PSYC1002 Lecture 6 2024 (002) Anxiety Disorders 2 Canvas.pptx

PSYC1002: Mental Health Conditions Lesson 6 Anxiety Disorders II Dr Elizabeth Seeley-Wait (Credit for slides: Dr Rebekah Laidsaar- Powell) Acknowledgement of Country I would like to acknowledge the traditional owners of this land: the Gadigal people. For Aboriginal and Torres Strait Islander peopl...

PSYC1002: Mental Health Conditions Lesson 6 Anxiety Disorders II Dr Elizabeth Seeley-Wait (Credit for slides: Dr Rebekah Laidsaar- Powell) Acknowledgement of Country I would like to acknowledge the traditional owners of this land: the Gadigal people. For Aboriginal and Torres Strait Islander people, there are additional historical, political and social determinants that increase the risk of depression and anxiety. These determinants include risk factors stemming from colonisation and contributing to intergenerational trauma, such as impacts of the Stolen Generations and removal of children, grief and loss, separation from culture, and discrimination. We acknowledge that addressing anxiety and depression among Aboriginal and Torres Strait Islander communities requires culturally competent mental health support that draws on a holistic concept of health, including social and emotional wellbeing. This means acknowledging the role of social and cultural protective factors such as social support, links to land, culture, spirituality and ancestry, self-determination, strong community governance and the passing on of cultural practices, in reducing incidences of anxiety and depression. Credits: Beyond Blue (2019). Beyond Blue Aboriginal and Torres Strait Islander people. Retrieved from: https://www.beyondblue.org.au/about/first-nations-peoples Calma, T., Dudgeon, P., Bray, A. (2017). Aboriginal and Torres Strait Islander social and emotional wellbeing and mental health. Australian Psychologist, 52(4), 255-260. 10.1111/ap.12299 Central Adelaide Local Health Network Mental Health Directorate (2021). Aboriginal mental health clinical practice guideline and pathways: a culturally appropriate guide for working with Aboriginal mental health consumers. Adelaide: South Australia Health. Nasir, B.F., Toombs, M.R., Kondalsamy-Chennakesavan, S., Kisely, S., Gill, N.S., Black, E., Hayman, N., Ranmuthugala, G., Beccaria, G., Ostini, R., Nicholson, G.C. (2018). Common mental disorders among Indigenous people living in regional, r emote and metropolitan Australia: a cross-sectional study. BMJ Open, 8(6). Retrieved from: https://doi.org/10.1136/bmjopen-2017-020196 Today’s Lesson Specific Phobia Generalised Anxiety Disorder Obsessive Compulsive Disorder Treatment of anxiety disorders 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  Remember This is a Diagnosis Free Zone - We will start looking at DSM-5 criteria, applying it, noticing patterns Support is available! - https://www.sydney.edu.au/students/counselling-and-mental-healt h-support.html Contact CAPS directly at: Level 5 of the Jane Foss Russell Building G02, City Road (beside the Wentworth Building), Camperdown Campus, 9am – 5pm, Monday to Friday. (02) 8627 8433 or 8627 8436. [email protected]. Also, you CAN access support from the Psychology Clinic on campus (the one that has provisional psychology Masters students there on placement – thank Specific Phobias DSM-5 Specific Phobias A marked and consistent fear reaction to the presence or anticipation of a specific object or situation Anxiety experienced is out of proportion to the actual threat Persistent, lasting 6 months or more Phobic stimulus is avoided or endured with intense fear The fear/anxiety/avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning DSM-5 Specific Phobias: Subtypes Animals Blood, Injection and Injury Natural environment Other Situational Normal anxiety vs phobias Normal Anxiety Phobia Feeling queasy while climbing Refusing to attend your best a tall ladder friend's wedding because it’s on the 25th floor of a hotel Worrying about taking off in a Turning down a big promotion plane during a storm because it involves air travel Feeling anxious around your Avoiding visiting your neighbours neighbour's pit bull for fear of seeing a dog Specific Phobia - causes Classical Conditioning? Bad experience >> phobia ?? Conditioning is not sufficient/ necessary as a cause Example: Dog Phobia (dog attack doesn’t always lead to phobia, phobia not always result of dog attack) Some stimuli are more likely to become phobic than others Hammer, knife, electricity etc phobias are rare despite injury rates Phobic fears: significant threat to survival during evolution “prepared” - ease of acquisition (Seligman, 1971) For example, phobias related to survival, such as snakes, spiders, and heights, are much more common and much easier to induce in the laboratory than other kinds of fears. According to Martin Seligman, this is a result of our evolutionary history. Specific Phobia – prevalence & course Prevalence Common in children & more intense in Adults 7-9% of adults More common in females (2:1) – particularly animal, environment, situational (blood/injection/injury equal across genders) Development & Course Sometimes develops following traumatic event, observing trauma, information transmission BUT some cannot recall specific reason for phobia (often develops in childhood) Childhood/adolescence – wax and wane, but those that persist into adulthood unlikely to remit Can develop in adulthood – e.g. choking phobia can happen at any age Generalised Anxiety Disorder Generalised Anxiety Disorder (GAD) Excessive and uncontrollable worry About a wide range of events or activities (no single trigger) See a lot of potential danger in life Associated with 3+: Restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance Not the classic autonomic arousal symptoms of anxiety Constant stream of consciousness Things that could go wrong “what if?” Meta-Worry At least 6 months duration (for diagnosis)  Generalised Anxiety Disorder Focus of worry Professional worries (underperformance, job insecurity) Finances Personal health/safety and health/safety of family members Impact of world events (e.g. terrorism) Minor matters (e.g. late to an appointment) Focus of worry may shift from one concern to another Often changes throughout lifespan (“age appropriate”) Youth, Adolescence, Early Adulthood, Middle Age, Elderly Generalised Anxiety Disorder Magnitude of worry Intensity / duration / frequency of worry is out of proportion to the actual likelihood or impact of the anticipated event Generalised Anxiety Disorder Control of worry Limited control over worry Process of catastrophising can occur automatically (quickly escalates) Stuck in traffic >>> Lose Job >>> Lose House >>> Homeless Difficult to keep worrisome thoughts I from interfering really should have been with attention to tasks at hand more careful nailing those pictures in the wall that time. What if it was asbestos. What if I breathed the dust in… I’ll die from mesothelioma Generalised Anxiety Disorder (GAD) Associated with: High trait anxiety Interpret ambiguous situations as threatening Intolerance of uncertainty Need to be 100% certain that negative outcome will not occur Reduced ability to tolerate distress Worry = maintenance/ safety behaviour Need to reduce possibility of distress Reduced problem-solving confidence Maintenance: Worry is necessary Positive Reinforcement GAD – Prevalence & Course Prevalence rates (lifetime prevalence) – 6.1% Age of onset: 31-39 years (‘anxious temperament’ in youth) Higher prevalence of females with GAD Clinical course: Most people w GAD do not seek help from mental health professionals Of those that do- delays > 10 years Chronic course- unlikely to improve without treatment Fluctuates in severity over time Obsessive Compulsive Disorder OCD as an adjective/joke….. DSM 5: Obsessive-Compulsive and Related Disorders Obsessive-Compulsive Disorder Body Dysmorphic Disorder Hoarding Disorder Trichotillomania (Hair-Pulling Disorder) Excoriation (Skin-Picking) Disorder Obsessive-Compulsive Disorder Obsessions: Repeated, intrusive, irrational thoughts or impulses, which cause severe anxiety or distress. Attempts made to ignore or suppress or neutralise the obsessions Continuum Normal: Positive and negative intrusions OCD: Intrusions = unacceptable  Anxiety Bad person, Might Happen Thought-Action Fusion: thinking thoughts are more than 'just thoughts'; like thoughts=action. Obsessive-Compulsive Disorder Specific content varies 4 dimensions of common obsessions have been identified: Contamination Doubt/Harm Symmetry/Order Forbidden/Taboo Obsessive-Compulsive Disorder Compulsions Repetitive/Ritualised behaviors or mental acts to neutralise obsessions /reduce anxiety Repetitive behaviour can be overt or covert May not be connected in a realistic way with what they are designed to neutralize or prevent, and/ or are clearly excessive. Common compulsions in OCD Washing/ Checking Repeating Cleaning Ordering and Mental Arranging Compulsions Obsessions / Compulsions Can have one without the other (but O+C is most common) Can have symptoms in more than one dimension O+C might be connected Contamination obsessions -> Cleaning compulsions Doubt obsessions -> Checking compulsions O+C might NOT be connected Forbidden/Taboo obsessions -> Mental compulsions like counting Harm obsessions -> Ordering and arranging Obsessions are unwanted, not pleasurable, not voluntary Intrusive and cause distress Compulsions are not done for pleasure BUT- may experience relief from anxiety/distress Obsessive-Compulsive Disorder Often associated with: Intolerance of uncertainty Need to be 100% certain that negative outcome will not occur Inflated responsibility “something bad will happen AND it will be my fault” Thought-action fusion “Thinking about it is as bad as doing it” “Thinking something makes it more likely it will happen” Magical ideation “if I don’t step on the cracks, I will pass the exam…” Treatment of anxiety disorders  Psychological Treatment of Anxiety Disorders Cognitive Behavioural Therapy (CBT) Aim to reduce threat appraisals LIKELIHOOD LIKELIHOOD of perceived harm: How likely is it that the event will happen? COST COST of perceived harm: How bad would it be if it did happen? Psychoeducation EXPOSURE Cognitive Techniques Behavioural Techniques EXPOSURE IS AN ESSENTIAL INGREDIENT  Psychological Treatment of Anxiety Disorders Psychoeducation Person’s specific triggers, responses, and impact on their life Explanation of anxiety in general The role of avoidance Teach relaxation techniques to address fight & flight response  Psychological Treatment of Anxiety Disorders Cognitive techniques Cognitive restructuring and thought challenging Thought-diaries: to recognise automatic thoughts => anxiety level Socratic questioning: Am I making an assumptions? Could I be misinterpreting things? Am I looking at all the evidence or just what supports my thought? Could my thought be an exaggeration of what is true?  Psychological Treatment of Anxiety Disorders Behavioural techniques Exposure Therapy – Graded exposure Imaginal In Vivo Development and progression through fear hierarchy Coupled with Relaxation Techniques deep breathing, progressive muscle relaxation, or meditation. Considerable evidence > exposure therapy treatment gains Psychological Treatment of Anxiety Disorders Anxiety exacerbation and maintenance as a result of escape or avoidance The eventual reduction in anxiety during prolonged exposure (without avoidance) over a 20 to 60 minute period. Psychological Treatment of Anxiety Disorders Behavioural techniques also affect cognition: Exposure to feared stimuli/situation (e.g. public transport) => reduces judgments of probability of harm (not as likely) Exposure to feared outcomes (e.g. negative social evaluation) => reduces judgments of cost of harm (not as bad) Treatment of anxiety disorders Biological Treatments Treat the symptoms NOT the cause Can be used in combination with psychological treatments Effective in the short term, BUT… Barbituates (Amobarbital, Phenobarbital): Quick acting Addictive, risk of OD, interacts with alcohol, high relapse rate Benzodiazepines (Valium, Xanax, Rohypnol): Quick acting Addictive, interacts with alcohol, high relapse rate Antidepressants - SSRIs (antidepressants, e.g. Prozac, Zoloft): Slower acting Fewer side effects, however relapse is still common What’s next Next lesson: Depressive disorders. Don't forget to use this line if ever needing more immediate help: Lifeline: 13 11 14 Try this link and have a look at the 98 (wow!) different services available! Surely one could be helpful to you or your friend? Mental health services and support contact list - Services and programs (nsw.gov.au) Lesson 4: Done