Anxiety, a state of fear, has three (3) basic components
Subjective reports of tension, apprehension, dread
Behavioral responses
Physiological responses
Anxiety disorders
Characterized by manifest anxiety or behavior aimed at warding
off anxiety
Neurosis
Historically seen as related to anxiety
Anxiety disorders
1. The single largest mental health problem in United States
Anxiety Disorder Syndromes
Panic Disorder
Panic attack characterized by sudden and unexpected anxiety
Subjective report of derealization and depersonalization
Disorder often first recognized by complaints of having heart
attack
Two kinds of panic attack
Uncued attacks come out of the blue
Cue attacks occur in response to situational trigger
Stressful events common
Complication is agoraphobia, which is fear of being in situation
where escape is difficult
Often preceded by panic attacks
DSM-IV-TR lists agoraphobia as complication of panic
disorder
Panic attacks can be induced in lab using pharmacological agents
Groups at risk
Affects 3.5% of population; agoraphobia affects 5.3%
Gender, age, and marital status are risk factors
Similarity across ethnic groups and cultures, but symptoms
vary
Generalized Anxiety Disorder (GAD)
Generalized anxiety disorder is chronic state of diffuse
anxiety
Common areas of worry include family, money, work, and health
Generalized anxiety disorder is distinct from panic disorder
Symptom profiles differ
Has more gradual onset than panic disorder
Run in families, but run separately
Groups at risk
Age at onset is early
Gender and marital status are risk factors
Similarity across cultures
Phobias
Phobias involve two factors
Intense and persistent fear of object or situation that poses
no real threat
Avoidance of phobic situations
Specific phobia
Specific phobias involve acrophobia, claustrophobia,
and animal phobias
Most people can manage their specific phobia without much
difficulty
Social phobia
Social phobia characterized by avoidance of performing
certain actions in front of others for fear of embarrassing or
humiliating oneself
Common social phobias include public speaking, eating in public,
and using public bathrooms
Fears restrict choice and may interfere with work
Social phobics have characteristics that make them prone to
social rejection
Social phobia is not specific phobia for social situations
Distinguishing social phobia from other syndromes is difficult
Social phobics recall themselves as being shy in childhood
Groups at risk
Often begin in childhood
Affects up to 11% of population
Gender, ethnicity, and SES are risk factors
Obsessive-Compulsive Disorder (OCD)
Obsession is thought or image that is intruding and irresistible
Compulsion is action that is repeated again and again
Obsessions are common in general populations, but pathological
obsessions do not pass, are recurrent and involve scandalous or violent
themes
Compulsions generally related to duty and caution
Cleaning rituals
Checking rituals
Can be completely disabling
Individuals with obsessive-compulsive disorder generally do not
show characteristics of obsessive-compulsive personality disorder
Not related to problems of excess that are seen as means to an
end
Obsessive-compulsive disorder does overlap with depression
Groups at risk
Affects 2-3% of general population
Marital status is a risk factor
Females and males equally at risk
Usually appears in late adolescence or early adulthood
Onset may be related to stressful event
Posttraumatic Stress Disorder (PTSD)
Posttraumatic stress disorder is severe psychological reaction
to traumatic events
Source of stress is external event that is very traumatic
Symptoms consist of heightened arousal, reactions to reminders
of trauma, and numbing to surroundings
Symptoms generally appear shortly after trauma, but there may
be an extended time between event and onset of symptoms
Combat can trigger disorder but is typically preceded by accumulated
stress
Victims of civilian catastrophes may also be related to posttraumatic
stress disorder
Those that escape a disaster may experience survivor's guilt
Groups at risk
Affects 8% of population
Marital status, gender, ethnicity, and type of trauma are
important
Not all people are disabled by traumatic experiences because
severity of trauma is significant
Coping and attributional style related to reaction to trauma
Environment to which individual returns to following trauma
important
Nature of trauma affects posttraumatic stress disorder and
type of symptoms
Problems in the classification of posttraumatic stress disorder
In DSM-IV-TR, reactions to ordinary trauma are considered
as adjustment disorders
Most victims show symptoms of posttraumatic stress disorder
There is disagreement regarding classifying posttraumatic
stress disorder as an anxiety disorder
Anxiety Disorders: Theory and Therapy
The Psychodynamic Perspective: Neurosis
The Roots of Neurosis
Anxiety is viewed as coming from external danger and breakdowns
of ego attempt to satisfy id without violating demands of reality
and superego resulting in neurosis
Anxiety chronically experienced is generalized anxiety disorder
Anxiety builds up in panic disorder as id impulses move closer
to the conscious mind
In phobia, ego defends against anxiety by displacing it
Symptoms of obsessive-compulsive disorder affect its explanation
Bowlby's attachment theory suggests that disturbances in parent-child
relationship may lead to anxiety disorder
Treating Neurosis
Goal is to expose, and neutral material ego is defending against
Free association, dream analysis, resistance,
and transference used to reveal unconscious material
Therapy moving toward briefer, face-to-face therapies directed
more to present and specific symptoms
The Behavioral Perspective: Learning to Be Anxious
How We Learn Anxiety
Avoidance learning has two components
Respondent learning changing neutral stimulus to anxiety-arousing
Avoidance of conditioned stimulus resulting in relief
from anxiety
Disorders are variations on avoidance-reinforced anxiety
Research supports avoidance-learning theory but has several
problems
Some anxiety patients do report conditioning, some do
not
Traditional learning theory has difficulty explaining
why very select, nonrandom types of stimuli become phobic
objects
Focus entirely on concrete stimuli and observable behaviors
and not thoughts
Cognitive processes play important role in anxiety such as
efficacy expectations and fear of fear
Unlearning Anxiety
Confrontation with feared stimulus
Systematic desensitization involves hierarchy of fears
and relaxation
Systematic desensitization effective with specific phobias
Relaxation unnecessary
Exposure with feared stimulus effective
Imagined exposure with feared stimulus is flooding
Exposure effective with anxiety disorders
More complex anxiety disorders may require combinations of
different cognitive techniques
The Cognitive Perspective: Overestimation of Threat
Anxiety as Overestimation (misperception)
People with anxiety disorders misperceive or misinterpret
stimuli: internal, and external
Panic disorder patients interpret bodily sensations as dangerous
and continue to pay even closer attention to internal sensations
Some research supports model
Model doesn't explain why panic attacks occurring during
sleep are often not connected with dreams and some patients
report catastrophic conditions after attack
Agoraphobia seen as extension of panic disorder where person
appraises that he cannot cope with panic
Other anxiety disorders seen as variations on misinterpretation-of-threat
theme
Reducing Perceptions of Threat
Focus is on panic attack itself rather than on avoidance behavior
Therapy involves three components
Identify patient's negative interpretations of bodily
sensations
Suggest alternative interpretations
Help patient test validity of alternative interpretation
Therapy has been successful at helping most patients to remain
free of panic attacks
Questions remain on why therapy works; suggestions include
exposure
Generalized anxiety disorder treated with combined cognitive
and behavioral therapy
The Neuroscience Perspective: Biochemistry and Medicine
Genetic Research
Panic disorder has genetic basis; other disorders have weaker
but significant genetic bias, with generalized anxiety disorder
having weakest evidence
A general vulnerability is inherited toward anxiety disorders
in general rather than toward specific disorder
The Role of Neurotransmitters
Anxiety disorders involve GABA, which is an inhibitory neurotransmitter;
it is affected by benzodiazepines
Panic disorder responsive to antidepressants suggesting another
mechanism
Chemical basis of panic disorder differs from generalized
anxiety
Panic disorder may be closely related to depression
Panic attacks may be triggered by increased activity in locus
ceruleus
Another model of panic disorder is called suffocation false
alarm hypothesis; some individuals have hypersensitive monitors
and produce false alarm
Obsessive-compulsive disorder related to serotonin abnormalities
and the basal ganglia
Little is known about the biology of social phobia, but may
involve serotonin abnormalities
Posttraumatic stress disorder may be explained by a hormonal
theory suggesting hormones affect memory of trauma to the point
that memory cannot fade
Minor Tranquilizers
Minor tranquilizers are used to reduce anxiety
Benzodiazepines are very popular minor tranquilizers
Are CNS depressants
Can lead to dose-dependent side effects such as daytime
sedation, memory disturbances
Withdrawal from benzodiazepines is a drawback
and may be followed by rebound as is case of Xanax
Short-acting and long-acting benzodiazepines have differing
pattern of withdrawal
Antidepressant Drugs
Antidepressant drugs used to elevate mood
Effective for panic disorder and obsessive-compulsive disorder
MAO inhibitors interfere with action of enzyme MAO
Effective treatment for anxiety disorders
Can have adverse effects on brain, liver, and cardiovascular
system
Tricyclics effective with panic disorder and obsessive-compulsive
disorder, but with side effects
