Chapter 5 - Anxiety Disorders
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1 Chapter 5 - Anxiety Disorders I. PANIC DISORDER A. Description - with &without Agoraphobia 1. PD w/o Agora - panic attacks - feeling of imminent death - numerous symptoms (racing heart, sweating, dizziness) - out of blue - fear another attack 2. PD w/agora - avoid certain situations - embarrassment, lack of help - Rare - More in women Psychodynamic: - anxiety from sexual/aggressive impulses leaking Cognitive: - Hypersensitive to internal states - Misinterpret symptoms - Perceive danger Behavioral: Classical conditioning - Panic attack (US) -> fear (UR) - Associate place (CS) with panic attack - Public place (CS) -> fear (CR) (embarrassment, lack of assistance) - Agoraphobia = stimulus generalization (all places like 1st place) Biological: - genetic sensitivity overactive BAS - hyperventilation causes symptoms Psychodynamic - Uncover conflict Cognitive
2 - Breathing retraining & relaxation - Self-statements & reappraisal of fears Biological - Mild tranquilizers (Xanax) Behavioral - Systematic desensitization Barlow: gradual exposure to panic symptoms until fear decreases II. PHOBIAS A. Description - fear specific object or situation - no threat or threat is exaggerated - common fears, but heightened - phobia = impairs your life 1. Specific Phobias - fear of specific situation/object - animal, nature (childhood) - blood-injection-injury - ~11% 2. Social Phobia - fear of being judged/embarrassed in social situations % 3. Agoraphobia - fear situations/public places - something bad might happen - fear panic but no actual attacks - avoid situation Psychodynamic: - Projection of own impulses onto object - avoid object to reduce anxiety & keep impulse out of awareness Cognitive - Catastrophize Behavioral: Mowrer s 2-Factor Theory 1st = fear is classically conditioned
3 2nd = fear maintained by operant conditioning - avoid situation = avoid punishment (negative reinforcement) - Preparedness - biologically prepared to fear certain stimuli harmful to ancestors - harder to unlearn these phobias - Best is behavioral (especially specific phobia) - Exposure to feared situation/object - learn that it is not so frightening - extinguish link of CS -> CR - Imaginal vs. in vivo exposure - Gradual (systematic) or flooding - Relax vs. not during exposure III. OBSESSIVE-COMPULSIVE DISORDER (OCD) A. Description - anxiety if do not perform certain actions - anxiety from certain thoughts - Actions are pointless, often embarrassing - Obsessions = meaningless, troublesome thoughts that cannot stop - Compulsions = meaningless acts person feels forced to repeat Psychodynamic: - obsessions = unconscious impulses - compulsions = behaviors that keep impulses unconscious Cognitive: Irrational beliefs: perfectionism & seeking approval of others Behavioral: obsessions -> anxiety compulsions reduce anxiety - modeling - Systematic desensitization + response prevention - Expose to thoughts and prevent behavior - Tolerate thoughts until anxiety decreases Medication SSRIs IV. POST-TRAUMATIC STRESS DISORDER (PTSD)
4 A. Description - extreme anxiety related to specific trauma - trauma is outside the normal range of human experience Symptoms - Intrusive thoughts: reliving event - Avoid reminders - Emotional numbness - Hypervigilance - Dissociation - detachment from self & surroundings 1. Acute Stress Disorder lasts a few weeks 2. Post-Traumatic Stress Disorder >1 month Psychodynamic: aggressive impulses leaking into awareness Cognitive: appraising threat as extremely traumatic Behavioral: - classical conditioning - environment becomes conditioned stimuli for PTSD response - stimulus generalization - cues that resemble original situation trigger PTSD Systematic Desensitization - progressive exposure, imaginal or in vivo Flooding - imagine worst-case scene - multiple times until anxiety decreases Disagreement about flooding for trauma V. GENERALIZED ANXIETY DISORDER (GAD) A. Description
5 - continual anxiety over everything - catch-all vs. true disorder Psychodynamic: general anxiety from impulses leaking Cognitive: General tendency to catastrophize, perceive threat Behavioral: Worrying modeled/reinforced Biological: Genetic predisposition + decreased GABA - GABA = inhibits firing - less GABA=more firing Behavioral: - Relaxation exercises (deep breathing, progressive muscle) Cognitive: - Discover & retrain automatic thoughts Biological: - Medications to stimulate GABA
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