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Anxiety disorder
Anxiety is a generalized state of
apprehension
The focus of anxiety is more internal
than external
It seems to be a response to a vague
or unrecognized danger
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 Anxiety is a physiological, behavioral
and psychological reaction all at once
 Therefore intervention programs in
general should focus on:
- to reduce physiological reactivity
- to eliminate avoidance behavior
- to change subjective reaction
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 Free-floating anxiety
Anxiety that comes out of blue
 Situational Anxiety
anxiety arises only in response to a specific
situation but it is unrealistic
situational anxiety will eventually become
phobic when you start to avoid the situation
 Anticipatory anxiety
thinking about one particular situation
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Anticipatory anxiety is closely
associated with the way you are
thinking.
With panic disorder, thoughts are
generally focused on worrying
about having a panic attack in a
situation that will result in
embarrassment, extreme
discomfort, a heart attack or even
worse.
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Different types of anxiety disorders
defined by DSM-IV-TR
 Panic disorders
 Agoraphobia
 Social Phobia
 Generalized Anxiety Disorder
 Obsessive Compulsive Disorder
 Post Traumatic Stress Disorder
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Panic Disorder
Characterized by sudden episodes
of acute apprehension or intense
fear that occur “out of blue” without
any apparent
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Panic Disorder
 Symptoms of panic disorder
- Shortness of breath or a feeling of being smothered
- Heart palpitations – pounding heart or accelerated heart rate
- Dizziness, unsteadiness
- Trembling or shaking
- Feeling of choking
- Sweating
- Nausea or abdominal distress
- Feeling of unreality
- Numbness or tingling in hands and feet
- Hot and cold
- Chest pain or discomfort
- Fears of going crazy or losing control
- Fear of dying
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Your symptoms would be diagnosed as
panic disorders if:
 You have had two or more panic attacks
 At least one of these attacks has been
followed by one month (or more) of
persistent concern about having another
panic attack.
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 The panic doesn’t occur because you
are thinking about, approaching or
actually entering a phobic situation
 It happens spontaneously and
unexpectedly for no apparent reason
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The causes of panic disorder
 Heredity
 chemical imbalances in the brain
 personal distress
major life changes may trigger the
onset of panic attacks
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Treatment
Medication
 antidepressant drugs such as tofranil and paxil
Personal wellness program
 regular exercise
 daily practice of deep relaxation
 good nutrition
 a shift in attitude to a calmer and easy-going
approach
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Generalized Anxiety Disorder
 Characterized by persistent feelings of
anxiety that are not triggered by any specific
object, situation or activity
 GAD having at least three of the following six
symptoms
- Restlessness
- Being easily fatigued
- Difficulty concentrating
- Irritability
- Muscle tension
- Difficulties with sleep
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 No specific phobias associated with
GAD but it is sustained by basic fears
- Fear of losing control
- Fear of not being able to cope
- Fear of failure
- Fear of rejection
- Fear of death and disease
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Phobic Disorders
 The word phobia derives from the Greek
phobos meaning fear
 Phobic disorders are irrational fears of
objects or situations
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Specific Phobias
 Persistent and excessive fears of specific
objects or situations
 The DSM-IV groups specific phobias within 5
subtypes
- Animal Type
- Natural Environment Type
- Blood Injection Injury Type
- Situational Type
- Other Type
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Social Phobia
 Fear of embarrassment or humiliation in
situations where you are exposed to the
scrutiny of others
 Typically your concern is that you will say or
do something that will cause others to judge
you as being anxious, weak, crazy or stupid
 The most common - Fear of Public Speaking
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Agoraphobia
 The word agoraphobia means fear of open
spaces / market places
 Afraid of being in situations from which
escape might be difficult or unavailable
 Fear of embarrassment plays a key role
 The most common feature of agoraphobia is
anxiety about being far away from home or
far from a “safe person”
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 Agoraphobia appears to be engendered
by panic disorder
 Different level of agoraphobia
- mild case
- moderate case
- severe case
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Obsessive Compulsive Disorder
 Obsessions are recurring ideas, thoughts,
images or impulses
 Compulsions are repetitive behaviors or
behaviors or rituals that you perform to dispel
the anxiety brought up by obsessions
 Obsessions may occur by themselves without
necessarily being accompanied by
compulsions
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 The most common compulsions include
washing, checking and counting
 Obsessive compulsive disorder is often
accompanied by depression
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Post Traumatic Stress Disorder
 The essential feature of post traumatic stress
disorder is the development of disabling
psychological symptoms following a traumatic
event
 The traumatic event involves either actual or
threatened death or serious physical injury or
threat to one’s own or another’s physical
safety
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Symptoms of PTSD
 Repetitive, distressing thoughts about the event
 Nightmares related to the event
 Flashbacks so intense that you feel or act as though the trauma
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were occurring all over again
An attempt to avoid thoughts or feelings associated with the
trauma
An attempt to avoid activities or external situations associated
with the trauma
Emotional numbness
Feeling of detachment or estrangement from others
Losing interest in activities that used to give you pleasure
Persistent symptoms of increased anxiety, such as difficulty
falling or staying asleep, difficulty concentrating
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 To receive a diagnosis of PTSD, these
symptoms need to have persisted at least 1
month
 Less than 1 month’s duration, the appropriate
diagnosis is “acute stress disorder”
 In addition, the disturbance must be causing
you significant distress, interfering with social,
vocational or other important areas of your
life
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Theoretical Perspectives
 Psychodynamic perspective
- anxiety disorders are viewed as neurosis
- the anxiety experienced in neurosis
reflects;
1 – the efforts of unacceptable, repressed
impulses to break into consciousness
2 – fear as what might happen if they do
Stress on the roles of defense mechanisms
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 Phobias develop through the use of
defense mechanism of projection and
displacement
 A phobic reaction is believed to
represent the projection of the person’s
own threatening impulses onto the
phobic object.
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Learning Perspectives
 Anxiety disorders are acquired through
conditioning
 Phobia
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Classical conditioning
Operant conditioning
Observational learning – modeling
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 Generalized anxiety
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a product of stimulus generalization
 Obsessive compulsive disorder
- compulsive behavior are operant responses
that
are negatively reinforced by relief of
the anxiety that is engendered by
obsessional thoughts
 PTSD
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classical conditioning
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Cognitive Perspectives
 Overprediction of fear
 Irrational beliefs
 Oversensitivity to threats
 Anxiety sensitivity
 Misattribution for panic sensation
 Low self-efficacy expentancies
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Biological Perspectives
 Genetic Factors
 Neurotransmitter
-
Gammaaminobutyric acid (GABA)
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TREATMENT FOR
ANXIETY DISORDERS
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 The specific treatment approach depends on
the type of anxiety disorder and its severity.
But in general, most anxiety disorders are
treated with cognitive-behavioral therapy,
medication, or some combination of the
two.
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SYSTEMATIC
DESENSITIZATION
 Systematic desensitization is a technique which is
used to help people manage and eventually conquer
phobias
 An individual learn to handle progressively more
disturbing stimuli while they remain relaxed
 About 10 – 20 stimuli are arranged in a hierarchy
(fear stimulus hierarchy)
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 Assumption (Joseph Wolpe, 1958) – maladaptive
anxiety responses, like other behaviors are learned
or conditioned. They can be unlearned by
conterconditioning.
 Advantages of systematic desensitization are:
- enhance self-efficacy expectancies
- lower catecholamine levels
- help people overcome phobias through a stepwise
approach of actual exposure to the phobic stimuli
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The procedures of systematic
desensitization
1. Begins with the collection of a history of
2.
3.
4.
5.
6.
the patient’s problem
The problem is explained to the patient
Explain the rationale of systematic
desensitization
Train the patient with relaxation
techniques
Establish an anxiety hierarchy
Imagery desensitization
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
Phobia About Driving on Freeways
1. Watching from a distance as cars drive past on
2.
3.
4.
5.
6.
the freeway
Riding in a car on the freeway with someone
else driving
Driving on a freeway the distance of one exit
with a friend sitting next to you at a time when
there is a little traffic
Driving the distance of one exit with a friend
when the freeway is busier
Repeat step 3 alone
Repeat step 4 alone
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7. Driving the distance of two exits with a friend
sitting next to you at a time when there is
little traffic
8. Driving the distance of two exits with a
friend sitting next to you at a time when there
is moderate traffic
9. Repeat step 7 alone
10. Repeat step 8 alone
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 Phobia about giving presentation
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Preparing a talk which you don’t give
Preparing a talk and delivering it in front of one friend
Preparing a talk and delivering it in front of three friend
Giving a brief presentation to three or four people at work
who you know well
Same as Step 4 but a longer presentation
Giving a brief presentation to 10 -15 people
Same as Step 6 but a longer presentation
Giving a brief presentation to 3 or 4 strangers
Same as step 8 but a longer presentation
Giving a brief presentation to 10 – 15 strangers
Giving a brief presentation to 50 strangers
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Cognitive Techniques
 Rational restructuring
Much maladaptive behavior is determined by the
assumptions people make about the world
In this rational restructuring, argument or
discussion may be used in an attempt to get patients
to see the irrationality of their belief
The therapist may attempt to teach them to modify
their internal sentences
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 Rational Emotive Therapy (RET) Ellis
(1962)
RET aims to change behavior by altering
the way the patient thinks about things
ABC – Beliefs (B) about activating events
or situations (A) that determine the
problematic emotional or behavioral
consequences (C)
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 Behavioral Treatment of Social Phobia
Flooding Method (exposure therapy)
 Behavioral Treatment of Agoraphobia
Exposure Therapy - gradual exposure to fearinducing stimuli
 Behavioral Treatment to PTSD
Exposure Therapy
 Behavioral Treatment for OCD
Exposure with response prevention
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Complementary treatments for anxiety disorders
 Exercise – Exercise is a natural stress buster and anxiety
reliever. Research shows that as little as 30 minutes of exercise
three to five times a week can provide significant anxiety relief.
To achieve the maximum benefit, aim for at least an hour of
aerobic exercise on most days.
 Relaxation techniques – When practiced regularly, relaxation
techniques such as mindfulness meditation, progressive muscle
relaxation, controlled breathing, and visualization can reduce
anxiety and increase feelings of relaxation and emotional wellbeing.
 Biofeedback – Using sensors that measure specific
physiological functions—such as heart rate, breathing, and
muscle tension—biofeedback teaches you to recognize the
body’s anxiety response and learn how to control them using
relaxation techniques.
 Hypnosis – Hypnosis is sometimes used in combination with
cognitive-behavioral therapy for anxiety. While you’re in a
state of deep relaxation, the hypnotherapist uses different
therapeutic techniques to help you face your fears and look at
them in new ways.
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