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Anxiety Disorders
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Anxiety vs. Fear
AnxietyApprehension about a future threat
Fear Response to an immediate threat
Both involve physiological arousal Sympathetic nervous system
Both can be adaptive Fear triggers flight or fight
ay save life
Anxiety increases preparedness oderate levels improve performance
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Anxiety Disorders
!S"#$"%R Specific and social phobias &anic disorder and agoraphobia
'enerali(ed anxiety disorder )bsessive compulsive disorder &osttraumatic stress disorder
ost common psychiatric disorders
*+, report anxiety symptoms -.essler et al/0 *1123 ost common are phobias
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Table 5.1 Summary of MajorAnxiety Disorders
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Phobias
!isruptive fear of a particular ob4ect orsituation Fear out of proportion to actual threat
A5areness that fear is excessive ust be severe enough to cause distress orinterfere 5ith 4ob or social lifeAvoidance
%5o types6
Specific Social
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Panic Attac
A discrete period in 5hich there is the sudden
onset of intense apprehension0 fearfulness0 or
terror0 often associated 5ith feeling of
impending doom/ !uring these attac7s0symptoms such as shortness of breath0
palpitations0 chest pain or discomfort0 cho7ing
or smothering sensations0 and fear of goingcra(y or losing control are present/
6
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S!eci"c Phobia
8n5arranted0 excessive fear of specific
ob4ect or situation
Sna7es0 blood0 flying0 spiders0 etc/
How likely are you to be bitten by a spider?
ost specific phobias cluster around a fe5
feared ob4ects and situations -%able 2/93
%rigger or feared ob4ect is avoided or
endured 5ith intense anxiety
:igh comorbidity of specific phobias
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Agoraphobia
#s anxiety about0 or avoidance of0 places or
situations from 5hich escape might be difficult
-or embarrassing3 or in 5hich help may not be
available in the event of having a &anic Attac7
or panic"li7e symptoms/
8
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Table 5.2 Words Used to Describe Highly Unlikely Phobias
Fear Phobia
Anything ne Neopho!i"
Asy##etri$"l things Asy##etripho!i"
%oos %i!liopho!i"
Chil'ren (e'opho!i"
)"n$ing Choropho!i"
*nglishness Anglopho!i"
+"rli$ Alli#pho!i"
(e"nt !tter sti$ing to the roo- o- the #oth Ar"$hi!tyropho!i"
.e$hnology .e$hnopho!i"
/i$e /sopho!i"
(se'os$ienti-i$ ter#s ellenopho!i"
Source:)r"n -ro# www.phobialist.com1
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Table 5.3Types of Specific Phobias
Type of Phobia Sorce of Fear !ssociated "haracteristics
Ani#"l Ani#"ls e1g1, sn"es, inse$ts +ener"lly !egins 'ring $hil'hoo'
N"tr"l eniron#ent Aspe$ts o- the n"tr"l eniron#ent
e1g1, stor#s, heights, "ter
+ener"lly !egins 'ring $hil'hoo'
%loo', ine$tion, inry %loo', inry, ine$tions, or other
in"sie #e'i$"l pro$e'res
Cle"rly rns in -"#ilies
Sit"tion"l Spe$i-i$ sit"tions e1g1, p!li$
tr"nsport"tion, tnnels, !ri'ges,
ele"tors, -lying, 'riing, $lose' sp"$es
.en's to !egin either in $hil'hoo' or in
#i'20s1
ther e"r o- $hoing, -e"r o- $ontr"$ting "n
illness, et$1 $hil'ren:s -e"rs o- lo'
son's, $lons, et$1
;
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1 minutes
Accompanied by at least ? other symptoms6 S5eating0 nausea0 labored breathing0 di((iness0 heart palpitations0
upset stomach0 lightheadedness0 etc/
)ther symptoms may include6 Depersonalization
Derealization
Fear of going cra(y0 losing control0 or dying
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23
&rognosis 5orse 5hen agoraphobia is
present
$ li d A i
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Post Traumatic StressDisorder &PTSD'
%hree categories of symptoms 6>/ Re"experiencing the traumatic event
Gightmares0 intrusive thoughts0 or images
*/ Avoidance of stimuli e/g/0 Refuse to 5al7 on street 5here rape occurred Nubing
!ecreased interest in others !istant or estranged from others 8nable to experience positive emotions
9/ #ncreased arousal #nsomnia0 irritability0 hypervigilance0 exaggerated startle
response %ends to be chronic -&er7onigg et al/0 *1123
Acute Stress Disorder
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/is Factors0 Personality
Behavioral inhibition %endency to be agitated0 distressed0 and cry in
unfamilar or novel settings )bserved in infants as young as ? months ay be inherited
&redicts anxiety in childhood and social anxiety inadolescence
Geuroticism React 5ith negative affect @in7ed to anxiety and depression -de'raaf et a/0 *11*3
&sychophysiological reactivity in firefighters predicteddevelopment of &%S! -'uthrie D Bryant0 *1123
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/is Factors0 *o#nitive
Belief that one lac7s control over environment
ore vulnerable to developing anxiety disorder
Childhood trauma or punitive parenting may foster beliefs
Amount of control during trauma may influence 5hetheranxiety disorder 5ill develop -ine7a D Linbarg0 *11K3
Attention to threat
%endency to notice negative environmental cues
Selective attention to signs of threat
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tiolo#y of S!eci"c Phobias
Conditioning
o5rerMs t5o"factor
model
&airing of stimulus 5ith
aversive 8CS leads tofear -Classical
Conditioning3
Avoidance maintained
though negative
reinforcement -)perant
Conditioning3
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Copyright 2009 John Wiley & Sons, NY 3 orry th"t > #ight h"e " he"rt
"tt"$1
>t s$"res #e hen > -eel -"int1
>t s$"res #e hen > -eel ?sh"y@ tre#!ling1
Source:(eterson & eiss,
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tiolo#y of A#ora!hobia
Fear"of"fear hypothesis -'oldstein DChambless0 >K+3
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tiolo#y of $AD
'ABA system deficits Bor7ovecMs cognitive model6
orry reinforcing because it distracts fromnegative emotions and images
Allo5s avoidance of more disturbing emotions e/g/0 distress of previous trauma
Avoidance prevents extinction of underlyinganxiety
#ndividuals 5ith 'A! less able to identify their
o5n negative feelings -ennin et al/0 *11*3
tiolo#y of (*D0
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#yeurobiolo#ical Factors
)C! symptoms common in certain
neurological disorders
:untingtonMs chorea
:yperactive regions of the brain6 )rbitofrontal cortex
Caudate nucleus
Anterior cingulate
@oss of neuronal function and underlying
biochemical abnormality -NOcel et al/0 *11K3
tiolo#y of (*D0
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Panic and A#ora!hobia
Cognitive Behavioral %herapy -CB%3 #ncrease patientMs a5areness of thoughts
that ma7e physical sensations threatening
&atient learns to challenge and changemaladaptive beliefs
CB% also effective for agoraphobia %reatment enhanced 5hen spouse or
significant other stops catering to partnerMsavoidance/
Psycholo#ical Treatment of
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$AD
Relaxation training
Cognitive Behavioral methods
Challenge and modify negative thoughts
#ncrease ability to tolerate uncertainty orry only during scheduled times
Focus on present moment
Psycholo#ical Treatment of(*D
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(*D
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PTSD
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