differences

• mood or emotion?

• time orientation?

•physiological response?

anxiety vs. fear:

biological vulnerability

• polygenic traits of neuroticism/ negative affect/behavioral inhibition

• vulnerability: anxiety or depression

• neurochemicals (GABA, 5-HT, NE, CRF)

psychological vulnerabilities

Generalized Psychological Vulnerability - sense of uncontrollability

- had unpredictable relationship w/ parents

- had overprotective parents = never learn they can control events

Specific Psychological Vulnerability - “_____ is dangerous” is learned by:

Classical conditioningOperant conditioningInformation transmission

generalized anxiety disorder

• 6 mo+ of uncontrollable worry to many issues

• 3+ of:

restlessness, fatigue, poor concentration,

irritable, muscle tension, sleep probs

• distress or impairment

CRITERIA

NOTEChronic & excessive worry over minor eventsConstant state of apprehension/upsetDifficult to make decisions & doubts if decision is right

-work

-finances

-illness

generalized anxiety disorder

• prevalence 3%

• 2:1 sex ratio

• onset 17-31 yrs (but most “always been this way”)

• prognosis: chronic

generalized anxiety disorder

• biological & generalized psych vulnerabilitiesETIOLOGY

• autonomic restrictors but increased muscle tension

• preferentially direct attention to threatening cues

• interpret ambiguous info in a threatening way

ASSOCIATED FEATURES

generalized anxiety disorder

TREATMENT

• cognitive therapy & relaxation techniques

• medication

- benzodiazepines (AKA anxiolytics)

- antidepressants

benzodiazepines

ValiumLibriumXanaxKlonopin

Also used for sleeping pills &

anti-seizure meds

panic attack

inappropriate fear response

CRITERIA

4+ of:

heart palpitations, sweating, shaking, short of breath, choking, chest pain, nausea, dizzy, derealization/depersonalizaiton, fear of losing control, fear of dying, chills/heat, numbness/tingling

panic attack

cued – conditioned to external cues

uncued – conditioned to interoceptive cues

situationally predisposed

panic disorder

CRITERIA

• recurrent panic attacks

• 1+ for 1 mo+:

- concern about future attacks or consequences

- sig behavioral change (avoidance of external or internal cues)

panic disorder

• prevalence 3%• 2:1 sex ratio• 50-70% will experience a serious depression• 1st attack usually after highly distressing life event

panic disorderETIOLOGY

Biological Vulnerability

to panic attack

General Psycholgical Vulnerabilitypanic is not in my control, something bad will happen

STRESSOR triggers PANIC ATTACK

Specific Psychological Vulnerability

Classical conditioning of either-Interoceptive cues - exteroceptive cues

panic disorder

PRESCRIBED MEDICATION

benzodiazepines & antidepressants

(relapse rates high 50-90% when meds stopped)

COGNITIVE-BEHAVIORAL THERAPY• cued: systematic desensitization

• uncued: induce interoceptive sensations + cognitive restructuring of perceived control + distraction from sensations

TREATMENT

educate about panic attacks

practicerelaxation

agoraphobia

CRITERIA

anxiety about situations where:

- hard to access help

- escape difficult/embarrassing

specific phobia

CRITERIA

• 6+ mo persistent, excessive, irrational fear of an object of situation

• anxiety/fear on exposure

• avoided or endured w/ intense anxiety

• insight that phobia is irrational

specific phobia

• 9% prevalence

• 4:1 sex ratio

• prognosis: chronic

• over 75% have multiple phobias

specific phobiaETIOLOGY

-Direct trauma experience (classical/operant cond)

-Classical conditioning during panic attack

-Vicarious experience

-Information transmission

NOTE-phobia is reinforced (avoidance = decreased anxiety)

-protective factor: previous experience w/ object

-prepared learning

TREATMENT

systematic desensitization

social phobia

CRITERIA

• fear of social/performance situations

• anxiety/fear upon exposure

• insight that fear is irrational

• avoidance behavior impairs functioning

social phobia• 7% prevalence• 1: 1 sex ratio

ETIOLOGY

-Direct experience of a social trauma-Classical conditioning during panic attack-Vicarious experience

NOTE

-Prepared learning for social disapproval-Interpret ambiguous social info as negative-Self-preoccupied w/ bodily responses-Overestimate others’ detection of their anxiety

social phobia

-cognitive-behavioral therapy (CBT)

-social skills training

TREATMENT

PSYCHOTHERAPY

PRESCRIBED MEDICATION

antidepressants

OCD

CRITERIA

• recurrent & persistent thoughts/images

• associated behaviors compelled to perform

(can be mental or physical acts)

• insight to how irrational

• distress, consumes 1+ hr/day, or impairs functioning

ocd

obsessionsrepetitive, unwelcome thoughts

compulsionsrepetitive, almost irresistible action

• germs

• something bad will happen

• symmetry

• religion

• #s

• washing

• counting

• checking

• touching

• rituals

OCD

• 1% prevalence

• sex ratio varies

• prognosis: chronic

• thought-action fusion

NOTE: OCD patients tend to:

-be more depressed than others

-have exceptionally high standards of conduct/morals

-believe thoughts = actions

-believe they should have perfect control over all of their thoughts & behaviors

ocdorbital frontal PFCbasal gangliacingulate

abnormal activation decreases after psychotherapy or medication

PTSD

CRITERIA

• trauma involving death, threat of death, serious injury and reaction of intense fear, helplessness, or horror

• persistent reexperienced 1+ for 1 month:

-Intrusive recollections

-Dreams

-Reliving as illusions, hallucinations, or flashbacks

-Avoidance of relevant stimuli

-Arousal (i.e. insomnia, irritability, hypervigilance)

-Distress or impairment

PTSD

ACUTE STRESS DISORDERPTSD before 1 month has passed

ACUTE PTSDDiagnosed 1 month after trauma

CHRONIC PTSDDiagnosed if PTSD exceeds 3 months

DELAYED ONSET PTSDWhen symptoms do not start immediately

TREATMENTRevisit original trauma, relive emotions, correct assumptions