Anxiety-based disorders

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Nora Hart
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1 Anxiety-based disorders the mountain lion anxiety Words/experiences used to describe Definition: Anxiety is the psychological experience of fear: apprehension, tension, fear itself, sense of danger, hypervigilance, uneasiness that stems from the anticipation of danger (an actual fear-provoking stimulus need not be present) Anxiety The source of anxiety may be external or internal. The manifestations of anxiety and fear are the same Fear is a state of immediate alarm in response to a serious, known threat to one s well-being Anxiety is fear or a state of alarm in response to a sense of threat or danger - can be inaccurately appraised (= the origin of anxiety dysfunction) Both have the same physiological features: increase in respiration, Is the fear/anxiety response useful/ adaptive? Yes, when the fight or flight response is protective the alarm response is an attempt to cope and adapt to danger No, when it is triggered by inappropriate situations, inaccurate appraisal of threat, or when it is too severe or long-lasting - can be disabling

Four groups of anxiety symptoms: 1. Motor tension 2. Autonomic hyperactivity Cognitive: 3.

Negative appraisal Anxiety can be experienced in many different ways: focused <-----> unfocused discrete/sudden

survival functions when activated: fight or flight engages and integrates activity of other central coordinating

amygdala modulates and activates the four basic Functions (four Fs ) of survival activated alarm reactions F F

2 Four groups of anxiety symptoms: 1. Motor tension 2. Autonomic hyperactivity Cognitive: 3. Vigilance/attention/memory 4. Negative appraisal Anxiety can be experienced in many different ways: focused <-----> unfocused discrete/sudden onset <-----> generalized intense memory <------> memory disturbance neurophysiology the role of the amygdala: basic survival functions when activated: fight or flight engages and integrates activity of other central coordinating areas, including the locus ceruleus, anterior cingulate cortex, prefrontal cortex, hypothalamus (anterior part) the amygdala modulates and activates the four basic Functions (four Fs ) of survival activated alarm reactions F F survival activities in calm states F F the anxiety disorders Specific Phobia Panic disorder Agoraphobia Social Anxiety Disorder(Social Phobia) Generalized anxiety disorder (GAD) mostly children: Separation Anxiety Disorder Selective Mutism

3 two developmental aspects of anxiety Likely to develop in late adolescence and early adulthood Women are twice as likely as men to be affected (NCS) Specific Phobia marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, seeing blood). exposure to the phobic stimulus almost invariably provokes an immediate anxiety response. the fear is excessive or unreasonable; the anxiety &/or distress interfere significantly with the person's functioning. the phobic situation is avoided, or else endured with intense anxiety or distress. Specific Phobia Types: (eliminates need for plethora of names like arachnophobia, claustrophobia, hematophobia, hippophobia (fear of horses),... etc.) Animal Environment Blood-injection-injury Situational Other Panic Panic is an extreme alarm reaction that can result when a threat suddenly emerges Panic attacks are periodic, short bouts of extreme anxiety that occur suddenly, reach a peak, and pass can occur in the presence or absence of a real threat During a panic attack people fear they are about to go crazy, lose control, or die, that something terrible is about to happen. They sweat, breathe rapidly, have a distinct increase in heart rate. They often seek safety, hide, stop what they are doing, etc.

4 Panic and Panic Disorder Anyone can experience a panic attack. but some people have panic disorder: having panic attacks repeatedly, unexpectedly, and without apparent reason also involve the experience of dysfunctional changes in thinking and behavior as a result of the attacks, including persistent worries about having an attack; planning behavior around possibility of future attack Agoraphobia From the Greek fear of the marketplace Fear of leaving home, fear of being in locations from which escape might be difficult or help unavailable, fear of unfamiliar or regularly-visited places, crowds, situations The feared places are often linked to fear, panic and extreme anxiety Social anxiety disorder (social phobia) a marked and persistent fear of one or more social situations exposure to the feared social stimulus almost invariably provokes an immediate anxiety response. extreme shyness Generalized Anxiety Disorder (GAD) multiple symptoms of excessive anxiety and worry (apprehensive expectation) difficulty controlling the worries the anxiety, worry, or physical symptoms cause significant distress or functional impairment. cross-context

5 Children s (?) anxiety disorders Separation anxiety disorder Selective mutism Review: the anxiety disorders Specific Phobia Panic disorder Agoraphobia Social Anxiety Disorder(Social Phobia) Generalized anxiety disorder (GAD) mostly children: Separation Anxiety Disorder Selective Mutism Another way to describe anxiety disorders: name of disorder feared stimulus simple phobia social anxiety agoraphobia generalized anxiety panic separation mutism a specific object or situation social interaction/evaluation by others/humiliation being trapped and/or vulnerable everything fear losing one s parents speaking with others from the NCS lifetime 12 month Anxiety Disorder prevalence prevalence panic disorder 3.5% 2.3% agoraphobia social phobia simple phobia GAD any anxiety disorder

6 Anxiety and GABA inactivity gamma-aminobutyric acid (GABA), a common neurotransmitter in the cortex. GABA regulates and inhibits excessive activity in the amygdala and frontal lobe that is associated with anxiety responses. GABA neurons regulate (and reduce) excess checking and rechecking defensiveness and aggression hypervigilance and startle etc. Anxiety and GABA inactivity thus GABA is an inhibitory neurotransmitter: when received, it causes excitatory neurons to STOP firing GABA inactivity seems to occur a lot in people with a wide variety of anxiety disorders Therefore, most traditional medications for anxiety increase GABA receptor sensitivity, thereby increasing GABA neuron activity. The increased GABA activity inhibits excitation in anxiety responses (especially in the amygdala). This results in euphoria, relaxation and calm. Neurotransmitter mechanism #2 mechanism #2: a medication that increases receptor sensitivity (moa: pore receptivity and more rapid metabolism) in the case of anxiety, anti-anxiety medications increase GABA sensitivity, which reduces anxiety (again: effect is to inhibit the excitation of the amygdala and frontal lobe areas associated with anxiety). Anti-anxiety medications Pre-1950s: barbiturates (sedativehypnotics) Post-1950s: benzodiazepines (e.g., Valium, Xanax)

7 Anti-anxiety medications benzodiazepines Provide temporary, modest relief. very pleasant, calming, and soothing. Help with sleep and dreams. Rebound anxiety with withdrawal and cessation of use - very unpleasant. Physical dependence is a problem Benzodiazepines are the primary drug of choice in prescription drug abuse Amplify the effects of other drugs (especially alcohol) Anti-anxiety medications 1980s: azaspirones (BuSpar) Different receptors and neurotransmitters, same effectiveness, fewer problems non-euphoric Treatment and intervention Treatment outcomes: manage/reduce panic and fear provoke fear increase actual safety Use of medication can disrupt the effectiveness of psychotherapy. Psychological treatment: CBT increase self-efficacy in situations that Psychosocial Tx: changing social conditions so there is less to fear taking back the night Treatment for social anxiety One treatment option is social skills training, a combination of several behavioral techniques to help people improve their social functioning Therapist provides feedback and reinforcement No single treatment approach is consistently helpful or superior to the others Results from using a combination of approaches seem to be most encouraging shyness clinics

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Anxiety vs. Fear. Anxiety. Fear. Both involve physiological arousal. Both can be adaptive. Apprehension about a future threat

Anxiety vs. Fear. Anxiety. Fear. Both involve physiological arousal. Both can be adaptive. Apprehension about a future threat Anxiety Disorders Anxiety vs. Fear Anxiety Apprehension about a future threat Fear Response to an immediate threat Both involve physiological arousal Sympathetic nervous system Both can be adaptive Fear