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ANARNA, BATTAD, CATALAN, MALUBAY Psychology 155 ANXIETY DISORDERS Anxiety Disorders o

January 10, 2012

TYPES OF PANIC ATTACK: ______________  there are specific situations or places that trigger these attacks Unexpected  Can happen anywhere, anytime, and without any warning Situationally predisposed  Certain situations or places could make someone with panic disorder or another anxiety disorder would more likely to have a panic attack, but they might not always have panic attacks in these situations or places  A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes: Symptoms: 1) palpitations, pounding heart, or accelerated heart rate 2) sweating 3) trembling or shaking 4) sensations of shortness of breath or smothering 5) feeling of choking 6) chest pain or discomfort 7) nausea or abdominal distress 8) feeling dizzy, unsteady, lightheaded, or faint 9) derealization (feelings of unreality) or depersonalization (being detached from oneself) 10) fear of losing control or going crazy 11) fear of dying 12) paresthesias (numbness or tingling sensations) 13) chills or hot flushes Causes: Biological  Genes  ________________ and neurotransmitters  Stimulant Use  Medication Withdrawal Psychological  Freud anxiety was a psychic reaction to danger surrounding the reactivation of an infantile fearful situation  Behavioral Theorists anxiety is a product of classical conditioning, modeling, or other forms of learning Social  Particular way we react to stress seems to run in families  Stressful life events trigger our biological and psychological vulnerabilities to anxiety Integrated Model  ________________ Theory First vulnerability: DIATHESIS Generalized biological vulnerability Second Vulnerability Generalized psychological vulnerability Third Vulnerability Specific psychological vulnerability Once this cycle starts, it tends to feed on itself, so it might not stop even when the particular life stressor has long since passed Integrated Approach  Learned Alarms

Panic attacks due to learned associations with internal or external factors

Comorbidity of Anxiety Disorders High rates of comorbidity among anxiety disorders emphasize how all of these disorders share the common features of anxiety and panic Common additional diagnosis for all anxiety disorder was major depression Comorbidity with Physicl Disorder Presence of any anxiety disorder was uniquely and significantly associated with thyroid disease, respiratory disease, etc. Something about having an anxiety disorder might cause, or contribute to the cause of the physical disorder Suicide

20% of people with panic disorders have attempted suicide The risk of someone with panic disorder attempting suicide is comparable to that for individuals with major depression Anxiety disorders with depression produces higher likelihood of having thoughts about suicide or suicide attempts

Generalized Anxiety Disorder o characterized by excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry symptoms: physiological  Fatigue, headaches, nausea, muscle aches, restlessness, chronically tense, etc. Psychological  Worry, irritability, poor concentration, etc.  High sensitivity to threat in general especially to a threat that has personal relevance Biological  GAD may run in families Genetic contribution to the personality trait of Neuroticism  substance- Induced social  Occurrence of events that can cause anxiety

Treatment Medicinal  Benzodiazepines for GAD y Give some relief, short term y Therapeutic effect is relatively modest y Seem to impair both cognitive and motor functioning  Imipramine, paroxetine, venlafaxine (better alternatives to benzodiazepines) Psychological  Relaxation treatments  Imagery  Cognitive Behavioral Treatment y Patients evoke the worry process during therapy sessions and confront anxietyprovoking images and thought head-on

Panic Disorder o Descriptions Onset: mid-teens to about 40 years old, often beginning at around 24 years old Two times more common in women than in men May occur in children but it is not diagnosed as such Different expressions across cultures

e.g. susto, ____________, kyol goeu Symptoms (book: p. 148, Table 5.3) Recurrent unexpected panic attacks followed by 1 month (or more) of one (or more) of the following:  Persistent concern about having additional attacks  Worry about the implications of the attack or its consequences  Significant change in behavior related to the attacks The panic attacks are not due to the direct physiological effects of a substance or a general medical condition The panic attacks are not better accounted for by another mental disorder such as social phobia, specific phobia, OCD, PTSD, or SAD The presence of agoraphobia *

_________________ Anxiety about being in places or situations from which escape might be difficult or embarrassing, or in which help may not be available in the event of an unexpected or situationally predisposed panic attack or panic-like symptoms Panic Disorder With Agoraphobia Phobic avoidance  Avoidance of places or situations that are perceived to cause anxiety Interoceptive avoidance  Avoidance of internal physical sensations similar to that of a panic attack e.g. exercising -> elevated heart rate, perspiration ______________ Panic Panic attacks that occur during delta wave sleep,  Not REM sleep not nightmares Approx. 60% of those with panic disorder experience it (Craske & Rowe, 1997; Uhde, 1994) Related to sleep terrors occurring in children Causes

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Biological predisposition Psychological predisposition  Anxiety sensitivity y Steven Reiss & Richard J. McNally (1985)  Conditioning  Early object loss and/or separation anxiety (psychodynamic) * Social and cultural factors

Treatment and therapy Medication SSRIs SNRIs TCAs Benzodiazepines MAOIs Therapy CBT  Exposure therapy Psychodynamic psychotherapy Others Relaxation Training Inositol  Nutritional supplement influencing serotonin Suggestions Joining support groups Avoiding caffeine, alcohol, and illegal drugs Stress management Exercise Sleep

Specific Phobia

Descriptions: An ____________ of a specific object or situation that markedly interferes with an individuals ability to function Severe common fear One of the most common psychological disorders Four times more common in women than in men Specific Phobia Runs a chronic course Median age of onset is 7 Prevalence varies across cultures Symptoms Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation Exposure to the phobic stimulus invokes and immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attacks  In children: Anxiety may be expressed as crying, tantrums, freezing, or clinging The person recognizes that this fear is excessive or unreasonable The phobic situation(s) is avoided or else is endured with intense anxiety or distress  In children: may be absent The avoidance, anxious anticipation, or distress in the feared situations interferes significantly with the persons normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia. In individuals under the age of 18, the duration is at least 6 months The anxiety, panic attacks, or phobic avoidance are not better accounted for by another mental disorder, such as OCD, PTSD, SAD, social phobia, PD or PDA

Subtypes ______________________ Phobia Situational Phobia Natural Environment Phobia Animal Phobia Other Phobias Separation anxiety disorder Unique to children; common to all young children to some extent An unrealistic and persistent worry that something will happen to their parents or other important people in their life or that something will happen to the children that will separate them from their parents Causes Traumatic conditioning experience  Direct experience (true alarm)  Experiencing a false alarm (panic attack)  Observing someone else experience severe fear (vicarious experience)  Information transmission (being told about danger) Biologically fear-relevant stimuli Anxiety sensitivity Genetics Social and cultural factors

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Treatment and therapy Behavior therapy Exposure therapy  Structured and consistent  For panic attacks: in the manner of treating panic disorder  For SAD: with parental involvement  For Blood-Injury-Injection Phobia: exposure therapy with modifications to keep blood pressure high to finish the exercise __________________

Social Phobia o Description a marked and persistent fear of one or more social or performance situations in the presence of unfamiliar people possible scrutiny from others (judgers) fear of embarrassment due to a specific behaviour or display of anxiety prevalent in young, undereducated, single individuals from a low socioeconomic class Types:

generalized type (or ______________________) -extreme shyness in almost all social situations performance anxiety -anxiety developed in situations required to express a behavior while others are observing evaluation of behavior  public speaking  bashful bladder or pee-shy Shinkeishitsu*  _________________________ -fear of looking at others in the eye -fear of expressing personal presentation would appear reprehensible  Embarrsing OTHERS rather than the individual himself

Causes

Heightened tendency due to:  Biological y Evolutionary adaptation -avoidance of hostile, angry, domineering people *socially anxious individuals noticed angry faces more readily  Deveolpmental y Congenital temperamental profile -inhibition or shyness *relates to generalized social phobia Under stress:  No alarm y Increase in anxiety and self-focused attention even w/o panic attack  False alarm (Panic Attack) y In a social situation y Association between panic attack (or symptoms) and social situation formed -classical conditioning  True alarm y In a social situation y Association between real social trauma and social situation formed -classical conditioning Specific psychological vulnerability  Danger in social evaluation (judgments) *can be learned through social observation (especially towards parents)

Treatment __________________________________  Behavioral -Rehearsal or role-playing of socially phobic situation of patient in front of fellow patients -exposure-based  Cognitive therapy -Covering and changing unconscious perceptions of danger -Emphasis on real-life experiences

*must involve parents Drug treatment  Tricyclic antidepressants y Monoamine oxidase (MAO) inhibitors *more effective than placebo *same effectiveness as psychological therapy, but relapse is more common in drug treatment  SSRIs *same effectiveness as psychological therapy, but relapse is more common in drug treatment  Zoloft *same effectiveness as psychological therapy, but relapse is more common in drug treatment  D-cycloserine (DCS) y Enhances effect of CBTs y Modifies neurotransmitter flow in glutamate system

Posttraumatic Stress Disorder o Description an emotional disorder that follows a ____________ exposure to a traumatic event during which someone feels fear, helplessness, or horror ______________ can lead to involuntarily reliving of the horrifying event Acute PTSD: diagnosed within 1 month after the event occurs; duration of symptoms is less than 3 months Chronic PTSD: PTSD continues longer than _______________ _____________ : onset of symptoms at least 6 months after the stressor o Symptoms -been exposed to a traumatic event -traumatic event is persistently ________________________ -persistent avoidance of stimuli associated with trauma and numbing of general responsiveness -persistent symptoms of increased arousal -duration of disturbance is more than one month -significant distress in social, ccupational, etc. Causes

someone personally experiences a trauma and develops a disorder Biological: a family history of anxiety suggests a generalized biological ______________ for PTSD Psychological: early experiences with unpredictable or uncontrollable events such as family instability Social&Cultural: broader and deeper network of _______________ = less chance of developing PTSD

Treatment PSYCHOLOGICAL: face the original trauma to develop effective coping strategies PSYCHOANALYTIC: _______________-relieving emotional trauma to relieve emotional suffering ____________________ : content of trauma and emotions associated with it are worked through systematically use of drugs such as SSRIs (Prozac and Paxil): effective for anxiety disorders in general

Obsessive-Compulsive Disorder o Description Devastating culmination of anxiety disorders usually _______________ with other disorders  severe generalized anxiety  panic attacks  avoidance  depression  tic disorder y movement of body parts repeatedly, quickly, and uncontrollably y syndrome: Pediatric Autoimmune Disorder associated with Streptococcal Infection (_________________)

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*sore throat resort to magic and rituals chronic avoidance of intrusive thoughts (obsessions) by the use of suppressing techniques (compulsions) relief  obsessions: -________________, persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate -not simple excessive worries about real life problems -individual attempts to suppress or neutralize them -recognition that obsessions are a product of his or her own mind -ex: y contamination y aggressive impulses y sexual content y somatic concerns y need for symmetry  compulsions: -repetitive behaviour or mental acts in response to obsessions -aimed at preventing or reducing obsessions y checking y ordering y arranging y washing and cleaning y movements caused by tic disorder y hoarding (retail therapy) -do not feel any problem, till people around them insist they get help *most are logical; severe cases are illogical *particular obsessions closely related to particular compulsions *sometimes, though rarely, patients (esp. children) succumb to compulsions without particular obsessions adults: higher in females children: higher in males earlier onset in males adolescent: equal

Similar tendencies as with other anxiety disorders Specific psychological vulnerability  Thoughts are dangerous and unacceptable ____________________________  Equate thoughts with specific actions represented by the thoughts Inflated responsibility Compulsions backfire

Treatment Drug treatment  Clomipramine *inhibit reuptake of serotonin  SSRIs *inhibit reuptake of serotonin *up to moderate treatment only *relapse Psychological treatment  ______________________ (ERP) y Gradual exposure to feared obsessions y Prevention of compulsions *reality testing

________________________  Surgical lesion to the _________________ (cingulotomy)  30% successful  Done as a last resort

References Barlow, D. H. & Durand, V. M. (2011). Abnormal psychology: Integrative approach. Philippines: Cengage Learning Asia Pte Ltd. http://aacap.org/page.ww?name=Tic+Disorders&section=Facts+for+Families http://www.med.upenn.edu/ctsa/panic_symptoms.html http://psychcentral.com/disorders/anxiety/panic.html http://psychcentral.com/disorders/anxiety/phobias.html http://psychcentral.com/disorders/sx29.htm http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001922/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001921/ Image from https://docs.google.com/viewer?a=v&q=cache:nhGo82hsj_IJ:abnormalpsych.nelson.com/instructor/chp5.pdf+% 22a+model+of+the+causes+of+panic+disorder+with+or+without+agoraphobia%22&hl=en&gl=ph&pid=bl&srcid=AD GEESgFk8v1R00PGdChuseJ5aNocKT_b0rGJ4nUJQLJjQ8xdCLgjqHiI44oyYeo4eHUidxPz_d1NAbkSeIdpKP6BpIkLNMPHX7ujglosBNMbO1 HYV7013bimvps85tWxDRKTHnXRNT&sig=AHIEtbRkgjTUv1u_32jCdl_M6SYvsLDCAw http://www.anxietysensitivityindex.com/ http://www.psychotherapybrownbag.com/psychotherapy_brown_bag_a/2009/07/i-think-im-having-a-heartattack-how-anxiety-sensitivity-makes-us-misinterpret-normal-sensations-as-.html http://www.mayoclinic.com/health/panic-attacks/DS00338/DSECTION=treatments-and-drugs http://www.mayoclinic.com/health/panic-attacks/DS00338/DSECTION=alternative-medicine http://www.mayoclinic.com/health/panic-attacks/DS00338/DSECTION=lifestyle-and-home-remedies http://www.mayoclinic.com/health/phobias/DS00272/DSECTION=treatments-and-drugs http://tenmost.com/ten-most-common-phobias/

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