Chapter 4 - Anxiety Disorders

I. Common feature: fear/anxiety that is irrational or excessive for given situation

A. Some anxiety is not only normal, but crucial

B. Fear vs anxiety

1. the fight-or-flight response

C. Three components of anxiety

II. Specific Disorders

A. Specific Phobia

1. fear of specific objects or situations

B. Social Phobia

1. fear of negative evaluation

2. generalized vs specific subtypes

C. Panic Disorder and Agoraphobia

1. Panic attacks from Out Of Blue (or, “uncued”)

2. Panic attacks ≠ panic disorder

3. Change in behavior (inc agoraphobic avoidance)

4. PD can be with OR without Ag

5. Ag can be (less often) without PD

D. Generalized Anxiety Disorder (GAD)

1. Key feature = worry

2. Also includes chronic physical symptoms

3. At least six months duration

E. Obsessive-Compulsive Disorder (OCD)

1. Obsessions are intrusive and irrational

2. Compulsions are NOT enjoyable

3. The compulsions neutralize the obsessions

F. Post-traumatic Stress Disorder (PTSD)

1. Severe traumatic event

a. objective component

b. subjective response

, 2. At least one month of

a. re-experiencing sx

b. avoidance/numbing sx

c. hyperarousal sx

3. Additional post-traumatic symptoms (e.g., in rape victims, guilt and shame)

a. common, and often targets of treatment for PTSD

b. BUT, are not included in diagnostic criteria for PTSD.

G. Separation Anxiety Disorder

1. Often the cause of school refusal

2. Fear of being away from parents

a. usually due to fears of something happening to parents, or to selves w/ parents not there

III. Etiology of Anxiety Disorders

A. Biological factors

1. genetic component (“general vulnerability factor”)

2. neuroanatomy: “fear circuit” differences (e.g., amygdala activation)

3. autonomic lability, behavioral inhibition

4. neurotransmitter imbalances

B. Psychoanalytic views

1. Defense against repressed impulses

2. Some specific conflicts for each d/o, but for all: CONTENT is important

C. Cognitive-behavioral factors

1. Conditioning processes

a. classical, operant, two-factor

i. role of avoidance, both overt and subtle

b. modeling (both causal and preventative)

c. role of “preparedness”

2. Information transmission

3. Cognitive processes

a. maladaptive interpretations

b. “fear of fear”

D. Triple vulnerability theory - combining many of above factors into:

1. generalized biological vulnerability

2. generalized psychological vulnerability

3. specific psychological vulnerability

IV. Treatment for Anxiety Disorders

A. Biological

1. Medications

a. anxiolytics

b. antidepressants

c. newer meds (DCS) to boost learning in exposure tx

2. Some surgeries

B. Psychoanalytic

1. Uncover roots of anxiety (conflict)

C. Cognitive-Behavioral

1. Exposure

a. imaginal

b. in vivo

c. interoceptive

d. may need other components (such as response/ritual prevention, or muscle tension)

2. Cognitive Challenging

3. Relaxation Training

D. Issues in and Evaluation of Treatments

1. In general, meds and CBT most effective

2. CBT generally superior long-term

3. Combo tx generally doesn’t outperform single txs

4. Iatrogenic or controversial treatments?

a. Debriefing

b. EMDR

c. Reinforcing avoidance?