Anxiety - An emotional state characterized by physiological arousal, unpleasant feelings of tension, and a sense of apprehension or foreboding.
Anxiety disorder - A class of psychological disorders characterized by excessive or maladaptive anxiety reactions.
PSY254 Behavior Problems and Personality Disorders: Chapter 6 Anxiety Disorders Alice Cheng, Ph.D. University of Hartford Anxiety Disorders Anxiety - An emotional state characterized by physiological arousal, unpleasant feelings of tension, and a sense of apprehension or foreboding. Anxiety disorder - A class of psychological disorders characterized by excessive or maladaptive anxiety reactions. * Fear or panic is a basic emotion that involves activation of the “fight-or-flight” response in the sympathetic nervous system * The Fear and Anxiety Response Patterns * Anxiety is a general feeling of apprehension about possible danger Anxiety is more oriented to the future and more diffuse than fear It has cognitive/subjective, physiological, and behavioral components * The Fear and Anxiety Response Patterns * Anxiety disorders have unrealistic, irrational fears or anxieties of disabling intensity * The Anxiety Disorders and Their Commonalities * The DSM-IV-TR recognizes seven primary types of anxiety disorders * The Anxiety Disorders and Their Commonalities Phobic disorders of the “specific” type Phobic disorders of the “social” type Panic disorder with agoraphobia Panic disorder without agoraphobia Generalized anxiety disorder Obsessive-compulsive disorder Post-traumatic stress disorder * There are some important similarities among The basic biological causes of these disorders The basic psychological causes of these disorders The effective treatments for these disorders * The Anxiety Disorders and Their Commonalities * Panic disorder Panic disorder - A type of anxiety disorder characterized by repeated episodes of intense anxiety or panic. There is a stronger bodily component to panic attacks than to other forms of anxiety. The attacks are accompanied by feelings of sheer terror and a sense of imminent danger or impending doom and by an urge to escape the situation. * Panic disorder is characterized by the occurrence of “unexpected” panic attacks that often seem to come “out of the blue” * Panic Disorder with and without Agoraphobia * The two features of panic attacks that distinguish them from other types of anxiety are Their characteristic brevity Their intensity Many people with panic disorder also develop an agoraphobic fear of situations in which they might have an attack * Panic Disorder with and without Agoraphobia * * Agoraphobia The word agoraphobia is derived from Greek words meaning “fear of the marketplace,” which suggests a fear of being out in open, busy areas. People with agoraphobia develop a fear of places and situations from which it might be difficult or embarrassing to escape in the event of panicky symptoms or a full-fledged panic attack or of situations in which help may be unavailable if such problems should occur. People with agoraphobia may fear shopping in crowded stores; walking through crowded streets; crossing a bridge; traveling on a bus, train, or car; eating in restaurants; or even leaving the house. * 3.5 percent of the adult population have had panic disorder at some time in their lives It’s twice as prevalent in women as men 50 percent of people with panic disorder have additional diagnoses * Panic Disorder * Panic disorder Agoraphobia - Excessive, irrational fear of open or public places. For a diagnosis of panic disorder to be made, the person must have experienced repeated, unexpected panic attacks, and at least one of the attacks must be followed by one of the following : a) At least a month of persistent fear of subsequent attacks. b) Worry about the implications or consequences of the attack. c) Significant change in behavior. * Prevalence of panic disorder by gender Panic disorder affects about two times as many women as men. * Panic disorder has a moderate heritable component There is a broad range of biochemical panic provocation agents There are also several areas of the brain implicated in panic attacks * Biological Causal Factors * * Panic and the Brain Panic attacks may arise from abnormal activity in the amygdala Phobic avoidance may involve activity of the hippocampus The anticipatory anxiety about future panic attacks is thought to arise from activity in the limbic system * Theoretical Perspectives The prevailing view of panic disorder reflects a combination of cognitive and biological factors, of misattributions misperceptions of underlying causes) on the one hand and physiological reactions on the other. Perceiving these bodily sensations as dire threats induces anxiety, which is accompanied by activation of the sympathetic nervous system. The changes in bodily sensations that trigger a panic attack may result from many factors, such as unrecognized hyperventilation (rapid breathing), exertion, changes in temperature, or reactions to certain drugs or medications. * * Panic Disorder: The Cognitive Theory of Panic Trigger stimulus (internal or external) 0 Apprehension or worry (e.g., about having a panic attack or about any distressing situation) Body sensations Interpretation of sensations as catastrophic Perceived threat Trigger stimulus (internal or external) * Medications Minor tranquilizers Antidepressants Behavioral and cognitive-behavioral treatments * Treating Panic Disorder and Agoraphobia * * A phobia is a persistent and disproportionate fear of some specific object or situation that presents little or no actual danger The DSM-IV-TR lists three main categories of phobias: specific phobia social phobia agoraphobia * Phobic Disorders * Specific Phobias Specific phobia - A phobia that is specific to a particular object or situation. Such as fear of heights (acrophobia), fear of enclosed spaces (claustrophobia), or fear of small animals such as mice or snakes and various other “creepy-crawlies.” The person experiences high levels of fear and physiological arousal when encountering the phobic object, which prompts strong urges to avoid or escape the situation or avoid the feared stimulus, as in the following case. * Phobic Disorders The word phobia derives from the Greek phobos, meaning “fear.” The concepts of fear and anxiety are closely related. Fear is anxiety experienced in response to a particular threat. A phobia is a fear of an object or situation that is disproportionate to the threat it poses. * * Common Specific Phobias Acrophobia Heights Algophobia Pain Astraphobia Thunderstorms Claustrophobia Enclosed places Hydrophobia Water Monophobia Being alone Mysophobia Contamination Nychtophobia Darkness Pyrophobia Fire Zoophobia Animals or some particular animal * Blood-injection-injury phobia occurs in about 3–4% of the population 16% of women and 7% of men suffer from some form of specific phobia in their life The age of onset for different phobias varies widely * Specific Phobias * * Specific Phobias Specific phobia - A phobia that is specific to a particular object or situation. Such as fear of heights (acrophobia), fear of enclosed spaces (claustrophobia), or fear of small animals such as mice or snakes and various other “creepy-crawlies.” The person experiences high levels of fear and physiological arousal when encountering the phobic object, which prompts strong urges to avoid or escape the situation or avoid the feared stimulus, as in the following case. * A range of factors have been implicated in the origins of specific phobias including relatively straightforward traumatic conditioning of fear Genetic and temperamental factors are known to affect the speed and strength of conditioning of fear * Specific Phobias * Exposure therapy is the most commonly used treatment for specific phobias Other therapies include participant modeling virtual reality therapies combining cognitive techniques with exposure-based therapies * Treating Specific Phobias * Social phobia involves disabling fears of one or more discrete social situations in which a person fears that she or he may be exposed to the scrutiny and potential negative evaluation of others * Social Phobia * Social Phobia It is not abnormal to experience some degree of fear in social situations such as dating, attending parties or social gatherings, or giving a talk or presentation to a class or group. Social phobia - Excessive fear of social interactions or situations. The underlying problem is an excessive fear of negative evaluations from others. * Percentage of people with social phobia reporting specific difficulties associated with their fears of social situations. More than 90% of people with social phobia feel handicapped by anxiety in their jobs. * Treatments for social phobias include behavior therapy cognitive-behavioral therapy medications * Social Phobia * Psychodynamic Perspectives From the psychodynamic perspective, anxiety is a danger signal that threatening impulses of a sexual or aggressive (murderous or suicidal) nature are nearing the level of awareness. To fend off these threatening impulses, the ego mobilizes its defense mechanisms. In phobias, the Freudian defense mechanism of projection comes into play. * Learning Perspectives The classic learning perspective on phobias was offered by psychologist O. Hobart Mowrer (1948). Two-factor model - A theoretical model that accounts for the development of phobic reactions on the basis of classical and operant conditioning. The fear component of phobia is believed to be acquired through classical conditioning, as previously neutral objects and situations gain the capacity to evoke fear by being paired with noxious or aversive stimuli. * Biological Perspectives Genetic factors can predispose individuals to develop anxiety disorders, including panic disorder and phobic disorders. Investigators showed links between variations of a particular gene and different patterns of brain activity when people were exposed to fearful stimuli (Hariri et al., 2002). Individuals with a particular form of the gene showed greater neuronal activity in response to fearful stimuli in the amygdala, an almond-shaped structure in the limbic system of the brain. * The amygdala and limbic system. The amygdala is part of the limbic system, a set of interconnected structures in the brain involved in forming memories and processing emotional responses. The limbic system, which also consists of specific parts of the thalamus and hypothalamus and other nearby structures, is located in the forebrain below the cerebral cortex. * The “all-clear” signal quells fear in rats. Evidence shows that “all-clear” signals from the prefrontal cortex to the amygdala inhibit fear in rats. This discovery may lead to treatments that can help quell fear reactions in humans. * Cognitive Perspectives Recent research highlights the importance of cognitive factors in determining proneness to phobias, including factors such as oversensitivity to threatening cues, overpredictions of dangerousness, and self-defeating thoughts and irrational beliefs: Oversensitivity to threatening cues. Overprediction of danger. Self-defeating thoughts and irrational beliefs. * Snakes and Spiders Snakes and spiders. According to the concept of prepared conditioning, we are genetically predisposed to more readily acquire fears of the types of stimuli that would have threatened the survival of ancestral humans—stimuli such as large animals, snakes, and other creepy-crawlers. * * Treatment Approaches Traditional psychoanalysis fosters awareness of how clients’ fears symbolize their inner conflicts, so the ego can be freed from expending its energy on repression. Modern psychodynamic therapies also foster clients’ awareness of inner sources of conflict. They focus to a greater extent than do traditional approaches on exploring sources of anxiety that arise from current rather than past relationships, however, and they encourage clients to develop more adaptive behaviors. * Learning-Based Approaches Systematic desensitization - A behavior therapy technique for overcoming phobias by means of exposure to progresively more fearful stimuli (in imagination or by viewing slides) while remaining deeply relaxed. Fear-stimulus hierarchy - An ordered series of increasingly fearful stimuli. Gradual exposure - In behavior therapy, a method of overcoming fears through a stepwise process of exposure to increasingly fearful stimuli in imagination or in real-life situations. * Learning-Based Approaches Flooding - A behavior therapy technique for overcoming fears by