Lecture 5 - Anxiety Disorders

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8 Mar 2011
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PSY 240 Lecture 5: Anxiety Disorders
Symptoms of Anxiety
Anxiety is on a spectrum, not necessarily pathological, some moderate anxiety is
important (ex. Motivation to study and keep working on personal development)
In pathology focus on interference of anxiety in daily life and functioning, amount
of interference, and length of interference
~20% of population will have some kind of anxiety disorder during their life, high
comorbidity (especially with mood disorders, drug/alcohol addictions, eating
disorders)
Anxious states when normal people have moments with high anxiety due to events
Anxious traits cause chronic anxious, affect reactions to event and make prone to
anxiety
Somatic - body experiences
goosebumps, tense muscles, increased heart rate + respiration + perspiration,
respiration deepens, spleen contracts, peripheral blood vessels dilate, liver releases
carbs, bronchioles widen, pupils dilate, adrenaline secreted, stomach acid inhibited,
salivation decreases, bladder relaxes
Emotional
sense of dread, terror, restlessness, irritability
Cognitive thinking processes
anticipation of harm, catastrophizing and exaggerating of danger, problems
concentrating, hypervigilance, worried + ruminative thinking, fear of losing control,
fear of dying, sense of unreality
Behavioural
escape, avoidance, aggression, freezing unsure of what to do, decreased appetite
responding, increased aversive responding (ex. Increased food or alcohol
consumption)
not everyone has the same kind of symptoms
individual factors are more important than situational factors, past coping and
experiences are important, two people in the same situation can have similar
responses
Models of Anxiety
Biological
ogenetic vulnerability
tempermental factors might be caused by early attachment with
mothers and caregivers
more heart palpitations and sweating seen as threats
www.notesolution.com
anxiety sensitivity hyper-focused on bodily changes, quick appraisals
earlier suffocation alarms so more prone to panicking
can run in families, but may be due to family interactions vs. genetics
so difficult to piece apart
OCD and PD higher genetic component
obrain structure/function
oneurotransmitters serotonin and norepinephrine could be cause of high
comorbidity
otreatments: common and effective in short-term but often relapses once off
medication, rebound anxiety, can be highly addictive and have high potential
for abuse since they turn off aversive states
benzodiazapines minor tranquilizers adavan, xanax, valium
several withdrawal and high potential for abuse so antidepressants
might be prescribed more often
antidepressants tricyclics and ssris (ex. prozac), especially helpful
for OCD and PD helps reduce physical symptoms but doesnt teach
problem-solving, may slow down thoughts instead of eliminating them
medications take time to kick in, patients might give credit for
improvement to the medications instead of themselves, so better to
start drugs and therapy at different times to know which is helping
exposures wont work as well on high doses on medication since the
anxiety wont go up in response
Psychodynamic
oanxiety develops as a result of repressing unresolved unconscious conflicts
specific focus on oedipal complex in young children desire for mother
and angry at father, but unexpressed since too close to parents
overy limited support
Behavioural a lot of empirical support
oOrigins of anxiety are often unclear so seems like a lifelong tempermental
condition, but with behavioural techniques you dont have to know how the
anxiety started just have to know whats maintaining the anxiety (ie.
Avoidance and subtle avoidance strategies, behavioural avoidance and
cognitive avoidance, strongly reinforced when anxiety drops after escaping
the situation but lose out on positive effects of exposure)
oMowrers two Factor Theory develops though classical condition and
maintained through operant conditioning (see above) by avoiding and escape
the stimulus since reinforcing consequences
Problems: in 50% of cases, ppl can identify the onset of their phobia
and in the other 50% there is no phobia caused by direct contact see
Rachman
oRachmans Pathways phobia learned by observation/modeling, being told to
watch out for certain things, bad event reported in media (ex. Plane crashes
even though they do not happen often)
oTreatments:
Considered essential, cant just have cognitive therapy for success
www.notesolution.com
Exposure to feared object or situation
Cognitive similar to cognitive theories of depression
oMaladaptive thoughts, appraisals, or perceptions contribute to anxiety
Ex. Overestimating probability of threat and consequences of harm,
underestimating ability to cope
Maintained by belief that things will come true (and when they do
rarely happen, beliefs are confirmed)
Lack of predictability and control
Evidence for intentional bias to interpret neutral things from
environment as anxious appraisals cognitive distortions
Fortune telling foretell anxious results, catastrophize, scared
of anxiety being noticed by other and being
humiliated/embarassed
oTreatments:
Behavioural experiments (called an experiment since different
rationale than behavioural methods to test a prediction), challenging
negative thoughts to promote cognitive change
Exposure
Just perceiving control can lower anxiety even when the control isnt
real
DSM-IV Anxiety Disorders
Many people meet sub-thresholds
Generalized Anxiety Disorder (GAD) high feeling of uncertainty
oProlonged chronic excessive anxiety and uncontrollable worry about current
and future events, occurring more days than not, for at least 6 months
oAbout many domains of life that arent attached to real stressors, role not
played by real danger
oCant shut the anxiety off
oAssociated symptoms:
Restlessness or feeling keyed up or on edge, difficulty staying still
Easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension usually in shoulders, neck, and back
Sleep disturbance worrying about being unable to get back to sleep
o%5 prevalence but many ppl in sub-threshold without symptoms clinically
interfering with life, often in childhood in adolescence, 2/3 in women
oCan wax and wane over time, content of worries may change
oCB model: - says probably some kind of biological vulnerability
Trigger can be external, internal
what if? everyone has this, but ppl with GAD have MANY
worry (cognitive) feels like uncontrollable thought process,
often future-oriented with low chance of ever actually
happening, worrying about worry (meta-worrying, may lead to
www.notesolution.com