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Anxiety

What distinguishes fear from anxiety? Fear is a state of immediate alarm in response to a

serious, known threat to one's well-being

Anxiety is a state of alarm in response to a vague senseof being in danger

Both have the same physiologial features ! inrease in

respiration, perspiration, musle tension, et"

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Anxiety #isorders

$ost ommon mental disorders in the %"&" n any given year, ()* of the adult population in the

%"&" experienes one of the six #&$-+- anxiety

disorders .lose to /0* develop one of the disorders at some point in their

lives

1nly one-fifth of these individuals seek treatment

$ost individuals with one anxiety disorder also

suffer from a seond disorder n addition, many individuals with an anxiety disorder

also experiene depression

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Anxiety #isorders

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2enerali3ed Anxiety #isorder 42A#5

6xessive anxiety under most irumstanes and

worry

&ymptoms7 restlessness, fatigue8 diffiulty

onentrating, musle tension, and9or sleepproblems &ymptoms must last at least six months

he disorder is ommon in Western soiety

%sually first appears in hildhood or adolesene

Around one-:uarter of those with 2A# are

urrently in treatment

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2A#7 he &oioultural ;erspetive

Aording to this theory, 2A# is most likely to

develop in people faed with soial onditions that

truly are dangerous esearh supports this theory 4example7 hree $ile sland in

(0atrina in /@, =aiti earth:uake in /(5

1ne of the most powerful forms of soietal stress is

poverty Why? un-down ommunities, higher rime rates, fewer

eduational and ob opportunities, and greater risk for health

problems

As would be predited by the model, there are higher rates

of 2A# in lower &6& groups

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2A#7 he ;syhodynami ;erspetive

Freud believed that all hildren experiene

anxiety ealisti anxiety when they fae atual danger

euroti anxiety when they are prevented fromexpressing id impulses

$oral anxiety when they are punished for expressing id

impulses

&ome hildren experiene partiularly high levelsof anxiety, or their defense mehanisms are

partiularly inade:uate, and they may develop

2A#

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2A#7 he ;syhodynami ;erspetive

;syhodynami therapists use the same general

tehni:ues to treat all psyhologial problems7 Free assoiation

herapist interpretations of transferene, resistane,and dreams

&peifi treatments for 2A# Freudians fous less on fear and more on ontrol of id

1bet-relations therapists attempt to help patients identify andsettle early relationship problems

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2A#7 he =umanisti ;erspetive

heorists propose that 2A#, like other

psyhologial disorders, arises when people stop

looking at themselves honestly and aeptingly

his view is best illustrated by .arl ogers'sexplanation7 Cak of Dunonditional positive regardE in hildhood

leads to Donditions of worthE 4harsh self-standards5

hese threatening self-udgments break through andause anxiety, setting the stage for 2A# to develop

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2A#7 he =umanisti ;erspetive

;ratitioners using this Dlient-enteredE approah

try to show unonditional positive regard for their

lients and to empathi3e with them

#espite optimisti ase reports, ontrolled studies havefailed to offer strong support

n addition, only limited support has been found for

ogers's explanation of 2A# and other forms of

abnormal behavior

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2A#7 he .ognitive ;erspetive

nitially, theorists suggested that 2A# is aused

by maladaptive assumptions Albert 6llis identified basi irrational assumptions7

t is a dire neessity for an adult human being to be loved orapproved of by virtually every signifiant person in his

ommunity

t is awful and atastrophi when things are not the way one

would very muh like them to be

When these assumptions are applied to everyday lifeand to more and more events, 2A# may develop

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2A#7 he .ognitive ;erspetive

ew wave ognitive explanations n reent years, several new explanations have

emerged7 $etaognitive theory

#eveloped by Wells8 suggests that the most problematiassumptions in 2A# are the individual's worry about worrying4meta-worry5

ntolerane of unertainty theory .ertain individuals onsider it unaeptable that negative events

may our, even if the possibility is very small8 they worry in an

effort to find DorretE solutionsAvoidane theory

#eveloped by Borkove8 holds that worrying serves a DpositiveEfuntion for those with 2A# by reduing unusually high levels ofbodily arousal

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2A#7 .ognitive herapies

.ognitive therapies .hanging maladaptive assumptions

6llis's rational-emotive therapy 465 ;oint out irrational assumptions

&uggest more appropriate assumptions

Assign related homework

&tudies suggest at least modest relief from treatment

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2A#7 .ognitive herapies

Breaking down worrying herapists begin by eduating lients about the role of

worrying in 2A# and have them observe their bodily arousaland ognitive responses aross life situations

n turn, lients beome inreasingly skilled at identifying theirworrying and their misguided attempts to ontrol their livesby worrying

With ontinued pratie, lients are expeted to see theworld as less threatening, to adopt more onstrutive ways

of oping, and to worry less esearh has begun to indiate that a onentrated fous on

worrying is a helpful addition to traditional ognitive therapy his approah is similar to mindfulness-based ognitive

therapy

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2A#7 he Biologial ;erspetive

Biologial theorists believe that 2A# is aused

hiefly by biologial fators &upported by family pedigree studies

Biologial relatives more likely to have 2A# 4(@*5 than

general population 4G*5

he loser the relative, the greater the likelihood here is, however, a ompeting explanation of shared environment

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2ABA inativity (0@s ! Ben3odia3epines 4+alium, Hanax5 found to

redue anxiety

Why? eurons have speifi reeptors 4like a lok and key5 Ben3odia3epine reeptors ordinarily reeive gamma-

aminobutyri aid 42ABA, a ommon neurotransmitter in the

brain5

2ABA arries inhibitory messages8 when reeived, it auses aneuron to stop firing

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n normal fear reations7 >ey neurons fire more rapidly, reating a general state

of exitability experiened as fear or anxiety

A feedbak system is triggered ! brain and bodyativities work to redue exitability &ome neurons release 2ABA to inhibit neuron firing, thereby

reduing experiene of fear or anxiety

$alfuntions in the feedbak system are believed to

ause 2A# ;ossible reasons7 oo few reeptors, ineffetive reeptors

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;romising 4but problemati5 explanation eent researh has ompliated the piture7

1ther neurotransmitters also bind to 2ABA reeptors

ssue of ausal relationships #o physiologial events .A%&6 anxiety? =ow an we know?What are alternative explanations?

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Biologial treatments Antianxiety drug therapy

6arly (0@s7 Barbiturates 4sedative-hypnotis5

Cate (0@s7 Ben3odia3epines ;rovide temporary, modest relief

ebound anxiety with withdrawal and essation of use

;hysial dependene is possible

;rodue undesirable effets 4drowsiness, et"5

$ix badly with ertain other drugs 4espeially alohol5

$ore reently7 Antidepressant and antipsyhoti mediations

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Biologial treatments elaxation training

on-hemial biologial tehni:ue

heory7 ;hysial relaxation will lead to psyhologial relaxation

esearh indiates that relaxation training is more effetive than

plaebo or no treatment

Best when used in ombination with ognitive therapy or

biofeedbak

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Biologial treatments Biofeedbak

herapist uses eletrial signals from the body to train people to

ontrol physiologial proesses

6letromyograph 46$25 is the most widely used8 provides

feedbak about musle tension

Found to have a modest effet but has its greatest impat when

used as an adunt to other methods for treatment of ertain

medial problems 4headahe, bak pain, et"5

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;hobias

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;hobias

Fear is a normal and ommon experiene =ow do ommon fears differ from phobias?

$ore intense and persistent fear

2reater desire to avoid the feared obet or situation

#istress that interferes with funtioning

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;hobias

$ost phobias tehnially are ategori3ed as

DspeifiE Also two broader kinds7

&oial anxiety disorder

Agoraphobia

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&peifi ;hobias

;ersistent fears of speifi

obets or situations

When exposed to the

obet or situation,

sufferers experiene

immediate fear

$ost ommon7 ;hobias of

speifi animals orinsets, heights, enlosed

spaes, thunderstorms,

and blood

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&peifi ;hobias

6ah year lose to 0* of all people in the %"&"

have symptoms of speifi phobia

$any suffer from more than one phobia at a time

Women outnumber men at least /7( ;revalene differs aross raial and ethni

minority groups8 the reason is unlear

+ast maority of people with a speifi phobia do1 seek treatment

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What .auses &peifi ;hobias?

6ah model offers explanations, but evidene

tends to support the behavioral explanations7 ;hobias develop through onditioning

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.lassial .onditioning of ;hobia

%.

Fear

%.

Fear

%.&

6ntrapment

unning

water

CS

Runningwater

.

Fear

+%.&

6ntrapment

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1ther behavioral explanations ;hobias develop through modeling

1bservation and imitation

;hobias are maintained through avoidane

;hobias may develop into 2A# when a person a:uires

a large number of them ;roess of stimulus generali3ation7 esponses to one stimulus

are also eliited by similar stimuli

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A behavioral-evolutionary explanation &ome speifi phobias are muh more ommon than

others

heorists argue that there is a speies-speifi

biologial predisposition to develop ertain fears

.alled DpreparednessE beause human beings are

theoretially more DpreparedE to a:uire some phobias

than others

$odel explains why some phobias 4snakes, spiders5

are more ommon than others 4meat, houses5 esearhers do not know if these predispositions are due to

evolutionary or environmental fators

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=ow Are &peifi ;hobias reated?

&ystemati desensiti3ation ehni:ue developed by Ioseph Wolpe

eah relaxation skills

.reate fear hierarhy

;air relaxation with the feared obets or situations &ine relaxation is inompatible with fear, the relaxation response is

thought to substitute for the fear response

&everal types7

n vivo desensiti3ation 4live5 .overt desensiti3ation 4imaginal5

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=ow Are &peifi ;hobias reated?

1ther behavioral treatments7 Flooding

Fored non-gradual exposure

$odeling herapist onfronts the feared obet while the fearful person

observes

.linial researh supports eah of these

treatments he key to suess is A.%AC ontat with the feared

obet or situationA growing number of therapists are using virtual reality as a

useful exposure tool

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Agoraphobia

Fear of being in publi

plaes or situations

where esape might be

diffiult or helpunavailable, should they

experiene pani or

beome inapaitated

;ervasive and omplex ypially develops in /s

or Js

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6xplanations for Agoraphobia

1ften explained in ways similar to speifi

phobias

$any people with agoraphobia experiene

extreme and sudden explosions of fear, alledpanic attacks

&uh individuals may reeive two diagnosesK

agoraphobia and panic disorder

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reatment for Agoraphobia

Behaviorists favor a variety of exposure

approahes for agoraphobia

6xposure therapy

&upport group =ome-based self-help

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&oial Anxiety #isorder

$arked, disproportionate, andpersistent fears about one or

more soial situations $ay be narrow ! talking,

performing, eating, or writing inpubli

$ay be broad ! general fear of

funtioning poorly in front of

others n both forms, people rate

themselves as performing less

ompetently than they atually

do

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What .auses &oial Anxiety #isorder?

.ognitive theorists ontend that people with this disorderhold a group of soial beliefs and expetations thatonsistently work against them, inluding7

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reatments for &oial Anxiety #isorder

1nly in the past (@ years have liniians beenable to treat soial anxiety disorder suessfully

wo omponents must be addressed7

1verwhelming soial fear Address fears behaviorally with exposure

Cak of soial skills &oial skills and assertiveness trainings have proved helpful

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;ani #isorder

;ani, an extreme anxietyreation, an result when areal threat suddenlyemerges

he experiene of Dpani

attaks,E however, isdifferent ;ani attaks are periodi,

short bouts of pani thatour suddenly, reah apeak, and pass

&ufferers often fear they willdie, go ra3y, or lose ontrol

Attaks happen in theabsene of a real threat

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;ani #isorder

$ore than one-:uarter of all people have one ormore pani attaks at some point in their lives,

but some people have pani attaks repeatedly,

unexpetedly, and without apparent reason #iagnosis7 ;ani disorder

&ufferers also experiene dysfuntional hanges in thinking and

behavior as a result of the attaks For example, they may worry persistently about having an attak or

plan their behavior around possibility of future attak

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;ani #isorder

;ani disorder often 4but not always5aompanied by agoraphobia ;eople are afraid to leave home and travel to loations

from whih esape might be diffiult or help unavailable

ntensity may flutuate

%ntil reently, liniians failed to reogni3e the lose link

between agoraphobia and pani attaks 4or pani-like

symptoms5

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What Biologial Fators .ontribute o ;ani

#isorder?

eurotransmitter at work is norepinephrine rregular in people with pani attaks

esearh suggests that pani reations are related to hanges in

norepinephrine ativity in the lous eruleus

esearh onduted in reent years has examinedbrain iruits and the amygdala as the more omplex

root of the problem t is possible that some people inherit a predisposition to

abnormalities in these areas

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;ani #isorder7 he Biologial ;erspetive

#rug therapies Antidepressants are effetive at preventing or reduing

pani attaks Funtion at norepinephrine reeptors in the pani brain iruit

Bring at least some improvement to )* of patients with pani

disorder

mprovements re:uire maintenane of drug therapy

&ome ben3odia3epines 4espeially Hanax Lalpra3olamM5 have

also proved helpful

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;ani #isorder7 he .ognitive ;erspetive

.ognitive theorists reogni3e that biologialfators are only part of the ause of pani attaks n their view, full pani reations are experiened only

by people who misinterpret bodily events

.ognitive treatment is aimed at orreting suh

misinterpretations

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$isinterpreting bodily sensations ;ani-prone people may be very sensitive to ertain

bodily sensations and may misinterpret them as signsof a medial atastrophe8 this leads to pani

Why might some people be prone to suhmisinterpretations? 6xperiene more fre:uent or intense bodily sensations =ave experiened more trauma-filled events

Whatever the preise ause, pani-prone peoplegenerally have a high degree of Danxiety sensitivityE hey fous on bodily sensations muh of the time, are unable to

assess the sensations logially, and interpret them as potentiallyharmful

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.ognitive therapy7 tries to orret people'smisinterpretations of their bodily sensations

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.ognitive therapy $ay also use Dbiologial hallengeE proedures to

indue pani sensations ndue physial sensations, whih ause feelings of pani7

Iump up and down

un up a flight of steps

;ratie oping strategies and making more aurate

interpretations

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1bsessive-.ompulsive #isorder

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#iagnosis is alled forwhen symptoms7 Feel exessive or

unreasonable

.ause great distress

ake up muh time

nterfere with daily

funtions

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ormal outines

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.lassified as an anxiety disorder beauseobsessions ause anxiety, while ompulsions areaimed at preventing or reduing anxiety Anxiety rises if obsessions or ompulsions are resisted

Between (* and /* of %"&" population sufferfrom 1.# in a given year8 as many as J* over alifetime

t is e:ually ommon in men and women andamong different raial and ethni groups

t is estimated that more than N* of those with1.# seek treatment

Wh t A th F t f 1b i d

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What Are the Features of 1bsessions and

.ompulsions?

1bsessions houghts that feel both intrusive and foreign

Attempts to ignore or resist them trigger anxiety


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.ompulsions?

.ompulsions D+oluntaryE behaviors or mental ats

Feel mandatory9unstoppable

$ost reogni3e that their behaviors are unreasonable Believe, though, that something terrible will our if they do not

perform the ompulsive ats

;erforming behaviors redues anxiety for a short time

Behaviors often develop into rituals


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.ompulsions?

.ompulsions .ommon forms9themes7

.leaning

.heking

1rder or balane

ouhing, verbal, and9or ounting


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.ompulsions?

$ost people with 1.# experiene both .ompulsive ats often our in response to

obsessive thoughts

.ompulsions seem to represent a yielding toobsessions

.ompulsions also sometimes serve to help ontrol

obsessions

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1.#7 he ;syhodynami ;erspetive

Anxiety disorders develop when hildren ome tofear their id impulses and use ego defense

mehanisms to lessen their anxiety

1.# differs from other anxiety disorders in thatthe DbattleE is not unonsious8 it is played out in

overt thoughts and ations d impulses O obsessive thoughts

6go defenses O ounter-thoughts or ompulsive ations

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he battle between the id and the ego hree ego defense mehanisms are ommon7

solation7 #isown disturbing thoughts

%ndoing7 ;erform ats to Danel outE thoughts

eation formation7 ake on lifestyle in ontrast to unaeptableimpulses

Freud believed that 1.# was related to the anal stage

of development

;eriod of intense onflit between id and ego ot all psyhodynami theorists agree

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;syhodynami therapies 2oals are to unover and overome underlying onflits

and defenses

$ain tehni:ues are free assoiation and interpretation

esearh has offered little evidene &ome therapists now prefer to treat these patients with short-

term psyhodynami therapies

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1.#7 he Behavioral ;erspetive

n a fearful situation, they happen to perform apartiular at 4washing hands5 When the threat lifts, they assoiate the improvement

with the random at

After repeated assoiations, they believe the

ompulsion is hanging the situation Bringing luk, warding away evil, et"

he at beomes a key method to avoiding orreduing anxiety

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1.#7 he Behavioral ;erspetive

Behavioral therapy 6xposure and response prevention 46;5

.lients are repeatedly exposed to anxiety-provoking stimuli and

are told to resist performing the ompulsions

herapists often model the behavior while the lient wathes =omework is an important omponent

Between @@ and )@ perent of lients have been found to

improve onsiderably with 6;, and improvements often

ontinue indefinitely

=owever, as many as /@* fail to improve at all, and the approahis of limited help to those with obsessions but no ompulsions

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1.#7 he .ognitive ;erspetive

.ognitive theorists begin by pointing out thateveryone has repetitive, unwanted, and intrusive

thoughts ;eople with 1.# blame themselves for normal

4although repetitive and intrusive5 thoughts and expet

that terrible things will happen as a result

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o avoid suh negative outomes, they attempt toDneutrali3eE their thoughts with ations 4or other

thoughts5

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f everyone has intrusive thoughts, why do onlysome people develop 1.#? ;eople with 1.# tend to7

Be more depressed than others

=ave exeptionally high standards of ondut and morality

Believe thoughts are e:ual to ations and are apable of

bringing harm

Believe that they an, and should, have perfet ontrol over their

thoughts and behaviors

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.ognitive therapists fous on the ognitiveproesses that help to produe and maintain

obsessive thoughts and ompulsive ats $ay inlude7

;syhoeduation

2uiding the lient to identify, hallenge, and hange distorted

ognitions

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.ognitive-Behavioral herapy 4.B5 esearh suggests that a ombination of the ognitive

and behavioral models is often more effetive than

either intervention alone

hese treatments typially inlude psyhoeduation aswell as exposure and response prevention exerises

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1.#7 he Biologial ;erspetive

wo reent lines of researh provide more diretevidene7 Abnormal serotonin ativity

6videne that serotonin-based antidepressants redue 1.#

symptoms8 reent studies have suggested otherneurotransmitters also may play important roles

Abnormal brain struture and funtioning 1.# linked to orbitofrontal ortex and audate nulei

Frontal ortex and audate nulei ompose brain iruit thatonverts sensory information into thoughts and ations

6ither area may be too ative, letting through troublesome thoughts

and ations

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&ome researh provides evidene that these twolines may be onneted &erotonin 4with other neurotransmitters5 plays a key

role in the operation of the orbitofrontal ortex and the

audate nuleiAbnormal neurotransmitter ativity ould be ontributing to the

improper funtioning of the iruit

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Biologial therapies &erotonin-based antidepressants

.lomipramine 4Anafranil5, fluoxetine 4;ro3a5, fluvoxamine

4Cuvox5

Bring improvement to @!)* of those with 1.# elapse ours if mediation is stopped

esearh suggests that ombination therapy

4mediation P ognitive behavioral therapy approahes5

may be most effetive

ap8 lecture 5

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