Anxiety Disorders, Chapter 5 PDF

Anxiety Disorders, Chapter 5 Comer & Comer, 2021 1 What We’re Covering Today Anxiety & Fear, What’s the Difference? Anxiety Disorders Generalized Anxiety Disorder (GAD) ○ Looking at GAD though each model ○ Current Treatments for GAD Anxiety Management Journal...

Anxiety Disorders, Chapter 5 Comer & Comer, 2021 1 What We’re Covering Today Anxiety & Fear, What’s the Difference? Anxiety Disorders Generalized Anxiety Disorder (GAD) ○ Looking at GAD though each model ○ Current Treatments for GAD Anxiety Management Journal 2 What does it feel like to be anxious? Feelings of tension Worried thoughts Physical changes: ○ increased blood pressure ○ sweating ○ upset stomach ○ rapid heart rate 3 Comer & Comer (2021) explained: Sometimes you can’t pinpoint a specific cause for your alarm, but you still feel tense and edgy, as if you expect something unpleasant to happen. The vague sense of being in danger is usually called anxiety. It has the same features — the same increases in breathing, muscular tension, and perspiration — as fear. Yoga Poses for Anxiety 4  Fear is an appropriate, present-oriented, and short-lived response to a clearly identifiable and specific threat. 5 A “Serious Threat” Anytime we are faced with a “serious threat” to our well-being we may react with alarm, avoidance, or fear. Fear is the… Central nervous system’s physiological and emotional response to a serious threat to one’s well-being 6 Fear Is Physical Fear triggers strong mental and physical reactions. When fear is recognized, the amygdala activates the nervous system, releasing stress hormones like cortisol and adrenaline. This leads to: an increased heart rate faster breathing changes in blood flow (fight or flight response) 7 Fearful Delights Controlled fear Some people like tension-producing experiences, as long as they are in control Examples: Fear Farm; Fear Weekend Haunted Houses (ex. The Gauntlet, AZ Field of Screams) Escape Rooms Horror Films 8 What’s the Difference? Fear & Anxiety Anxiety, on the other hand, is more generalized and often occurs without a clear or immediate threat. It's a response to a perceived future danger or something uncertain, leading to ongoing worry or unease. While fear has a direct cause, anxiety is more often associated with anticipation, and its symptoms can be persistent, even in the absence of a present threat. 9 Anxiety The central nervous system’s physiological and emotional response to a vague sense of threat or danger Anxiety Related Disorders Anxiety-Related Disorders are a group of mental health conditions that can significantly impact daily functioning and well-being. Anxiety is a normal response to stress, but when it becomes overwhelming and persistent, it can lead to disorders that require clinical attention. Phobias: Intense, irrational fears that lead to avoidance behavior. Social Anxiety Disorder: Fear of social situations that leads to significant discomfort and avoidance. Panic Disorder: Recurrent panic attacks characterized by sudden and intense fear, often misinterpreted as life-threatening conditions. Obsessive-Compulsive Disorder (OCD): A cycle of intrusive thoughts and compulsive behaviors aimed at reducing anxiety. 11 Developmental Pathology Perspective of Anxiety Disorders Each of these conditions presents unique challenges and symptoms, but they all share a common thread—intense, often irrational fear and anxiety that interferes with a person's ability to lead a fulfilling life. We will integrate a developmental pathology perspective, examining how these disorders emerge, evolve, and can be treated throughout the lifespan. By understanding the interaction between individual development and anxiety disorders, we gain deeper insights into prevention and intervention strategies. 12 Anxiety Disorders are the most common in the U.S. In any given year, 40 million adults (19% of the U.S. population) experiences one of the six DSM-5-TR anxiety disorders (generalized anxiety disorder, phobias, agoraphobia, social anxiety disorder, panic disorder, obsessive compulsive disorder). About 31% develop one of the disorders at some point in their lives. About 42% of these individuals seek treatment. Approximately 7% of children (aged 3-17) experience issues with anxiety each year Speaking of Psychology: What is anxiety and how can we treat it effectively?, with Bunmi Olatunji, PhD, APA, 2022. Generalized Anxiety Disorder (GAD) A disorder marked by persistent and excessive feelings of anxiety and worry about numerous events and activities. Excessive anxiety is experienced under most circumstances The individual may worry about practically anything; free-floating anxiety Reduced quality of life Affects 6.8 million adults, 3.1% of U.S. population ○ 2:1 ratio of women to men ○ 43% receive treatment ○ non-Hispanic white Americans are more likely than African, Hispanic, or Asian Americans to develop an anxiety disorder during their lifetime (Comer & Comer, 2021, Vilsaint et al., 2019). The cause of this racial-ethnic difference is not well understood. American Psychological Association: Dictionary of Psychology: Generalized Anxiety Disorder Definition, 2022 For a formal diagnosis of GAD, Worry is often experienced as difficult to control, and the various symptoms that accompany the worry and anxiety occur on more days than not for a period of 6 months or more. Worry is the defining feature of GAD. 15 Excessive Worry Generalized Anxiety Disorder Excessive anxiety and worry about a range of concerns (e.g., world events, 1. For 6 months or more, person experiences disproportionate, uncontrollable, and ongoing finances, health, appearance, activities of anxiety and worry about multiple matters. family members and friends, work, school) 2. The symptoms include at least three of the is accompanied by such symptoms as: following: edginess, fatigue, poor concentration, irritability, muscle tension, sleep problems. restlessness fatigue 3. Significant distress or impairment. impaired concentration irritability muscle tension disturbed sleep Separation Anxiety Disorder: Not Just for Kids Anymore Individuals with separation anxiety disorder feel extreme anxiety, often panic, whenever they are separated from key people in their lives. Most common disorder among young children DSM-5-TR determined separation anxiety can develop in adults. New categorization as an anxiety disorder is controversial. Generalized Anxiety Disorder (GAD) through Each Model 18 Generalized Anxiety Disorder Sociocultural perspective Prevalence of Anxiety Disorders and OCD (Compared with Rate in Total Population) GAD is most likely to develop in people faced with dangerous Female Low-Income Elderly ongoing social conditions or Generalized anxiety disorder Higher Higher Higher highly threatened environments. Specific phobias Higher Higher Lower Supported by research Agoraphobia Higher Higher Higher findings Social anxiety disorder Higher Higher Lower Panic disorder Higher Higher Lower Some forms of societal stress Obsessive-compulsive Same Higher Lower disorder Poverty Race and ethnicity Widespread illness Today’s Psychodynamic Perspective Freud believed that all children experience some degree of anxiety and use ego mechanisms to control this. GAD occurs with high anxiety levels or inadequate defense mechanisms. People with GAD are likely to use defense mechanisms (especially repression) Adults, who as children suffered extreme punishment for expressing id impulses, have higher levels of anxiety later in life. Psychodynamic Theorists Disagree & Agree Disagree with some Freudian GAD explanations, but agree GAD can be traced to early parent–child relationships Research testing psychodynamic explanations GAD and defense mechanisms Repressed memories Harsh punishment Overprotectiveness Current research: Psychodynamic Formulation and Psychodynamic Psychotherapy for Pediatric Anxiety Disorders; Shapiro, 2023. Psychodynamic Treatments for GAD Psychodynamic therapies Free association Therapist interpretations of transference, resistance, and dreams to reduce fear of id impulses and control Specific treatments for GAD Freudians focus less on fear and more on control of id (instinct/pleasure principle). Object-relations therapists attempt to help patients identify and settle early relationship problems. Short-term psychodynamic therapy is more effective than longer treatments. The Humanistic Perspective of GAD Humanistic perspective GAD arises when people stop looking at themselves honestly and acceptingly. Carl Rogers' explanation Lack of unconditional positive regard in childhood leads to conditions of worth (i.e., harsh self-standards). Threatening self-judgments break through and cause anxiety, setting the stage for GAD to develop. Generalized Anxiety Disorder (part 7) Humanistic treatment approach Client-centered therapy is used to show unconditional positive regard for clients and empathize with them. Despite optimistic case reports, controlled studies have failed to offer strong support. Only limited support for Rogers' explanation of GAD and other forms of abnormal behavior  Animated Anxiety In the animated film Inside Out, a young girl’s five basic emotions come to life and guide her every behavior. Clinicians note that the emotional figure named Fear personifies the core symptoms of generalized anxiety disorder. He sees potential catastrophes everywhere — a mindset that leads to continuous worrying and tension (Comer & Comer, 2021). Generalized Anxiety Disorder & The Cognitive Behavioral Perspective Cognitive-behavioral perspective Problematic behaviors and dysfunctional thinking often cause psychological disorders. Treatment focus involves the nature of behavior and thoughts. Early approach Maladaptive or basic irrational assumptions (Ellis) Silent assumptions (Beck) Ellis & Beck Initially, theorists suggested that generalized anxiety disorder is caused by maladaptive assumptions. Albert Ellis identified basic irrational assumptions: It is a dire necessity for an adult human being to be loved or approved of by virtually every significant person in his community. It is awful and catastrophic when things are not the way one would very much like them to be. When these assumptions are applied to everyday life and to more and more events, GAD may develop. Beck & Beck Aaron Beck, another cognitive theorist, argued that persons with GAD constantly hold silent assumptions that imply imminent danger: A situation/person is unsafe until proven safe. It is always best to assume the worst. Researchers have repeatedly found that people with GAD do hold maladaptive assumptions, particularly about dangerousness. Generalized Anxiety Disorder (part 9) In one survey, 62% of college students said they spend less than 10 minutes at a time worrying about something. In contrast, 20 percent worry for more than an hour. (Information from Tallis, 2015, 2014; Tallis et al., 1994.) Worry Impairs the Problem-Solving Process: Results from an Experimental Study (2020) This study experimentally manipulated worry before problem solving in a controlled lab setting. Researchers found that the worry process negatively impacts problem solving. Many individuals believe worry is helpful for confronting problems and confuse it with problem solving. This study suggests that worry is different from adaptive problem solving. While worry highlights potential threats, it hinders proactive and optimal problem-solving efforts. Worry may lead individuals to repeatedly focus on worst-case scenarios rather than finding solutions. This was the first study to empirically manipulate worry to test the effects of a laboratory-based worry induction on problem-solving abilities. The Penn State Worry Questionnaire & the Generalized Anxiety Disorder Questionnaire were used in the study 30 Highlights from the research Worrying about a personal problem lowered confidence in solutions for high-trait worriers. Thinking objectively about a problem led to more effective solutions than worrying or focused breathing. State worry predicted less intention to implement solutions, while controlling for trait worry. Worrying beforehand led to elevated worry and anxiety after solving a personal problem. 31 Newer Cognitive-behavioral Explanations Metacognitive theory (developed by Flavell, Wells) and meta-worries Suggests that the most problematic assumptions in GAD are the individual's worry about worrying (meta-worry) What is Metacognitive Knowledge? a. Knowledge about one's own cognitive processes, products, or related matters (declarative in nature). Metacognitive Control: a. Active supervision, regulation, and organization of cognitive processes concerning tasks or goals (procedural in nature). Generalized Anxiety Disorder | New CB Explanations Newer cognitive-behavioral explanations Intolerance of uncertainty theory (Koerner and colleagues) All people face uncertainty The presence of uncertainty is often unpleasant Individuals vary along a continuum in terms of the extent to which they are comfortable coexisting with that uncertainty. Generalized Anxiety Disorder | New CB Explanations Newer cognitive-behavioral explanation Uncertainty theory: Certain individuals consider it unacceptable that negative events may occur, even if the possibility is very small; They worry in an effort to find “correct” solutions  Generalized Anxiety Disorder | Avoidance Theory Newer cognitive-behavioral explanations Avoidance theory: Developed by Borkovec States that worrying serves a “positive” function for those with GAD by reducing unusually high levels of bodily arousal Generalized Anxiety Disorder | The Model of Worry The Contrast Avoidance Model of Worry suggests that individuals with generalized anxiety disorder (GAD) avoid negative emotional contrasts (shifts) by creating and sustaining negative emotions through worry The main fear in these individuals is negative emotional contrasts  Generalized Anxiety Disorder (part 10) Cognitive-behavioral therapies Changing maladaptive assumptions Ellis's rational-emotive therapy (RET) Breaking down worrying Mindfulness-based cognitive-behavioral therapy Acceptance and commitment therapy Mindfulness meditation Albert Ellis on Rational Emotive Therapy and how humor helps (2.00) Generalized Anxiety Disorder (part 11) Biological perspective GAD is caused chiefly by biological factors. Supported by family pedigree studies and brain researchers Challenged by competing explanation of shared environment Fear reactions are tied to brain circuits. Generalized Anxiety Disorder (part 11) Biological relatives are more likely to have GAD (approximately 15 percent): The closer the relative, the greater the likelihood. Clinical investigators must be careful in interpreting the reactions of animal subjects. This infant monkey was considered “fearful” after being separated from its mother in research conducted back in the 1960s. ○ Perhaps it was feeling depressed or experiencing arousal that does not correspond to either fear or depression. Generalized Anxiety Disorder & The Biological Model Biological explanations Everyday fear reactions are tied to brain circuits. Fear circuit hyperactivity may be tied to development of GAD. Benzodiazepines (alprazolam, lorazepam, diazepam) provide anxiety relief. Benzodiazepine receptors ordinarily receive neurotransmitter gamma-aminobutyric acid (GABA). GABA carries inhibitory message that ends firing of neuron receptor. Low GABA could help produce excessive brain circuit communication and contribute to GAD development.  Generalized Anxiety Disorder (part 13) Drug therapies Generic Name Trade Name Early 1950s: Barbiturates Alprazolam Xanax (sedative-hypnotics) Chlordiazepoxide Librium Late 1950s: Benzodiazepines Clonazepam Klonopin Significant problems Clorazepate Tranxene More recently Diazepam Valium Antidepressants that increase Estazolam ProSom serotonin and norepinephrine Lorazepam Ativan neurotransmitter activity Midazolam Versed Antipsychotics (schizophrenia; Oxazepam Serax psychosis) Phobias 42 Phobias (part 1) How do phobias differ from fear? More intense and persistent fear Can be unreasonable fears of particular objects, activities, or situations Greater desire to avoid the feared object, situation, or thoughts about it Create distress that interferes with functioning Phobias (part 2) Categories of phobias Specific phobias Agoraphobia Although these young women cling tightly to each other, frozen with fear as they try to walk across a bridge, they are not displaying a phobia. Persistent and unreasonable fears of particular objects, activities, or situations Avoidance of the object or thoughts about it. Phobias (part 3) Specific Phobias Checklist Yearly symptoms exist in 9 Marked, persistent, and percent of all people in the U.S. disproportionate fear of a 13 % of people experience particular object or situation; symptoms during their lifetime. usually lasting at least 6 Women outnumber men 2:1. months Exposure to the object produces At most, 32 % seek treatment. immediate fear Avoidance of the feared situation Significant distress or impairment Phobias | Agoraphobia Agoraphobia Checklist Yearly symptoms exist in Pronounced, disproportionate, around 1% of U.S. population. or repeated fear about being in 1.3% of people experience at least two delineated symptoms during lifetime; situations Around 46% seek treatment. Avoidance of the agoraphobic situations Symptoms usually continue for at least 6 months Significant distress or impairment Pronounced, Disproportionate, or Repeated Pronounced, disproportionate, or repeated fear about being in at least two of the following situations: Public transportation (e.g., auto or plane travel) Parking lots, bridges, or other open spaces Shops, theaters, or other confined places Lines or crowds Away from home unaccompanied Fear of such agoraphobic situations derives from a concern that it would be hard to escape or get help if panic, embarrassment, or disabling symptoms were to occur (APA, 2022). 47 Phobias (part 5) What causes specific phobias? Cognitive-behavioral theories receive the most research support Focuses primarily on behavioral dimension First fear of certain objects, situations, or events are learned through conditioning. Once fears are acquired, individuals avoid dreaded object or situation and permit fears to become entrenched. Phobia (part 6) Phobias may develop into GAD when a person acquires a large number of them. Process of stimulus generalization: Responses to one stimulus are also elicited by similar stimuli. Classical conditioning: A process of learning in which two events that repeatedly occur close together in time become tied together in a person’s mind and so produce the same response. Modeling: A process of learning in which a person observes and then imitates others. Also, a therapy approach based on the same principle. How are fears learned? Phobias develop through modeling: Observation and imitation Phobias are maintained through avoidance. 50 Anxiety Management Your Participation Activity for this week, is for you to keep an anxiety management log. Everyone has experienced some form of anxiety or stress in their lives; It doesn’t take a diagnosis of Generalized Anxiety Disorder to experience stressful thoughts and emotions. Because these feelings are so universal, everyone can also benefit from anxiety management techniques.. 51 Anxiety Management Strategies Your goal for the week is to try at least 2 of the following anxiety management strategies EVERY DAY. Fill out the attached log to document your efforts and submit the log for participation points. Deep Breathing/Belly Breathing/Diaphragmatic Breathing Advanced Belly Breathing (4-7-8) Progressive Muscle Relaxation Guided Meditation Mindfulness Meditation Journaling (includes writing prompts) Scheduling Worry Time 52 Questions, Comments, & What’s Next? On Thursday we’re continuing Chapter 5 and examining Phobias through each model, Social Anxiety Disorder, & Obsessive Compulsive Disorder Anxiety Management Journal is due Sunday, January 26, 2025. Begin thinking about movie and tv characters you may want to focus your Anxiety and Phobias Paper on…you can select any show or movie character (doesn’t have to come from the list). ○ Anxiety and Phobias Paper is due February 2nd. See you Thursday! 53