Chapter 5 Anxiety Disorders. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights...

Chapter 5

Anxiety Disorders

Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 52

Fear: Fight-or-Flight Response


Emotional, cognitive, and behavioral responses to threat


Fear in People with Anxiety Disorders Severe enough to lower the quality of life Chronic and frequent enough to interfere with

functioning Out of proportion to the dangers that they

truly face


Posttraumatic Stress Disorder and Acute Stress Disorder

By definition, are the consequences of experiencing extreme stressors


Symptoms of PTSD


Events that can precipitate PTSD

Disasters Tornadoes, floods, earthquakes, fires

Common Traumatic Events Car accidents, sudden deaths of loved ones

Combat and War-Related Traumas Combat fatigue syndrome, “Shell Shock”

Abuse Physical, emotional, sexual


Acute Stress Disorder

Occurs in response to similar traumas as does PTSD

Diagnosed when symptoms arise within 1 month of exposure to the stressor and last no longer than 4 weeks

Dissociative symptoms are prominent At high risk of developing PTSD


Adjustment Disorder

Stress-related diagnosis Consists of emotional and behavioral

symptoms (depressive symptoms, anxiety symptoms, and /or antisocial behaviors)

Arise within 3 months of the experience of a stressor

The stressors that lead to adjustment disorder can be of any severity


Explanations of PTSD Vulnerability Environmental and Social Factors

Event characteristics: severity, duration, and proximity

Available social support. Psychological Factors

Preexisting anxiety, depression, or distress Coping styles Dissociation

Gender and Cross-Cultural Differences Biological Factors


Treatments for PTSD

Cognitive behavioral therapy Systematic desensitization is used to extinguish fear reactions to memories; cognitive techniques are used to challenge irrational thoughts

Stress management Therapist helps client solve concrete problems to reduce stress; may use thought stopping strategies to quell intrusive thoughts

Biological therapies Antianxiety and antidepressant drugs are used to quell symptoms


PANIC DISORDER AND AGORAPHOBIA


Panic Disorder


Panic Disorder

Panic attacks become a common occurrence Panic attacks not usually provoked by any

particular situation Person begins to worry about having panic

attacks and changes behaviors as a result of this worry


Agoraphobia

About one-third to one-half of people diagnosed with panic disorder develop agoraphobia.

Agoraphobics fear places where they might have trouble escaping or getting help if they become anxious or suffer a panic attack.

Agoraphobics also often fear they will embarrass themselves if others see their symptoms or efforts to escape during an attack.


Theories of Panic Disorder


Genetics Neurobiological contributors




The Cognitive Model

Anxiety sensitivity Interoceptive awareness and conditioning


Biological Treatments for Panic Disorder

Tricyclic antidepressants– Increase levels of norepinephrine and a number of other

neurotransmitters

• Serotonin reuptake inhibitors– Increase levels of serotonin

• Benzodiazepines– Suppress the central nervous system and influence

functioning in the GABA, norepinephrine, and serotonin neurotransmitter systems


Cognitive-Behavioral Therapy

1. Clients are taught relaxation and breathing exercises.

2. The clinician guides clients in identifying the catastrophizing cognitions they have about changes in bodily sensations.

3. Clients practice using their relaxation and breathing exercises while experiencing panic symptoms in the therapy session.


Cognitive-Behavioral Therapy, continued4. The therapist will challenge clients’ catastrophizing

thoughts about their bodily sensations and teach them to challenge their thoughts for themselves.

5. The therapist will use systematic desensitization techniques to gradually expose clients to those situations they most fear while helping them to maintain control.


SPECIFIC PHOBIAS AND SOCIAL PHOBIA People can develop phobias of many objects

and situations Specific phobias: fear of specific items or

situations Social phobia: fear of social encounters


Specific Phobias

Animal type Natural environment type Situational type Blood-injection-injury type



Social Phobia



Theories of Phobias

Psychodynamic Behavioral

Negative reinforcement Prepared classical conditioning

Cognitive Biological


Treatment of Phobias

Behavioral 1) Systematic desensitization 2) Modeling 3) Flooding

Biological Reduce symptoms of anxiety

generally so that they do not arise in the feared situation

Cognitive-Behavioral Helps clients identify and

challenge negative, catastrophizing thoughts about feared situations


Generalized Anxiety Disorder (GAD)


Theories and Treatment of GAD

Cognitive Biological


OBSESSIVE-COMPULSIVE DISORDER

Obsessions: thoughts, images, ideas, or impulses that are persistent, that uncontrollably intrude upon consciousness, and that cause significant anxiety or distress.

Compulsions: repetitive behaviors or mental acts that an individual feels he or she must perform.



Theories of OCD

Biological Theories Cognitive Theories


Treatments for OCD

Biological therapies Serotonin-enhancing drugs like Paxil, Prozac

Behavioral therapies Exposure and response prevention


Vulnerability (diathesis)-stress models

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Chapter 5 Anxiety Disorders. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights...

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