emotional The physiologic changes of the fight or flight response results from the activation of 2 systems controlled by the hypothalamus the autonomic nervous system sympathetic NS and the adrenal cortical system The sympathetic system produces key bodily changes liver releases extra glucose for muscles heart rate blood pressure and breathing increase body secretes endorphins surface blood vessels constrict to reduce bleeding incase of injury spleen releases more red blood cells The hypothalamus activates the adrenal cortical system by releasing corticotrophin release factor CRF which signals the pituitary gland to secrete adrenocorticotropic hormone ACTH the body s major stress hormone ACTH stimulates the adrenal cortex releasing a group of hormones the major one being cortisol Emotionally we experience dread and terror and we are often irritable and restless Cognitively we are on the lookout for danger We anticipate harm exaggerate danger have problems concentrating are hypervigilant are worried have a fear of losing control or dying and have a sense of unreality Behaviorally we seek to confront the threat or escape it They may experience forms of freezing aggression decreased appetitive responding or increased aversive responding 3 Adaptive maladaptive Fears Are 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 4 Other factors that should be considered when making diagnosis Severe enough to lower quality of life Chronic and frequent enough to interfere with functioning BUT insight varies 5 Anxiety disorders are especially likely to differ cross culturally context environmental influences the content of fears people of Latino cultures report a syndrome known as attack of the nerves which may include trembling heart palpitations a sense of heat in the rising into the head difficulty moving limbs loss of consciousness or the mind ataque de nervios chest going blank memory loss sensation of needles in parts of the body paresthesia chest tightness etc behavioral symptoms include shouting swearing and striking out person then falls to ground and convulses or lies as if dead researchers believe it is because nervios expresses the anger and frustration of being at the bottom and provides temporary release from the grinding everyday burderns of life Mexican females more than twice as distressed by hurricanes than African American and non hispanic white Americans and African American men more likely to be distressed by hurricanes than Mexican men and non white Hispanic American males women to be fearless need this suggests sex roles among theses cultures influenced sex differences in PTSD symptoms There is more social pressure in Mexican than US passive self sacrificing and compliant and for men to be dominant and strong this may lead Mexican women to feel more helpless than Mexican men following a trauma and to be less able to get the marital support they the tendency to dissociate in response to severe stress also appears greater among Latinos which may increase the risk of PTSD in Latino cultures generally 6 Diagnostic Criteria for GAD A Anxiety and worry occurring more days than not for at least 6 months About a number of events or activities B Worry is difficult to control C Associated with 3 of the following more days than not for past 6 months 1 Restlessness or feeling keyed up or on edge 2 Easily fatigued 3 Difficulty concentrating or mind going blank 4 Irritability 5 Muscle tension 6 Sleep disturbance D Focus is not confined to features of Axis I disorders E Impairment or Distress F Not due to Substance use GMC or does not occur exclusively during mood psychotic or pervasive developmental disorders 7 What are the proposed changes of the DSM 5 In the DSM 5 the name for this disorder is proposed to be changed to generalized anxiety and worry disorder to reflect the fact that worry is a central feature The criteria for the new disorder are likely to undergo a number of other changes as well The proposed new criteria will require that because of anxiety and worry about situations individuals frequently 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 these behavioral symptoms have been added to the proposed criteria in response to evidence that they are very common and lead to significant impairment 8 Prevalence and Course of the GAD 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 9 Theories of GAD Cognitive Theory people with GAD think about threat constantly including focusing on detecting possible threats in the environment the function of worry Avoidance worry is an attempt at suppression of negative images avoidance prevents them from habituating to the negative emotions associated with the event or considering ways they might cope Wells Butler say GAD patients have 2 competing ideas about worry worry prevents bad things from happening worrying is dangerous to your health Biological Theory GABA theory individuals with GAD have deficiency in GABA receptors resulting in excessive firing the limbic system Genetic Theory biological vulnerability to GAD is inherited Are biological theories and cognitive theories mutually exclusive 10 Treatments for GAD Psychosocial Treatment Cognitive Behavioral Therapy CBT Some Techniques Therapist works with client to identify and alter negative automatic thoughts Self monitor worrying and schedule worry time Relaxation Techniques i e Progressive Muscle Relaxation Deep Breathing Biological Treatments Benzodiazepines i e Xanax Valium Short term relief from anxiety Very addictive many side effects Tricyclic Antidepressants Tofranil and SSRIs Paxil Paxil reduces anxiety better than benzodiazepines Serotonin Norepinephrine Reuptake Inhibitor Effexor Better than placebo 11 Diagnostic Criteria for PTSD A Exposed to trauma with both of the following present 1 Event
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