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    Anxiety Disorder

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    Three Components of Anxiety

    Physical symptoms

    Cognitive component Behavioral component

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    Physiology of Anxiety: Physical

    System

    Perceived danger

    Brain sends message to autonomic nervous system

    Sympathetic nervous system is activated (all or nonephenomena)

    Sympathetic nervous system is the fight/flight system

    Sympathetic nervous system releases adrenaline andnoradrenalin (from adrenal glands on the kidneys).

    These chemicals are messengers to continue activity

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    Parasympathetic Nervous System

    Built in counter-acting mechanism for the

    sympathetic nervous system Restores a realized feeling

    Adrenalin and noradrenalin take time todestroy

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    Cardiovasular Effects

    Increase in heart rate and strength of heartbeat tospeed up blood flow

    Blood is redirected from places it is not needed (skin,fingers and toes) to places where it is more needed(large muscle groups like thighs and biceps)

    Respiratory Effects-increase in speed and dept ofbreathing

    Sweat Gland Effects-increased sweating

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    Behavioral System

    Fight/flight response prepares the body for

    action-to attack or run When not possible behaviors such as foot

    tapping, pacing, or snapping at people

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    Cognitive System

    Shift in attention to search surroundings for

    potential threat Cant concentrate on daily tasks

    Anxious people complain that they are easilydistracted from daily chores, cannot

    concentrate, and have trouble with memory

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    U Shaped Function of Anxiety

    Useful part of life

    Expressed differently at various age levels

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    Generalized Anxiety Disorder

    Unfocused worry

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    Generalized Anxiety Disorder:

    Diagnostic Criteria

    Excessive anxiety or worry occurring more

    days than not for atleast 6 months

    about anumber of events or activities

    Difficulty controlling worry

    3 of 6 symptoms are present for more days

    than not:restlessness, easily fatigued, difficultyconcentrating, irritability, muscle tension, sleepdisturbance

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    Generalized Anxiety Disorder

    (GAD): Prevalence

    ~ 4% of the population (range from 1.9% to

    5.6%) 2/3 or those with GAD are female in developed

    countries

    Prevalent in the elderly (about 7%)

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    Generalized Anxiety Disorder:

    Genetics

    Familial studies support a genetic model (15% of therelatives of those with GAD display it themselves-base

    rate is 4% in general population)

    Risk of GAD was greater for monozygotic female twinpairs than dizygotic twins.

    The tendency to be anxious tends to be inherited

    rather than GAD specifically

    Heritability estimate of about 30%

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    Generalized Anxiety Disorder:

    Neurotransmitters

    Finding that benzodiazepines provide relief

    from anxiety (e.g. valium) Benzodiazepine receptors ordinarily receive

    GABA (gamma-aminobutyric acid)

    GABA causes neuron to stop firing (calms

    things down)

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    Generalized Anxiety Disorder:

    Neurotransmitters

    Getting Anxious

    Hypothesized Mechanism:

    Normal fear reactions

    Key neurons fire more rapidly

    Create a state of excitabilitythroughout the brain and body

    perspiration, muscle tensionetc.

    Excited state is experiences asanxiety

    Calming Down

    Feedback system is triggered

    Neurons release GABA

    Binds to GABA receptors oncertain neurons and orders

    neurons to stop firing

    State of calm returns

    GAD: problem in this feedbacksystem

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    GABA Problems?

    Low supplies of GABA

    Too few GABA receptors GABA receptors are faulty and do not capture

    the neurotransmitter

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    Generalized Anxiety Disorder:

    Cognitions

    Intense EEG activity in GAD patients reflecting intensecognitive processing: low levels of imagery

    Worrying is a form of avoidance

    They restrict their thinking to thoughts but do notprocess the negative affect

    Worry hinders complete processing of more disturbingthoughts or images

    Content of worry often jumps from one topic to anotherwithout resolving any particular concern

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    Generalized Anxiety Disorder:

    Treatment

    Short term-benzodiazepine (valium)

    Cognitive Therapy (focus on problem)

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    Phobia: Diagnostic Criteria

    Marked & persistent unreasonable fear of

    object or situation Anxiety response

    Unreasonable

    Object or situation avoided or endured withdistress

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    Differential Diagnosis of Specific

    Phobia

    Vs. SAD: not related to fear of separation

    Vs. Social Phobia: not related to fear of asocial situation or fear of humiliation

    Vs. Agoraphobia: fear not related to closedplaces

    Vs. PTSD: fear not related to a specific pasttraumatic event

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    Phobias: Types

    Specific phobias

    Blood-Injection Injury phobias

    Situational phobia

    Natural environment phobia

    Animal phobia

    Pa-leng (Chinese) colpa daria (Italian) Germs

    Choking phobia..

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    What are your fears???

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    Developmentally Normal FearsAge Normal Fear

    Birth- 6 Months Loud noises, loss of physical support,rapid position changes, rapidlyapproaching other objects

    7-12 Months Strangers, looming objects, unexpectedobjects or unfamiliar people

    1-5 Year Strangers, storms, animals, dark,

    separation from parents, objects,machines loud noises, the toilet

    6-12 Year Supernatural, bodily injury, disease,burglars, failure, criticism, punishment

    12-18 Performance in school, peer scrutiny,

    appearance, performance

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    Normal Rituals and Behaviors

    Even some ritualistic behaviors are normal

    Any rituals?

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    Phobias: Prevalence

    Fears are very prevalent

    Phobias occur in about 11% of the population More common among women

    Tends to be chronic

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    Etiology of Phobias: Genetics

    31% of first degree relatives of phobics also

    had a phobia (compared to 11% in the generalpopulation)

    Relatives tended to have the same type ofphobia

    Not clear if transmission is environmental orgenetic

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    Specific Phobia: Behavioral

    Perspective

    Case of Little Albert

    Two-factor model:

    Acquisition-classicalconditioning

    Maintenance-operantconditioning

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    Specific Phobia: Behavioral Perspective

    Classical conditioning

    Modeling Stimulus generalization

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    Specific Phobia: Behavioral-Evolution

    Perspective (Preparedness)

    Discussion Section Topic

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    Specific Phobia: Cognitive

    Perspective

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    Specific Phobia: Social and

    Cultural Factors

    Predominantly female

    Unacceptable in cultures around the world formen to express fears

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    Specific Phobia: Treatment

    Systematic Desensitization

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    Social Phobia

    Fearful apprehension

    Social situations

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    Social Phobia: Diagnostic Criteria

    Marked or persistent fear in one or more socialor performance situations

    Exposure to fear situation is associated withextreme anxiety

    Person recognizes that fear is excessive or

    unreasonable Feared social and performance situations are

    avoided or endured with intense anxiety

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    Social Phobia: Prevalence

    13% of the general population

    About equally distributed in males and females,however, males more often seek treatment

    Usually begins around age 15

    Equally distributed among ethnic groups

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    Etiology Social Phobia: Emotions

    Temperament and Biological Theories (Kagan)

    Behaviorally inhibited children 2 remained inhibited atage 7 and 12 (see video)

    Biological preparedness

    We are prepared to fear rejecting people Social phobics more likely to foucs on critical facial

    experessions

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    Biological Basis of Temperament

    Kagan proposed temperamental differencesrelated to inborn differences in brain structure

    and chemistry:He found inhibited children have:

    Higher resting heart rates

    Greater increase in pupil size in response tounfamiliar

    Higher levels of cortisol (released with stress)

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    Temperament and Anxiety

    Disorders

    Inhibited temperament: risk factor in socialphobia

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    Kagans Temperamental/Biological

    Theory and Prevention

    Early identification of at risk children

    Parental training Avoid overprotecting

    Encourage children to enter new situations

    Help kids to develop coping skills

    Avoid forcing the child

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    Encouraging Shy Children: helpful

    hints

    Use rewards

    Arrange dont push No nagging

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    Social Phobia: Treatment

    Cognitive-Behavioral Therapy

    Assess which social

    situations are problematic Assess their behavior in

    these situations

    Assess their thoughts inthese situations

    Teaches more effectivestrategies

    Rehearse or role playfeared social situations in agroup setting

    Medication

    Tricyclic antidepressants

    Monoamine oxidase inhibitors SSRI (Paxil) approved for

    treatment

    Relapse is common withmedications are discontinued