Anxiety Disorders

• Fear


  Physiological and emotional response to a direct threat
• Anxiety


  Physiological and emotional response to a vague sense of threat
• Generalized anxiety disorder (GAD)


  Persistent and excessive anxiety and worry about various events and activities
• Anxiety disorders are the most common mental disorders in the US
• 18% experience an anxiety disorder in a given year
• 29% develop an anxiety disorder in their lifetime
• Women experience anxiety disorders more often than men
• Separation Anxiety Disorder


  Previously considered a childhood disorder, now recognized in adults
• There is controversy regarding the categorization of Separation Anxiety Disorder as an anxiety disorder
• Generalized Anxiety Disorder (GAD)


  • Persistent worry, edginess, fatigue, poor concentration, irritability, muscle tension, sleep problems
• Sociocultural perspective on GAD


  Linked to dangerous social conditions (poverty, racism)
• Psychodynamic perspective on anxiety

  • Realistic anxiety (actual danger)
  • Neurotic anxiety (blocked id impulses)
  • Moral anxiety (punishment for id impulses)
• Psychodynamic treatment for anxiety

  Free association, therapist interpretations
• Humanistic perspective on GAD

  Caused by lack of self-acceptance and conditions of worth
• Humanistic treatment for GAD


  Client-centered therapy
• Cognitive-behavioral perspectives on GAD


  • Maladaptive assumptions (Ellis)
  • Silent assumptions (Beck)
  • Metacognitive theory (Wells)
  • Intolerance of uncertainty theory (Koerner et al.)
  • Avoidance theory (Borkovec)
• Cognitive-behavioral treatments for GAD

  • Changing maladaptive assumptions (RET)
  • Mindfulness-based CBT
  • Acceptance and commitment therapy
• Biological perspective on GAD


  • Hyperactive fear circuit involving GABA and several brain structures (prefrontal cortex, anterior cingulate cortex, insula, amygdala)
• Biological treatment for GAD

  Drug therapy (barbiturates, benzodiazepines, antidepressants, antipsychotics)
• Specific phobias


  Intense and persistent fear of a specific object or situation
• Agoraphobia


  Fear of being in situations where escape might be difficult or help unavailable
• Causes of phobias


  • Classical conditioning (cognitive-behavioral)
  • Modeling (cognitive-behavioral)
  • Preparedness (behavioral-evolutionary)
• Treatments for specific phobias

  • Exposure therapy (systematic desensitization, flooding, modeling)
• Treatments for agoraphobia


  • Exposure therapy
  • Support groups
  • Home-based self-help programs
• Social Anxiety Disorder


  • Fear of social situations where one could be scrutinized, fear of negative evaluation, avoidance of social situations
• Cognitive-behavioral perspective on Social Anxiety Disorder

  • Dysfunctional beliefs and expectations
  • Anticipation of social disasters
  • Avoidance and safety behaviors
• Treatments for Social Anxiety Disorder

  • Exposure therapy
  • Cognitive-behavioral therapy
  • Medications (benzodiazepines, antidepressants)
  • Social skills training
• Panic attack


  Sudden, intense fear with physical symptoms (heart palpitations, shortness of breath, sweating, etc.)
• Panic Disorder


  • Recurrent panic attacks, fear of future attacks, dysfunctional behavior changes
• Biological perspective on Panic Disorder

  • Hyperactive panic circuit (amygdala, hippocampus, hypothalamus, etc.)
• Biological treatment for Panic Disorder

  Drug therapy (antidepressants, benzodiazepines)
• Cognitive-behavioral perspective on Panic Disorder

  • Misinterpretation of bodily sensations
  • Anxiety sensitivity
• Cognitive-behavioral treatments for Panic Disorder

  • Cognitive therapy (correct misinterpretations)
  • Biological challenge test
• Obsessions


  Intrusive thoughts, ideas, impulses, or images
• Compulsions


  Repetitive behaviors or mental acts to reduce anxiety
• Obsessive-Compulsive Disorder (OCD)


  • Recurrent obsessions or compulsions, time-consuming, distress or impairment
• Psychodynamic perspective on OCD

  • Conflict between id and ego
  • Anal stage of development
• Psychodynamic treatment for OCD


  Free association, therapist interpretations (limited support)
• Cognitive-behavioral perspective on OCD

  • Unwanted thoughts
  • Neutralization of thoughts through actions
  • Irrational thoughts (high moral standards, thought-action fusion, need for control)
• Cognitive-behavioral treatments for OCD

  • Exposure and response prevention (ERP)
  • Videoconferencing for ERP