PSYC 407 1st Edition Lecture 7 Outline of Last Lecture II. Nature of fear and anxietyIII. Causes of Anxiety DisordersIV. Comorbidity of Anxiety DisordersOutline of Current Lecture I. Nature of fear and anxietyII. Causes of Anxiety DisordersIII. Comorbidity of Anxiety DisordersIV. Generalized Anxiety DisorderV. Panic Disorder w/wo AgoraphobiaVI. Specific PhobiaVII.Social PhobiaVIII.Post-traumatic Stress DisorderCurrent LectureGeneralized Anxiety Disorder: The “Basic” Anxiety Disorder• Overview and defining features– Excessive uncontrollable anxious apprehension and worry– Coupled with strong, persistent anxiety– Persists for 6 months or more occurring on more days than not– Somatic symptoms differ from panic (e.g., muscle tension)Somatic sx.- 3 or more of the following sx:- Restlessness, keyed up- Easily fatigued- Difficulty concentrating- Irritability- Muscle tension- Sleep problemsGeneralized Anxiety Disorder: The “Basic” Anxiety Disorder (continued)These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.• Statistics– Affects about 4% of the general population– Females outnumber males approximately 2:1– Onset is often insidious, beginning in early adulthood– Very prevalent among the elderly– Tends to run in familiesGeneralized Anxiety Disorder: Associated Features and Treatment• Associated features– Persons with GAD have been called “autonomic restrictors”– Fail to process emotional component of thoughts and images• Treatment of GAD: Generally weak– Benzodiazapines – often prescribed – Psychological interventions – cognitive-behavioral therapy– Combined treatments – acute vs. long-term outcomesPanic Disorder With and Without Agoraphobia• Overview and defining features– Experience of unexpected panic attack (i.e., a false alarm)– Develop anxiety, worry, or fear about another attack – Many develop agoraphobia – Facts and statistics– Affects about 3.5% of the general population– Onset is often acute, beginning between 25 and 29 years of age– 75% of individuals with agoraphobia are femalePanic Disorder: Associated Features and Treatment• Associated features– Nocturnal panic attacks – 60% panic during deep non-REM sleep– Interoceptive/exteroceptive avoidance• Medication treatment– Target serotonergic, noradrenergic, and GABA systems– SSRIs (e.g., Prozac and Paxil) are preferred drugs– Relapse rates are high following medication discontinuation• Psychological and combined treatments• Cognitive-behavioral therapies are highly effective• No evidence that combined treatment produces better outcome• Best long-term outcome is with cognitive-behavioral therapy aloneSpecific Phobias: An Overview• Overview and defining features– Extreme irrational fear of a specific object or situation– Persons will go to great lengths to avoid phobic objects– Most recognize that the fear and avoidance are unreasonable– Markedly interferes with one’s ability to function• Facts and statistics– Females are again over-represented– Affects about 11% of the general population– Phobias tend to run a chronic courseSpecific Phobias: Associated Features and Treatment• Associated features and subtypes of specific phobia– Blood-injury-injection phobia – unusual vasovagal response – Situational phobia – trains, planes, automobiles, closed spaces– Natural environment phobia – natural events (e.g., heights, storms)– Animal phobia – animals and insects– Separation anxiety – seen in children• Causes of phobias– Biological and evolutionary vulnerability– Three pathways – conditioning, observational learning, information• Psychological treatments of specific phobias– Cognitive-behavior therapies are highly effective – exposureSocial Phobia: An Overview• Overview and defining features– Extreme and irrational fear in social/performance situations– Markedly interferes with one’s ability to function– Often avoid social situations or endure them with great distress– Generalized subtype – affects many social situations • Facts and statistics– Affects about 13% of the general population– Prevalence is slightly greater in females than males– Onset is usually during adolescence– Peak age of onset at about 15 yearsSocial Phobia: Associated Features and Treatment• Causes– Biological and evolutionary vulnerability– Similar learning pathways as specific phobias • Psychological treatment– Cognitive-behavioral treatment – Cognitive-behavioral therapies are highly effective• Medication treatment – Tricyclic antidepressants and monoamine oxidase inhibitors – SSRIs Paxil, Zoloft, and Effexer – are FDA approved – Relapse rates are high following medication discontinuationPosttraumatic Stress Disorder (PTSD): An Overview• Overview and defining features– Main etiologic characteristics – trauma exposure and response– Reexperiencing (e.g., memories, nightmares, flashbacks)– Avoidance – Emotional numbing and interpersonal problems – Markedly interferes with one's ability to function• Problems concentrating, with memoryDSM Timelines for PTSD– PTSD diagnosisacute- one month AFTER traumachronic - lasts longer than 3 months delayed onset – much later– Acute Stress Disorder – within the first monthPosttraumatic Stress Disorder• Statistics– Remarkably low prevalence of PTSD in traumapopulations– Combat and sexual assault are the most common traumas– About 7.8% of the general population meet criteria for PTSD– Causes of PTSD– Intensity of the trauma and one's reaction to it (i.e., true alarm)– Biological vulnerability– Uncontrollability and unpredictability as a child– Learn alarms – direct conditioning and observational learning (stimuli that remind them of original true alarm)– Risk takingSocial Factors in PTSDExtent of social support, or lack thereof, post-trauma.Support from loved ones reduces cortisol secretion and activity of the HPA axisHypothalamic-pituitary-adrenocortical axis,Brain-endocrine system implicated in stressPTSD: Treatment• Psychological treatments– Cognitive-behavioral therapies (CBT) are highly effective– CBT may include graduated or massed (e.g., flooding) imaginal exposure– It may be that early interventions after trauma may preclude