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Lecture 5

Lecture 5 - Anxiety Disorders

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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
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
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
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
escape, avoidance, aggression, freezing – unsure of what to do, decreased appetite
responding, increased aversive responding (ex. Increased food or alcohol
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
Models of Anxiety
ogenetic vulnerability
tempermental factors – might be caused by early attachment with
mothers and caregivers
more heart palpitations and sweating – seen as threats
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
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 doesn’t 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 won’t work as well on high doses on medication since the
anxiety won’t go up in response
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 don’t have to know how the
anxiety started – just have to know what’s 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)
oMowrer’s 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
oRachman’s 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)
Considered essential, can’t just have cognitive therapy for success
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
β€’Fortune telling – foretell anxious results, catastrophize, scared
of anxiety being noticed by other and being
Behavioural experiments –(called an experiment since different
rationale than behavioural methods – to test a prediction), challenging
negative thoughts to promote cognitive change
Just perceiving control can lower anxiety even when the control isn’t
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 aren’t attached to real stressors, role not
played by real danger
oCan’t 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
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