Anxiety Disorders about many potentially bad things that

may happen;

- Fear is the emotional response to real or

perceived imminent threat, whereas
anxiety is anticipation of future threat. A. Generalized Anxiety Disorder (GAD)
- The hallmark symptoms of anxiety-
related disorders are excessive fear or
worry related to behavioral
disturbances.
- Fear is an adaptive response, as it often
prepares your body for an impending
threat.
- Anxiety, however, is more difficult to
identify as it is often the response to a
vague sense of threat.
- are characterized by unrealistic,
irrational fears or anxieties that cause - Most common of the anxiety disorders,
significant distress and/or impairments is characterized by a global and
in functioning. persistent feeling of anxiety.
- Commonly referred to as GAD, is a
disorder characterized by an underlying
Anxiety excessive worry related to a wide range
of events or activities.
- In contrast to fear and panic, the anxiety
- Individuals with GAD experience worry
response pattern is a complex blend of
of greater intensity and for longer
unpleasant emotions and cognitions that
periods than the average person.
is both more oriented to the future and
- Often unable to control their worry
much more diffuse than fear.
through various coping strategies,
- involves negative mood, worry about
which directly interferes with their
possible future threats or danger, self-
ability to engage in daily social and
preoccupation, and a sense of being
occupational tasks.
unable to predict the future threat or to
- Individuals with GAD will also
control it if it occurs.
experience somatic symptoms during
Among the disorders recognized in DSM-5 are: intensive periods of anxiety. These
somatic symptoms may include
1. Specific phobia sweating, dizziness, shortness of breath,
2. Social anxiety disorder (social phobia) insomnia, restlessness, or muscle aches.
3. Panic disorder
4. Agoraphobia
5. Generalized anxiety disorder B. Specific Phobia

People with these varied disorders differ from

one another both in terms of the amount of fear
or panic versus anxiety symptoms that they
experience and in the kinds of objects or
situations that most concern them.

- People with specific or social phobias

experience a fear or panic response not
only when they encounter the object or
situation that they fear, but also in
response to even the possibility of
encountering their phobic situation.
- People with panic disorder experience
both frequent panic attacks and intense
anxiety focused on the possibility of
having another one.
- People with agoraphobia go to great
lengths to avoid a variety of feared
situations, ranging from open streets
and bridges to crowded public places.
- People with generalized anxiety
disorder mostly experience a general
sense of diffuse anxiety and worry
- Distinguished by fear or anxiety
specific to an object or a situation.
- When individuals are face-to-face with
their specific phobia, immediate fear is
present.
- It should also be noted that these fears
are excessive and irrational, often
severely impacting one’s daily
functioning.
- When making a diagnosis of specific
phobia, it is important to identify the
stimulus.
 - Among the most commonly diagnosed
specific phobias are animals, natural
environments (height, storms, water),
blood-injection-injury (needles,
invasive medical procedures), or
situational (airplanes, elevators,
enclosed places.
C. Agoraphobia
- Intense fear triggered by a wide range
of situations; however, unlike GAD, the
fears are related to situations in which
the individual is in public situations
where escape may be difficult.
- In order to receive a diagnosis of
agoraphobia, there must be a presence
of fear in at least two of the following
circumstances: using public
transportation such as planes, trains,
ships, buses; being in large, open spaces
such as parking lots or on bridges; being
in enclosed spaces like stores or movie
theaters; being in a large crowd similar
to those at a concert; or being outside of
the home in general.
- It should be noted that fear and anxiety-
related symptoms are present every time
the individual encounters these
situations.
- It should be noted that fear and anxiety-
related symptoms are present every time
the individual encounters these
situations.
D. Social Anxiety Disorder
- Anxiety or fear relates to social
situations, particularly those in which
an individual can be evaluated by
others.
- The individual is worried that they will
be judged negatively and viewed as
stupid, anxious, crazy, boring, or
unlikeable, to name a few.
E. Panic Disorder
- Consists of a series of recurrent,
unexpected panic attacks coupled with
the fear of future panic attacks.
Panic attack - a sudden or abrupt surge of
fear or impending doom along with at least
four physical or cognitive symptoms.
Physical symptoms include heart
palpitations, sweating, trembling or shaking,
shortness of breath, feeling as though they
are being choked, chest pain, nausea,
dizziness, chills or heat sensations, and
numbness/tingling.
Cognitive symptoms may consist of feelings
of derealization (feelings of unreality) or
depersonalization (feelings of being
detached from oneself), the fear of losing
control or ‘going crazy,’ or the fear of dying.
EPIDEMIOLOGY
A. Generalized Anxiety Disorder
- Prevalence rate for generalized
anxiety disorder is estimated to be 3%
of the general population, with nearly
6% of individuals experiencing GAD
sometime during their lives.
- While it can present at any age, it
generally appears first in childhood or
adolescence. Similar to most anxiety-
related disorders, females are twice as
likely to be diagnosed with GAD as
males.
B. Specific Phobia
- The prevalence rate for specific
phobias is 7-9% within the United
States. While young children have a
 prevalence rate of approximately vulnerabilities, both biological and
5%, teens have nearly a double psychological.
prevalence rate than that of the
general public at 16%. There is a 2:1 B. Specific Phobia
ratio of females to males diagnosed - Onset of specific phobias occurs at a
with specific phobia. younger age than most other anxiety
- Animal, natural environment, and disorders, it is generally the primary
situational specific phobias are more diagnosis with the occasional
commonly diagnosed in females, generalized anxiety disorder
whereas blood-injection-injury comorbid diagnosis.
phobia is reportedly diagnosed - Children and teens diagnosed with a
equally between genders. specific phobia are at an increased
risk for additional psychopathology
C. Agoraphobia later in life. More specifically, other
- The yearly prevalence rate for anxiety disorders, depressive
agoraphobia across the lifespan is disorders, substance-related
roughly 1.7%. females are twice as disorders, and somatic symptom
likely as males to be diagnosed with disorders.
agoraphobia.
- While it can occur in childhood, C. Agoraphobia
agoraphobia typically does not - Comorbid diagnoses include
develop until late adolescence/early additional anxiety disorders,
adulthood and usually tapers off in depressive disorders, and substance
later adulthood. use disorders, all of which typically
occurs after the onset of
D. Social Anxiety Disorder agoraphobia.
- Overall prevalence rate of social - High comorbidity between
anxiety disorder is significantly agoraphobia and PTSD.
higher in the United States than in
other countries, with an estimated D. Social Anxiety Disorder
7% of the US population diagnosed - Most common comorbid diagnoses
with a social anxiety disorder. with a social anxiety disorder are
- Significant decrease in the diagnosis other anxiety related disorders,
of social anxiety disorder among major depressive disorder, and
older individuals. substance-related disorders.
- Regarding gender, there is a higher - High comorbidity rate among
diagnosis rate in females than males. anxiety-related disorders and
This gender discrepancy appears to substance-related disorders is likely
be greater among children and connected to the efforts of self-
adolescents than adults. medicating. For example, an
individual with social anxiety
E. Panic Disorder disorder may consume more alcohol
- Prevalence rates for panic disorder in social settings in efforts to
are estimated at around 2-3% in alleviate the anxiety of the social
adults and adolescents. situation.
- Females are more commonly
diagnosed than males with a 2:1 E. Panic Disorder
diagnosis rate—this gender - Panic disorder rarely occurs in
discrepancy is seen throughout the isolation, as many individuals also
lifespan. Although panic disorder report symptoms of other anxiety
can occur in young children, it is disorders, major depression, and
generally not observed in individuals substance abuse.
younger than 14 years of age. - Unlike some of the other anxiety
disorders, there is a high comorbid
diagnosis with general medical
COMORBIDITY symptoms.
A. Generalized Anxiety Disorder - More specifically, individuals with
- High comorbidity between panic disorder are more likely to
generalized anxiety disorder and the report somatic symptoms such as
other anxiety related disorders, as dizziness, cardiac arrhythmias,
well as major depressive disorder, asthma, irritable bowel syndrome,
suggesting they all share common and hyperthyroidism.

ETIOLOGY
Biological
1. Genetic Influences. While genetics
have been known to contribute to the
presentation of anxiety symptoms, the
interaction between genetics and
stressful environmental influences
appears to account for more anxiety
disorders than genetics alone.
2. Neurobiological Structures. Identified
several brain structures and pathways
that are likely responsible for anxiety
responses: amygdala, the area of the
brain that is responsible for storing
memories related to emotional events.
When presented with a fearful situation,
the amygdala initiates a reaction to
ready the body for a response. The
second pathway is activated by the
feared stimulus itself, by sending a
sensory signal to the hippocampus and
prefrontal cortex, for determination if
threat is real or imagined.
Psychological
1. Cognitive. Centers around
dysfunctional thought patterns.
- maladaptive assumptions are
routinely observed in individuals
with anxiety related disorders, as
they often engage in interpreting
events as dangerous or overreacting
to potentially stressful events, which
contributes to an overall heightened
anxiety level.
- Negative appraisals, in combination
with a biological predisposition to
anxiety likely contribute to the
development of anxiety symptoms.
Individuals with social anxiety disorder tend to
hold unattainable or extremely high social beliefs
and expectations.
2. Behavioral. Behavioral explanation for
the development of anxiety disorders is
mainly reserved for phobias, both
specific and social phobia. Behavioral
theorists focus on classical conditioning
– when two events that occur close
together become strongly associated
with one another, despite their lack of
causal relationship.
3. Modeling. An individual acquires a fear
though observation and. (for specific
and social phobias)
- While modeling and classical
conditioning largely explain the
development of phobias, there is
some speculation that the
accumulation of a large number of
these learned fears will develop into
GAD.
Sociocultural
- Living in poverty, experiencing
significant daily stressors, and
increased exposure to traumatic
events are all identified as
significant contributors to anxiety
disorders, additional sociocultural
influences such as gender and
discrimination have also received
considerable attention.
- Women are more likely to use
emotion-focused coping, which is
less effective in reducing distress
than problem-focused coping. These
factors may increase levels of stress
hormones within women that leave
them susceptible to develop
symptoms of anxiety. A
combination of genetic,
environmental, and social factors
may explain why women tend to be
diagnosed more often with anxiety-
related disorders.
TREATMENT
A. Generalized Anxiety Disorder
1. Psychopharmacology.
Benzodiazepines, a class of sedative-
hypnotic drugs originally replaced
barbiturates as the leading anti-anxiety
medication due to their less addictive
nature, yet equally effective ability to
calm individuals at low dosages.
- Due to these negative effects,
selective serotonin-reuptake
inhibitors (SSRIs) and serotonin-
norepinephrine reuptake inhibitors
(SNRIs) are generally considered to
be first-line medication options for
those with GAD.
- Other effective treatment options
such as CBT, relaxation training,
and biofeedback are often
encouraged before the use of
pharmacological interventions.
2. Rational-Emotive therapy. Albert
Ellis developed rational emotive
therapy in the mid-1950s as one of the
first forms of cognitive-behavioral
therapy. The goal of rational emotive
therapy is to identify irrational, self-
defeating assumptions, challenge the
rationality of those assumptions, and
 to replace them with new, more
productive thoughts and feelings.
3. Cognitive Behavioral Therapy
(CBT). Also, effective treatment
options for a variety of anxiety
disorders, including GAD.
- The fundamental goal of CBT is a
combination of cognitive and
behavioral strategies aimed to
identify and restructure maladaptive
thoughts while also providing
opportunities to utilize these more
effective thought patterns through
exposure-based experiences.
Through repetition, the individual
will be able to identify and replace
anxious thoughts outside of therapy
sessions, ultimately reducing their
overall anxiety levels.
4. Biofeedback. Provides a visual
representation of a patient’s
physiological arousal.
Electromyography (EMG)
Electroencephalography (EEG)
Heart rate Variability (HRV)
Galvanic Skin Response (GSR)
B. Specific Phobias
1. Exposure treatments. Individual is
exposed to their feared stimuli. This can
be done in several different approaches:
systematic desensitization, flooding,
and modeling.
C. Agoraphobia
- Similar to the treatment approaches for
specific phobias, exposure-based
techniques are among the most effective
treatment options for individuals with
agoraphobia.
- Best treatment approach for those with
agoraphobia and panic disorder is a
combination of exposure and CBT
techniques.
- For individuals with agoraphobia
without panic symptoms, the use of
group therapy in combination with
individual exposure therapy has been
identified as a successful treatment
option.
D. Social Anxiety Disorder
1. Exposure. Treatment approach for all
anxiety disorders. Specific to social
anxiety disorder, the individual is
encouraged to engage in social
situations where they are likely to
experience increased anxiety.
- The patient is encouraged to continue
with these exposures outside of
treatment to help reduce anxiety
related to social situations.
2. Social skills training. Specific to social
anxiety disorder as it focuses on the
patient’s skill deficits or inadequate
social interactions that contribute to
their negative social experiences and
anxiety.
- During a session, the clinician may
use a combination of skills such as
modeling, corrective feedback, and
positive reinforcement to provide
feedback and encouragement to the
patient regarding their behavioral
interactions.
3. Cognitive restructuring. Additive
component in treatment to provide
substantial symptom reduction. s. The
clinician can then help the patient
establish new, positive thoughts to
replace these negative thoughts.
E. Panic Disorder
1. Cognitive Behavioral Therapy (CBT).
Most effective treatment option for
individuals with panic disorder as the
focus is on correcting misinterpretations
of bodily sensations.
2. Psychoeducation. Treatment begins by
educating the patient on the nature of
panic disorder, the underlying causes of
panic disorder, as well as the
mechanisms that maintain the disorder
such as the physical, cognitive, and
behavioral response systems.
3. Self-monitoring. Or the awareness of
self-observation, is essential to the CBT
treatment process for panic disorder.
- In this part of treatment, the individual
is taught to identify the physiological
cues immediately leading up to and
during a panic attack. Then, the
patient is encouraged to recognize and
document the thoughts and behaviors
associated with these physiological
Abnormal Psychology Study Guide
Page 32 symptoms. By bringing
awareness to the symptoms, as well as
the relationship between physical
arousal and cognitive-behavioral
responses, the patient learns the
fundamental processes with which
they can manage their panic
symptoms.
4. Relaxation training. Similar to that in
exposure-based treatment for phobias,
prior to engaging in exposure training,
the individual must learn relaxation
techniques to apply during onset of
panic attacks.
5. Progressive muscle relaxation. In
PMR, the patient learns to tense and
relax various large muscle groups
throughout the body. Generally
speaking, the patient is encouraged to
start at either the head or the feet, and
gradually work their way through the
 entire body, holding the tension for
roughly 10 seconds before relaxing.
6. Cognitive restructuring. Ability to
recognize cognitive errors and replace
them with alternate, more appropriate
thoughts, is likely the most powerful
part of CBT treatment for panic
disorder, aside from the exposure part.
7. Exposure. Patient is next encouraged to
engage in a variety of exposure
techniques such as in vivo exposure and
interoceptive exposure, while also
incorporating the cognitive restructuring
and relaxation techniques previously
learned to reduce and eliminate ongoing
distress.
- Interoceptive exposure involves
inducing panic-specific symptoms to
the individual repeatedly for a
prolonged period, so that maladaptive
thoughts about the sensations can be
disconfirmed and conditional anxiety
responses are extinguished.
- Some examples of these exposure
techniques include spinning a patient
repeatedly in a chair to induce
dizziness and breathing in a paper bag
to cause hyperventilation. Patient must
endure the physiological sensations
for at least 30 seconds to 1 minute to
ensure adequate time for applying
cognitive strategies to misappraisal of
cognitive symptoms.
8. Pharmacological interventions.
Suggested that medications be reserved
for those who do not respond to CBT
therapy alone.