1、Anxiety Disorders,Panic Disorder Specific Phobias Social Phobia Obsessive-Compulsive Disorder (OCD) Posttraumatic Stress Disorder (PTSD) Generalized Anxiety Disorder (GAD),Panic Attack,A period of intense fear or discomfort involving at least 4 of the following symptoms that develop abruptly and pea
2、k within 10 min. Racing heart, pounding heart (palpitations) Sweating Trembling or shaking Feeling short of breath or smothering sensations Feeling of choking Chest pain or discomfort Nausea or abdominal distress Feeling dizzy, unsteady, lightheaded, & faint Derealization or depersonalization Fear o
3、f losing control or going crazy Fear of dying Numbness or tingling Chills or hot flushesMay be expected or unexpected (“out of the blue”),Main Diagnostic Criteria for Panic Disorder,Recurrent unexpected panic attacks Persistent worry about having more attacks Worry about the implications of the atta
4、ck or its consequences (e.g., losing control, having a heart attack, “going crazy“) Significant change in behavior related to the attacks Presence or Absence of agoraphobia The attacks are not due to a substance or a medical condition (thyroid problems),Main Diagnostic Criteria for Specific Phobia,E
5、xcessive or unreasonable fear triggered by a specific object or situation (e.g., flying, animals). Exposure to the phobic stimulus invariably provokes anxiety. The person recognizes the fear is irrational. The phobic situation(s) is avoided or endured with intense anxiety. Significant personal distr
6、ess or interference with routine.,Categories of Specific Phobias,Animal Dogs, spiders, snakes Natural environment Water, storms, heights Situational Bridges/tunnels, flying, driving, elevators, tight spaces Blood-injection-injury Involves drop in blood pressure and can involve fainting Other Choking
7、, vomiting, balloons, clowns,Main Diagnostic Criteria for Social Phobia,Excessive fear of one or more social and performance situations where the person is exposed to unfamiliar people or to possible scrutiny by others. Fear of acting in a way (or show anxiety symptoms) that will be humiliating or e
8、mbarrassing. Exposure to the feared social situation invariably provokes anxiety May take the form of a panic attack The person recognizes the fear is excessive or unreasonable. The feared social or performance situations are avoided or endured with intense anxiety Excessive personal distress/interf
9、erence in functioning,Main Diagnostic Criteria for OCD,Obsessions as defined by: Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive, senseless, and inappropriate Cause marked anxiety or distress the thoughts, impulses, or images are not simply excessive worries
10、about real-life problems the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind,Main Diagnostic Criteria for OC
11、D (2),Compulsions as defined by: Rituals: Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) The person feels driven to perform the rituals in response to an obsession, or according to certain rules the rituals are aimed a
12、t preventing or reducing distress or preventing some dreaded event or situation The rituals either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive,Main Diagnostic Criteria for OCD (3),At some point during the course of the disorder,
13、the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the persons routine.With Poor insi
14、ght: if, for most of the time the person does not recognize the obsessions and compulsions are excessive or unreasonable,Some Common Obsessions,contamination - dirt, germs, bodily waste, chemicals mistakes - locks, appliances, paperwork, decisions impulses - violent, sexual, religious, embarrassing
15、order - neatness, symmetry, numbers,Uncommon Obsessions,Contamination from people with disabilities Thoughts of becoming pregnant (male) Crumbs of the communion wafer fell in my underwear Put the baby in the oven by mistake,Some Common Compulsive Rituals,Washing/Cleaning hand washing, showering, toi
16、let, inanimate objects, hand gel Checking locks, appliances, for assurance, Mental rituals praying, neutralizing, mental reviewing Repeating steps, touching Ordering/arranging left-right balance,Causes of anxiety disorders,Biological/genetic General vulnerability Negative affect Intensity of fight/f
17、light response Psychological/environmental/learning Personal experiences (traumatic?) Vicarious learning Informational transmission,Persistence of anxiety disorders,Physiological Fight/flight response Cognitive Dysfunctional beliefs and interpretations Overestimates of probability and severity Behav
18、ioral Avoidance Safety behaviors, rituals, & safety signals,Types of Exposure Therapy,In vivo: confrontation with fear-evoking situations example: party, closet, floor, driving Imaginal: confrontation with anxiety-evoking thoughts/doubts Fires, responsibility for harming a loved one Interoceptive: c
19、onfrontation with fear-evoking bodily sensations example: dizziness, breathlessness, headache,Criteria for Fear Reduction During Exposure Therapy,Elicit fearAllow habituation to occurProvide corrective information,Effects of Repeated and Prolonged Exposure on Irrational fear,Sarah: Contamination OCD
20、,Married female in her late 20s, has baby Fears of contamination from animals (pets, bugs) Will get germs and then perhaps get sick Compulsive washing, cleaning, & changing clothes rituals to minimize contact with contaminants and to keep anxiety manageable Avoidance: neighbors home, own baby, certa
21、in clothes, handling food Asks others to touch many things,Exposure Therapy Hierarchy: Fear of contamination from animals,Situation (SUDS) Office floor (40) Floor near entry to home (45) Neighbors house/couch (65) Neighbors pet Dresser where bug was found (70) Clothes from “buggy” dresser (75) Bugs (85),Response Prevention: Washer,No contact with water except for 1 daily ten-minute shower No changing clothes during the day No cleaning objects in the house No use of gloves/towels to touch surfaces No asking others to open doors, hold baby, prepare food, etc.,
