Chapter 2 Anxiety Disorders PDF

7/27/2024 Copyright Notice Do not remove this notice. 1 CHAPTER 2 ANXIETY DISORDERS Copyright © 2017 McGraw-Hill Education (Australia) Pt...

7/27/2024 Copyright Notice Do not remove this notice. 1 CHAPTER 2 ANXIETY DISORDERS Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-2 2 1  7/27/2024 LEARNING OBJECTIVES 2.1 Describe the nature of anxiety and models regarding the aetiology of anxiety disorders 2.2 Describe the diagnostic criteria, epidemiology, aetiology and treatments for specific phobias 2.3 Describe the diagnostic criteria, epidemiology, aetiology and treatments for panic disorder and agoraphobia 2.4 Describe the diagnostic criteria, epidemiology, aetiology and treatments for social anxiety disorder 2.5 Describe the diagnostic criteria, epidemiology, aetiology and treatments for generalised anxiety disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-3 3 Chapter 2 Anxiety Disorders – General issues regarding anxiety and related disorders (including epidemiology) – Focus on Specific Disorders  Specific Phobias  Panic Disorder and Agoraphobia  Social Anxiety Disorder  Generalised Anxiety Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-4 4 2  7/27/2024 Chapter 2 Anxiety Disorders – General issues regarding anxiety and related disorders (including epidemiology) – Focus on Specific Disorders  Specific Phobias  Panic Disorder and Agoraphobia  Social Anxiety Disorder  Generalised Anxiety Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-5 5 The Nature of Fear and Anxiety Disorders Fear is an immediate alarm reaction triggered by a perceived danger which prepares the body either for fight or flight. Anxiety is apprehension about a future threat A true alarm is when fear is in response to a direct danger. A false alarm occurs when there is no direct threat. False alarms are the hallmark of anxiety disorders (Barlow). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-6 6 3  7/27/2024 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-7 7 The Nature of Fear and Anxiety Disorders Vulnerabilities increase the sensitivity of the alarm trigger and involve: – A biological vulnerability (e.g., inheriting a predisposition towards anxiety) – A generalised psychological vulnerability (e.g., a belief that the world is a dangerous place) – A specific psychological vulnerability acquired, for example, through conditioning Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-8 8 4  7/27/2024 Barlow’s (2002) Triple Vulnerability Leading to an Anxiety Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-9 9 The Nature of Fear and Anxiety Disorders Anxiety and Fear – 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 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-10 10 5  7/27/2024 The Fight or Flight Response Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-11 11 Anxiety Disorders If anxiety and/or fear are excessive and/or inappropriate… Considered a disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-12 12 6  7/27/2024 Diagnoses of Anxiety Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-13 13 Diagnoses of Anxiety Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-14 14 7  7/27/2024 Diagnoses of Anxiety Disorders Also with DSM-5-TR, two disorders added from childhood disorders section – Separation anxiety disorder – Selective mutism We won’t cover these at this point – we may return to them in the context of childhood disorders. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-15 15 Chapter 2 Anxiety Disorders – General issues regarding anxiety and related disorders – Focus on Specific Disorders  Specific Phobias  Panic Disorder and Agoraphobia  Social Anxiety Disorder  Generalised Anxiety Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-16 16 8  7/27/2024 Anxiety Disorders With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-17 17 Chapter 2 Anxiety Disorders – General issues regarding anxiety and related disorders – Focus on Specific Disorders  Specific Phobias  Panic Disorder and Agoraphobia  Social Anxiety Disorder  Generalised Anxiety Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-18 18 9  7/27/2024 Phobias Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-19 19 Phobias Three disorders with “phobia” in their names: – Specific phobias – Social Phobia (aka Social Anxiety Disorder) – Agoraphobia Typically, the term phobia refers to the specific phobias Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-20 20 10  7/27/2024 Specific Phobias With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-21 21 Specific Phobias Marked and consistent fear when specific object or situation is encountered. Fear is out of proportion to danger posed by object or situation. Fear causes emotional, social and/or occupational disruption. Trigger or feared object is avoided or endured with intense anxiety Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-22 22 11  7/27/2024 DSM-5 Diagnostic Criteria - Specific Phobia A. Marked fear or anxiety about a specific object of situation (e.g., flying, heights, animals, receiving an injection, seeing blood). NOTE: In children, the fear or anxiety might be expressed by crying, tantrums, freezing or clinging. B. The phobic object or situation almost always provokes immediate fear or anxiety. C. The phobic object or situation is actively avoided or endured with intense fear or anxiety. D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context. E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. G. The disturbance is not better explained by another mental disorder …. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-23 23 The Four Subtypes of Specific Phobia in the DSM Animal Natural environment (e.g., heights, water) Blood injection and injury Situational (e.g., airplanes, enclosed spaces). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-24 24 12  7/27/2024 Types of Specific Phobias Type of Phobia Source of Fear Associated Characteristics Animal Animals (e.g., snakes, insects) Generally begins during childhood Natural environment Aspects of the natural environment Generally begins during childhood (e.g., storms, heights, water) Blood, injection, injury Blood, injury, injections, or other May run in families invasive medical procedures Situational Specific situations (e.g., public Tends to begin either in childhood or transportation, tunnels, bridges, in mid-20s. elevators, flying, driving, closed spaces) Other Fear of choking, fear of contracting an — illness, etc.; children’s fears of loud sounds, clowns, etc. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-25 25 Specific Phobias With each disorder, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-26 26 13  7/27/2024 Anxiety Disorders in Australia Data from: Teesson, Mitchell, Deady, Memedovic, Slade, & Baillie. (2011). Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 45, 939-946 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-27 27 The Epidemiology of Specific Phobias Lifetime prevalence is estimated around 12 per cent in the USA. Textbook refers to 7-9% lifetime prevalence, but that should be 12- month prevalence. Not clear data regarding AUS prevalence Female to male ratio is 2:1. Most begin in childhood and early adolescence Prevalence is greater among children than adults People rarely seek treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-28 28 14  7/27/2024 Specific Phobias With each disorder, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-29 29 The Aetiology of Specific Phobias Evidence that phobias have a heritable component. Conditioning Mowrer’s two-factor model – Fear acquired through classical learning – Avoidance maintained though negative reinforcement (operant learning) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-30 30 15  7/27/2024 Aetiology of Specific Phobias Problems with two-factor model – Many people never experience aversive interaction with phobic object – People with phobias tend to fear only certain types of objects (prepared learning)  Snakes, insects, blood, heights, etc. – Even phobias linked to modeling influenced by prepared learning  Monkeys acquired fear after watching another monkey exhibit fear to snake but not flower (Cook & Mineka, 1989) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-31 31 Percent of People Reporting Conditioning Experiences Before the Onset of a Phobia Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-32 32 16  7/27/2024 Specific Phobias With each disorder, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-33 33 The Treatment of Specific Phobias Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-34 34 17  7/27/2024 The Treatment of Specific Phobias Exposure-based treatments are most effective for phobias. – Exposure may work through extinction. Treatments may also work by challenging expectations of danger leading to an increased sense of control. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-35 35 Chapter 2 Anxiety Disorders – General issues regarding anxiety and related disorders – Focus on Specific Disorders  Specific Phobias  Panic Disorder and Agoraphobia  Social Anxiety Disorder  Generalised Anxiety Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-36 36 18  7/27/2024 Panic Disorder and Agoraphobia With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-37 37 Panic Disorder and Agoraphobia Frequent panic attacks unrelated to specific situations Panic attack – Sudden, intense episode of apprehension, terror, feelings of impending doom  Symptoms reach peak intensity within 10 minutes – Accompanied by at least 4 other symptoms:  Sweating, nausea, labored breathing, dizziness, heart palpitations, upset stomach, lightheadedness, etc. – Other symptoms may include:  Depersonalisation  Derealisation  Fear of going crazy, losing control, or dying Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-38 38 19  7/27/2024 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-39 39 Panic Attack – Heart rate Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-40 40 20  7/27/2024 Panic Attack – EMG Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-41 41 Panic Attack Case illustration Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-42 42 21  7/27/2024 Panic Disorder Uncued attacks – Occur unexpectedly without warning – Panic disorder diagnosis requires recurrent uncued attacks. Cued attacks  Triggered by specific situations (e.g., tunnel)  More likely a phobia Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-43 43 DSM-5 Diagnostic Criteria For Panic Disorder A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge in intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur: Note: The abrupt surge can occur from a calm state or an anxious state. 1. Palpitations, pounding heart, or accelerated heart rate. 2. Sweating. 3. Trembling or shaking. 4. Sensations of shortness of breath or smothering. 5. Feelings of choking. 6. Chest pain or discomfort. 7. Nausea or abdominal distress. 8. Feeling dizzy, unsteady, light-headed, or faint. 9. Chills or heat sensations. 10. Parasthesias (numbness or tingling sensations). 11. Derealisation (feeling of unreality) or depersonalisation (being detached from oneself). 12. Fear of losing control or “going crazy.” 13. Fear of dying. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-44 44 22  7/27/2024 DSM-5 Diagnostic Criteria For Panic Disorder 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 or worry about additional panic attacks or their consequence (e.g., losing control, having a heart attack, “going crazy”). 2. A significant maladaptive change in behaviour related to the attacks (e.g., behaviours designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations). C. The disturbance is not attributable to the physiological effects of a substance (e.g., drug or abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders). D. The disturbance is not better explained by another mental disorder …. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-45 45 Panic Disorder Panic Disorder with Agoraphobia – Avoidance of situations in which escape would be difficult or embarrassing – Panic disorder with agoraphobia tends to be more chronic. – In DSM-5 Agoraphobia is moved to a separate disorder. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-46 46 23  7/27/2024 Typical Situations Avoided by People with Agoraphobia Driving Public Transportation Waiting in lines Crowds Stores Restaurants Theaters Auditoriums Wide, open spaces Closed in spaces Boats Airplanes Elevators (lifts) Escalators Staying at home alone Long walks Going far from home Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-47 47 DSM-5 Diagnostic Criteria for Agoraphobia A. Marked fear or anxiety about two (or more) of the following five situations: 1. Using public transportation 2. Being in open spaces. 3. Being in enclosed places. 4. Standing in line or being in a crowd. 5. Being outside of the home alone. B. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence). C. The agoraphobic situations almost always provoke fear or anxiety. D. The agoraphobic situations are actively avoided, require the presence of a companion or are endured with intense fear or anxiety. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-48 48 24  7/27/2024 DSM-5 Diagnostic Criteria for Agoraphobia E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context. F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. G. The fear, anxiety, or avoidance causes, clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. If another medical condition (e.g., inflammatory bowel disease) is present, the fear, anxiety, or avoidance is clearly excessive. I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-49 49 Panic Disorder and Agoraphobia With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-50 50 25  7/27/2024 Anxiety Disorders in Australia Data from: Teesson, Mitchell, Deady, Memedovic, Slade, & Baillie. (2011). Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 45, 939-946 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-51 51 The Epidemiology of Panic Disorder and Agoraphobia Lifetime prevalence of panic disorder is 3.5 per cent Lifetime prevalence of agoraphobia is 2.3 per cent Panic disorder is somewhat more common among females The proportion of females to males increases as the severity of agoraphobia increases Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-52 52 26  7/27/2024 The Epidemiology of Panic Disorder and Agoraphobia Other Epidemiological Information – Often begins in adolescence – 25% unemployed for more than 5 years because of symptoms – Prognosis worse when agoraphobia is present Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-53 53 Panic Disorder and Agoraphobia With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-54 54 27  7/27/2024 The Aetiology of Panic Disorder and Agoraphobia Generalised biological vulnerability (e.g., anxiety proneness). Generalised psychological vulnerability (e.g., anxiety sensitivity). Specific psychological vulnerability (e.g., catastrophising physical sensations). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-55 55 The Interaction of Vulnerabilities Giving Rise to Panic Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-56 56 28  7/27/2024 Aetiology of Panic Interoceptive conditioning – Classical conditioning of panic in response to bodily sensations People with panic disorder sustain classically conditioned fears longer Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-57 57 Aetiology of Panic Cognitive factors – Lack of perceived control can trigger panic – Fear of bodily changes  Interpreted as impending doom I must be having a heart attack!  Beliefs increase anxiety and arousal  Creates vicious cycle Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-58 58 29  7/27/2024 Sample Items from Anxiety Sensitivity Index Sample Items from the Anxiety Sensitivity Index Unusual body sensations scare me. When I notice that my heart is beating rapidly, I worry that I might have a heart attack. It scares me when I feel faint. It scares me when I feel “shaky” (trembling). Source: Peterson & Reiss, 1987. Note: People respond to each item on a 0 (very little) to 4 (very much) scale. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-59 59 Aetiology of Agoraphobia Mowrer’s Two-factor theory, as with phobias. – Panic attack may become associated with external stimuli – Avoidance of those external stimuli is negatively reinforced. – Because of stimulus generalisation, people may avoid more and more situations. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-60 60 30  7/27/2024 Panic Disorder and Agoraphobia With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-61 61 The Treatment of Panic Disorder and Agoraphobia Medications Psychoeducation Cognitive behaviour therapy including graded exposure to feared situations Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-62 62 31  7/27/2024 Psychological Treatment of Panic and Agoraphobia Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-63 63 Psychological Treatment of Panic and Agoraphobia Panic Control Therapy (PCT; Craske & Barlow, 2001) – Exposure to somatic sensations associated with panic attack in a safe setting  Increased heart rate, rapid breathing, dizziness – Use of coping strategies to control symptoms  Relaxation  Deep breathing – PCT benefits maintained after treatment ends. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-64 64 32  7/27/2024 Psychological Treatment of Panic and Agoraphobia Cognitive-Behavioural Therapy (CBT) – Increase patient’s awareness of thoughts that make physical sensations threatening – Patient learns to challenge and change maladaptive beliefs CBT also effective for agoraphobia – Treatment enhanced when spouse or significant other stops catering to partner’s avoidance. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-65 65 Psychological Treatment of Panic and Agoraphobia Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-66 66 33  7/27/2024 Chapter 2 Anxiety Disorders – General issues regarding anxiety and related disorders – Focus on Specific Disorders  Specific Phobias  Panic Disorder and Agoraphobia  Social Anxiety Disorder  Generalised Anxiety Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-67 67 Social Anxiety Disorder With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-68 68 34  7/27/2024 The Diagnosis of Social Anxiety Disorder Persistent, intense fear of social situations – Fear of negative evaluation or scrutiny More intense and extensive than shyness – Exposure to trigger leads to anxiety about being humiliated or embarrassed socially. – Onset often adolescence – There is a “performance only” subtype. 33% also diagnosed with Avoidant Personality Disorder – Overlap in genetic vulnerability for both disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-69 69 DSM-5 Diagnostic Criteria for Social Anxiety Disorder A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech). NOTE: In children, the anxiety must occur in peer settings and not just during interactions with adults. B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others). C. The social situations almost always provoke fear or anxiety. NOTE: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking or failing to speak in social situations. D. The social situations are avoided or endured with intense fear or anxiety. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-70 70 35  7/27/2024 DSM-5 Diagnostic Criteria continued E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context. F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder. J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-71 71 Susie O’Neill was distressed by her shyness. A main aspect of social anxiety is that the fear of social interaction results in a desire to avoid social situations. © Newspix/News Ltd Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-72 72 36  7/27/2024 Social Anxiety Disorder With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-73 73 The Epidemiology of Social Anxiety Disorder Social anxiety disorder is one of the most common and earliest in onset of the anxiety disorders Half of all sufferers report onset prior to 12 years of age Lifetime prevalence of social anxiety disorder is 8 per cent More common in females than males Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-74 74 37  7/27/2024 Anxiety Disorders in Australia Data from: Teesson, Mitchell, Deady, Memedovic, Slade, & Baillie. (2011). Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 45, 939-946 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-75 75 Social Anxiety Disorder With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-76 76 38  7/27/2024 The Aetiology of Social Anxiety Disorder Two factor model – Avoidance or safety behaviors  Avoid eye contact, appear aloof, stand apart from others in social settings Excessive attention to internal cues – e.g., heart rate Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-77 77 The Aetiology of Social Anxiety Disorder Twin studies support a genetic vulnerability. Excessive parental criticism may undermine self-confidence. Cognitive dysfunctions may distort the way in which people perceive how others evaluate them. – Negative self evaluation  Harsh, punitive self-judgment – Fear of negative evaluation by others  Expect others to dislike them Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-78 78 39  7/27/2024 Social Anxiety Disorder With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-79 79 The Treatment of Social Anxiety Disorder Cognitive-behaviour therapy either individually or in groups Psychoeducation about the disorder Challenging negative cognitions Exposure to feared social situations Imagery rescripting Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-80 80 40  7/27/2024 Chapter 2 Anxiety Disorders – General issues regarding anxiety and related disorders – Focus on Specific Disorders  Specific Phobias  Panic Disorder and Agoraphobia  Social Anxiety Disorder  Generalised Anxiety Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-81 81 Generalised Anxiety Disorder With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-82 82 41  7/27/2024 The Diagnosis of Generalised Anxiety Disorder (GAD) Excessive worry about a number of events such as work, relationships, health, etc. Worry or anxiety must have been present on most days for at least six months. Worry difficult to control and is associated with symptoms such as sleep problems and agitation. Other symptoms: – Restlessness, poor concentration, irritability, muscle tension, tires easily, sleep disturbance Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-83 83 DSM-5 Diagnostic Criteria Generalised Anxiety Disorder A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The individual finds it hard to control the worry C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months): Note: Only one item is required in children 1. Restlessness or feeling keyed up or on edge 2. Being easily fatigued 3. Difficulty concentrating or mind going blank 4. Irritability 5. Muscle tension 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-84 84 42  7/27/2024 DSM-5 Diagnostic Criteria Generalised Anxiety Disorder D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not attributable to the physiological effects of a substance (e.g., drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). F. The disturbance is not better explained by another mental disorder…. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-85 85 Generalised Anxiety Disorder With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-86 86 43  7/27/2024 Anxiety Disorders in Australia Data from: Teesson, Mitchell, Deady, Memedovic, Slade, & Baillie. (2011). Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 45, 939-946 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-87 87 The Epidemiology of Generalised Anxiety Disorder (GAD) Lifetime prevalence of GAD is 6.1 per cent More common in women than men Early age of onset and chronic course – “I’ve always been this way” Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-88 88 44  7/27/2024 Generalised Anxiety Disorder With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-89 89 The Aetiology of Generalised Anxiety Disorder (GAD) Information Processing Model: – People with GAD are vigilant for potential threats. Metacognitive Model: – People with GAD hold both positive and negative beliefs about worry. – Type I versus Type II worry Avoidance Theory of Worry: – People with GAD use worry as a strategy to avoid fears or concerns. Intolerance of Uncertainty Model: – People with GAD have a need to control. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-90 90 45  7/27/2024 Metacognitive Model of GAD: (Wells, 1999) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-91 91 Generalised Anxiety Disorder With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Other epidemiological information – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-92 92 46  7/27/2024 The Treatment of Generalised Anxiety Disorder (GAD) Medications Cognitive-behaviour therapy – Includes relaxation training and graded exposure Interpersonal psychotherapy – Addresses interpersonal problems Mindfulness meditation – Individuals learn to be more present-focused, rather than future-focused Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-93 93 Medications for GAD Anxiolytics – Drugs that reduce anxiety Two common types of medications used to treat anxiety – Benzodiazepines  Valium, Xanax – Antidepressants  Tricyclics,Selective Serotonin Reuptake Inhibitors (SSRIs), and Serotonin Reuptake Inhibitors (SRIs) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-94 94 47  7/27/2024 Psychological Treatment of GAD Relaxation training (earlier treatments) Cognitive-Behavioural methods – Challenge and modify negative thoughts – Increase ability to tolerate uncertainty – Worry only during “scheduled” times – Focus on present moment – “worry exposure” Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-95 95 Any Questions? If so, post them online Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 2-96 96 48