PSYC1002 Lecture 5 2024 Canvas (1).pptx

PSYC1002: Mental Health Conditions Lesson 5 Introduction to Anxiety Disorders Dr Elizabeth Seeley-Wait (Credit for slides: Dr Rebekah Laidsaar-Powell) Today’s Lesson What is anxiety? Normal anxiety / Abnormal anxiety Introduction to Anxiety & Related Disorders Panic Attack Pani...

PSYC1002: Mental Health Conditions Lesson 5 Introduction to Anxiety Disorders Dr Elizabeth Seeley-Wait (Credit for slides: Dr Rebekah Laidsaar-Powell) Today’s Lesson What is anxiety? Normal anxiety / Abnormal anxiety Introduction to Anxiety & Related Disorders Panic Attack Panic Disorder Remember Diagnosis Free Zone - We will start looking at DSM-5 criteria, applying it, noticing patterns BUT actual diagnosis is a long long way away- need diagnostic experience/skill via Postgraduate study Diagnosing yourself, family, friends with DSM-5 What is anxiety? Anxiety The experience of anxiety is the same in normal anxiety and abnormal anxiety (severe, often, excessive) Activated in response to perceived threat The experience of anxiety arises form the activation of these 3 inter-related systems 1. Physical 2. Cognitive 3. Behavioural Anxiety- Physical System Fight/Flight response: Mediated by SNS Mobilise physical resources to deal with the threat: Heart rate and blood pressure increases, (palpitations) Stress hormones and different neurotransmitters are released Our breathing speeds up to get more oxygen for muscles (dizzy and lightheaded) Saliva production reduces (dry mouth) Body prepares us to fight or run away (muscle tension) We start to cool down the body (sweating) Our digestion slows down as blood flows away from our stomach and to our muscles (upset or queasy stomach) Anxiety- Cognitive System How you pay attention, what you attend to, and your interpretations of the situation/object/person 1. Perception of threat 2. Attentional shift towards the threat (i.e. driving, walking at night) 3. Hypervigilance to source of threatening information - Difficulty concentrating on other tasks Anxiety as helpful in ambiguous situations: Example: Rustle in the bushes Anxiety as unhelpful Example: Test anxiety Yerkes-Dodson law Normal and Pathological Anxiety Normal Anxiety Evolutionary  Necessary for Survival Individual Differences Genetics: Sensitivity/ Temperament Intensity of Fear experienced varies Learned: Things feared vary across individuals Abnormal / Pathological Anxiety Abnormal anxiety is not qualitatively different from normal anxiety Similar physical/cognitive/behavioural The occurrence is either Inappropriate: In the absence of objective threat Excessive: Is more intense than the objective level of threat (Resulting in interference with functioning) Characterised by overestimation of threat Likelihood: Perceived probability of a negative outcome Cost: Perceived cost of negative outcome (Often based on past experiences, observations) Example: Party DSM Classification of Anxiety DSM 5: Anxiety disorders Separation Anxiety Disorder (child or adult) Selective Mutism Specific Phobia Panic Disorder Agoraphobia Social Anxiety Disorder (SAD) Generalised Anxiety Disorder (GAD) DSM-IV Anxiety Disorders DSM 5: Trauma and Stressor-Related Spe Disorders Posttraumatic Stress Disorder (PTSD) c ific Acute Stress Disorder P ho D bia OSC Adjustment Disorders s ocia Reactive Attachment Disorder P TS D an x l Disinhibited Social Engagement Disorder iety DSM 5: Obsessive-compulsive and related disorders Obsessive-Compulsive Disorder (OCD) Hoarding Disorder Trichotillomania (Hair-Pulling Disorder) Excoriation (Skin-Picking) Disorder Body Dysmorphic Disorder Changes from DSM-4 to DSM-5 DSM-IV ANXIETY DISORDERS DSM-5 ANXIETY DISORDERS Separation Anxiety Separation Anxiety Disorder Disorder Selective Mutism Specific Phobia Specific Phobia Social Phobia Social Anxiety Disorder Generalized Anxiety Generalized Anxiety Disorder Disorder Panic Disorder Panic Disorder - with Agoraphobia Agoraphobia Acute Stress Disorder Posttraumatic Stress Disorder DSM Classification of Anxiety DSM 5: Anxiety disorders Separation Anxiety Disorder (child or adult) Selective Mutism Specific Phobia Panic Disorder Agoraphobia Social Anxiety Disorder (SAD) Generalised Anxiety Disorder (GAD) Panic Attack (specifier) DSM 5: Trauma and Stressor-Related Disorders Posttraumatic Stress Disorder (PTSD) Acute Stress Disorder Adjustment Disorders Reactive Attachment Disorder Disinhibited Social Engagement Disorder DSM 5: Obsessive-compulsive and related disorders Obsessive-Compulsive Disorder (OCD) Hoarding Disorder Trichotillomania (Hair-Pulling Disorder) Excoriation (Skin-Picking) Disorder Body Dysmorphic Disorder Panic Attacks Panic Attack NOT a diagnosis BUT relevant to all anxiety disorders 1/3 of all people have experienced a panic attack Panic Attack Discrete period of intense fear or discomfort that appears abruptly and peaks usually within 10 mins Classic symptoms of autonomic arousal (sweating, pounding heart, shaking, shortness of breath, nausea, dizziness etc) Fear of dying, losing control, going mad, intense dread Can be given as a specifier to any DSM-5 diagnosis Specifiers are extensions to a diagnosis to further clarify a disorder or illness. They allow for a more specific diagnosis E.g. Generalised Anxiety Disorder with Panic Attack Specifier Panic Attack Extremely severe anxiety/fear reaction Can occur in the context of any anxiety disorder Unexpected Expected (cued) (uncued/spontaneo panic attack us) panic attack Panic Disorder Panic Disorder A. Recurrent unexpected (e.g. unknown trigger) panic attacks B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following 1. Persistent concern/worry about having another attack 2. A significant maladaptive change in behaviour related to attacks Panic related behaviours include Avoidance: of situations where panic is likely of activities that produce panic-like sensations Escape “Safety behaviours” including distraction, anxiety medication, mobile phones, bottled water, significant others Experience of panic is associated with catastrophic cognitions I will die, collapse, lose control, go mad, go crazy etc Panic Attacks vs. Panic Disorder Panic attack (e.g. in person with social anxiety disorder) may experience a panic attack before having to give a speech- fear focuses on the negative evaluation by others and expected social embarrassment. Panic disorder the attacks themselves become a problem, as indicated by the fear of future attacks and altered behaviour in response to the attacks. Panic Disorder is often described as a “fear of fear” Panic Disorder Approx 5% of Australians have had PD in their lifetime; about 3-4% in any 12 month period More common in females Onset in early adulthood Comorbidity - Depression - Agoraphobia Fear or avoidance of situations or events associated with panic (avoiding public places): Avoid physical activity, quit job, become housebound Treatment seeking- many years after onset - often confused as attribute this to medical factors - some cannot leave house Cognitive Theory of PD (Clark, 1988) High sensitivity to bodily experiences Example: Big strong coffee (Panic vs Normal) Bodily Sensations (shaking, increased HR) Cognitive Theory of PD (Clark, 1988) High sensitivity to bodily experiences Example: Big strong coffee (Panic vs Normal) Bodily Sensations (shaking, increased HR) Misinterpret the bodily sensations Cognitive Theory of PD (Clark, 1988) High sensitivity to bodily experiences Example: Big strong coffee (Panic vs Normal) Bodily Sensations (shaking, increased HR) Misinterpret the bodily sensations ANXIETY Cognitive Theory of PD (Clark, 1988) High sensitivity to bodily experiences Example: Big strong coffee (Panic vs Normal) Bodily Sensations (shaking, increased HR) Misinterpret the Increases Bodily bodily sensations Sensations ANXIETY Cognitive Theory of PD (Clark, 1988) High sensitivity to bodily experiences Example: Big strong coffee (Panic vs Normal) Bodily Sensations (shaking, increased HR) Misinterpret the Increases Bodily PANIC PANIC bodily sensations Sensations ANXIETY Cognitive Theory of PD (Clark, 1988) High sensitivity to bodily experiences Example: Big strong coffee (Panic vs Normal) Bodily Sensations (shaking, increased HR) Cognitive Theory of PD (Clark, 1988) High sensitivity to bodily experiences Example: Big strong coffee (Panic vs Normal) Bodily Sensations (shaking, increased HR) Notice the bodily sensations Cognitive Theory of PD (Clark, 1988) High sensitivity to bodily experiences Example: Big strong coffee (Panic vs Normal) Bodily Sensations (shaking, increased HR) Notice the bodily sensations Wooahh, I need to ease up on the caffeine! Cognitive Theory of PD (Clark, 1988) High sensitivity to bodily experiences Example: Big strong coffee (Panic vs Normal) Bodily Sensations (shaking, increased HR) Tolerance of body Notice the bodily sensations given sensations attribution to caffeine Wooahh, I need to ease up on the caffeine! Treatment Cognitive Behavioural Therapy: Psychoeducation; Exposure and Interoceptive Exposure Interoceptive Exposure Graded exercises that induce the physical sensations of a panic attack Repeated and sufficient duration Challenge beliefs about physical sensations and extinguish conditioned anxiety Lesson 3: Done