SR 1 –

• The anxiety disorders have anxiety or panic or both at their core.
  
• They were initially considered a subset of the neuroses,
• But recent versions of the DSM-III and DSM-IV-TR have largely abandoned this term.

SR 2 – Fear or Panic

• Fear or panic is a basic emotion that involves activation of the fight-or-flight response of the autonomic nervous system.
  

SR 3 – Anxiety

• Anxiety is a more diffuse blend of emotions that include:
  
  • High levels of negative affect,
  • worry about possible threat or danger,
  • and the sense of being unable to predict threat or to control it if it occurs.

SR 4 -

• Anxiety and panic are each associated with a number of distinct anxiety disorder syndromes.
  

SR 5 – Specific Phobias

• With specific phobias, there is an intense and irrational fear of specific objects or situations;
  
• When confronted with a feared object, the phobic person often shows activations of the fight-or-flight response, which is also associated with panic.
  • Many sources of fear and anxiety are believed to be acquire through conditioning or other learning mechanisms.
  • However, some people (because of either temperamental or experimental facts) are more vulnerable than others to acquiring such responses.
  • We seem to have a biologically base preparedness to acquire readily fears of objects or situations that posed a threat to our early ancestors.

SR 6 – Social Phobias

• In social phobias, a person has disabling fears of one or more social situations usually because of fears of negative evaluations by others or of active in an embarrassing or humiliating manner,
  
• in some cases a person with social phobia may actually experience panic attacks in social situations.
  • We seem to have an evolutionary based predisposition to acquire fears of social stimuli signaling dominance and aggression from other humans.
  • People with social phobias are also preoccupied with negative self-evaluative thoughts that tend to interfere with their ability to interact in a socially skillful fashion.

SR 7 – Panic Disorder

• In panic disorder, a person experiences unexpected panic attacks that often create a sense of stark terror, which usually subsides in a matter of minutes.
  
  • Many people who experience panic attacks develop anxious apprehension about experiencing another attack; this apprehension is required for a diagnosis of panic disorder.
  • Many people with panic disorder also develop agoraphobic avoidance of situations in which they fear they might have an attack.
  • The conditioning theory of panic disorder proposes that panic attacks cause the conditioning of anxiety primarily to external cues associated with the attacks, And conditioning of panic itself primarily to interceptive cues associated with the early stages of the attacks.
  • The cognitive theory of panic disorder holds that this condition may develop in people who are prone to making catastrophic misinterpretations of their bodily sensations, a tendency that may be related to preexisting high levels of anxiety sensitivity.
  • Other biological theories of panic disorder emphasize that the disorder may result from the biochemical abnormalities in the brain as well as abnormal activity of the neurotransmitters norepinephrine and serotonin.
  • Panic attacks may arise primarily from the brain area called the amygdala, although many other areas are also involved.

SR 8 – Generalized Anxiety Disorder

• In Generalized Anxiety Disorder, (GAD) a person has chronic and excessively high levels of worry about a numbers of events or activities and responds to stress with high levels of psychic and muscle tension.
  
  • GAD may occur in people who have had extensive experience with unpredicted and/or uncontrollable life events.
  • People with generalized anxiety seem to have schemas about their inability to cope with strange and dangerous situations that promote worries focused on possible threats.
  • The neurobiological facter most implicated in generalized anxiety is a functional deficient in the neurotransmitter GABA, which is involved in the inhibiting anxiety in stressful situations;
  • The limbic system is the brain area most involved.

SR 9 -

• Thus different neurotransmitters and brain areas are involved in panic attacks and generalized anxiety.
  

SR 10 – Obsessive-Compulsive Disorder (OCD)

• In obsessive-compulsive disorder, a person experiences unwanted and intrusive distressing thoughts or images that are usually accompanied by compulsive behaviors performed to neutralize those thoughts or images.
  
• Checking and cleaning rituals are most common.
  • Biological casual factors also seem to be involved in obsessive-compulsive disorder, with evidence coming from genetic studies, studies of brain functioning, and psychopharmacological studies.
  • Once this disorder begins, the anxiety-reducing qualities of the compulsive behaviors may help to maintain the disorder.

SR 11 -

• Once a person has an anxiety disorder, mood-congruent information processing, such as attentional and interpretative biases, seem to help maintain it.
  

SR 12 -

• Many people with anxiety disorders are treated by physicians,
  
• Often with medications designed to allay anxiety or with antidepressant medication that also have anti-anxiety effects.
  • Such treatment focuses on suppressing the symptoms, and some medications have addictive potential.
  • Once the medications are discontinued, relapse rates tend to be high.

SR 13 -

• Behavioral and cognitive therapies have a very good track record with regard to treatment of the anxiety disorders.
  
  • Behavior therapies focus on prolonged exposure to feared situations; with obsessive- compulsive disorder, the rituals also must be prevented following exposure to the feared situations.
  • Cognitive therapies focus on helping clients understand their underlying automatic thoughts, which often involve cognitive distortions such as unrealistic predictions of catastrophes that in reality are very unlikely to occur.
  • Then they learn to change these inner thoughts and beliefs through a process of logical reanalysis known as cognitive restructuring.

Key Terms

agoraphobia (P. 195) fear of being in places or situations where a panic attack may occur, and from which escape would be physically difficult or psychologically embarrassing, or in which immediate help would be unavailable in the event that some mishap occurred.

amygdala (P. 199) a collection of nuclei that are almond-shaped which lie in front of the hippocampus in the limbic system of the brain. It is involved in regulation of emotion and is critically involved in the emotion of fear.

anxiety (P. 181) a general feeling of apprehension about possible danger.

anxiety disorders (P. 180) an unrealistic, irrational fear or anxiety of disabling intensity. DSM-IV-TR recognizes seven types of anxiety disorders: phobic disorders (specific or social), panic disorder (with or without agoraphobia), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

anxiety sensitivity (P. 201) a personality trait involving a high level of belief that certain bodily symptoms may have harmful consequences.

blood-injection-injury phobia (P. 185) Persistent and disproportionate fear of the sight of blood or injury, or the possibility of having an injection. Afflicted persons are likely to experience a drop in blood pressure and sometimes faint.

compulsions (P. 211)overt repetitive behaviors (such as hand washing or checking) or more covert mental acts (such as counting, praying, saying certain words silently, or ordering) that a person feels driven to perform in response to an obsession.

fear (P. 181) A basic emotion that involves the activation of the “fight-or-flight” response of the sympathetic nervous system.

generalized anxiety disorder (GAD) (p.205) chronic excessive worry about a number of event s or activities, with no specific threat present, accompanied by at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance.

interoceptive fears (P. 205) fear of various internal bodily sensations.

neuroses (P. 180)

neurotic behavior (P. 180) anxiety driven, exaggerated use of avoidance behaviors and defense mechanisms.

obsessions (P. 211) Persistent and recurrent intrusive thoughts, images, or impulses that a person experiences as disturbing and inappropriate but has difficulty suppressing.

obsessive-compulsive disorder (OCD) (P. 211) Anxiety disorder characterized by the persistent intrusion of unwanted and intrusive thoughts or distressing images; these are usually accompanied by compulsive behaviors designed to neutralize the obsessive thoughts or images or to prevent some dreaded event or situation.

panic (P. 181) A basic emotion that involves activation of the “fight-orflight” response of the sympathetic nervous system and that is often characterized by an overwhelming sense of fear or terror.

panic disorder (P. 194) Occurrence of repeated unexpected panic attacks, often accompanied by intense anxiety about having another one.

panic provocation agent (P. 198) A variety of biological challenge procedures that provoke panic attacks at higher rates in people with panic disorder than in people without panic disorder.

phobia (P. 183) A variety of biological challenge procedures that provoke panic attacks at higher rates in people with panic disorder than in people without panic disorder.

social phobia (P. 190) Fear of situations in which a person might be exposed to the scrutiny of others and fear of acting in a humiliating or embarrassing way.

specific phobia (P. 183) Persistent or disproportionate fears of various objects, places, or situations, such as fears of situations (airplanes or elevators), other species (snakes, spiders), or aspects of the environment (high places, water).

SR 1 –

• Many factors influence a person’s response to stressful situations.
  
• The impact of stress depends not only on its severity but also on the person’s preexisting vulnerabilities.

SR 2 – Conflict Situations

• A person’s response to conflict situations may be viewed differently, depending on whether the conflicts are approach-avoidance, double-approach, or double avoidance.
  
  • Approach-avoidance conflicts involve strong tendencies to approach and to avoid the same goal.
    Mary has been offered an appealing new job in another department of the company in which she is employed. The job is one that she has had her eye on for several years and includes a substantial pay raise and better benefits. Unfortunately, her ex-husband, with whom she has been having great difficulty, also works in that department. She becomes very upset when she has to deal with him and is concerned that the work atmosphere would be unbearable.

  • Double-approach conflicts involve choosing between two or more desirable goals.
    Although the experience may cause more eustress (positive stress) than distress (negative stress), the stress is still real and the choice difficult. In either case, the person gives up something. Charles G. is faced with a decision that many would envy but that is giving him a lot of sleepless nights. He has been admitted into two graduate programs that have almost equal appeal. One is a program at a highly prestigious university whose graduates tend to get the best positions. The other school is also highly respected (though not as much as the first (school) and has exactly the type of specialization he has wanted, with an outstanding faculty. Choosing one, of course, means turning down the other. He has been vacillating between the choices, sometimes changing his decision every 5 minutes.
  • Double-avoidance conflicts are those in which the choices are between undesirable alternatives.
    Neither choice will bring satisfaction, so the task is to decide which course of action will be least disagreeable-that is, the least stressful. Jenny’s mother sent her an airline ticket to enable her to attend an “important” family outing the likes of which Jenny has grown to despise. She is considering a course of action that she finds very distasteful-lying to her mother about being so busy that she cannot attend. She knows that her mother will be very punitive if she fails to go, but the family gatherings have become very stressful.

SR 3 – Types of Responses to Stress

• A wide variety of psychosocial stressors exist, and a person can respond to them in different ways.
  
• For instance, a person may react with task-orientated or defense-orientated responses.
  • Task-orientated response: making changes in one’s self, one’s surroundings, or both, depending ton the situation.
  • Defense-orientated responses: Behavior directed primarily at protecting the self from hurt and disorganization rather that at resolving the situation.

SR 4 – DSM-IV-TR

• The DSM-IV-TR classifies people’s problems in response to stressful situations under two general categories: adjustment disorders and post-traumatic stress disorder (which included with the anxiety disorders).
  
  • Adjustment disorder: a disorder in which a person’s response to a common stressor is maladaptive and occurs within 3 months of the stressor.
    • Maladaptive (abnormal) behavior: Behavior that is detrimental to the well being of an individual and/or group.
    • Stressor: Adjustive demands that require coping behavior on the part of an individual or group.
  • Post-traumatic stress disorder (PTSD): disorders that occurs following an extreme traumatic event, in which a person reexperiences the event, avoids reminders of the trauma, and exhibits persistent increased arousal.

SR 5 – Post-Traumatic Stress Disorder (PTSD)

• Several relatively common stressors (prolonged unemployment, military combat, imprisonment, being held hostage, forced relocation, or torture) may be categorized as post-traumatic stress disorder.
  

SR 6 -

• PTSD can involve a variety of symptoms including intrusive thoughts and repetitive nightmares about the event,
  
• Intense anxiety, avoidance of stimuli associated with the trauma, and increased arousal manifested as chronic tension, irritability, insomnia, impaired concentration and memory, and depression.

SR 7 -

• If the symptoms begin 6 months or more after the traumatic event, the diagnosis is delayed post-traumatic stress disorder.
  

SR 8 – Factors

• Many factors contribute to a breakdown under excessive stress, including:
  
  • the intensity or harshness of the stress situation,
  • the length of the traumatic event,
  • the person’s biological makeup and personality adjustment before the stressful situation,
  • and the ways in which the person manages problems once the stress full situation is over.

SR 8 -

• In many cases the symptoms recede as the stress diminishes, especially if the person is given supportive psychotherapy.
  
• In extreme cases, however, there may be residual damage or the disorder may be of the delayed variety, not actually occurring until sometime after the trauma.

SR 9 – Approaches to treatment

• Several approaches to treating the symptoms of PTSD are in use today:
  
  • Short-term crisis therapy involving face-to-face discussions,
  • Debriefing sessions with victims of disaster,
  • Direct-exposure therapy for those whose PTSD symptoms persist,
  • Telephone hotlines, and
  • Psychotropic medications to relieve symptoms of PTSD

Key Terms

Anxiety: A general feeling of apprehension about possible danger.

Stress: Effects created within an organism by the application of a stressor.

Stressor: Adjustive demands that require coping behavior on the part of an individual or group.

acute stress disorder (P. 158) disorder that occurs within 4 weeks after a traumatic event and lasts for a minimum of 2 days and a maximum of 4 weeks.

adjustment disorder (P. 154) a disorder in which a person’s response to a common stressor is maladaptive and occurs within 3 months of the stressor.

coping strategies (P. 144) efforts to deal with stress.

crisis (P. 147) stressful situations that approaches or exceeds the adaptive capacities of an individual or group.

crisis intervention (P. 147) provisions of psychological help to an individual or group in times of severe and special stress.

debriefing sessions (P. 172) Psychological debriefing is a brief, directive treatment method that is used in helping people who have undergone a traumatic situation. This approach is often a good first step for helping people process their reaction to traumatic events. Debriefing sessions are usally conducted with small groups of trauma victims shortly after the incident for the purpose of helping them dealing with the emotional residuals of the event.

defense-oriented response (P. 150) Behavior directed primarily at protecting the self from hurt and disorganization rather that at resolving the situation.

disaster syndrome (P. 158) reactions of many victims of major catastrophes during the traumatic experience and the initial and long-lasting reactions after it.

distress (P. 144) negative stress, associated with pain, anxiety, or sorrow.

eustress (P. 144) positive stress

general adaptation syndrome (p.151) A model that helps explain the course of a person’s biological deterioration under excessive stress; consistent of three stages (alarm reaction, the stage of resistance, and exhaustions).

personality or psychological decompensation (P. 151) Inability to adapt to sustain or severe stressors.

post-traumatic stress disorder (PTSD) (p.157) disorders that occurs following an extreme traumatic event, in which a person reexperiences the event, avoids reminders of the trauma, and exhibits persistent increased arousal.

psychoneuroimmunology (P. 153) study of the interactions between the immune system and the nervous system and the influence of these factors on behavior.

stress (P. 144) Effects created within an organism by the application of a stressor.

stress-inoculation training (P. 171) preventive strategy that prepares people to tolerate an anticipated threat by changing the things they say to themselves before the crisis

stress tolerance (P. 148) A person’s ability to withstand stress without becoming seriously impaired.

stressors (P. 144) Adjustive demands that require coping behavior on the part of an individual or group.

task-oriented response (P. 150) making changes in one’s self, one’s surroundings, or both, depending ton the situation.