#14079 - Anxiety - Psychology

Anxiety

• Anxiety is a survival mechanism for dealing with real dangers

  • Attention focuses on perceived danger

  • Increase in arousal (heart rate; sweating; butterflies in stomach; more blood to muscles) in preparation for flight/ fight

  • Strong urge to avoid

• Anxiety is problematic when danger is imagined

• Anxiety disorder when axiety is out of proportion to the danger, is persistent and disabling

• More than 1 in 20 people suffer from anxiety disorder each year

Types of anxiety disorders

• Panic disorder – repeated unexpected attacks of anxiety

• Phobias (specific + social) – vertigo/ coyote ugly: marked fear and avoidance of a situation

• Obsessive compulsive disorder- distressing thoughts or images with putting right acions

• Post traumatic stress disorder- rape/ road traffic accident- unwanted, distressing memories of traumatic event

• Generalised anxiety disorder – finance/studies/health – excessive worry about several different things

Impact of anxiety disorders

• Common

• Varying in disability from mild to very disabling

• Around 2/3^rd would warrant treatment

• Higher rate in women than men

• Co-morbidity with depression and substance abuse common

• Runs in families but genetic vulnerability is broader than just anxiety disorders

• Varies in persistence

• Cost to society of untreated anxiety disorders and depression

Treatments

• Medications

  • Benzodiazopines- for short term distress

  • Anti-depressants – SSRIs/ SNRIs

• Psychological treatments

  • Cognitive behaviour therapy

    • 8-16 sessions, once a week, hour long

    • Based on cognitive model of emotional disorders

    • Aims to change problematic beliefs and related behaviours

    • Strong foundation in academic sychology

    • Patient is very active

• No treatment- wait lists, controls for natural recovery

• Psychosocial placebo or active treatment

Panic disorder

• Repeated attacks of anxiety with marked bodily sensations that come out of the blue

• Persistent panic attacks results from catastrophic misinterpretation of benign body sensations

• Sensations that are misinterpreted are mainly those involved in normal anxiety responses

• Misinterpretation involves believing the sensations indicate immediate physical/ mental disaster

• Sympathetic nervous system goes into overdrive to produce a fight or fight response to an unthreatening stimulus. This is thought to be due to deficiency in areas of the brain that regulate this response- low levels of serotonin in the limbic system

  • Symptoms: racing heart, sweating, breathlessness, muscle tremor, nausea

  • Cognitive symptoms: I’m going to die

  • Behavioural symptoms: freezing, being unable to move

  • Emotional symptoms: Sense of dread and terror

• Panic disorder often leads to agoraphobia- a fear of any place where they might be trapped / unable to receive help in emergency

Maintenance of panic disorder

• Selective attention to body- notice physical sensations and misinterpret them

• Safety behaviours- when anxious tightness in chest, patients think it is their safety behaviour that is saving them

Cognitive therapy

• Identify catastrophic interpretations of bodily sensation

• Generate alternative, non-catastrophic interpretations of bodily sensations- heart rate is increasing to increase blood flow not it is going to cause a heart attack

• Test out validity of catastrophic and non-catastrohic interpretations by discussion and behavioural experiements

• Behavioural experients

  • Induce feared sensations to show their true cause

    • Reading word pairs (breathless-suffocate)

    • Focus attention on body

  • Drop safety behaviours in presence of feared sensation to discover they are not dangerous

Social anxiety disorder

Signs

• Marked fear and avoidance of social or performance situations

  • meeting strangers

  • talking to a group

  • eating or drinking while being observed

  • using public toilets

  • public speaking

Incidence and prevalence

• Most common anxiety disorder

• Typically...