Anxiety Disorders

Different aspects of Anxiety

• Phenomenological– Affective: dread, tension, worry– Cognitive: expectations of an

inability to cope, impaired cognitive ability

• Behavioural – Impaired motor functioning and

avoidance

• Physiological– increased blood pressure, heart

rate, breathing; disruptions in GI functioning and dizziness

Types of Anxiety Disorders

• Panic Disorder

• Generalized Anxiety Disorder

• Phobias

• Posttraumatic Stress Disorder

• Obsessive-Compulsive Disorder

Panic Disorder

• Panic Attack

• Cued (situationally bound) v.s. Uncued (unexpected) panic attacks

• Panic Disorder

Panic Disorder: Agoraphobia

• Fear of being in a situation where having a panic attack would be dangerous or where escape would be impossible

Generalized Anxiety Disorder

• Chronic state of diffuse anxiety

Phobias

• Phobias involve– intense, persistent fear of

something that poses no real threat

– avoidance of the feared object/situation

Specific Phobia– fear of circumscribed objects or

situations

Phobias

• Algophobia -pain

• Astraphobia -thunderstorms

• Pathophobia -disease

• Monophobia -being alone

• Mysophobia -contamination

• Nyctophobia -darkness

• Ochlophobia -crowds

Phobias: Social Phobia

• Fear of social embarrassment or humiliation– public speaking– eating in public– using public bathrooms

• Impact on self confidence and restricts social activity

Posttraumatic Stress Disorder

• Intense fear and helplessness in response to events involving actual or threatened death or serious injury.

• Acute Stress Disorder– symptoms last for 2 days - 4

weeks

• Posttraumatic Stress Disorder– symptoms last at least 1 month

Obsessive-Compulsive Disorder

• Obsession– unwanted thought or image that

keeps intruding into awareness

• Compulsion– an action that a person feels

compelled to repeat again and again despite a lack of desire to do so

The Psychodynamic Approach to Anxiety

• Anxiety is a signal that the ego is having a hard time mediating between reality, id and superego.

• Different anxiety disorders are the result of different defense mechanisms used to cope.

The Psychodynamic Approach to Anxiety: Attachment Theories

• Bowlby– disturbances in parent-child bond

leads to “anxious attachment” and a vulnerability to anxiety disorders later in life

The Behavioural Approach to Anxiety

• Mowrer (1948) Avoidance learning– 1) classical (respondent)

conditioning– 2) negative reinforcement

The Behavioural Approach to Anxiety

• Barlow (1988) Anxiety Sensitivity or “Fear of Fear”

The Behavioural Approach to Anxiety

• Treatment:– systematic desensitization– exposure– flooding

The Biological Approach to Anxiety

• Genetic Component– family and twin studies suggest a

genetic component in most anxiety disorders

– panic disorder shows the strongest genetic component and generalized anxiety disorder the least

The Biological Approach to Anxiety

• “Suffocation false alarm hypothesis” of panic disorder

• serotonin and basal ganglia abnormalities in OCD

• hormonal theory of PTSD

• State-dependent learning

The Cognitive Approach to Anxiety

• Individuals misperceive and misinterpret internal and external stimuli

Cognitive Appraisal

• Stimulus--->Appraisal---> Response– evaluation of stimulus based on

memories, beliefs, and expectations

Information Processing

• Schema– how we understand the

information we take in from the environment

• Selective Attention– what information we take in

Cognitive Approach to Panic Disorder

• Catastrophic interpretations of bodily sensations

• Feeling of control

• Some Problems:– panic attacks during sleep– why do catastrophic

interpretations develop

Anxiety and Selective Attention

Bodybags

Nam

Firefight

Landmine

Explosion

Airlift

• Several cognitive models of anxiety suggest that attentional biases to threat cues cause and maintain anxiety disorders.

• Empirical findings:– Lavy and van den Hout (1993),

individuals with spider phobia show an attentional bias to spiders

– Ehlers and Breuer (1995), individuals with panic disorder show an attentional bias towards unpleasant body cues

Attentional bias in Social Phobia

Pair of Pictures: 500ms

Fixation Cross: 1000ms

F / E judgement

Temporal sequence of events for each trial

+

E

Probe Display:until response

Participants

• Two kinds of participants (high and low social anxiety)

• Participants were university students selected for high and low social anxiety (FNE, also measured trait anxiety)

Experimental Conditions

• Two kinds of experimental conditions (threat and no threat)

• Threat: Half of the participants were told the experiment was an assessment of social skills and public speaking ability.

Picture Displays

• Three kinds of picture displays (positive, negative and neutral face, each paired with a household object)

Experimental Design

• Two kinds of participants (high and low social anxiety)

• Two kinds of experimental conditions (threat and no threat)

• Three kinds of faces (negative, neutral and positive) each displayed with a household object (clocks, chairs etc.)

Bias Score

Bias Score =

RT to identify probe when the face and probe are in opposite positions

RT to identify probe when the face and probe are in the same position

-

Pair of Pictures: 500ms

Fixation Cross: 1000ms

F / E judgement

Temporal sequence of events for each trial

+

E

Probe Display:until response

Results

• In the social threat condition, the high socially anxious participants avoided negative and positive faces,

• whereas the low socially anxious participants showed no bias.

Discussion of Results

• Lavy and van den Hout (1993) found that spider phobics show an attentional bias towards pictures of spiders.– Why are spider phobics and social

phobics different?

Discussion of Results

• How might this attentional bias (to avoid emotionally expressive faces) contribute to the maintenance of social phobia?

Mansell, et al. (1999). Social anxiety and

attention away from emotional faces.

Cognition and Emotion, 13(6), 673-690.