PHASE 2

• Anxiety


  Negative mood state characterized by body symptoms of physical tension and by apprehension about the future

  
• Fear


  An immediate alarm reaction to danger
• Panic


  Sudden overwhelming reaction
• Panic Attack


  Abrupt experience of intense fear or acute discomfort, accompanied by physical symptoms
• Types of Panic Attacks

  • Expected (Cued) - if you have a clue of what/where situations a panic attack could occur
  • Unexpected (Uncued) - if you don't have a clue when/where the next attack will occur
• Biological Contributions to Anxiety

  • We inherit the tendency to be tense, uptight, and anxious
  • Low GABA levels = increased anxiety
  • Low Serotonin = increased anxiety
  • Corticotropin-Releasing Factor (CRF) activates Hypothalamic-Pituitary-Adrenocortical (HPA) axis which has a wide-ranging effects on areas of the brain implicated in anxiety
  • Limbic System - mediator between the brain stem and the cortex that is most often associated with anxiety
  • Behavioral Inhibition System - activated by signals from the brain stem of unexpected events
  • Fight/Flight System (FSS) - produces an immediate alarm-and-escape response that looks very much like panic in humans
  • FFS is activated partly by the deficiencies in serotonin
• Psychological Contributions to Anxiety

  • Freud: anxiety was a psychic reaction to danger surrounding the reactivation of an infantile fearful situation
  • Behaviorists: Anxiety was a product of learning (Conditioning, Modeling, or other forms of learning)
  • In childhood, we may acquire an awareness that events are not always in our control - the continuum of this perception may range from total confidence in our control of all aspects of our lives to deep uncertainty about ourselves
  • The way parents who interact with their children by responding to their needs contributes to the development of anxiety
  • Anxiety Sensitivity: appears to be an important personality trait that determines who will and who will not experience problems with anxiety under certain stressful conditions
• Social Contributions to Anxiety

  • Stressful life events trigger our biological and psychological vulnerabilities
  • Repeated denials of their true thoughts, emotions and behavior make these people extremely anxious
  • Children who fail to receive unconditional positive rewards may be over critical of themselves and develop harsh self-standards
  • Many people are guided by irrational beliefs that lead them to act in inappropriate ways (Basic Irrational Assumptions)
  • People with GAD constantly hold silent assumptions that imply they are in imminent danger
  • Metacognitive Theory (Wells): people with GAD implicitly hold both positive and negative beliefs about worrying; they believe that worrying is a useful way of appraising and coping with threats of life
  • Intolerance of Uncertainty Theory: certain individuals cannot tolerate the knowledge that negative events may occur
  • Avoidance Theory: people with GAD have greater bodily arousal and that worrying reduces this arousal
• Triple Vulnerability Theory


  (1) Generalized Biological Vulnerability; (2) Generalized Psychological Vulnerability; and (3) Specific Psychological Vulnerability
• Generalized Anxiety Disorder (GAD)


  • Individuals with GAD do not respond as strongly to stressors as individuals with anxiety disorders in which panic is prominent
  • Low cardiac vagal tone, leading to autonomic inflexibility
  • May have arisen in early stressful experiences where they learned the world is a dangerous place
  • Intense cognitive processing in the frontal lobs as indicated by EEG activity, particularly in the left hemisphere
  • Intense worrying may act as avoidance

  
• Treatment for GAD


  Benzodiazepines (but creates dependence to it) & Cognitive-Behavioral Treatment (beneficial for long-term), Rational-Emotive Therapy
• Rarely occur prior to adolescence; may occur early in life but manifested as anxious temperament
• Diagnosis of disorder due to another medical condition should be assigned if the anxiety and worry, based on history to be physiological effect of another specific medical condition

  
• Substance or medication must not be the etiological cause of anxiety
• Worry whether or not they are being judged/evaluated
• May worry about separation but could also worry about other things
• If the individual experiences unexpected panic attacks as well and shows persistent concern and worry or behavioral change because of the attacks, then additional diagnosis should be considered
• Worry about multiple events, situations, or activities
• Focus of the worry is about forthcoming problems
• May be diagnosed comorbidly if the anxiety/worry is sufficiently severe to warrant clinical attention

  
• Women diagnosed with this disorder outnumber men 2 to 1
• Children experience some degree as part of growing up and that all use ego defense mechanisms; their defense mechanisms are particularly inadequate
• Fear Circuit is excessively active
• Improper functioning by various neurons, structures, interconnections, or other neurotransmitters throughout the fear circuit
• Panic Disorder (PD)


  • Mean age at onset is 34.7 yrs
  • Very rare in childhood
  • Chronic in adolescence and comorbid with other disorders
  • PD shouldn't be diagnosed if full-symptom panic attacks was never experienced
  • PD is not diagnosed with panic attacks are direct physiological consequence of another medical conditions or substance
  • Norepinephrine activity is indeed irregular in people who suffer from panic attacks

  
• Culture-Bound Syndromes related to Panic

  • Susto - disorder that is characterized by sweating, increased heart rate, and insomnia but not by reports of anxiety or fear, even though a severe fright is the cause
  • Ataques De Nervios - quite similar to panic attack but with shouting or bursting into tears
  • Kyol Goeu - wind overload, too much wind or gas in the body which may cause blood vessels to burst
  • Nocturnal Panic - occur during delta wave or slow wave sleep, which typically occurs several hours after we fall asleep and is the deepest stage of sleep

  
• Agoraphobia


  • Develops after a person has unexpected panic attacks
  • Initial Onset: before 35 yrs old, with 21 yrs the mean age
  • Persistent and chronic
  • If the fear, anxiety is limited to one of the agoraphobic situation, the Specific Phobia must be diagnosed
  • Although we all typically experience rapid heartbeat, if you have psychological or cognitive vulnerability, you might interpret the response as dangerous and feel a surge of anxiety
  • Early object loss and/or separation anxiety predispose to someone to develop the condition as an adult

  
• Separation Anxiety Disorder (SepAnx)

  • Predominantly concerns real or imagined separation from attachment figures
  • Onset: early as preschool age and may occur some time during childhood and adolescence
  • In SepAnx, threats of separation from close attachments may lead to extreme anxiety and panic attacks
  • SepAnx is not responsible for school absences or school avoidance
  • SepAnx = fear of POSSIBLE separation is the central thought
  • SepAnx concern about the proximity and safety of key attachment figures

  
• Treatment for SepAnx


  High-Potency Benzodiazepines, SSRIs, closely related serotonin-norepinephrine reuptake inhibitors, Panic Control Treatment, Exposure exercises, CBT
• Specific Phobia


  Irrational fear of a specific object or situation that markedly interferes with an individual's ability to function
• Types of Specific Phobias

  • Blood-Injection-Injury Phobia - Nosocomephobia (hospitals), Hemophobia (blood), Trypanophobia (needles), Dentophobia (dentists)
  • Situational Phobia - Aerophobia (flying), Claustrophobia (tight or crowded spaces), Glossophobia (public speaking), Sociophobia (social judgment)
  • Nature Environment Phobia - Acrophobia (heights), Entomophobia (insects), Mysophobia (dirt and germs), Escalophobia (escalators)
  • Animal Phobia - Zoophobia (animals), Arachnophobia (spiders), Cynophobia (dogs), Musophobia (mice and rats)
• Specific Phobias


  • Acquired through direct experience, experiencing in false alarm, and observing others
  • Usually develops in early childhood
  • Situational phobias tend to have a later age at onset
  • Women: Men, 2:1
• Treatment for Specific Phobias

  Exposure-based exercises
• Social Anxiety Disorder (Social Phobia)


  • Fearful of scrutiny by others
  • Panic attacks are always cued by social situations and do not occur "out of the blue"
  • Typically have adequate age-appropriate social relationships and social communication capacity

  
• Selective Mutism


  • Rare childhood disorder characterized by a lack of speech in one or more setting in which speaking is socially expected
  • Usually before age 5 yrs
  • Many individuals outgrow selective mutism
  • Restricted to specific social situation
  • Should be diagnosed only when a child has an established capacity to speak in some social situations
  • SAD may be associated with SM
• Social Anxiety Disorder


  • Holding unrealistically high standards
  • They learn to perform avoidance and safety behaviors to avoid disasters
• Treatment for Social Anxiety Disorder

  CBT, D-Cycloserine
• Reactive Attachment Disorder


  • Disorder manifest in similar fashion between the ages of 9 months and 5 years
  • Less is known about the clinical presentation of reactive attachment disorder in children, and diagnosis should be made with caution in children older than 5 yrs
  • Experienced history of severe social neglect
  • Show social communicative functioning comparable to their overall level of intellectual functioning
  • Show lack of preferred attachment despite having attained a developmental age of at least 9 months

  
• Disinhibited Social Engagement Disorder


  • Described from the second year of life through adolescence among children raised in institutional settings, and even into young adulthood
  • Can be distinguished from ADHD by not showing difficulties in attention or hyperactivity
• Posttraumatic Stress Disorder (PTSD)


  • Someone experiences trauma and developed disorder
  • The greater the vulnerability, the more likely we are to develop PTSD
  • Higher intelligence predicted decreased exposure to these types of traumatic events
  • If you have a strong supportive group of people around you, it is much less likely you develop PTSD after trauma
  • Heightened activity in the HPA axis