ANXIETY DISORDERS

CLINICAL DESCRIPTIONS OF THE ANXIETY

DISORDERS
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.
 1. SPECIFIC PHOBIAS
A specific phobia is a disproportionate fear caused by a
specific object or situation, such as fear of flying, fear of
snakes, and fear of heights.
 Proposed DSM-5 Criteria for
SPECIFIC PHOBIA
1. Marked and disproportionate fear consistently triggered
by specific objects or situations

2. The object or situation is avoided or else endured with

intense anxiety

3. Symptoms persist for at least 6 months

 2. SOCIAL ANXIETY DISORDER
Social anxiety disorder is a persistent, unrealistically
intense fear of social situations that might involve being
scrutinized by, or even just exposed to, unfamiliar people.
Labeled SOCIAL PHOBIA in the DSM-IV-TR
Among people with social anxiety disorder, at least a third
also meet the DSM IV- TR criteria for a diagnosis of
avoidant personality disorder
Social anxiety disorder generally begins during
adolescence
 Proposed DSM-5 Criteria for
SOCIAL ANXIETY DISORDER

1. Marked and disproportionate fear consistently triggered

by exposure to potential social scrutiny
2. Exposure to the trigger leads to intense anxiety about
being evaluated negatively
3. Trigger situations are avoided or else endured with
intense anxiety
4. Symptoms persist for at least 6 months.
 3. PANIC DISORDER
Panic disorder is characterized by frequent panic attacks that are
unrelated to specific situations and by worry about having more
panic attacks
A panic attack is a sudden attack of intense apprehension, terror,
and feelings of impending doom, accompanied by at least four other
symptoms
Physical symptoms can include labored breathing, heart palpitations,
nausea, upset stomach, chest pain, feelings of choking and
smothering, dizziness, lightheadedness, sweating, chills, heat
sensations, and trembling.
Depersonalization; derealization
Fears of losing control, of going crazy, or even of dying.
Among those who develop panic disorder, the onset is typically in
adolescence
 Proposed DSM-5 Criteria for
PANIC DISORDER
1. Recurrent uncued panic attacks

2. 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
 4. AGORAPHOBIA
Agoraphobia (from the Greek agora, meaning
marketplace) is defined by anxiety about situations in
which it would be embarrassing or difficult to escape if
anxiety symptoms occurred
 Proposed DSM-5 Criteria for
AGORAPHOBIA
1. 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 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; being in shops,
theaters, or cinemas; or standing in line or being in a
crowd
2. These situations consistently provoke fear or anxiety
3. These situations are avoided, require the presence of a
companion, or are endured with intense fear or anxiety
4. Symptoms last at least 6 months
 5. GENERALIZED ANXIETY DISORDER

People with GAD are persistently worried, often about

minor things.

The term worry refers to the cognitive tendency to chew

on a problem and to be unable to let go of it

GAD typically begins in adolescence

 Proposed DSM-5 Criteria for
GENERALIZED ANXIETY DISORDER
1. Excessive anxiety and worry at least 50 percent of days about at least two
life domains (e.g., family, health, finances, work, and school)
2. The worry is sustained for at least 3 months
3. The anxiety and worry are associated with at least three of the following:
restlessness or feeling keyed up or on edge
being easily fatigued
difficulty concentrating or mind going blank
irritability
muscle tension
sleep disturbance
The anxiety and worry are associated with marked avoidance of situations in
which negative outcomes could occur, marked time and effort preparing for
situations that might have a negative outcome, marked procrastination, difficulty
making decisions due to worries, or repeatedly seeking reassurance due to worries
 COMORBIDITY IN ANXIETY DISORDERS
Beyond high rates of diagnosable anxiety disorders, it is very
common for people with one anxiety disorder to report
subthreshold symptoms (symptoms that do not meet full
diagnostic criteria) of other anxiety disorders

Comorbidity within anxiety disorders arises for two primary

reasons:
1. The symptoms used to diagnose the various anxiety
disorders overlap; for example, social anxiety and
agoraphobia might both involve a fear of crowds
2. Some etiological factors, like certain neurobiological or
personality characteristics, may increase risk for more than
one anxiety disorder
COMORBIDITY IN ANXIETY DISORDERS

More specifically, about 60 percent of people in treatment

for anxiety disorders meet the diagnostic criteria for
major depression

Other conditions commonly comorbid with anxiety

disorders include substance abuse and personality
disorders, medical disorders (heart disease)
 GENDER AND SOCIOCULTURAL
FACTORS IN THE ANXIETY DISORDERS
GENDER
Several studies suggest that women are at least twice as likely
as men to be diagnosed with an anxiety disorder
CULTURE
In Japan a syndrome called taijin kyofusho involves fear of
displeasing or embarrassing others; people with this syndrome
typically fear such things as making direct eye contact, blushing,
having body odor, or having a bodily deformity.
Kayak-angst, a disorder that is similar to panic disorder, occurs
among the Inuit people of western Greenland; seal hunters
who are alone at sea may experience intense fear,
disorientation, and concerns about drowning
 GENDER AND SOCIOCULTURAL
FACTORS IN THE ANXIETY DISORDERS
CULTURE
koro (a sudden fear that ones genitals will recede into the
bodyreported in southern and eastern Asia),
shenkui (intense anxiety and somatic symptoms attributed to
the loss of semen, as through masturbation or excessive sexual
activityreported in China and similar to other syndromes
reported in India and Sri Lanka), and
susto (fright-illness, the belief that a severe fright has caused
the soul to leave the bodyreported in Latin America and
among Latinos in the United States)
Cambodian refugees, very elevated rates of panic disorder
(often diagnosed traditionally as kyol goeu, or wind overload)
 COMMON RISK FACTORS ACROSS THE
ANXIETY DISORDERS
1. Behavioral conditioning (classical and operant
conditioning)
2. Genetic vulnerability
3. Increased activity in the fear circuit of the brain
4. Decreased functioning of GABA and serotonin;
increased norepinephrine activity
5. Behavioral inhibition
6. Neuroticism
7. Cognitive factors, including sustained negative beliefs,
perceived lack of control, and attention to cues of
threat
 COMMON RISK FACTORS ACROSS THE
ANXIETY DISORDERS
FEAR CONDITIONING
Behavioral theory of anxiety disorders focuses on
conditioning. Mowrers two-factor model of anxiety
disorders, published in 1947, continues to influence
thinking in this area
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)
 COMMON RISK FACTORS ACROSS THE
ANXIETY DISORDERS
NEUROBIOLOGICAL FACTORS:THE FEAR
CIRCUIT AND THE ACTIVITY OF
NEUROTRANSMITTERS
A set of brain structures called the fear circuit tend to
be involved when people are feeling anxious or fearful
Elevated activity in the fear circuit, particularly the
amygdala, may help explain many different anxiety
disorders
The medial prefrontal cortex appears to be
important in helping to regulate amygdala activityit is
involved in extinguishing fears as well as using emotion
regulation strategies to control emotions
 COMMON RISK FACTORS ACROSS THE
ANXIETY DISORDERS
PERSONALITY: BEHAVIORAL INHIBITION AND
NEUROTICISM
behavioral inhibition, a tendency to become agitated
and cry when faced with novel toys, people, or other
stimuli
Neuroticism is a personality trait defined by the
tendency to react to events with greaterthan- average
negative affect
COGNITIVE FACTORS
focus on three: sustained negative beliefs about the future, a
perceived lack of control, and attention to signs of threat
 ETIOLOGY OF
ANXIETY DISORDERS
Anxiety disorders also appear to involve poor functioning of the
GABA and serotonin systems as well as high norepinephrine
levels.
Specific phobias are believed to reflect conditioning in response
to a traumatic event.
Social anxiety disorder appears related to conditioning and
behavioral inhibition
Neurobiological research demonstrates that panic attacks are
related to high activity in the locus ceruleus.
Behavioral models emphasize the possibility that people could
become classically conditioned to experience panic attacks in
response to external situations or internal somatic signs of
arousal.
Conditioning to somatic signs is called interoceptive
conditioning. Cognitive perspectives focus on catastrophic
misinterpretations of somatic symptoms
 ETIOLOGY OF
ANXIETY DISORDERS

A cognitive model of agoraphobia focuses on fear of

fear, or overly negative beliefs about what will happen if
one experiences anxiety.
Generalized anxiety disorder (GAD) has been related to
deficits in the GABA system. One cognitive model
emphasizes that worry might actually protect people
from intensely disturbing emotional images.
People with GAD also appear to be intolerant of
ambiguity
 TREATMENTS OF THE
ANXIETY DISORDERS
Effective psychological treatments for anxiety disorders
share a common focus: exposure that is, the person
must face what he or she deems too terrifying to face.
Systematic desensitization was the first widely used
exposure treatment (Wolpe, 1958).
The effects of CBT appear to endure when follow-up
assessments are conducted 6 months after treatment
Virtual reality is sometimes used to simulate feared
situations such as flying, heights, and even social
interactions
 TREATMENTS OF THE
ANXIETY DISORDERS
PSYCHOLOGICAL TREATMENT OF PHOBIAS
Many different types of exposure treatments have been
developed for phobias. Exposure treatments often include
in vivo (real-life) exposure to feared objects.
Systematic desensitization is effective in vivo exposure is
more effective than systematic desensitization
PSYCHOLOGICAL TREATMENT OF SOCIAL
ANXIETY DISORDER
David Clark (1997) has developed a version of cognitive
therapy for social anxiety disorder that expands on other
treatments in a couple of ways.
 TREATMENTS OF THE
ANXIETY DISORDERS
PSYCHOLOGICAL TREATMENT OF PANIC DISORDER
A psychodynamic treatment for panic disorder has been
developed. The treatment involves 24 sessions focused on
identifying the emotions and meanings surrounding panic attacks.
One well-validated cognitive behavioral treatment approach
called panic control therapy (PCT) is based on the tendency
of people with panic disorder to overreact to the bodily
sensations
PSYCHOLOGICAL TREATMENT OF AGORAPHOBIA
Cognitive behavioral treatments of agoraphobia also focus on
exposurespecifically, on systematic exposure to feared
situations
 TREATMENTS OF THE
ANXIETY DISORDERS
PSYCHOLOGICAL TREATMENT OF
GENERALIZED ANXIETY DISORDER
The most widely used behavioral technique involves
relaxation training to promote calmness
Relaxation techniques can involve relaxing muscle groups
one-by-one or generating calming mental images.
 MEDICATIONS THAT REDUCE ANXIETY
Drugs that reduce anxiety are referred to as sedatives,
minor tranquilizers, or anxiolytics (the suffix -lytic comes
from a Greek word meaning to loosen or dissolve).
Two types of medications are most commonly used for
the treatment of anxiety disorders: benzodiazepines
(e.g., Valium and Xanax) and antidepressants, including
tricyclic antidepressants, selective serotonin reuptake
inhibitors (SSRIs), and a newer class of agents called
serotoninnorepinephrine reuptake inhibitors
(SNRIs
D-cycloserine (DCS), though, is a different type of drug,
one that enhances learning
 PSYCHOLOGICAL TREATMENT FOR THE
ANXIETY DISORDERS
Behavior therapists focus on exposure to what is feared.
Systematic desensitization and modeling may be used as parts of
exposure therapy. For some anxiety disorders, cognitive
components may also be helpful in therapy.
Exposure treatment for specific phobias tends to work quickly and
well.
Adding cognitive components to exposure treatment may help for
social anxiety disorder
Treatment for panic disorder often involves exposure to
physiological changes
Treatment for agoraphobia may be enhanced by including partners
in the treatment process
Relaxation and cognitive behavioral approaches are helpful for
GAD.
1. fear - an emotional response to immediate danger
2. anxiety - a state of apprehension often accompanied by
mild autonomic arousal
3. worry - thinking about potential problems, often without
settling on a solution
4. phobia - an excessive fear of a specific object or situation
that causes distress or impairment
5. GAD is defined by: a. worry
6. A person with one anxiety disorder has about a
percent chance of developing a second disorder and
about a percent chance of developing major
depressive disorder. c. 75, 60
7. The odds that a person will develop an anxiety disorder sometime
during his or her lifetime are at least: c. 1 in 4

1. Research suggests that genes can explain percent of

the variance in anxiety disorders other than panic disorder b. 2040
percent
2. is a personality trait characterized by a tendency to
react to events with intense negative affect. c. Neuroticism
3. Cognitive factors found to correlate with anxiety disorders
include: d. lack of perceived control
4. A key structure in the fear circuit is the: b. amygdala
5. Panic disorder - anxiety sensitivity
6. GAD- avoidance of powerful negative emotions
7. Specific phobias - prepared learning
8. The first step in Mowrers two-factor model includes
conditioning, and the second step involves conditioning.
c. classical, operant
 FALSE 1. Anxiolytic medications work better than CBT.
TRUE 2. Anxiety symptoms often return when a person stops
taking anxiolytic medications.
FALSE 3. Antidepressants are addictive.
FALSE 4. Side effects are no longer a concern with modern
anxiolytics.
5. Which of the following are valid treatment approaches to
anxiety disorders?
b. benzodiazepines
c. antidepressants
d. exposure
6. D-cycloserine:
c. bolsters the effects of exposure treatment