Anxiety Disorders

1. Anxiety Disorders

2. Different aspects of Anxiety • Phenomenological • Affective: dread, tension, worry • Cognitive: expectations of an inability to cope, impaired cognitive ability • Behavioural • Impaired motor functioning and avoidance • Physiological • increased blood pressure, heart rate, breathing; disruptions in GI functioning and dizziness

3. Types of Anxiety Disorders • Panic Disorder • Generalized Anxiety Disorder • Phobias • Posttraumatic Stress Disorder • Obsessive-Compulsive Disorder

4. Panic Disorder • Panic Attack • Cued (situationally bound) v.s. Uncued (unexpected) panic attacks • Panic Disorder

5. Panic Disorder: Agoraphobia • Fear of being in a situation where having a panic attack would be dangerous or where escape would be impossible

6. Generalized Anxiety Disorder • Chronic state of diffuse anxiety

7. Phobias • Phobias involve • intense, persistent fear of something that poses no real threat • avoidance of the feared object/situation Specific Phobia • fear of circumscribed objects or situations

8. Phobias • Algophobia -pain • Astraphobia -thunderstorms • Pathophobia -disease • Monophobia -being alone • Mysophobia -contamination • Nyctophobia -darkness • Ochlophobia -crowds

9. Phobias: Social Phobia • Fear of social embarrassment or humiliation • public speaking • eating in public • using public bathrooms • Impact on self confidence and restricts social activity

10. Posttraumatic Stress Disorder • Intense fear and helplessness in response to events involving actual or threatened death or serious injury. • Acute Stress Disorder • symptoms last for 2 days - 4 weeks • Posttraumatic Stress Disorder • symptoms last at least 1 month

11. Obsessive-Compulsive Disorder • Obsession • unwanted thought or image that keeps intruding into awareness • Compulsion • an action that a person feels compelled to repeat again and again despite a lack of desire to do so

12. The Psychodynamic Approach to Anxiety • Anxiety is a signal that the ego is having a hard time mediating between reality, id and superego. • Different anxiety disorders are the result of different defense mechanisms used to cope.

13. The Psychodynamic Approach to Anxiety: Attachment Theories • Bowlby • disturbances in parent-child bond leads to “anxious attachment” and a vulnerability to anxiety disorders later in life

14. The Behavioural Approach to Anxiety • Mowrer (1948) Avoidance learning • 1) classical (respondent) conditioning • 2) negative reinforcement

15. The Behavioural Approach to Anxiety • Barlow (1988) Anxiety Sensitivity or “Fear of Fear”

16. The Behavioural Approach to Anxiety • Treatment: • systematic desensitization • exposure • flooding

17. The Biological Approach to Anxiety • Genetic Component • family and twin studies suggest a genetic component in most anxiety disorders • panic disorder shows the strongest genetic component and generalized anxiety disorder the least

18. The Biological Approach to Anxiety • “Suffocation false alarm hypothesis” of panic disorder • serotonin and basal ganglia abnormalities in OCD • hormonal theory of PTSD • State-dependent learning

19. The Cognitive Approach to Anxiety • Individuals misperceive and misinterpret internal and external stimuli

20. Cognitive Appraisal • Stimulus--->Appraisal---> Response • evaluation of stimulus based on memories, beliefs, and expectations

21. Information Processing • Schema • how we understand the information we take in from the environment • Selective Attention • what information we take in

22. Cognitive Approach to Panic Disorder • Catastrophic interpretations of bodily sensations • Feeling of control • Some Problems: • panic attacks during sleep • why do catastrophic interpretations develop

23. Anxiety and Selective Attention

24. Bodybags Nam Firefight Landmine Explosion Airlift

25. Several cognitive models of anxiety suggest that attentional biases to threat cues cause and maintain anxiety disorders. • Empirical findings: • Lavy and van den Hout (1993), individuals with spider phobia show an attentional bias to spiders • Ehlers and Breuer (1995), individuals with panic disorder show an attentional bias towards unpleasant body cues

26. Attentional bias in Social Phobia

27. Fixation Cross: 1000ms + J Pair of Pictures: 500ms Probe Display: until response E Temporal sequence of events for each trial F / E judgement

28. Participants • Two kinds of participants (high and low social anxiety) • Participants were university students selected for high and low social anxiety (FNE, also measured trait anxiety)

29. Experimental Conditions • Two kinds of experimental conditions (threat and no threat) • Threat: Half of the participants were told the experiment was an assessment of social skills and public speaking ability.

30. Picture Displays • Three kinds of picture displays (positive, negative and neutral face, each paired with a household object)

31. Experimental Design • Two kinds of participants (high and low social anxiety) • Two kinds of experimental conditions (threat and no threat) • Three kinds of faces (negative, neutral and positive) each displayed with a household object (clocks, chairs etc.)

32. Bias Score RT to identify probe when the face and probe are in opposite positions RT to identify probe when the face and probe are in the same position Bias Score = -

33. Fixation Cross: 1000ms + J Pair of Pictures: 500ms Probe Display: until response E Temporal sequence of events for each trial F / E judgement

34. Results • In the social threat condition, the high socially anxious participants avoided negative and positive faces, • whereas the low socially anxious participants showed no bias.

35. Discussion of Results • Lavy and van den Hout (1993) found that spider phobics show an attentional bias towards pictures of spiders. • Why are spider phobics and social phobics different?

36. Discussion of Results • How might this attentional bias (to avoid emotionally expressive faces) contribute to the maintenance of social phobia?

37. Mansell, et al. (1999). Social anxiety and attention away from emotional faces. Cognition and Emotion, 13(6), 673-690.