• Basic Emotion
• Perception of threat or danger
• Activates autonomic nervous system(ANS) and fight-or-flight response

• Occurs in the absence of any external danger.
• Sense of impending doom, fear of dying, etc.

Negative mood

Worry about future threat/danger

Sense of unpredictability/uncontrollability

Tension

Chronic over-arosal

Primed for F-O-F response

Helps prepare for and respond to threat/danger

Mild to moderate anxiety enhances learning/performance

- heart palpitations

-trembling/shaking

-choking

-dizzy, lightheaded, faint

-paresthesias

-derealization/depersonalization

-fear of losing control/going crazy

-sweating

-shortness of breath

-chest pain

-nausea, abdominal distress

-chills/ hot flushes

-fear of dying

General diathesis

High in neuroticism

Limbic system

Neurotransmitter systems

- it is a personality trait

-proneness to experience negative emotion

-emotion reactivity

-set of brain structures

- involved in anxiety disorders

GABA

Norepinephrine

Serotonin

- bencodiazepines

-antidepressants

Thalamus

Hypothalamus

Amygdala

Hippocampus

Pituitary

-receives perceptual info from cortex

-influences emotion, memory, and endocrine system

-Recognizes their fear is excessive or unreasonable

-Exposure produces immediate fear response, resembling panic attack (but w/ identifiable trigger)

- makes great effort to avoid the feared stimulus

-Animals

-Natural Environment

-Blood-Injury-Injection

-Situational

-Other (choking, vomiting)

Childhood: animals

Adolescence - young adulthood: many others

-explains onset

-direct and vicarious CC

-explains maintenance of fear

-through NegRFT (avoidance learning)

-hierarchy of fear

-systematic desensitization

- fear of one or more social situations

-fear of negative evaluation, being embarrassed/humiliated

-excessive shyness

-avoidance of social situations or endurance with much distress

comorbidity

50%+ anxiety disorder

50% depressive disorder

33% alcohol abuse

-behavioral inhibition

-shy, avoidant

-easily distressed by unfamiliar stimuli and situations

CBT:

-Exposure

-Cognitive restructuring

Pharmacology:

-antidepressents, esp SSRIs

-10 minutes peak

-20-30 minutes subside

- recurrent, unexpected (out of the blue)

- no identifiable trigger

Comorbidity with Panic Disorder

-Percent

-Disorders

83% comorbidity

-anxiety disorders

-depressed mood

-substance abuse (tobacco, alcohol)

-Classical Conditioning model of PD

-Pt has inital PA, triggered by some anxiety-provoking event

-bodily sensations(NS) of the inital PA(UCS) become associated with the full PA experience (UCR).

-Those bodily sensations(CS) come to elicit a full PA(CR) on their own - in the absence of anxiety provoking event.

-As PAs continue to occur, over time, in select location.

-Those locations become associated with bodily sensations that elicit a full PA.

-Pt is hypersensitive to bodily sensations.

- when they occur Pt is prone to giving dire interpretations to those sensations

-occurs as automatic thoughts

-increases the intensity of the bodily sensations

-leads to full PA

-Sometimes negative

-example: catastrophic thoughts that occur with Panic Disorder

-Anxiolytics

-Traquilizers

-Tricyclics

-SSRIs

-Only as effective as long as medication is taken

-ineffective thereafter

-Education about anxiety and panic

-Teach Pt to induce PAs

-Interoceptive exposure

-Cognitive restructuring

-Pattern of uncontrollable worry, about multiple event and areas of life

-Restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbance

-Constant future-oriented mood state of uncontrolled anxious apprehension, tension, worry, and uneasiness

-Most commonly Pts are anxious throughout their life

-Other anxiety disorders

-Mood Disorders (many mildly-moderate depressed)

-Overuse of benzodiazepines, sleeping pills, and alcohol

-Modest heritability

-Deficiencies among GABA, serotonin, and norepinephrine NT systems

-History of experiencing uncontrollable/unpredictable events

example: chaotic upbringing

-Attentional bias for threatening information

-Negative interpretative bias for information

-Benzodiazepines

-Antidepressants

-enhance the effect of the neurotransmitter gamma-aminobutyric acid, which results in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, muscle relaxant and amnesic action

-Xanax

-Valium

-Klonopin

-Ativan

-relaxation training

-cognitive restructuring

(it is hard to expose people to Anxiety so behavior portion is hard to do)

-Both CBT and Pharmacology are equally effective

-CBT has longer lasting treatment effects

-recurrent, intrusive thoughts, images, or impulses

-experienced as disturbing, inappropriate, uncontrollable

either overt behaviors or covert mental rituals designed to:

-neutralize obsessions

-prevent an undesirable event/outcome

-time consuming (>1hr daily) and interferes with functioning

- cleaning

- checking

- repeating

- ordering/arranging

- counting

1.6% life time prevalence

(lower than other anx. dis.)

late adolescents- young adult onset

- child onset common among boys and assoc. w/ greater severity

Onset: classical conditioning. A formerly neutral stimulus (door knob) becomes associated with a disturbing thought (germs). Over time, that stimulus elicits anxiety.

Maintenance: operant conditioning. Pt performs a behavior (hand washing) that relieves the anxiety (Neg RFT). Over time the complusions are extremely resistant to extinction

-benzodiazepines

-antidepressants

- Behavior therapy treatment for OCD

- Repeated exposure to anxiety-provoking obsessions, followed by prevention of compulsive behavior.

Exposure and Response prevention:

2 Pro's

1 Con

- Most effective treatment for OCD

-Most lasting gains

-Tx dropout can be problematic