Anxiety Disorder.pptx for a soft form regarding mental health

Health care

1. Anxiety Disorders [email protected]

2. Anxiety vs. Fear Anxiety Apprehension about a future threat Fear Response to an immediate threat Both involve physiological arousal Sympathetic nervous system Both can be adaptive Fear triggers “fight or flight” May save life

3. Anxiety Disorders DSM-5 Anxiety Disorders Specific phobias Social anxiety disorder Panic disorder Agoraphobia Generalized anxiety disorder Most common psychiatric disorders 28% report anxiety symptoms Most common are phobias

4. Criteria for Anxiety Disorders DSM-5 criteria for each disorder: Symptoms interfere with important areas of functioning or cause marked distress Symptoms are not caused by a drug or a medical condition Symptoms persist for at least 6 months or at least 1 month for panic disorder The fears and anxieties are distinct from the symptoms of another anxiety disorder

5. Phobias Disruptive fear of a particular object or situation Fear out of proportion to actual threat Awareness that fear is excessive Must be severe enough to cause distress or interfere with job or social life Avoidance

6. Specific Phobia Disproportionate fear of a particular object or situation Common examples: fear of flying, snakes, heights, etc. Fear out of proportion to actual threat Awareness that fear is excessive Most specific phobias cluster around a few feared objects and situations High comorbidity of specific phobias

7. DSM-5 Criteria for Specific Phobia Marked and disproportionate fear consistently triggered by specific objects or situations The object or situation is avoided or else endured with intense anxiety Symptoms persist for at least 6 months

8. Table 6.2: Types of Specific Phobias

9. Social Anxiety Disorder Previously called Social Phobia Causes more life disruption than other phobias More intense and extensive than shyness Persistent, intense fear and avoidance of social situations Fear of negative evaluation or scrutiny Exposure to trigger leads to anxiety about being humiliated or embarrassed socially Onset often adolescence 33% also diagnosed with Avoidant Personality Disorder Overlap in genetic vulnerability for both disorders

10. DSM-5 Criteria for Social Anxiety Disorder Marked and disproportionate fear consistently triggered by exposure to potential social scrutiny Exposure to the trigger leads to intense anxiety about being evaluated negatively Trigger situations are avoided or else endured with intense anxiety Symptoms persist for at least 6 months

11. Panic Disorder Frequent panic attacks unrelated to specific situations Panic attack Sudden, intense episode of apprehension, terror, feelings of impending doom Intense urge to flee Symptoms reach peak intensity within 10 minutes Physical symptoms can include: Labored breathing, heart palpitations, nausea, upset stomach, chest pain, feelings of choking and smothering, dizziness, sweating, lightheadedness, chills, heat sensations, and trembling Other symptoms may include: Depersonalization Derealization Fears of going crazy, losing control, or dying 25% of people will experience a single panic attack (not the same as panic disorder)

12. DSM-5 Criteria for Panic Disorder Recurrent unexpected panic attacks At least 1 month of concern about the possibility of more attacks, worry about the consequences of an attack, or maladaptive behavioral changes because of the attacks

13. Agoraphobia From the Greek word “agora” or marketplace Anxiety about inability to flee anxiety- provoking situations E.g., crowds, stores, malls, churches, trains, bridges, tunnels, etc. Causes significant impairment In DSM-IV-TR, was a subtype of Panic Disorder At least half of agoraphobics do not suffer panic attacks

14. DSM-5 Criteria for Agoraphobia Disproportionate and marked fear or anxiety about at least 2 situations where it would be difficult to escape or receive help in the event of incapacitation or panic-like symptoms, such as: being outside of the home alone; traveling on public transportation; open spaces such as parking lots and marketplaces; being in shops, theaters, or cinemas; standing in line or being in a crowd These situations consistently provoke fear or anxiety These situations are avoided, require the presence of a companion, or are endured with intense fear or anxiety Symptoms last at least 6 months

15. Generalized Anxiety Disorder (GAD) Involves chronic, excessive, generalized, uncontrollable worry Lasts at least 6 months Interferes with daily life Often cannot decide on a solution or course of action Other symptoms: Restlessness, poor concentration, tiring easily, irritability, muscle tension Common worries: Relationships, health, finances, daily hassles Often begins in adolescence or earlier I’ve always been this way

16. DSM-5 Criteria for Generalized Anxiety Disorder Excessive anxiety and worry at least 50 percent of days about at least two life domains (e.g., family, health, finances, work, and school) The person finds it hard to control the worry The worry is sustained for at least 3 months The anxiety and worry are associated with at least three (or one in children) of the following: 1. restlessness or feeling keyed up or on edge 2. being easily fatigued 3. difficulty concentrating or mind going blank 4. irritability 5. muscle tension 6. sleep disturbance

17. Comorbidity 50% of those with anxiety disorder meet criteria for another anxiety disorder 75% of those with anxiety disorder meet criteria for another psychological disorder Disorders commonly comorbid with anxiety: 60% with anxiety also have depression Substance abuse Personality disorders Medical disorders, e.g. coronary heart disease

18. Gender and Sociocultural Factors Women are twice as likely as men to have anxiety disorder Possible explanations Women may be more likely to report symptoms Men more likely to be encouraged to face fears Women more likely to experience childhood sexual abuse Women show more biological stress reactivity Cultural factors Culture can shape anxieties and fears Culturally specific syndromes Taijin kyofusho Japanese fear of offending or embarrassing others Kayak-angst Inuit disorder in seal hunters at sea similar to panic Rate of anxiety disorders varies by culture, but ratio of somatic to psychological symptoms appears similar ( Kirmayer , 2001)

19. Table 6.3: Percent of People Who Meet Diagnostic Criteria for Anxiety Disorders in the Past Year and in Their Lifetime

20. Table 6.5: Factors that May Increase the Risk for More than One Anxiety Disorder Behavioral conditioning (classical and operant conditioning) Genetic vulnerability Increased activity in the fear circuit of the brain Decreased functioning of GABA and serotonin; increased norepinephrine activity Behavioral inhibition Neuroticism Cognitive factors, including sustained negative beliefs, perceived lack of control, and attention to cues of threat

21. Etiology of Specific Phobias Conditioning Mowrer’s two-factor model Pairing of stimulus with aversive UCS leads to fear (Classical Conditioning) Avoidance maintained though negative reinforcement (Operant Conditioning)

22. Risk Factors Genetic Twin studies suggest heritability About 20-40% for phobias, GAD, and PTSD About 50% for panic disorder Relative with phobia increases risk for other anxiety disorders in addition to phobia Neurobiological Fear circuit overactivity Amygdala Medial prefrontal cortex deficits Neurotransmitters Poor functioning of serotonin and GABA Higher levels of norepinephrine

23. Risk Factors: Personality Behavioral inhibition Tendency to be agitated, distressed, and cry in unfamiliar or novel settings Observed in infants as young as 4 months May be inherited Predicts anxiety in childhood and social anxiety in adolescence Neuroticism Tendency to react with frequent negative affect Linked to anxiety and depression Higher levels linked to double the likelihood of developing anxiety disorders

24. Risk Factors: Cognitive Sustained negative beliefs about future Bad things will happen Engage in safety behaviors Belief that one lacks control over environment More vulnerable to developing anxiety disorder Childhood trauma or punitive parenting may foster beliefs Serious life events can threaten sense of control Attention to threat Tendency to notice negative environmental cues Selective attention to signs of threat

25. Etiology of Social Anxiety Disorder Behavioral factors Factors similar to specific phobia (i.e., classical and operant conditioning) Cognitive factors Unrealistic negative beliefs about consequences of behaviors Excessive attention to internal cues Fear of negative evaluation by others Expect others to dislike them Negative self-evaluation Harsh, punitive self-judgment

26. Etiology of Panic Disorder Neurobiological factors Locus coeruleus Major source of norepinephrine A trigger for nervous system activity People with panic disorder more sensitive to drugs that trigger the release of norepinephrine

27. Etiology of Panic Disorder Behavioral factors: Interoceptive conditioning Classical conditioning of panic in response to internal bodily sensations

28. Etiology of Panic Disorder Cognitive factors Catastrophic misinterpretations of somatic changes Interpreted as impending doom I must be having a heart attack! Beliefs increase anxiety and arousal Creates vicious cycle Anxiety Sensitivity Index High scores predict development of panic “Unusual body sensations scare me.” “When I notice that my heart is beating rapidly, I worry that I might have a heart attack.”

29. Etiology of Panic Disorder Genetic risk Polymorphism in a gene guiding neuropeptide S function, the NPSR1 gene, has been tied to an increased risk of panic disorder and is associated with: Amygdala response to threat Cortisol response Higher anxiety sensitivity scores Genetic risk shapes stress responses and hypersensitivity to somatic changes, and this may then increase the risk for panic disorder.

30. Etiology of Agoraphobia Fear-of-fear hypothesis (Goldstein & Chambless , 1978) Expectations about the catastrophic consequences of having a public panic attack What will people think of me?!?!

31. Etiology of GAD GABA system deficits Borkovec’s cognitive model: Worry reinforcing because it distracts from negative emotions and images Allows avoidance of more disturbing emotions e.g., distress of previous trauma Worrying decreases psychophysiological arousal Avoidance prevents extinction of underlying anxiety

32. Treatment of the Anxiety Disorders Psychological treatments emphasize Exposure Face the situation or object that triggers anxiety Should include as many features of the trigger as possible Should be conducted in as many settings as possible 70-90% effective Systematic desensitization Relaxation plus imaginal exposure Cognitive approaches Increase belief in ability to cope with the anxiety trigger Challenge expectations about negative outcomes

33. Psychological Treatment of Phobias Phobias Exposure In vivo (real-life) exposure more effective than systematic desensitization Social Anxiety Disorder Exposure Role playing or small group interaction Social skills training Reduce use of safety behaviors Cognitive therapy Clark’s (2003) cognitive therapy more effective than medication or exposure

34. Psychological Treatment of Panic Panic Control Therapy (PCT; Craske & Barlow, 2001) Exposure to somatic sensations associated with panic attack in a safe setting Increased heart rate, rapid breathing, dizziness Use of coping strategies to control symptoms Relaxation Deep breathing PCT benefits maintained after treatment ends

35. Psychological Treatment of Agoraphobia Cognitive Behavioral Therapy (CBT) Systematic exposure to feared situations Self-guided treatment effective

36. Psychological Treatment of GAD Relaxation training Cognitive behavioral methods Challenge and modify negative thoughts Increase ability to tolerate uncertainty Worry only during “scheduled” times Focus on present moment

37. Medications Anxiolytics: drugs that reduce anxiety Benzodiazepenes Valium Xanax Antidepressants Tricyclics Selective Serotonin Reuptake Inhibitors (SSRIs) Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) Side effects can be problematic with continuing medication D- cycloserine (DCS) Enhances learning and can bolstered treatment effectiveness