ANXIETY DISORDERS
Anxiety vs. Fear
Anxiety is defined as apprehension
over an anticipated problem
Fear is a reaction to immediate
danger.
Both involve physiological arousal
Sympathetic nervous system
Both can be adaptive
Fear triggers “flight or fight”
May save life
Anxiety increases preparedness
Moderate levels improve performance
General Criteria
Symptoms must interfere with important
areas of functioning or cause marked
distress.
Symptoms are not caused by a drug or a
medical condition.
The fears and anxieties are distinct from the
symptoms of another anxiety disorder.
Summary of Anxiety Disorders
Specific Phobia
Marked and disproportionate
fear consistently triggered by
specific objects
or situations
The object or situation is
avoided or else endured with
intense anxiety
Symptoms persist for at least
6 months.
Social Anxiety Disorder
Marked and disproportionate fear
consistently triggered by exposure to
potential social scrutiny
Exposure to the trigger leads to intense
anxiety about being evaluated negatively
Trigger situations are avoided or else
endured with intense anxiety
Symptoms persist for at least 6 months
Panic Disorder
Recurrent uncued panic attacks
At least 1 month of concern about the
possibility of more attacks, worry about the
consequences of an attack, or maladaptive
behavioral changes because of the
attacks.
Panic Attacks
Uncued
Occurred unexpectedly without warning
Cued
Triggered by specific situation
Panic Attack
is a sudden attack of intense apprehension,
terror, and feelings of impending doom,
accompanied by at least four other
symptoms.
Physical symptoms
labored breathing, heart palpitations, nausea,
upset stomach, chest pain, feelings of choking
and smothering, dizziness, lightheadedness,
sweating, chills, heat sensations, and trembling.
Other symptoms include:
Depersonalization
Derealization
Agoraphobia
Disproportionate and marked fear or anxiety about
at least 2 situations where it would be difficult to
escape or receive help in the event of
incapacitation, embarrassing symptoms, or panic-
like symptoms such as being outside of the home
alone; traveling on public transportation; being in
open spaces such as parking lots and
marketplaces.
These situations consistently provoke fear or
anxiety
These situations are avoided, require the presence
of a companion, or are endured with intense fear or
anxiety
Symptoms last at least 6 months
Generalized Anxiety Disorder
Excessive anxiety and worry at least 50 % of
days about a number of events or activities
The person finds it hard to control the worry
The worry is sustained for at least 6 months
The anxiety and worry are associated with at
least three (or one in children) of the
following: restlessness or feeling keyed up or
on edge; easily fatigued; difficulty
concentrating or mind going blank; irritability;
muscle tension; sleep disturbance
Comorbidity of Anxiety
Disorders
¾ of those anxiety disorder meet criteria for another
disorder
60% meet criteria for major depression
Other disorders commonly comorbid with anxiety
Substance Abuse
Personality Disorders
Medical Disorders e.g. coronary heart diseases
It is very common for people with one anxiety disorder to
report subthreshold symptoms (symptoms that do not
meet full diagnostic criteria) of other disorders
Gender and Sociocultural Factors in
the Anxiety Disorders
Women are at least twice as likely as men to be diagnosed
with an anxiety disorder
Possible Explanations:
Women may be more likely to report their symptoms.
Women are much more likely than men to be sexually assaulted
during childhood and adulthood
Women show more biological reactivity to stress than do men
Socio-cultural Factors
Focus of these problems appears to vary by culture.
Taijin kyofusho (Japan) - fear of displeasing or embarrassing others
Koro (South and East Asia) - a sudden fear that one’s genitals will recede
into the body
Shenkui (China) - intense anxiety and somatic symptoms attributed to the
loss of semen, as through masturbation or excessive sexual activity
Common Risk Factors across the
Anxiety Disorders
Genetics
Neurobiological risk factors
Behavioral conditioning
Personality traits
Cognition
Risk Factors: Genes and
Neurobiological Factors
Genetic
Twin Studies
20–40 percent for specific phobias,
social anxiety disorder, GAD and
PTSD
about 50 percent for panic disorder
genes may elevate risk for several
different types of anxiety disorder
Neurobiological
Fear Circuit Activity
Amygdala (Active)
Medial prefrontal cortex (Less Active)
Neurotransmitters
Serotonin, GABA (Poor Functioning)
Norepinephrine (Higher than Normal)
Risk Factors: Behavioral
Fear Conditioning
Mowrer’s two-factor
model
1. Through classical conditioning, a
person learns to fear a neutral
stimulus (the CS) that is paired with
an intrinsically aversive stimulus
(the UCS).
2. Through operant conditioning, a
person gains relief by avoiding the
CS. This avoidant response is
maintained because it is reinforcing
(it reduces fear).
Risk Factors: Personality
Behavioral Inhibition
a tendency to become agitated and cry when faced with novel or
unfamiliar settings
strong predictor of anxiety in childhood and social anxiety
disorder in adolescents
Observed in infants as young as 4 months old
May be inherited
Neuroticism
Tendency to react to events with greater than-average negative
affect.
Linked to anxiety and depression
Twice as likely to develop an anxiety disorder
Risk Factors: Cognitive
Factors
Sustained Negative Beliefs about the Future
People with anxiety disorders often report believing that bad
things are likely to happen.
Perceived Control
People who think that they lack control over their environment
appear to be at greater risk for a broad range of anxiety disorders
than people who do not have that belief.
Attention to signs of threat
People with anxiety disorders have been found to pay more
attention to negative cues in their environment than do people
without anxiety disorders
able
Commonalities across
Psychological Treatments:
EXPOSURE
Exposure - that is, the person must face what
he or she deems too terrifying to face.
Chinese proverb puts it, “Go straight to the
heart of danger, for there you will find safety.”
Even psychoanalysts, who believe that the
unconscious sources of anxiety are buried in
the past, eventually encourage confronting
the source of fears
Exposure Therapy Approaches
Systematic desensitization - the client is first
taught relaxation skills. Then the client uses
these skills to relax while undergoing exposure
to a list of feared situations developed with the
therapist— starting with the least feared and
working up to the most feared
Behavioral view of exposure - is that it works by
extinguishing the fear response
Cognitive view of exposure treatment - helps
people correct their mistaken beliefs that they
are unable to cope with the stimulus.
Exposure Therapy Approaches
Virtual reality is sometimes used to simulate
feared situations such as flying, heights, and
even social interactions
CBT Exposure - exposure should include as
many features of the feared object as
possible. Exposure should be conducted in
as many different contexts as possible.
