Lecture 9 - Anxiety Disorders (Part 2) - Fall 2024 PDF

LECTURE 9 Anxiety Disorders (Part 2) Chapter 5 of Barlow textbook PSYC 257 – Dr. Pamela Seeds 1 Outline 1. The nature and functions of anxiety 2. The DSM-5-TR anxiety disorders a) Generalized anxiety disorder b) Panic disorder Last class...

LECTURE 9 Anxiety Disorders (Part 2) Chapter 5 of Barlow textbook PSYC 257 – Dr. Pamela Seeds 1 Outline 1. The nature and functions of anxiety 2. The DSM-5-TR anxiety disorders a) Generalized anxiety disorder b) Panic disorder Last class c) Agoraphobia d) Specific phobia Today e) Social anxiety disorder PSYC 257 - P. Seeds 2 2  Cognitive Theory of Panic Trigger stimulus (internal or external) Perceived threat Apprehension or worry Interpretation (e.g., about having a of sensations panic attack or about as catastrophic any distressing situation) Body sensations Trigger stimulus (internal or external) Trigger worries and fear going to have a panic attack or what will happen if do have a panic attack Feel symptoms and then start have the worry about what is going to happen Body snesations Sometimes don’t nitce until mentioned Feeds into cycle and a further trigger for attributions and worry and concern Then sensations are catastrophic and then leads to more symptoms and then spiral again Points of interventions change thoughts about bodily snesations about what is happening Not paying attention might not notice Treat panic disorder by understanding what causes maintencce of it is thoughts about what symptoms mean and that the symptoms are problematic instead of just acknowledging and not thinking much out of it 3  Treatment of Panic Disorder Medication Treatments  SSRIs preferred drugs (e.g., Prozac and Paxil)  SNRIs (e.g., Caldirola)  Benzodiazepines effective but problematic Psychological and Combined Treatments  CBT including panic control treatment  CBT + meds  CBT with exposures (agoraphobia) Medications route can be effective to treat but when discontinued just as bad as it was before High relapse rate Benzos but problematic but not most adviabsle Most effective but most scary is CBT give info about symptoms having Might combine CBT and medications Titrate people off medications Not performing surgery Face situations that are being avoided Going to malls Best long term outcomes are for CBT alone not for medications Just are doing therapy we balme ourselves instead of other things 4  Sample exposure hierarchy EVENT FEAR RATING Driving toward bridge alone but not going 20% on bridge Driving over bridge without traffic with 50% husband/mother in car Driving over bridge WITH traffic with 60% husband or mother in car Driving over bridge WITH traffic by 80% yourself Driving over bridge WITH traffic with baby 100% daughter in car but no one else PSYC 257 - P. Seeds 5 Gradual way to face feared situations in increasing difficulty not asking to do the hardest thing first Two ends of the bridge Really be stuck on bridge with child in car with them Start with goinog alone not during traffic fairly quick process and over increasing larger bridges and time spent gets longer build up exposure and extinguish anxiety surrounding 5  QUESTIONS?? PSYC 257 - P. Seeds 6 AGOROPHBIA exposure - Elevators are very scary - Feel anxiety it will not hurt you - Does with in with doors open then with trip with researcher then herself several times - Then takes train with therapist then on own - And then bus too - And drive a car - Stroll streets - Quite liberating - Do things many of us take for granted - Frequency able to do it example 1 a week with homework can take longer or even longer if many anxieties - Some can do an aggressive approach and get done in 2 weeks - Once do one more encouraged to do others - Systematic desensitization 6  (d) Specific Phobia PSYC 257 - P. Seeds 7 l 7  Specific Phobias Overview Extreme and irrational fear of a specific object or situation Recognize fears as unreasonable, but go to extremes to avoid phobic objects Markedly interferes with one's ability to function Fears intense and irrational unreasonable Children and adults don’t recognize irrational or extreme Do everything in power to be away from stimuli Distress if faced with stimuli or interference in life Cant do stuff because of fears Lots with phobia often have more than one 8  Subtypes of Specific Phobias Specify if… 1. Animal type 2. Natural environment type 3. Blood-injection-injury type 4. Situational type 5. Other type 2 heights wether storm, water in nature 3 blood bodily fluids injection injury run in families 4 elevators airplanes enclosed places 5 clowns balloons chocking vomittinggetting and infection mascots Can have two sepecifc phobias but could be related 9  Specific Phobias Facts and Statistics  Lifetime prevalence  Age of onset  Course Acrophbia → heights Algophobia → pain Astraphobia → thungerstorms Claustrophbia → enclosed places Hydrophobia → Water Monophobia → being alone Mysophbia → contamination Nychtophbia → fear of the dark Pyrophbia → fire Zoophbia → animals or some particular animal - Affect sig propoation 7-9% women over rpespresnet - Onset varies child adolescent some other times - Chronic and sneaky requires treatment - Healpfult o teach patients is that we have evoleved as a species to be afraid of things to survive water fire snakes can kill us things very easy phobia development - Not evolutaionary developed to have fears of other things pencials earrings 10  televisions - Don’t necessarily endanger our survival - Things make sense - Bite and injure makes sense to develop a phbia - Learning that happens - Direct exerinces to make why phbias happen - Like dogs have a dog attack and now afraid of all dogs - Stuck in a elevator before - False alarma had panic attack in a sisutations didn’t make sense to feel afraid and now brain think that something that caused it is actually something to be afraid of - Parent interpret things afraid then we are also afraid from watching - Kid being brave and parents cant handel it - Fearless in these things to be coach and help treat - Media coverage overrepresents issues and cause people to develop fears of things cuz overestimate effect and frequency of these things - Not okay for men to display how they feel or afraid of these things - Wont present for treatment causing discrepancy 10 Causes of Specific Phobias  Biological and evolutionary vulnerabilities  Learning pathways  Direct experience  False alarm  Observing others  Informational transmission  Social and cultural factors 11  Psychological Treatments of Specific Phobias  Structured and consistent graduated exposure highly effective  New developments: ◦ Single day treatment ◦ Virtual reality Simliar to agorophbia and panic disorder gradually face things afraid of Highly effective Womren did exposure in one day not being able to look at thing to having it all over her Over many weeks/sessions usually Seems scary to treat Ideas can be paralyznug and pull out of therapy Success rates when treat are basically 100% treatable Really tiny steps therapist with you safe other person cognitively pretened it isn’t that thing Slowly gradually sometimes steps too big but have to go back One meaningful success and are super excited and proud helps a lot Virtual reality→ things cant expose can use VR if cant directly expose or imagination or POV ride rollercoaster all over world without needing to get on a roller coaster Depends on fear agoraphobia afraid of just the one thing Target of fear itself be a detective to figure out what it is 12  QUESTIONS?? PSYC 257 - P. Seeds 13 Exposure Terrified of snakes Strong belief in catastrophe what drives the phobia Stay exposed long enough anxiety level foes down Practice breathing techniques too Habituation leading to extincition Confidence and self esteem increases Patirent with help of therapist accepting to take in new information Encouragments and positive rienforcment Calm 80% success and sticks at a 1 year follow up After have maintenance to keep it up some fears developmentally normative like being away from care givers being away grow out of fear of dark monsters those are outgrown other kinds don’t usually outgrow dogs hiehgts and snakes 13  (e) Social Anxiety Disorder (formerly Social Phobia) PSYC 257 - P. Seeds 14 Exculsively social anxiety disroder 14  Social Anxiety Disorder Overview ◦ Extreme fear/anxiety in social situations where may be scrutinized or negatively evaluated ◦ Avoid or endure with great distress ◦ Interferes with functioning DSM-5-TR SPECIFIER: Performance Judgement or scrutinity from others Negatively revluated Public speaking Eating in front Using public restrooms Any time can be observed or seen by others Avoid situations where possible and observe with significant distress Impairment with distress Someone in life who has struggle with social anxiety disorder Have 2 subtype generalized many social situations and ways evaluated Specific prefmeromance subtype predominantly afraid in performance situations → performing for things 15  Social Anxiety Disorder Facts and Statistics Prevalence Sex differences Onset Comorbidity - Somewhat common → 7% of population some say most common of all anxiety disorder 13-14 % will have at some point in life - Late highschool university college age - Peak when others develop and come into fruition - Not significant bias - Hint more females - Start in adolescents - Time where idea cosntntly ebign scruntinized or potentially by parents or other adults and misattribute that other people care about things all the time and only one people are noticeing and not focused on themselves - Major depressive disorder and eating dirsoder 16  Social Anxiety Disorder Causal Factors  Biological and evolutionary vulnerability  Behavioral inhibition - heritable  Learning experiences PSYC 257 - P. Seeds 17 - A know vulnerability biologicall should care what others things to maintina belogniness cuz if not get left behind when herd or group leave - Pay attenteiont to others and what they are looking at us - Catastrophic when it comes to this though - Many times people engage in safety behvaiours - Things seem like functioning and have specific social anxiety - Change topic when don’t know enough about topic - Not making eye topics - Headphones in own world - Not going out - For most part look at people and see them now don’t do that - Sit at back of room - Go places with a safe person - Smoking drinking engaging in other things - Precircumscibed activity - Don’t want to be observed - But don’t feel like survive if in this situation 17 - Chew and most people don’t care - Tempormental quality - Developmental psychology - Behvaiour inhabitation → neonate some babies where don’t like novelty like same things not loud sounds and not okay with those things quiet peace and quick → introverts - Highly heritable charactersitcs predispose to shyness socially withdrawn behviaours hard when expect to survive in an extrovert world - Easier to develop social anxiety disorder especially if pushed to do other things - Those who have it being made fun of on other things → learned to feel like this - Negative spiral and is really treatable 17  Social Anxiety Disorder CBT Maintenance Model Affect i.e., anxiety, panic, shame Behaviour Cognition i.e., safety strategies, i.e., negative thoughts, avoidance threat-focused attention VIDEO →function but with enormous effort Interact a lot it is hard to form relationship socialize and have friends Disroder panifest in only performance and others every aspect of live Shy not like but able to do Social anxiety very ditressed or cant do these things Society awards those who like to work alone SOCIAL anxiety documentary afraid of people - Know where it comes from - Something or familial - More avoid more driven to avoid world shrinks and shrinks - Started with things with kids at school - Stop doing anything else and only away from people - Sometimes need realy baby steps - Negative meitoins and thoughts have about negative emtions terrible and distress is really uncomfroatbel if had to give a speech remember how hard that happens every time you have to do simple person to person tasks 18 - Very focussed and quick to pick up on ques of disapproval of others - Think face is about what im doing - Often engage in safety behaviours and push themselves - Will avoid situations minimize emtions but doesn’t teach that those situations aren’t dangerous - Becomes a perpetual cycle feeding into eachother 18  Treatment for Social Anxiety  Medications ◦ Tricyclic antidepressants ◦ Monoamine (MAO) inhibitors ◦ SSRIs (Paxil, Zoloft, Effexor) ◦ Relapse rates  CBT especially in a group ◦ Exposures ◦ Social skills training Many treatmetns from depression effect for anxiety disorder Similar to many anxiety disroders once stop taking medications problem comes back Doesn’t permantently chage Cbt especially targeting behvaiours and congitinon having Group therapy highly recommended Group of socialily anxious individuals all suffering with same thing and empathisize and exposure and coach eachother Sometimes oscial skills training for lagging skills and lack of interactive functioning Remarkable what can happen in 8-10 weeks better coach then therapist Everytime do step cheerleaders and encourage when failing Catastophic thing happen shows still survive and but usually something in middle Something happens and still survive and not gonna die might feel like social death not actually death Look at combo of medication plus therapy see that therapy is shocikingly more effective then medication route Self exposure not as effective 19 SE = self-exposure Clark et al. (2003) 20 20 QUESTIONS?? PSYC 257 - P. Seeds 21 21 Summary  Specific Phobia  Social Anxiety Disorder PSYC 257 - P. Seeds 22 22  Commonalities in Maintenance and Treatment of Anxiety Disorders  Safety and avoidance behaviours  Exposure to target these behaviours PSYC 257 - P. Seeds 23 When face fears emtion heighten natural hill more times do it the smaller hill become Smaller overtime 23 Anxiety Disorders Overall Summary 1. Nature of anxiety and fear 2. When anxiety is disordered 3. Nature of effective treatments PSYC 257 - P. Seeds 24 24  Practice Questions To address panic symptoms, a panic- control treatment (PCT) was developed at one of Barlow’s clinics. Which of the following would be included in this therapy? a) exposure to the scary bodily sensations b) minimizing heart rate at all times c) anti-anxiety medication d) psychoanalysis PSYC 257 - P. Seeds 25 a 25 Practice Questions What is the difference between fear and anxiety? a) Fear is a response to immediate danger whereas anxiety is future focused b) Fear is future focused whereas anxiety is a response to immediate danger c) Fear results in bodily symptoms of physical tension and anxiety results in psychological symptoms d) Fear is only experienced in response to rational dangers whereas anxiety is only experienced in response to irrational dangers PSYC 257 - P. Seeds 26 26