ANXIETY DISORDERS

Anxiety vs. Fear

 Anxiety is defined as apprehension
over an anticipated problem
 Fear is a reaction to immediate
danger.
 Both involve physiological arousal
 Sympathetic nervous system
 Both can be adaptive
 Fear triggers “flight or fight”
 May save life
 Anxiety increases preparedness
 Moderate levels improve performance
General Criteria
 Symptoms must interfere with important
areas of functioning or cause marked
distress.
 Symptoms are not caused by a drug or a
medical condition.
 The fears and anxieties are distinct from the
symptoms of another anxiety disorder.
Summary of Anxiety Disorders
 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.
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
Panic Disorder
 Recurrent uncued 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.
 Panic Attacks
 Uncued
 Occurred unexpectedly without warning
 Cued
 Triggered by specific situation
Panic Attack
 is a sudden attack of intense apprehension,
terror, and feelings of impending doom,
accompanied by at least four other
symptoms.
 Physical symptoms
 labored breathing, heart palpitations, nausea,
upset stomach, chest pain, feelings of choking
and smothering, dizziness, lightheadedness,
sweating, chills, heat sensations, and trembling.
 Other symptoms include:
 Depersonalization
 Derealization
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, embarrassing symptoms, or panic-
like symptoms such as being outside of the home
alone; traveling on public transportation; being in
open spaces such as parking lots and
marketplaces.
 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
Generalized Anxiety Disorder
 Excessive anxiety and worry at least 50 % of
days about a number of events or activities
 The person finds it hard to control the worry
 The worry is sustained for at least 6 months
 The anxiety and worry are associated with at
least three (or one in children) of the
following: restlessness or feeling keyed up or
on edge; easily fatigued; difficulty
concentrating or mind going blank; irritability;
muscle tension; sleep disturbance
Comorbidity of Anxiety
Disorders
 ¾ of those anxiety disorder meet criteria for another
disorder
 60% meet criteria for major depression

 Other disorders commonly comorbid with anxiety

 Substance Abuse

 Personality Disorders

 Medical Disorders e.g. coronary heart diseases

 It is very common for people with one anxiety disorder to

report subthreshold symptoms (symptoms that do not
meet full diagnostic criteria) of other disorders
Gender and Sociocultural Factors in
the Anxiety Disorders
 Women are at least twice as likely as men to be diagnosed
with an anxiety disorder
 Possible Explanations:
 Women may be more likely to report their symptoms.
 Women are much more likely than men to be sexually assaulted
during childhood and adulthood
 Women show more biological reactivity to stress than do men
 Socio-cultural Factors
 Focus of these problems appears to vary by culture.
 Taijin kyofusho (Japan) - fear of displeasing or embarrassing others
 Koro (South and East Asia) - a sudden fear that one’s genitals will recede
into the body
 Shenkui (China) - intense anxiety and somatic symptoms attributed to the
loss of semen, as through masturbation or excessive sexual activity
Common Risk Factors across the
Anxiety Disorders
 Genetics
 Neurobiological risk factors
 Behavioral conditioning
 Personality traits
 Cognition
 Risk Factors: Genes and
Neurobiological Factors
 Genetic
 Twin Studies
 20–40 percent for specific phobias,
social anxiety disorder, GAD and
PTSD
 about 50 percent for panic disorder
 genes may elevate risk for several
different types of anxiety disorder
 Neurobiological
 Fear Circuit Activity
 Amygdala (Active)
 Medial prefrontal cortex (Less Active)
 Neurotransmitters
 Serotonin, GABA (Poor Functioning)
 Norepinephrine (Higher than Normal)
Risk Factors: Behavioral
 Fear Conditioning
 Mowrer’s two-factor
model
1. Through classical conditioning, a
person learns to fear a neutral
stimulus (the CS) that is paired with
an intrinsically aversive stimulus
(the UCS).
2. Through operant conditioning, a
person gains relief by avoiding the
CS. This avoidant response is
maintained because it is reinforcing
(it reduces fear).
Risk Factors: Personality
 Behavioral Inhibition
 a tendency to become agitated and cry when faced with novel or
unfamiliar settings
 strong predictor of anxiety in childhood and social anxiety
disorder in adolescents
 Observed in infants as young as 4 months old

 May be inherited

 Neuroticism
 Tendency to react to events with greater than-average negative
affect.
 Linked to anxiety and depression
 Twice as likely to develop an anxiety disorder
Risk Factors: Cognitive
Factors
 Sustained Negative Beliefs about the Future
 People with anxiety disorders often report believing that bad
things are likely to happen.

 Perceived Control
 People who think that they lack control over their environment
appear to be at greater risk for a broad range of anxiety disorders
than people who do not have that belief.

 Attention to signs of threat

 People with anxiety disorders have been found to pay more
attention to negative cues in their environment than do people
without anxiety disorders
able
Commonalities across
Psychological Treatments:
EXPOSURE
 Exposure - that is, the person must face what
he or she deems too terrifying to face.
 Chinese proverb puts it, “Go straight to the
heart of danger, for there you will find safety.”
 Even psychoanalysts, who believe that the
unconscious sources of anxiety are buried in
the past, eventually encourage confronting
the source of fears
Exposure Therapy Approaches
 Systematic desensitization - the client is first
taught relaxation skills. Then the client uses
these skills to relax while undergoing exposure
to a list of feared situations developed with the
therapist— starting with the least feared and
working up to the most feared
 Behavioral view of exposure - is that it works by
extinguishing the fear response
 Cognitive view of exposure treatment - helps
people correct their mistaken beliefs that they
are unable to cope with the stimulus.
Exposure Therapy Approaches
 Virtual reality is sometimes used to simulate
feared situations such as flying, heights, and
even social interactions
 CBT Exposure - exposure should include as
many features of the feared object as
possible. Exposure should be conducted in
as many different contexts as possible.