ANXIETY AND ANXIETY DISORDERS
FORMERLY THE NEUROSES
Most Prevalent of All Mental Disorders
LATIN ROOTS OF ANXIETY
ANGH - Constriction, as in anguish, anger, and angst
FREUD AND ANXIETY,
"SIGNAL ANXIETY"
DANGER TO EGO
REALITY ANXIETY- FEAR
NEUROTIC - NEUROSIS
MORAL- SHAME, GUILT
TRAIT ANXIETY
STATE ANXIETY
ANXIETY AS A TRIPARTITE CONSTRUCT
COGNITIVE, PHENOMENOLOGICAL
THINK AND SENSE "I FEEL FRIGHTENED" "DOOM," "DANGER"
PHYSIOLGICAL
SYMPATHETIC N.S.
FIGHT OR FLIGHT
MOBILIZES ENERGY
SYMPATHO-ADRENO-MEDULLARY AROUSAL
ADRENERGIC
CATABOLIC
PARASYMPATHETIC N.S.
CONSERVATION - WITHDRAWAL
ANABOLIC
BEHAVIORAL
PERFORMANCE SIGNS
AVOIDANCE
ANXIETY DISORDERS:
DSM-IV
SPECIFIC PHOBIA
SOCIAL PHOBIA
PANIC DISORDER/AGORAPHOBIA
OBSESSIVE-COMPULSIVE DISORDER
POSTTRAUMATIC & ACUTE STRESS DISORDER
GENERALIZED ANXIETY DISORDER
.. ASSOCIATED WITH MEDICAL CONDITION
SUBSTANCE INDUCED ANXIETY DISORDER
SEPARATION ANXIETY DISORDER
ADJUSTMENT DISORDER WITH ANXIETY
PANIC ATTACK
DISCRETE FEAR ATTACK
PEAKS IN 10 MINUTES
FOUR OR MORE + Sx
HEAR RATE, PALPITATIONS
TREMBLING, SHAKING
SMOTHERING SENSATIONS
CHEST PAIN, DISCOMFORT
NAUSEA, GI DISTRESS
DIZZY, LIGHTHEADED,FAINT
DEREALIIZATION,PRESONALIZATON
FEAR LOSING CONTROL, GOING CRAZY
FEAR DYING
PARATHESIA
CHILLS OR HOT FLASHES
SWEATING
PANIC ATTACKS
Three types
SITUATIONALLY BOUND
PHOBIC STIMULUS (each time)
SITUATIONALLY PREDISPOSED
INCREASED IN CERTAIN SITUATIONS (e.g. Driving; Crowds; Malls)
UNEXPECTED (UNCUED)
"SPONTANEOUS", Without apparent stimulus.
SPECIFIC PHOBIAS
DIAGNOSTICS
Marked, excessive, persistent ,unreasonable fear cued by an object or situation
Exposure almost invariably provokes fear (S/B, S/P)
Adults recognize unreasonable
Avoided/ endured with distress
reaction interferes with normal routine, function, activities, relationships OR marked distress about having it
if < 18 y/o, persists 6 months
Specific Phobia Subtypes
Animal:(dog, cat, spider, snake)
High prevalence but infrequent in clinics.
onset in early childhood (M=4)
Most resolve early on
few seek tx unless situation changes
Natural Environment
Storms, wind, heights, water
Few seek treatment
Blood, Injection, Injury
Most prevalent clinically
most serious consequences
Vasovagal Syncope (80%)
neither necessary nor sufficient for dx of phobia
Situational (elevators, planes, driving, crowds)
Feeling trapped is much of the base here
Freudian theory and phobias
highly organized libidinal energy from sexual or aggressive drive.
Ego focuses on object or situation that symbolized conflict and projects fear to that object:
snakes, fish, sharks symbolize castration anxiety
Pathways to Origins of Phobias
Direct Traumatic Conditioning
painful US
fearful US
Vicarious, Observational Conditioning
Informational
media
stories
Biologically Prepared Conditioning
(Garcia Effect
)
Prepared taste aversion conditioning:
plastic --> radiation nausea
no conditioning to light, sound
Selective Association
Belongingness of taste & nausea
Prepared animal phobia
(Seligman)
single trial conditioning
non-cognitive
resistent to extinction
Vicarious Prepared Conditioning
(Mineka)
Wild Monkey = demonstrator
Niave monkey = observer
Single trial, resistent to extinction
Selective Conditioning to Snake
not fear to flowers
to toy snakes and alligators
Adaptive Conservatism
over-generalize danger
SOCIAL PHOBIA DIAGNOSITICS
MARKED, PERSISTENT FEAR OF SOCIAL OR PERFORMANCE
FEARS SCRUTINY BY OTHERS
FEARS WILL ACT TO EMBARRASS OR HUMILIATE SELF
CHILDREN, AGE APPROPRIATE
EXPOSURE ALMOST ALWAYS ELICITS THE FEAR
SITUATIONS ARE AVOIDED OR ENDURED WITH DISTRESS
INTERFERES WITH ROUTINES
IF < 18, 6 MOS. DURATION
SOCIAL PHOBIA
11% MALE, 15% FEMALE
LEAST GENDER DIFFERENCE
ONSET IN TEENS
MORE COGNITIVE THAT SIMPLE PHOBIAS
GENERALIZED TYPE
FEARS MOST SOCIAL SITUATIONS
CIRCUMSCRIBED TYPE
SPECIFIC SITUATIONS
FEARED SOCIAL SITUATIONS
PUBLIC SPEAKING & PERFORMANCE
USE OF RESTROOMS
EATING IN PUBLIC
WRITING IN PUBLIC (SCRIPTOPHOBIA)
AUTHORITIES
OPPOSITE SEX
Circumscribed or Generalized
ORIGINS OF SOCIAL PHOBIAS
TRAUMA DURING TEENS, AT SCHOOL, IN PUBLIC
VICARIOUS LEARNING
PREPARED FEAR
FEAR OF FACES, STARING
THREAT
CULTURE
TAI-JIN KYOFU SHO
JAPANESE
TAIJIN KYOFUSHO
JAPANESE SOCIAL PHOBIA
Blushing
Improper facial expression (rigid)
innapproriate eye contact
offensive odors
appearing misshapen
perspiring profusely
trembling hands, voice, feet
uncontrolled flatulance
Treatment for Social Phobia
Cognitive Restructuring
Think differently
Preparation & Rehearsal
Social Skills Training
Relaxation and Physiologic self-control
Systematic Desensitization
Drug Therapy:
(marginal effect)
Beta adrenergic blockers
phenalzine (MAO-I)
Phobia Treatments
Bandura: Enhance Self-Efficacy
Self belief in ability to perform
All effective txs operate through this cognitive mechanism.
Verbal Persuasion (psychotherapy) does not work
Effective treatments for phobias
Systematic Desensitization
train in relaxation
anxiety Hierarchy
imagry
Applied Relaxation
progressive relaxation
breathing retraining
"in vivo" desensitization
Modeling (observational)
perceived similarity
number and varied models
imagry rehearsal
Exposure (Extinction) based treatments
Flooding
response prevention (no escape)
Graduated Exposure
live
imaginal
Participant Modeling