Unit 6: Panic Anxiety and Their Disorders

Psychological causal factors of Social Phobia

1) *Learned Behaviour*: Social phobias; seem to originate from simple instances of direct or vicarious classical conditioning such as experiencing or witnessing a perceived social defeat or humiliation, or being/ witnessing the target of anger of criticism. People with Generalised Social phobias may also be especially likely to have grown up with parents who were emotionally cold, socially isolated, and avoidant. These parents do not typically encourage sociability. All these factors provide ample opportunity for vicarious learning of social fears. these factors are correlated, but not causated 2) *Evolutionary context*: Social fears and phobias may have evolved as a byproduct of dominance hierarchies that are common in the social arrangement among animals such as primates. Dominance hierarchies are established through the aggressive encounters between members of the same social group, and a defeated individually usually displays fear and submissive behaviour but rarely attempts to escape the situation completely. Thus investigators argue that it is not surprising people behave with social phobia endure being in their feared situations rather than running away to escape them. If this is true, it is also unsurprising that humans have an evolutionary based predisposition to acquire fears of social stimuli that signal dominance or aggression from other humans. Another study shows that people develop a stronger conditioned response with slides of angry faces were paired with mild electric shocks than when happy faced people were paired with the same shocks. Even very brief subliminal presentations of an angry face significantly activated a conditioned response because these images stimulate the amygdala - the central structure for fear a learning. Such results may explain why the seemingly irrational quality of social phobia, in that the angry faces are processed very quickly, and an emotional reaction can be activated without a person's awareness of any threat. 3) *Perceptions of Uncontrollability* and Unpredictability may play a large role in the development of social phobias. Perceptions of these elements often lead to submissive and unassertive behaviour, which is characteristic of socially anxious or phobic people. 4) *Cognitive Bias* suggests that people with social bias tend to expect that others will negatively evaluate or reject them. This leads to a sense of vulnerability when they are around people who might pose a threat. These danger schemes fo socially anxious people lead them to expect that they will behave in an awkward and unacceptable fashion, resulting in rejection and a loss of status. This leads to a preoccupation with negative self-images in social situations and overestimating how easily others will detect their inferiorities. These all interfere with one's ability to interact skillfully.

Psychological Causal Factors for Panic: Safety behaviors and the maintenance of panic.

people with panic disorder engage in specific behaviors that they perceive as helping them avoid heart attacks. These safety behaviors are attributed to not having a heart attack instead of the reasoning that panic attacks don't actually lead to heart attacks. In treatment it is important for therapists to identify these safety behaviors and get rid of them so that the clients see that they are blowing their symptoms out of proportion.

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Anxiety

* General feelings of unpleasant emotions, mood, and cognitions and apprehension about a possible future danger and inability to control or predict it. * Much for diffused than fear. * Often creates a physical state of tension and chronic overarousal, which may reflect risk assessment and readiness for dealing with danger should it occur. ( something awful may happen, and I should be ready for when it does). * Anxiety does prepare or prime a person for the fight or flight response should the anticipated danger occur as with fear. * Causes us at a behavioural level to avoid situations where danger may occur, but there is not the immediate behavioural urge to flee with anxiety as there is with fear. * The adaptive value of anxiety is that it helps us plan and prepare for possible threat, and in a moderate degree it enhances learning and performance. However, when it become chronic and severe, anxiety can become maladaptive. * Most sources of fear and anxiety are learned. Basic fear and response patterns are highly conditional. *Previously neutral stimuli that are repeatedly paired with, and reliably predict, frightening or unpleasant events such as various psychical and psychological trauma can acquire the capacity to elicit fear or anxiety. For example, Angela sometimes saw and heard her father physically abuse her mother. After a while, Angela started to become anxious as soon as she heard her father's car drive up in the driveway. In such situations, a wide variety of initially neutral stimuli may accidently serve as cues that something threatening or unpleasant is about to happen - and thereby elicits anxiety.

Treatments for Social Phobias

*Cognitive restructuring techniques* This is when the therapist attempts to help the client with social phobia by identifying their underlying negative, automatic thoughts. After helping clients understand such automatic thoughts, which usually occurs just below the surface of awareness, often involve cognitive distortions, the therapist helps the client change these inner thoughts and beliefs through logical reanalysis. Many studies have shown that exposure and cognitive behavioural therapy show similar results, however, this new cognitive restructuring therapy may be more effective than exposure therapy. *Medications* Social phobias can sometimes be treated with medications. The most common are through antidepressants. In some cases, the results of these effects have been similar to the results in cognitive behavioural treatments. However, the newer cognitive restructuring techniques produce much more substantial results than medication. Moreover, medications must be taken over a longer period of time. Behavioural and Cognitive therapies thus show an advantage over medications, as they show more long lasting improvements with very low relapse rates.

Treatment for panic disorder: behavioral and cognitive behavioral treatment

*Exposure therapy treatment* Similar to what is done with specific and social phobias, the idea was to make people gradually face situations until you learned that there was nothing to fear. Such exposure-based treatments were quite effective in treating agoraphobia but limitations include; exposure doesn't specifically target panic attacks. One technique involves the variance on exposure known as *interoceptive exposure*, Meaning deliberate exposure to your internal sensations. The idea was that exposure of these internal sensations should be treated in the same way that external agoraphobic situations are treated - through prolonged exposure to those internal sensations so that fear me be extinguished. Cognitive restructuring technique called *panic control treatment* was implemented in the treatment of both panic attacks & agoraphobia avoidance; to counter panic attacks specifically. This integrated treatment produces better results than the original exposure-based techniques that focus exclusively on exposure to external situations alone. Overall, the magnitude of the improvement is often greater with the cognitive behavioral treatment with medication.

Biolgical factors of Panic attacks

*Genetics*: Panic disorders have moderate heritability component. There is a great deal of genetic overlap, however among many different panic disorders and generalized anxiety disorders. *Panic and the Brain*: We now know that it is increased activity in the amygdala that plays more of a central role in panic attacks than does the locus coeruleus. Stimulation of the amygdala is known to stimulate the locus coeruleus and other automatic, neuroendocrine, and behavioural responses that occur during panic attacks. Different brain areas are probably involved in the different aspects of panic disorders. For people who go on to develop significantly conditioned anxiety about having another panic attack in particular contexts, the hippocampus is thought to generate this conditioned anxiety and is probably involved in the learned avoidance associated with agoraphobia. Finally, the cognitive symptoms that occur during panic attacks and overreactions to the danger posed by possibly threatening bodily sensations are likely to be mediated by the higher cortical centers. *Biomechanical Abnormalities* Klein hypothesis that panic attacks of alarm reactions caused by biochemical dysfunction.panic provocation procedures are used to put stress on certain neurobiological systems which produces intense physical symptoms of arousal. such as increased heart rate, respiration & blood pressure. Two primary neurrrotransmitter systems are most implicated in panic attacks 1. noradrenergic activity in certain brain areas can stimulate cardivascular symptoms associated with panic. the serotonergic systems; decreases noradrenergic activity which is why SSRI's are the most widely used medication to treat panic disorder. SSRI's increases serotonin levels in the brain while decreasing norephinepine activity which in turn decreases many of the cardiovascular symptoms associated with panic attacks

treatments for generalized anxiety disorder

*Medications*: most often medications from the *benzodiazepine* category such as *Xanax or Klonopin* are used - and miss used - for tension relief, the release of other somatic symptoms and relaxation. There affect on worry and other psychological symptoms not great. They can also create physiological and psychological dependence and withdraw and are therefore difficult to taper. A newer medication called *Buspiron* it's also effective, and it neither is sedating nor leads to psychological dependence. It also has a greater effect on psychic anxiety then do the benzodiazepines. However, it may take 2 to 4 weeks to see results. Several categories of antidepressant medications are also useful in the treatment of general anxiety disorder. They also seem to have a greater effect on the psychological symptoms then do their benzodiazepines. However, they also take several weeks before the affects are realized. *Cognitive behavioral treatment*: cognitive behavioral therapy for generalized anxiety disorder has become increasingly effective as clinical researchers have refined techniques used. It usually involves a combination of behavioral techniques, such as training in applied muscle relaxation, and cognitive restructuring techniques aimed at reducing distorted cognition and information processing biases associated with general anxiety disorder as well as reducing catastrophizing about minor events.

psychological causal factors for generalized anxiety disorder: psychoanalytic viewpoint

*The psychoanalytic viewpoint*: generalized or free-floating anxiety results from the unconscious that is not adequately conflict between id and ego impulses not adequately dealt with because the person's defense mechanisms have either broken down would have never developed. Freud believed it was primarily sexual, and aggressive impulses blocked or punished upon expression that leads to free-floating anxiety. Defense mechanisms may become overwhelmed when a person experiences frequent and extreme levels and anxiety as might happen if ID impulses are frequently blocked from expression. According to this view, the primary difference between specific phobia and free-floating anxiety is that phobias, the defense mechanisms of repression and displacement of an external object or situation actually work, whereas in free-floating anxiety he's defense mechanisms do not work, leaving the person anxious nearly all of the time. This viewpoint is not testable and is therefore largely abandoned.

Cognitive causal factors of OCD

*attempting to suppress obsessive thoughts*: when normal people attempt to suppress unwanted thoughts, they may sometimes experience a paradoxical increase in those thoughts later. When people with OCD were asked to record intrusive thoughts in a diary, on days when they were told to try to suppress those thoughts and on days without instructions to suppress, they reported approximately twice as many intrusive thoughts on the days when they were attempting to suppress them. Using a naturalistic diary study of people with OCD, Investigators found that such individuals do indeed engage in frequent, extraneous, and time-consuming attempts to control the intrusive thoughts, Although they are generally not effective in doing so. *appraisals of responsibility for intrusive thoughts* People with OCD often seem to have an inflated sense of responsibility. Simply having a thought about doing something is morally equivalent to actually having done it, or that the thought actually increases the chance of actually doing so. This is known as *thought action fusion*. This inflated sense of responsibility for the harm they may cause adds to the perceived awfulness of any harmful consequences and also may motivate compulsive behaviors to try to reduce the likelihood of anything harmful happening. *cognitive biases and distortions* Cognitive factors have also been implicated in an obsessive compulsive disorder. People with OCD have shown that they're attention is drawn to disturbing material relevant to their excessive concerns, much as occurs in the other anxiety disorders. People with OCD also seem to have difficulty blocking out negative, irrelevant input or distracting information. People with OCD also have low confidence in their memory abilities, which may contribute to the repeating. An additional factor contributing to the repetitive behavior is that people with OCD have a deficit in their ability to inhibit motor responses and a relevant information.

Biological Causal Factors of Social Phobia

1) Genetic and temporal factors: The most important temperamental variable is behavioural inhibition, which shares characteristics with both neuroticism and introversion. Behaviorally inhibited infants who are easily distressed by unfamiliar stimuli and who are shy and avoidant are more likely to become fearful during childhood, and by adolescence, show increased risk of developing social phobia. Results from several studies of twins have also shown a modest genetic contribution to social phobias, about 30%. However, an even greater proportion is due to the nonshared environmental factors, which is consistent with a strong role for learning.

Treatment of OCD. *Behavioral and cognitive Behavioral treatment:*

A Behavioral treatment that combines exposure and response prevention seems to be the most effective approach to treating OCD. This treatment involves having the OCD client developed a hierarchy upsetting stimuli and rate them on a 0 to 100 scale according to their capacity to Evo Anxiety, Distress, or disgust. Send the clients were asked to expose themselves repeatedly to stimuli that would provoke session. Following each exposure, they're asked to not engage individuals that they would ordinarily engage in to reduce the anxiety or distress. Preventing the rituals is essential so that they can see if they allow enough time to pass, the anxiety created by the of session will dissipate naturally. In addition to the exposure conducted during therapy sessions, homework is liberally assigned. Although some people refuse such treatment, For drop out, it does help a majority of clients who stick with the treatment. These results are considered superior to those obtained with medication.

Specific Phobia

A person is diagnosed as having a specific phobia if she or her shows strong and persistent fear that s/he realises is excessive or unreasonable and triggered by the presence of a specific object or situation. When individuals with specific phobias encounter a phobic stimulus, they often show an immediate fear response that often resembles a panic attack except for the existence of a clear external trigger. Such individuals also experience anxiety if they anticipate they may encounter a phobic object or situation and so go to great lengths to avoid encounters with their phobic stimulus. Avoidance is a cardinal characteristic of phobias. As they approach their fear, they are overcome with fear or anxiety which vary from mild feelings to activation of fight or flight. Phobic behaviour then tends to be reinforced because every time the person with the phobia avoids a feared situation, his or her anxiety decreases. In addition, one secondary benefits such as increased attention, sympathy, and some controversy the behaviour of others also help reinforce a phobia. Common Subtypes of Specific Phobia include: a) Animal - snakes, spiders, insects, birds b) Natural Environment - storms, heights, water c) Blood-Injection-Injury - seeing blood or an injury, receiving an injection, seeing a person in a wheelchair. d) Situational - Public transportation, tunnels, bridges, elevators, flying, driving, enclosed spaces. e) Other - Choking, Vomiting, space phobias ( falling if away from walls or support)

psychological causal factors of generalized anxiety disorder: a sense of mastery

A person's history of control over the important aspects of their environment is another important experimental variable strongly affecting reactions to the anxiety provoking situation. In human children experiences with control and mastery also occurred in the context of the parent-child relationship, and so parents responsiveness to their children's needs directly influences their children developing a sense of mastery. Unfortunately parents of anxious children, Overcontrolling parenting style, which may serve only to promote their children's anxious behaviors by making them think of the world as an unsafe place.

Anxiety Disorders

All have unrealistic, irrational fears or anxieties of disabling intensity as their principle and most obvious manifestation. This include: 1) Specific Phobia 2) Social Phobia 3) Panic disorder with or without agoraphobia and agoraphobia without panic. 4) Generalised anxiety disorder 5) obsessive-compulsive disorder 6) acute stress disorder 7) PTSD Common Biological causal factors such a genetics, and brain structure, psychological causal factors such as conditioning and cognition, and sociocultural environments all play a note in the similarities of these disorders. Many commonalities across effective treatment for the various disorders also exist.

Agoraphobia WIthout Panic

Although agoraphobia is typically associated with panic disorder, it can also occur without prior full-blown panic attacks. When this happens there is usually a gradual spreading of fearfulness in which more and more aspects of the environment outside the nome become threatening. These cases are extremely rare and when they are seen, there is a history of what are called "limited symptom attacks" with fewer than 4 symptoms experience or some other unpredictable physical ailment such as epilepsy or colitis that makes a person afraid of being suddenly incapacitated.

Fear

An alarm reaction that occurs in response to immediate danger. Fear is a basic emotion shared by many animals that involve a fight or flight response of the autonomic nervous system. This is an almost instantaneous reaction to any imminent threat such as a dangerous predator or someone pointing a loaded gun. Its adaptive value as a primitive alarm response to imminent danger is that it allows us to escape. When fear responses occur in the absence of any obvious external danger, we say that a person is experiencing a *panic attack*

Psychological Causal: CATASTROPHIZING Cognitive Theory of Panic

An earlier cognitive theory of panic disorder proposed that individuals with panic disorder are hypersensitive to their bodily sensations and are very prone to giving them the direst possible interpretation. This was known as catastrophizing the meaning of bodily sensation. These frightening thoughts of what it could be often lead to greater symptoms of anxiety, which continue to fuel this way of thinking in a vicious cycle. Clark: people with panic disorder tend to catastrophize about the meaning of their bodily sensations. Thoughts can lead a vicious circle that feeds panic. Beck referred to these thoughts as automatic thoughts that are a triggers of panic. By teaching clients to change their cognitive thought processes about bodily sensations can reduce or prevent panic. In a study people with panic disorder were either given a brief detailed explanation of what physical symptoms 2 expect from an infusion of sodium lactate and why they shouldn't worry about the symptoms, another group was given a minimal explanation. Those with the longer explanation were less likely to report feeling like they had a panic attack. The person may not be aware they are doing this, they are automatic thoughts just under the layer of consciousness. These thoughts are seen as the sense triggers of panic. The cognitive model suggests that only people with this tendency to catastrophize go on to develop panic disorders.

Treatment for panic disorder: Medication

Anxiolytics, benzodiazepine; Act very quickly in acute situations of intense panic/ Anxiety. They have undesirable side effects like drowsiness and sedation; can lead to cognitive and motoric performance, can lead to withdrawal. SSRI's and tricyclics are also used but can take up o 4 weeks to be effective. Relapse rates when drugs are discontinued are extremely high.

Sociocultural Causal Factors for All Anxiety Disorders

Cross-cultural research suggests that although anxiety is a universal emotion, and anxiety disorders probably exist in all human societies, There are some differences in the prevalence and in the form in which the different disorders are expressed in different cultures. Results showed lifetime risk for social phobia, generalized anxiety disorder, And panic disorder it Is somewhat lower amount the minority groups then along non-Hispanic whites. However, went disorder have developed, the disorder are equally persistentAcross the three groups. Latin Americans from the Caribbean, And other people from the Caribbean, you show a higher rate of a variant of a panic disorder called *ataque de nervios*. Most of the symptoms are the same as in a panic attack, but they may also include bursting into tears, Anger, and uncontrolled shouting. Other symptoms include shakiness, Verbal or physical aggression, Dissociative experiences, And seizure like or fainting episodes. Such attacks are often associated with a stressful event is relating to the family, and a person may have amnesia for the episode. In Puerto Rico, this disorder is quite common in children and adolescence. Individuals who experience this disorder also seem to be vulnerable to a wider range of other anxiety and mood disorders. Studied by the world health organization showed anxiety disorders are the most common category of disorder reported in all the wind country Ukraine. However, reported prevailing rate for all the anxiety disorders combined varied.

Neurobiological differences between anxiety and panic

Fear and panic involve the action of the fight or flight response, and the brain areas and neurotransmitters that seem most strongly implicated in these emotional responses are the amygdala and the neurotransmitters norepinephrine and serotonin. Generalized anxiety is a more diffuse emotional state involving arousal and a preparation for possible impending threat; and the brain area, neurotransmitters, and hormones that seem most strongly implicated are the limbic system, GABA, and CRH. Although serotonin may play a role in both anxiety and panic, It probably does so in somewhat different ways.

Obsessive-compulsive disorder

Diagnostically, *obsessive-compulsive disorder (OCD)* is defined by the occurrence of unwanted and intrusive and obsessive thoughts or distressing images; these are usually accompanied by compulsive behaviors performed to neutralize excessive thoughts or images, or to prevent some dreaded event or situation. I person with OCD usually feels driven to perform these compulsive, ritualistic behavior in response to an obsession, and they're often very rigid rules regarding how the compulsive behaviors should be performed. The compulsive behaviors are performed with the goal of preventing or reducing distress for preventing some dreaded event or situation. The diagnosis requires that obsessions and compulsions must take at least one hour a day, and in severe cases they may take most of the persons quaking hours. Obsessive thoughts consist most often of contamination fears, fears of harming oneself or others, and pathological doubt. Other common themes are concerned about are needs for symmetry, sexual obsession, or are concerning religion or aggression. These themes are quite consistent across culture and across the lifespan. There are five primary types of compulsive rituals: cleaning oneself, repeated checking, repeating, ordering or arranging, and counting, and many people show multiple kinds of rituals. Hoarding is another form of compulsive behavior it has only been recently perceived with much attention. Many compulsions overlap: Both cleaning and checking rituals, for example, are often performed a specific number of times and thus also involve repetitive counting.

Blood Injection Phobia

Disgust or fear and unique psychological response when confronted wit blood or injury. Unlike typical responses, these people show an initial increase in heart rate and blood pressure, followed by a dramatic drop in both. This is frequently accompanied by nausea, dizziness, and fainting which do not occur with other specific phobias. These unique physiological patterns are only seen in the presence of blood and injury stimuli; they exhibit the most typical fight or flight responses in their other feared objects. The reason for this response could be evolutionary, as fainting may cause the further attack to be inhibited and drop in blood pressure would minimise blood loss.

Biological causal factors for OCD: *genetic factors*

Evidence from twin studies reveals a moderately high concordance rate for identical twins and a lower rate Four fraternal twins. This is consistent with moderate genetic heritability, although it may be at least primarily in nonspecific neurotic predispositions. Consistent with twin studies, some studies has found higher rates of OCD in first-degree relatives of OCD clients than would be expected from current estimates at the prevailing Of OCD. Evidence also shows that early onset of OCD has a higher genetic loading and later onset OCD. In recent years some molecular genetics studies have begun to examine the association of OCD with specific genetic polymorphisms (naturally occurring gene variations). Preliminary findings suggest that different genetic polymorphisms are implicated in OCD with Tourette's syndrome and OCD without Tourette's syndrome, suggesting that these two forms of OCD or at least distinguishable at a genetic level.

Generalized anxiety disorder

For some people, anxiety and worry about many different aspects of life become chronic, excessive and unreasonable. In these cases, generalized anxiety disorder (GAD) may be diagnosed. According to the DSM-IV-TR criteria specified that the very must occur more days than not for at least six months and that it must be experienced as difficult to control. the worry must be about some different events or activities, and its content cannot be exclusively related to the worry associated with another concurrent Axis I disorder such as the possibility of having a panic attack. The subjective experience of excessive worry must also be accompanied by at least 3 of 6 other symptoms such as muscle tension or being easily fatigued. The general picture of people suffering from the generalized anxiety disorder is that they live in a relatively constant future-oriented mood state of apprehension, chronic tension, worry, and uneasiness they cannot control. They also frequently show marked vigilance for possible signs of threat in the environment and frequently engage in certain avoidance activities such as procrastination. Such apprehension also occurs in other anxiety disorders. But this apprehension is the essence of Gad. They have no appreciation of the logic which most of us conclude, that it is pointless to torment yourself about possible outcomes over which we have no control. It is not surprising then that a recent study of the personal and economic burden of GAD found that those with GAD experienced a similar amount of role impairment and lessened quality-of-life to those with major depression.

Gender and Age Causes of Specific Phobias

Gender and Age: Specific phobias are quite common at about 12% prevalence rate over a lifetime. an over 75% have at least one other fear. Gender ratios vary considerably according to the type of phobia but are more common in women than men. The average age of onset also varies widely. Animal phobias usually begin in childhood, as do blood injection phobias, however, others such as claustrophobia begin in adolescence or early adulthood.

comorbidy with other disorders

Generalized anxiety disorder often concur with the other axis I disorders, especially other anxiety and mood disorders such as panic disorder, social phobia, specific phobia, PTSD and major depressive disorder. Also, many people with GAD experience occasional panic attacks without qualifying for a diagnosis of panic disorder. Many of these people are also mildly to moderately depressed as well as chronically anxious.

Age and gender differences in generalized anxiety disorder

Generalized anxiety is a relatively common condition. Approximately three percent population Approximately 3% of the population suffers from it in any one year. And 5.7% percent at some point in their life. It also tends to be chronic. After age 50 the disorder seems to disappear for many people. GAD is approximately twice as common in women than men. Although GAD is quite common, Most people with the disorder managed to function despite their high levels of worry and low perceived well-being. They are less likely to go to clinics for psychological treatment than are people with panic disorder for major depressive disorder. However, people with GAD do you frequently Trina in doctors offices with medical complaints. They are known to be over user at healthcare resources. Age of onset is difficult to as most people describe having the conditions their entire life.

Biological Causes of Specific Phobias.

Genetic and temperamental variables affect the speed and strength of conditioning of fear. Depending on the genetic makeup or the temperament and personality, people are more or less likely to acquire fears and phobia. Individuals who carried one of the two variants on the serotonin - transporter gene - linked to higher levels or neuroticism- show superior fear conditioning about individuals who do not carry this allele. Behaviorally inhibited toddlers ( extensive timid and shy temperament) at 21 months of age were at a higher risk of developing specific phobias by 7-8 years of age. Several studies have also shown modest genetic contributions to the development of specific phobias. This showed that identical twins were more likely to share animal phobias and situational phobias than non-identical twins. However, non-shared environmental factors also play very substantial roles in the origins of specific phobia supporting the idea of learned behaviours.

Compare and evaluate the merits of Freud's use of the concept of anxiety in the etiology of the neuroses versus the descriptive approach used in DSM since 1980.

Historically cases of anxiety disorders were considered to be classic examples of *Neurotic disorders*. They are NOT out of touch with reality, incoherent or dangerous. Neurotic behaviours develop when intrapsychic conflict produces significant anxiety. Anxiety to Freud was a sign of the inner battle between some primitive desires of the id and prohibitions against this expression from the ego and superego. Sometimes this anxiety was overtly expressed as in the disorders we today classify as anxiety disorders. In certain other neurotic disorders, however, he believed the anxiety might not be so obvious as defense mechanisms were used to hide or deflect the anxiety. The DSM is about categorising specific disorders, Freud's approach had fewer structures and was not focused on classifying the disorder as it was working through the conflicts to relieve the anxiety in whatever form it came.

Cultural differences in sources of worries

In their your Yoruba culture of Nigeria, there are three primary clusters of symptoms associated with generalized anxiety: Worry, Dreams, and bodily complaints. The sources of worry Focus I'm creating and maintaining a large family and on fertility. Dreams are a major source of anxiety because they're thought to indicate that one may be bewitched. The common somatic complaints are also unusual from the western standpoint: "I have the feeling that something like water in my brain". Nigerian with this syndrome often has a paranoid fear of malevolent attack by witchcraft. In India also there are many more worries about being possessed by spirits and about sexual inadequacy that is seen in generalized anxiety in western culture. In China and Southeast Asian countries, men experience *Koro*, which involves intense, Acute fear, of the penis retracting into the body and that when this process is complete he will suffer and die. Koro tends to occur in academics as a form of mass hysteria.

Treatments for Specific Phobias

Include *exposure therapy* - the best treatment for specific phobias - involves the gradual, controlled exposure to the stimuli or situations. One variation also includes *Participant modelling* which is more effective than exposure on its own. Here the therapist calmly models ways of interacting with the stimulus. The technique enables clients to learn that these situations are not as frightening or harmful as they thoughts and the fear will gradually dissipate. Virtual reality environments are also being used to stimulate certain phobic situations - and studies are showing promising results in reducing phobias. Some therapists have also tried combining cognitive restructuring techniques or medications with exposure therapies to see if they produce additional gains. Cognitive techniques alone have not shown as promising results as exposure based, and medication is ineffective by itself. However, the drug known as D-cycloserine may enhance the effectiveness of small amounts of exposure therapy for fear of heights in a virtual reality environment. By itself, however, it has no effect.

Social Phobias

Is characterised by disabling fears of one or more specific social situations ( such as public speaking). Also, a person fears that she or he may be exposed to the scrutiny, and potential negative evaluation of others or she or he may act in an embarrassing or humiliating manner. Because of these fears, people with social phobias usually avoid these situations or endure them with great distress.Intense fear of public speaking is the single most common type of social phobia. People with *generalised social phobia* have a significant social fear of most social situations rather than a few. They often have a diagnosis of avoidant personality disorder in the DSM-IV

Prevalence in Age and Gender

It si about twice as prevalent in women than in men and agoraphobia is also more frequently seen in women. The percentage of women increases as the extent of agoraphobic avoidance increases. The most common explanation for this is a sociocultural one. In many cultures, it is more acceptable for a woman who experiences panic to avoid the situation they fear and to need a trusted companion to accompany them when they enter feared situation. Men who experience these situations are more prone to tough it out.

Comorbidity with the other disorders

Like all the anxiety disorders obsessive-compulsive disorder frequently co-occurs with other mood and anxiety disorders. Depression is especially common. The anxiety disorders with which OCD most often co-occurs include social phobia, panic disorder, General anxiety disorder, and posttraumatic stress disorder. The personality disorders most commonly found in people with OCD are dependent and avoidant. Body dysmorphic disorder also co-occurs rather commonly with OCD. In one large study, 12% of patients with OCD also have body dysmorphic disorder, which many researchers believe to be closely related.

* Medication Treatment for OCD*

Medications that affect the Nero transmitter serotonin seem to be the primary class of drug that seems to have a reasonably good effect on treating OCD. A major disadvantage of medication is when medication is discontinued relapse rates are very high. That's why many people who do not seek alternative forms of behavior therapy that have more long-lasting benefits may have to stay on these medications indefinitely. Finally, because OCD in its most severe forms is such a crippling and disabling disorder, psychiatrists has begun to re-examine the usefulness of certain neurosurgical technique for the treatment of severe OCD.

Psychological causal factors for OCD: Mowrers two process theory of Avoidance learning*

OCD as learned behavior: the dominant behavioral view of OCD is derived from *Mowrers two process theory of Avoidance learning*. According to this theory, neutral stimuli become associated with frightening thoughts or experiences classical conditioning and come to elicit anxiety. For example, touching a doorknob or shaking hands might become associated with this scary idea of contamination. Once having met this Association, the person may discover that the anxiety produced by shaking hands or touching a doorknob can be reduced by hand washing. Washing his or her hands extensively reduces the anxiety, and so the washing response is reinforced. This makes them more likely to occur again in the future with other situations evoke anxiety about contamination. Once learn, such as avoidance responses are extremely resistance to extinction. Moreover, any stressors that raise anxiety levels can lead to a heightened frequency of Avoidance responses in animals or compulsive rituals in humans.

Age and onset of gender differences in OCD

OCD is more prevailing than once thought. But considerably less than other anxiety disorders. Lifetime surveillance has been as high as 3%, but the average one-year prevalence rate was 1.2%. Some studies show little or no gender difference in adults, which would make OCD quite different from the rest of anxiety disorders. Although this disorder begins in late adolescence or early adulthood, it is not uncommon for children, Where symptoms are strikingly similar to those adults. Early childhood and adolescence-onset is more common in boys and girls and is often associated with a greater severity and greater heritability. In most cases of the disorder has a gradual onset, and once it becomes a serious condition, it tends to become chronic. Although symptoms sometimes wax and wane over time.

Psychological Causal: Anxiety Sensitivity And Perceived Control

Other cognitive and learning explanations of panic and agoraphobia to looked at a number of different factors that can generally be explained within individual learning or cognitive perspective. People with high anxiety sensitivity are more prone 2 panic attacks and panic disorder; Anxiety Sensitivity is the trait like belief that certain bodily sensations have harmful consequences. Many studies prove that having the trait of anxiety sensitivity can lead to panic attacks. Just having a sense of perceived control can lead to a reduction of anxiety and can even block pain. In addition having a safe person when undergoing a panic provocation procedure are likely to show reduced distress lowered physiological arousal and reduced likelihood of panic. Furthermore perceived control over emotions and threatening situations can protect people against developing agoraphobic avoidance.

Covington biases for threatening information

People with generalized anxiety disorder process threatening information in a biased way. Many studies have shown that's generally anxious people tend to preferentially allocate their attention towards threatening cues when both threat and non-threats cues are present in the environment. Non-anxious people do not show a bias except under limited circumstances in which they actually may show the opposite bias. This attentional vigilance for threat cues can occur at a very early stage of information processing, even before the information entered the person's conscious awareness. Generally, anxious people are more likely than not anxious people to think that those bad things are likely to happen in the future, and they have a much stronger tendency to interpret ambiguous information in a threatening way. This has been shown to increase anxiety in several situations, including watching a Stressful video.

Psychological Causal Factors for Panic: Cognitive basis and the maintenance of panic

People with panic disorder are biased in the way they process threatening information.They are automatically drawn to threatening information in the environment such as words that represent things they fear. Some study uses FMRI technology to exhibit that people with panic disorder tend to have greater activation to threat words in brain areas involved in memory processing of threatening material

Psychological Causes of Specific Phobias

Psychological Causal Factors: 1. Psychoanalytical view: where phobias represent a defence mechanism against the anxiety that stems from repressed impulses of the Id. Because it is too dangerous to fully know these impulses, the anxiety is displaced onto some external object or situation that has some symbolic relationship to the real object or anxiety. This account has been long criticised as being far too speculative. 2. Phobias as Learned Behaviours: The fear response can be readily conditioned to previously neutral stimuli when paired with traumatic or painful events. Once acquired these phobic fears also generalise to other situations or objects similar. a) Vicarious/ observational conditioning: simply watching a phobic person behaving fearfully with his or her phobic object can be distressing enough to an observer can result in the fear being transmitted from one person to another through vicarious or observational classical conditioning. Also, watching a non-fearful person interact with a frightening experience can also lead to this conditioning. b) Life experience in Learning: Some life experiences leading up to and after an experience may serve as risk factors and make certain people more vulnerable than others to acquiring phobias, and other may serve as protective factors against. Ex. Years of positive experience with a friendly dog before being bitten will probably keep a victim from developing a phobia of dogs/ appropriate experiences following an attack may help guard as well. c) Personal Cognitions and thoughts have also been found to maintain our phobias once they are acquired. People with phobias are consistently on alert for things that they are afraid of, while non-phonic people tend to direct their attention away from these things. The phobic will also overestimate the probability that these events will occur. This cognitive bias may help maintain or strengthen fears over time. c) Evolutionary preparedness for Learning Certain Fears and Phobias. Our evolutionary history may have affected which stimuli we are more likely to fear. This explains why we have more common fears of snakes and spiders over guns that prove more imminent of a threat. *prepared learning* develops as an evolutionary preparedness to rapidly associate certain objects - such as snakes, spiders, and water - with frightening and unpleasant events. This occurs because over the course of evolution, those who rapidly acquired fears to these things that posed real threats may have enjoyed a selective advantage. These are not inborn but easily acquired to resist extinction.

Comobidity of panic disorders

Studies show that 83 percent of people with panic disorders also have at least one comorbid disorder. Most commonly these include generalized anxiety, social phobia, PTSD, depression, and substance use disorders.Anxiety disorders are also linked to suicidal tendencies and depression.

Anxiety Disorders according to the DSM

The DSM has identified groups of disorders that share obvious symptoms of clinically significant fear or anxiety. They effect 25-29% of the US population at some point in their life and are most common in women and second most common in men. These disorders create enormous personal, economic, and health care problems for those affected. Anxiety disorders are also associated with an increased prevalence of some medical conditions including asthma, chronic pain, hypertension, arthritis, cardiovascular disease, and irritable bowel syndrome, and are very high users of medical services.

Timing of panic attacks

The first attack usually comes as a response to feelings of distress of some nature. However, not all who experience an attack after a distressing situation go on to develop a panic disorder. 23% of people have experienced at least one panic attack in their lifetime. People who experience other anxiety disorders or major depression often experience the occasional panic attack as well. An attack is thus much more common than developing a full blown disorder.

Agoraphobia

The most commonly feared and avoided situations include streets and crowded places such as shopping malls, movie theatres, and stores. Thought to have been developed as a result of complications when having panic attacks in one or more such situations. Concerned that they may have a panic attack or get sick, people with _______________ are anxious about being in places or situations from which escape would be physically difficult or psychologically embarrassing, or would not be immediately available if something bad were to happen. Typically these people are also frightened by their bodily sensations so they avoid activities that would create arousal such as exercising, engaging in sexual activity, or watching scary movies. As it first develops people and to avoid a situation in which the panic attacks have occurred, but usually avoidance gradually spreads to other situations where attacks might occur. In moderate to severe cases, people with _________ may be anxious event when venturing outside their homes alone. In very severe cases this is a disabling disorder in which a persona can not go beyond the narrow confines of home, or even particular parts of the home.

Panic Disorders without Agoraphobia

The occurrence of panic attacks that often seem to come out of the blue. The person must have experienced recurring, unexpected attacks and must have bee persistently concerned about having another attack or worried about the consequences of having another attack for at least a month ( often referred to as anticipatory anxiety). For such an event to qualify as a full-blown panic attack, there must be an abrupt onset of at least 4-13 symptoms, most of which are physical, although three are cognitive. 1) Depersonalization ( a feeling of being detached from one's body) or derealization ( feeling that the external world is strange or unreal). 2) Fear of dying 3) Fear of going crazy Panic attacks are usually very brief but intense, with symptoms developing abruptly and usually reaching peak intensity within 10 minutes. The usually subside in 20-30 minutes and rarely last more than an hour. In contrast periods of anxiety usually, do not have such abrupt onset and a more long lasting. Panic attacks are usually unexpected in that they do not appear to be provoked by identifiable aspects of the immediate situation. They may occur in situations we least expect it such as during sleep. In other cases, panic attacks are situationally predisposed occurring only while in a particular situation. Because 10 of the 13 symptoms are physical, it is not surprising that 85% of people experiencing them end up in the emergency rooms repeatedly. Unfortunately, usually, a correct diagnosis is not made due to normal results popping up in medical tests. Further complications arise because cardiac patients are almost two-fold as likely to develop a panic disorder. Prompt diagnosis is important because panic disorders cause approximately as much impairment in social and occupational functioning as that caused by major depressive disorders, and because panic disorders can contribute to the development or the worsening of a variety if medical problems.

Psychological causal factors generalize anxiety disorder: Worry And Positive Function

The worry process is now considered an essential feature of general anxiety disorder and has been the focus research in recent years. Studies suggest the benefits of worrying are the actual function that worries serve. Several of the benefits that people with general anxiety disorder most commonly think derive from worry are: 1. superstitious avoidance of catastrophe ( worry makes it less likely that the events will occur) 2. avoidance of deeper emotional topics ( worrying is about most of the things I worry about is a way to distract myself from worrying about even more emotional things That I don't want to think about). 3. coping and preparation ( worrying about a predictive negative event will help me prepare for its occurrence) There is evidence that these positive beliefs about worry Play a key role in maintaining high levels of anxiety and worry, especially in early phases of the development of general anxiety disorder.

Taijin Kyofusho

There is also some evidence that the form that certain anxiety disorders take has actually evolved to fit certain cultural patterns. _________________ relates to the western diagnosis of social phobia. It is a fear of interpersonal relations or of social situations. However, most people with ______________________ are concerned about doing something that will embarrass or offend others opposed to embarrass or offend themselves. For example, they may fear the offending others by blushing, admitting an offensive odor, we're staring inappropriately. This fear of bringing shame to others is what leads to social avoidance.

Genetic factors of generalized anxiety disorder

There is modest heritability, although perhaps smaller than that for most other anxiety disorders except phobias. Twin studies reveal how heritability estimates vary as a function of one's definition a general anxiety disorder. The largest and most recent of these twin studies using the DSM-IV-TR diagnostic criteria estimated that 15 to 20% of the variance in liability to general anxiety disorder is due to genetic factors. The evidence is increasingly strong that general anxiety disorder and major depressive disorder have a common underlying genetic predisposition. What determines this genetic risk depends entirely on this specific environmental experiences they have.

Biological causal factors of OCD

There is now a substantial body of evidence implicating biological causal factors in OCD. This evidence comes from genetics studies, Studies at abnormalities in brain function, and for studies and neurotransmitter abnormalities. Although the exact nature of these factors and how they are interrelated is not yet fully understood, major research efforts that are currently underway are sure to enhance our understanding of this very serious and disturbing disorder

psychological causal factors Of Generalized anxiety disorder: negative consequences of worry

There is now considerable evidence that attempts to control thoughts and worry may paradoxically lead to increased experience of intrusive thoughts and enhanced perception of being able to control them. Somewhat paradoxically, these intrusive thoughts can serve as further trigger topics for more worry, and a sense of uncontrolled abilities over worry may develop in people caught In the cycle that occurs in general anxiety disorder. Perceptions of uncontrolled abilityAre also known to be associated with Increased anxiety, So a vicious circle of anxiety, worry, and intrusive thoughts may develop.

Prevalence of Age or Gender in Social Phobia

This diagnosis is very common. 12% of the population will qualify fo this diagnosis at some point in their life. This is somewhat more common among women than men. Unlike specific phobias that often generate in childhood, social phobias typically begin during early to late adolescence and early adulthood.1/3 of the population also use drug or alcohol to help manage the situation they fear. 2/3 of people with social phobia also suffer from additional anxiety disorders and depressive disorders at the same time. Pople on average also suffers from lower employment and economic status due to their fears. The disorder is also remarkably resistant.

psychological causal factors for generalized anxiety disorder: perceptions of uncontrollable and unpredictability

Uncontrollable and unpredictable adverse events are much more stressful than uncontrollable but predictable adverse events, so it is perhaps not surprising that the former creates more fear and anxiety. Conversely, experience with controlling aspect of one's life may immunize one against developing general anxiety. People with GAD may have a history of experiencing many important events in their lives as unpredictable and uncontrollable. There is some evidence that people with GAD be more likely to have had a history of trauma and childhood. This a low tolerance for uncertainty suggests that they are especially disturbed By not being able to predict the future. Some findings also show the greater the intolerance of uncertainty, the more severe the GAD.

Panic Attack

When fear responses occur in the absence of any obvious external danger. Symptoms are nearly identical to those experienced during a state of fear except that a panic attack is often accompanied by a subjective sense of impending doom, including fears of dying, going crazy, or losing control. These latter cognitive symptoms do not generally occur during fear states, thus panic has three components 1. Cognitive/Subjective components ( I feel afraid; "I'm going to die") 2. Physiological components ( increased heart rate and heavy breathing). 3. Behavioural components ( A strong urge to escape or flee) Some of these symptoms may show while others may not. They are loosely coupled.

Explain The Difference between Fear and Anxiety?

Whether there is a clear source of danger that would be regarded as real by most people. When a source of danger is obvious, we call those emotions experiences fear. With Anxiety, frequently we cannot explain specifically what the danger is.

Obsessions

according to the DSM-IV-TR, involve persistence and be current intrusive thoughts, Images, or impulses that are experienced as disturbing, Inappropriate, and uncontrollable. People who have such obsessions actively try to resist or suppress them, for to neutralize them with some other thought or action.

Psychological Causal: DisorderComprehensive learning theory

an Initial Panic Attacks become associated with internal and external stimulus. Anxiety then becomes conditioned to these initially neutral introceptive and exteroceptive stimuli; the more intense the panic attacks the stronger the conditioning will be.

Compulsions

can involve either overt repetitive behaviors that are performed as lengthy rituals (such as handwashing, checking, or ordering over and over again) for more covert mental rituals (such as accounting, printing, or saying certain words silently over again)