Anxiety Disorders

What is anxiety?

• A normal response to demands placed upon us.

• A warning sign.• A motivator.• Physical sx-heart palpitations, pounding

heart, sweating, trembling, shaking, shortness of breath, etc.

• Worry or fear-of a specific event, object, situation or in general.

At what point does it become a disorder?

Distinguishing substance-related anxiety from primary anxiety

1. Anxiety-inducing substances• How can you determine which substances

cause sx of anxiety?• How are intoxication and withdrawal

relevant?• What about prescription meds?

• Antipsychotics and antidepressants

• Medical conditions can also cause anxiety

2. Consider the rules for distinguishing substance-induced from primary anxiety.

3. Look at the whole of the client’s experience.

• Do they experience isolated sx of anxiety?• Are there specific situations in which the sx

occur?• What psychosocial stressors or traumas

have they experienced?

Anxiety Disorders

• Panic Attack• Panic Disorder• Agoraphobia• Specific Phobia• Social Phobia• Obsessive-Compulsive Disorder• Posttraumatic Stress Disorder• Acute Stress Disorder• Generalized Anxiety Disorder• Anxiety Disorder Due to a General Medical Condition• Substance-Induced Anxiety Disorder• Anxiety Disorder NOS

PTSD Small group discussionBased on reading of pg. 408-416

1. What are the symptoms of PTSD? What questions do you have about them?

2. Discuss your assigned section of the reading

3. Prepare a poster for a poster session highlighting key points from the reading and your discussion.

4. Questions?

PTSD Symptomotology

A. Exposure to trauma

B. Persistent re-experiencing of the trauma

C. Persistent avoidance of stimuli

D. Persistent increased arousal

E. Duration 1 month+

F. Clinically significant distress• Specifiers: acute or chronic=<3 mos, >3 mos• With delayed onset…6 months after event

PTSD-Key issues

• Co-occurs very frequently with SUD.• Sometimes individual is self-medicating.• Substance abuse/dep can also lead to additional

stressors.• Pharmacotherapy

– Sertraline (zoloft) is approved for ptsd– Benzodiazepines may be used but are problematic– Anticonvulsants or antipsychotics may be used

Strategies, Tx and Tools

1. During assessment, screen for ptsd but avoid details of trauma.

2. Avoid confrontation and coercion.3. Establish safety-in tx and in general.4. Triggers may occur in group setting.5. Deal with crisis.6. Refer for integrated tx.

• Exposure treatment• CBT• Seeking Safety

Small groups case scenarios