Anxiety Disorders &

Related Disorders
 Anxiety Disorders
Fear: innate, adaptive response to immediate
danger/threat in environment
Prepares for fight or flight (sympathetic nervous
system)
Need parasympathetic system to calm down
Anxiety: innate, adaptive response to anticipation of
danger/threat, more diffuse than fear
Feared stimulus/event is vague, not identifiable, or in
the future
Anxiety Disorders
Natural anxiety/fear response becomes inappropriate
& dysfunctional
 Diagnostic Criteria for Specific Phobia
A. Marked fear or anxiety about a specific object or situation
B. Exposure to phobic stimulus almost always provokes an immediate anxiety
response
C. Phobic situation avoided or endured with intense anxiety or distress
D. The fear or anxiety is out of proportion to the actual danger posed by the
specific object or situation and to the sociocultural context.
E. Fear or anxiety is persistent typically lasting for 6 months or more.
F. Fear must interfere significantly with persons life, or they are markedly
stressed by the fear.
G. Not better accounted for by another condition/disorder
Subtypes:
Animal Type (e.g., dogs, spiders, horses, etc.)
Natural Environment Type (e.g., heights, storms, water, etc.)
Blood-Injection-Injury Type
Situational Type (e.g., airplanes, elevators, enclosed places)
Other Type (e.g., in children: loud sounds, costumed characters, clowns)
 Specific Phobia

Prevalence: Point = 4-9%, Lifetime = 7-11%

Gender Diffs: Women x2 as likely as men
Cultural Diffs: Phobias exist in all cultures
The themes are culturally relative
Course: Typically begin in childhood
 Theories of Specific Phobia
Biological Theory: genetic vulnerability (predisposition) to anxiety
Ex: predisposition to be anxious in general likely to have
phobia
Psychodynamic Theory
Displacement: shift feelings towards one object/person to
another. Hans feelings toward dad feelings towards horse
Anxiety displaced onto neutral object (horse)
Ex: Little Hans
Projection: internal feelings that seems dangerous/unacceptable
is attributed to someone else.
Ex: Hans feelings of competition/hostility to horse projected
onto horse so Hans thought horse was hostile to him
Behavioral Theory
Classical conditioning: fearful response paired with neutral
stimuli
 Theories of Specific Phobia
Behavioral Theory
Operant Conditioning: experience punishment
(anxiety)
Leave situation anxiety goes away (negative
reinforcement)
Maintains anxiety
Observational Learning
Preparedness Theory: biologically/genetically
prepared to learn certain association quicker than
others
Snakes vs. Flowers
Develop phobia to avoid stimuli like snakes and be safe.
 Treatment of Specific Phobia
Exposure Therapy
Systematic Desensitization
Create hierarchy of fears
Teach relaxation exercises
Work up the hierarchy from the least to most feared
Research shows addition of relaxation NOT helpful.
Its more about the exposure!
Used less than in vivo (in real life) exposure alone
In vivo Exposure
Used more than systematic desensitization
No relaxation
May be 1 session for 2-3 hrs. effective!
Modeling
Flooding: intense exposure until anxiety extinguishes
Dont do it unless you are 100% certain
 Sample hierarchy
10: Let large dog that is off leash lick face while pet dog
9: Let large dog that is on leash lick face
8: Let small dog off leash lick face
7: Let small dog on leash lick face
6: Pet small dog while is on leash
5: Small dog next to me on leash
4: Small dog 1 foot away on leash
3: Small dog 2 feet away on leash
2: Small dog across the room on leash
1: Small dog in next room on leash
 Treatments of Specific Phobia

Virtual Reality Exposure Therapy: uses

virtual reality to do exposure
Helpful w/ phobias of bridges, planes, heights
and other stimuli that more difficult to do
exposure to b/c of difficulty in access to
 Social Anxiety Disorder (Social Phobia)
A. Marked & persistent fear in soc. Situat. where exposed to possible
scrutiny by others.
B. Fear that will act in a way or show anxiety that will be neg. evaluated
by others
C. Social situations almost always provoke fear/anxiety
D. Avoid social sit or endure w/ intense anxiety/distress
E. Fear/anxiety out of proportion to actual threat.
F. Fear/anx./avoidance persistent, typically lasting 6 mnths or more.
G. Fear/anx./avoidance causes clinically sig distress or impairment
H. Fear/anx./avoidance not due to a sub. or med. condition.
I. Fear/anxiety/avoidance not better explained by another psych disorder.
J. If another medical condition (burns, obesity, etc) is present,
fear/anxiety/avoidance unrelated to this or is excessive.
Specify if performance only (public speaking/performing)
 Social Phobia
Prevalence
Lifetime: Men = 11%, Women = 14% (higher)
Onset
Early childhood; Adolescence
Course
Tends to be chronic few people seek
treatment (becomes a social situation)
 Theories of Social Phobia
Many are similar to specific phobia
Cognitive Theories

Psychodynamic Theories (Object relations)

Developmental Influences
Anxious, overprotective and critical parents
Temperament behaviorally inhibited
 Treatment of Social Phobia

Biological

Cognitive-Behavioral Treatment (CBT)

Psychodynamic
 Panic Attack
An abrupt surge of intense fear or discomfort
that reaches a peak w/i minutes
Attacks include at least 4 of the following:

Palpitations, pounding heart Feeling dizzy, unsteady, light-headed

Sweating
Trembling/shaking
Shortness of
breath/smothering
Feelings of choking
Chest pain/discomfort
Nausea/abdominal distress
or faint.
Chills or heat sensations
Numbness/tingling sensations
Feeling detached from oneself or like
things arent real
Fear of losing control or going crazy
Fear of dying
 DSM Criteria for Panic Disorder
A. Recurrent, unexpected panic attacks
B. At least 1 of the attacks has been followed by 1 mnth or
more of :
Persistent concern or worry about having another attack or their
consequences (losing control, having heart attack, going crazy).
Significant maladaptive change in behav. Related to the attacks
(avoidance of exercise, unfamiliar situations, etc).
C. Not due to a substance.
D. Not better explained by another psych disorder.
Video clip Wiley & Sons #6.
 Panic Disorder
Prevalence
Lifetime: 3-4% (Men = 2%, Women = 4%)
One-year: 1-2%
Age of onset

Panic is seen in nearly all cultures

 Theories of Panic Disorder
Biological Theories
Genetic Risk
 Theories of Panic Disorder
Cognitive Theory
Catastrophic Misinterpretation Model

Anxiety Sensitivity
 Theories of Panic Disorder

Cognitive theories (cont.)

Interoceptive Awareness

Perception of Control

Attachment theory
Anxiety associated with insecure attachment
Diathesis-Stress
 Treatment for Panic Disorder

Antidepressant Medications

Cognitive-Behavioral Therapy (CBT)

Cognitive = address catastrophic thoughts/beliefs
Behavioral = Exposure to agoraphobic situations
Relaxation Techniques, Breathing Exercises
Interceptive Exposure = exposure to bodily panic
symptoms/physical cues
http://www.youtube.com/watch?v=wE5F-FjbTRk