Chapter 6 -- Anxiety Disorders

I. Definitions
A. Anxiety is a negative mood state characterized by physical tension and apprehension about the future
B. Fear is an immediate alarm reaction to present danger
C. Worry refers to the thoughts about threats of danger or loss

II. Theoretical Causes of Anxiety
A. Biological: genetic influences on temperament, neurotransmitters, and hormones
B. Emotional: physical discomfort and difficulty with expression of emotions and relaxation
C. Cognitive: exaggerated thoughts of threat and the lack or loss of resources
D. Behavioral: learned through classical conditioning or modeling, avoidance gives relief and rewards it through operant conditioning
E. Interpersonal: changes, loss, or conflicts in social relationships, indirect communication
F. Psychodynamic: unconscious conflicts among the id, ego, and superego
G. Humanistic: blocked growth, lack of positive regard, and inconsistency between the real and ideal self

III. Risk Factors for Anxiety
A. Genetic: Heritability is 20 to 40% for most, 50% for panic disorder
B. Biological: Medial frontal cortex regulates amygdala, poor functioning of serotonin system and GABA, excessive norepineprine
C. Personality: High neuroticism and behavioral inhibition (agitated by novel stimuli)
D. Cognitive: Negative beliefs about the future, lack of perceived control, and attention to threat
E. Gender: females have twice the rate of males
F. Comorbidity of anxiety with depression is 60%, with other anxiety disorders is 50%

IV. Separation Anxiety Disorder
A. Characteristics (Prevalence 1 to 2% of adults, 4% of children)
1. Recurrent excessive distress when anticipating or experiencing separation from home or a major attachment figure
2. Persistent and excessive worry about losing an attachment figure
3. Persistent and excessive worry about experiencing an event that causes separation from an attachment figure
4. Persistent reluctance or refusal to go out because of fear of separation
5. Persistent and excessive fear of being alone
6. Persistent reluctance to sleep away from home
7. Repeated nightmares about separation
8. Repeated complaints of physical symptoms when separated from attachment figure

V. Specific Phobias
A. Characteristics (12% lifetime prevalence, 6 month duration)
1. Persistent fear of an object or situation
2. Results in avoidance behavior
3. Illness/injury, storms, and animals occur most
B. Treatment (cognitive-behavioral)
1. Gradual Exposure in vivo
2. Flooding in vivo
3. Imaginal flooding
4. Systematic Desensitization (relaxation plus gradually imagining)

VI. Social Anxiety Disorder
A. Characteristics (12% lifetime prevalence, 6 months duration)
1. Persistent fear that one will be scrutinized
2. Anxiety about negative evaluation in specific social situations
3. Avoid situations or endure intense anxiety
B. Treatment
1. Social skills training
2. Cognitive restructuring with gradual exposure
3. Medication (SSRIs such as Zoloft and Prozac)

VII. Panic Disorders
A. Characteristics (6% prevalence, 1 month duration)
1. A panic attack is a period of intense fear (pounding heart, sweating, fear of dying, chest pain)
2. Teens who smoke 20 or more cigarettes daily are 15 times more likely to develop panic disorder than nonsmokers
B. Treatment
1. Panic control therapy (elevate heart rate, breathing retraining, and cognitive restructuring)
2. Gradual Exposure and Relaxation training
3. Medication: Prozac (SSRI) and Xanax or Valium (Benzodiazepenes)

VIII. Agoraphobia (6 month duration)
A. Marked fear of 2 or more situations that are difficult to escape or receive help
B. These situations consistently provoke fear or anxiety
C. These situations are avoided, elicit intense anxiety, or require a companion
D. Treatment with gradual exposure

IX. Generalized Anxiety Disorder
A. Characteristics (5.7% lifetime prevalence, 3 months duration)
1. Excessive worry at least 50% of days about 2 or more circumstances
2. At least 3 symptoms of restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance
3. Anxiety causes impairment and avoidance, seeking reassurance
B. Treatment
1. Cognitive Therapy (Beck's AWARE technique)
a. Accept the anxiety
b. Watch the anxiety (rate it on a 10 point scale)
c. Act with the anxiety (act as if you are not anxious)
d. Repeat the steps
e. Evaluate
2. Deep muscle relaxation and positive imagery
3. Benzodiazepines (tranquilizers) such as Valium, Xanax (addictive)