Anxiety Disorders�Module 5.4a

LEARNING TARGETS:

• Describe generalized anxiety disorder, panic disorder, phobias, OCD, PTSD.
• Describe how conditioning, cognition, & biology contribute to feelings & thoughts that can cause anxiety disorders.

Anxiety

• Anxiety is an unpleasant emotional state characterized by physical arousal and feelings of tension, apprehension, and worry
• Puts us on physical alert, preparing us to defensively “fight” or “flee” potential dangers,
• Also puts us on mental alert, making us focus our attention squarely on the threatening situation

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Anxiety Disorders

• In the anxiety disorders, the anxiety is maladaptive, disrupting everyday activities, moods, and thought processes and at times leading to dysfunctional anxiety-reducing behaviors.
• Three features distinguish normal anxiety from pathological anxiety. Pathological anxiety is:
1. Irrational—it is provoked by perceived threats that are exaggerated or nonexistent, and the anxiety response is out of proportion to the actual importance of the situation.
2. Uncontrollable—the alarm reaction cannot be shut off even when the person knows it’s unrealistic.
3. Disruptive—it interferes with relationships, job or academic performance, or everyday activities

Generalized Anxiety Disorder�(GAD)

• Disruptive levels of persistent, unexplained feelings of apprehension and tenseness
• Constantly in a state of autonomic nervous system arousal
• Lasting for 6 months or more
• Concentration switches from worry to worry making one jittery, agitated & sleep-deprived.
• Anxiety is free-floating – not linked to anything specifically

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GAD

Panic Disorder

• An anxiety disorder characterized by sudden bouts of intense, unexplained feelings of dread & terror
• Panic attacks—sudden episode of helpless terror with high physiological arousal
• Very frightening—sufferers live in fear of having them
• may happen several times a day
• Agoraphobia often develops as a result

Agoraphobia

• Fear of situations the person views as difficult to escape or help unavailable when panic strikes
• Fear of leaving one’s home or room in the house

Specific Phobia

• Disruptive, irrational fear of a specific object, activity or situation
• The fear must be both irrational and disruptive.
• Causes one to avoid the feared situation
• About 10 percent of the general population will experience a specific phobia at some point in their lives.

Phobias

• It is not phobic to simply be anxious or afraid about something
• It needs to be irrational & debilitating

Phobias

• Generally, the objects or situations that produce specific phobias tend to fall into four categories
1. Natural environment—heights, water, lightning
2. Situation—flying, tunnels, crowds, social gathering
3. Injury—needles, blood, dentist, doctor
4. Animals or insects—insects, snakes, bats, dogs

Watch this video of a girl with a phobia for pickles

Obsessive-Compulsive Disorder (OCD)

• An anxiety disorder characterized by unwanted, repetitive thoughts and actions
• Obsessions – irrational, disturbing repetitive thoughts that intrude into consciousness
• Compulsions – repetitive actions performed to alleviate obsessions
• The obsessions/compulsions begin to take control of the person’s life.

Obsessive-Compulsive Disorder (OCD)

• Obsessions—irrational, disturbing repetitive thoughts that intrude into consciousness
• Compulsions—repetitive actions performed to alleviate obsessions
• Overt physical behaviors, such as repeatedly checking or washing your hands
• Covert mental behaviors, such as counting or reciting certain phrases to yourself

Potential Biological Causes:

The caudate nucleus is located in the basal ganglia and is associated with initiation of learned, habitual motor activities

Drugs that increase Serotonin reduces the activity of the caudate nucleus and leads to a reduction in the obsessions and compulsions - people who recover from OCD using behavioral and cognitive therapies also show a reduction in activity in the caudate nucleus

Finding Your OCD Score

• Circle the following item numbers if you marked TRUE for them: 1, 2, 4, 6, 7, 8, 16, 17, 21
• Circle the following item numbers if you marked FALSE for them: 5, 9, 10, 11, 12, 13, 14, 19, 20, 22
• Now add up your total score. Highest score possible is a 20 (items 3 & 15 are validity checks)
• The mean (average) score is 11.15 for males and 11.24 for females.

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• Remember, even if you scored high on this scale it doesn’t mean you have OCD. Always ask yourself, “Do these tendencies I have disrupt my daily life and relationships?” If the answer is NO you don’t have a problem.

OCD Related Disorders

• Hoarding Disorder – cluttering space with possessions they can’t part with
• An example of what it’s like

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• Trichotillomannia – Hair pulling - An example

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• Body Dysmorphic Disorder – Exaggerated concern and preoccupation about minor or imagined defects in appearance.
• See CNN video on new biological evidence – 2 min.
• See the Many Faces of Michael Jackson (40 sec.)

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Posttraumatic Stress Disorder�(PTSD)

• Reliving a severely traumatic event through distressing memories & nightmares
• Follows events that produce intense horror or helplessness (traumatic episodes)
• Core symptoms include:
• Frequent recollection of traumatic event, often intrusive and interfering with normal thoughts
• Avoidance of situations that trigger recall of the event
• Increased physical arousal associated with stress
• There is a high correlation of suicide and drug abuse in PTSD

What doesn’t kill us, can make us stronger

• Survivor Resiliency – Even though 50% of adults will have a traumatic experience only 5 - 10% will develop PTSD. Most will recover healthy functioning.
• Greater the emotional distress during a trauma, the higher the risk for PTSD

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• Posttraumatic Growth – after struggling through a challenging crisis, people may report…
• increase in appreciation for life
• more meaningful relationships
• increased personal growth
• changed priorities
• a richer spiritual life.

Causes of Anxiety Disorders

Conditioning leading to Phobias

• Classical conditioning may be involved in the development of a specific phobia that can be traced back to some sort of traumatic event.
• People with phobias may have developed a conditioned response of fear to a conditioned stimulus then generalize that onto all similar stimuli

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• Problems with this theory:
• often no memory of a traumatic experience
• traumatic experience may not produce phobia

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Other Learning Factors

• Observational learning--watching another experiencing fearfulness--may result in developing fear.
• Monkey’s learning to fear snakes by observing

other monkeys.

• Operant Conditioning - Fear of an object may be negatively reinforced by avoiding the feared objects.

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Cognitive-Behavioral Theory of Panic Disorder

• Some people are hypervigilant – they are more likely to define something as a threat when really there is no threat there.
• Sufferers tend to misinterpret the physical signs of arousal as catastrophic and dangerous
• This interpretation leads to further physical arousal, tending toward a vicious cycle
• After their first panic attack, they become even more attuned to physical changes, increasing the likelihood of future panic attacks
• Therapy involves trying to get the person to rethink their phobia.

Biological Factors

• Hereditary/Gene factors may result in a predisposition for developing anxiety disorders
• If one Identical develops an anxiety disorder, the other has a strong chance of also developing an anxiety disorder.
• Stress can turn on certain genes (epigenetics)

• Brain functions appear to be different in an anxiety disorder patient
• The Caudate Nucleus is located in the Basal Ganglia and is associated with initiation of learned, habitual motor activities is overactive in OCD
• Anterior Cingulate Cortex – monitors our actions and checks for errors is hyperactive with OCD
• PTSD seems affected by an overactive Amygdala

Biological Perspective�Natural Selection/Preparedness Theory

• We fear threats that were faced by our ancestors.
• Humans seem biologically prepared to acquire fears of certain animals and situations that were survival threats in human evolutionary history
• Compulsions typically exaggerate behaviors that contributed to our species’ survival
• Grooming, hand-washing, checking