ANXIETY

Overview
What is Anxiety? What are the different types of anxiety disorders? What are the causes? What are the symptoms? What are the treatments?

Definition of Anxiety
Anxiety is a feeling of apprehension or fear. The source of this uneasiness is not always known or recognized, which can add to the distress you feel. Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety.

Anxiety Facts
Most common mental illness in the U.S. with 19 million of the adult (ages 18-54) U.S. population affected. Anxiety disorders cost more than $42 billion a year. More than $22 billion are associated with the repeated use of healthcare services, as those with anxiety disorders seek relief for symptoms that mimic physical illnesses. Anxiety is highly treatable (up to 90% of cases), but only one-third of those who suffer from it receive treatment People with an anxiety disorder are three-to-five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than non-sufferers. Depression often accompanies anxiety disorders
2003 Anxiety Disorders Association of America

Types of Anxiety Disorders

Panic Disorder Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder Phobias Generalized Anxiety Disorder

Panic Disorder
The abrupt onset of an episode of intense fear or discomfort, which peaks in approximately 10 minutes, and includes at least four of the following symptoms:
A feeling of imminent danger or doom

The need to escape Palpitations Sweating Trembling Shortness of breath or a smothering feeling A feeling of choking Chest pain or discomfort

Nausea or abdominal discomfort Dizziness or lightheadedness A sense of things being unreal, depersonalization A fear of losing control or "going crazy" A fear of dying Tingling sensations Chills or hot flushes

Panic Disorder
There are three types of Panic Attacks:
1. Unexpected - the attack "comes out of the blue" without warning and for no discernable reason. 2. Situational - situations in which an individual always has an attack, for example, upon entering a tunnel.

3. Situationally Predisposed - situations in which an individual is likely to have a Panic Attack, but does not always have one. An example of this would be an individual who sometimes has attacks while driving.

Obsessive-Compulsive Disorder
Characterized by uncontrollable obsessions and compulsions which the sufferer usually recognizes as being excessive or unreasonable. Obsessions are recurring thoughts or impulses that are intrusive or inappropriate and cause the sufferer anxiety:
Thoughts about contamination, for example, when an individual fears coming into contact with dirt, germs or "unclean" objects; Persistent doubts, for example, whether or not one has turned off the iron or stove, locked the door or turned on the answering machine; Extreme need for orderliness; Aggressive impulses or thoughts, for example, being overcome with the urge to yell 'fire' in a crowded theater

Obsessive-Compulsive Disorder
Compulsions are repetitive behaviors or rituals performed by the OCD sufferer, performance of these rituals neutralize the anxiety caused by obsessive thoughts, relief is only temporary.
Cleaning. Repeatedly washing their hands, showering, or constantly cleaning their home; Checking. Individuals may check several or even hundreds of times to make sure that stoves are turned off and doors are locked; Repeating. Some repeat a name, phrase or action over and over; Slowness. Some individuals may take an excessively slow and methodical approach to daily activities, they may spend hours organizing and arranging objects; Hoarding. Hoarders are unable to throw away useless items, such as old newspapers, junk mail, even broken appliances

In order for OCD to be diagnosed, the obsessions and/or compulsions must take up a considerable amount of the sufferers time, at least one hour every day, and interfere with normal routines .

Obsessive-compulsive disorder (OCD)

Usually person performs the behavior (compulsion) to try to get the thought (obsession) to go away Behavior is negatively reinforcing because it gets unpleasant thoughts to temporarily go away

Obsessive-compulsive disorder (OCD)

Example: checking lock repeatedly to get rid of thought that a burglar might get in and rob the house

Post-Traumatic Stress Disorder

Exposure to traumas such as a serious accident, a natural disaster, or criminal assault can result in PTSD. When the aftermath of a traumatic experience interferes with normal functioning, the person may be suffering from PTSD.
Symptoms of PTSD are:
Reexperiencing the event, which can take the form of intrusive thoughts and recollections, or recurrent dreams; Avoidance behavior in which the sufferer avoids activities, situations, people,and/or conversations which he/she associates with the trauma; A general numbness and loss of interest in surroundings; Hypersensitivity, including: inability to sleep, anxious feelings, overactive startle response, hypervigilance, irritability and outbursts of anger.

Phobias
Persistent, irrational fear of a specific object or situation

Arachnophobia- the fear of spiders Social phobia - the fear of social situations Aerophobia - the fear of flying. In a plane Agoraphobia the fear of inescapable situations Claustrophobia the fear of confined spaces

Acrophobia the fear of heights Emetophobia the fear of vomit Carcinophobia the fear of cancer. Brontophobia the fear of thunderstorms. Also known as astraphobia

 Necrophobia the fear of death.

 Person knows phobia is irrational, doesnt make sense, but person cannot stop the phobia.

Social Phobia/Anxiety
Social anxiety disorder, also known as social phobia, is an intense fear of social situations. This fear arises when the individual believes that they may be judged, scrutinized or humiliated by others. Individuals with the disorder are acutely aware of the physical signs of their anxiety and fear that others will notice, judge them, and think poorly of them.
In extreme cases this intense uneasiness can progress into a full blown panic attack.

Social phobias
Shyness to the extreme Persistent, irrational fear linked to presence of others Fear of being scrutinized or negatively evaluated by others

Social Phobia/Anxiety
Common anxiety provoking social situations include:
public speaking talking with people in authority dating and developing close relationships making a phone call or answering the phone interviewing attending and participating in class speaking with strangers meeting new people eating, drinking, or writing in public using public bathrooms driving shopping

Phobias can be culture dependent

China: fear of loss of body heat Japan: Taijin Kyofushu, fear of offending others by emitting odors, staring, having a blemish or an improper facial expression

Generalized Anxiety Disorder

Excessive uncontrollable worry about everyday things. This constant worry affects daily functioning and can cause physical symptoms.
GAD can occur with other anxiety disorders, depressive disorders, or substance abuse.

Generalized anxiety disorder

Person is continually tense, apprehensive, and in a state of ANS arousal.

Generalized anxiety disorder

Tense and jittery Worried bad things will happen Muscular tension Agitation Sleeplessness

Generalized anxiety disorder

Person cannot identify the cause of the anxiety, and therefore cant avoid or deal Free floating anxiety

Generalized anxiety disorder

Worry about things that are not too likely to happen Worry more intensely

Generalized anxiety disorder

Lifetime prevalence of 5% 2/3 of cases are women

Generalized Anxiety Disorder

The focus of GAD worry can shift, usually focusing on issues like job, finances, health of both self and family; but it can also include more mundane issues such as, chores, car repairs and being late for appointments. The intensity, duration and frequency of the worry are disproportionate to the issue

Specific Disorder Facts

Generalized Anxiety Disorder
Women are twice as likely to be afflicted than men. Very likely to exist along with other disorders.

Obsessive Compulsive Disorder

It is equally common among men and women. One third of afflicted adults had their first symptoms in childhood.

Panic Disorder
Women are twice as likely to be afflicted than men. Occurs with major depression in very high rates.

2003 Anxiety Disorders Association of America

Specific Disorder Facts

Posttraumatic Stress Disorder
Women are more likely to be afflicted than men. Rape is the most likely trigger of PTSD, 65% of men and 45.9% of women who are raped will develop the disorder. Childhood sexual abuse is a strong predictor of lifetime likelihood for developing PTSD.

Social Anxiety Disorder

It is equally common among men and women.

Specific Phobia affects

Women are twice as likely to be afflicted as men

2003 Anxiety Disorders Association of America

Anxiety Statistics
Anxiety Disorders One-Year Prevalence (Adults)
Percent Population Estimate* (Millions)

Any Anxiety Disorder

Panic Disorder Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder Any Phobia Generalized Anxiety Disorder

13.3
1.7 2.3 3.6 8.0 2.8

19.1
2.4 3.3 5.2 11.5 4.0

* Based on 7/1/98 U.S. Census resident population estimate of 143.3 million, age 18-54

Common Causes
There is no one cause for anxiety disorders. Several factors can play a role
Genetics Brain biochemistry Overactive "fight or flight" response Can be caused by too much stress Life circumstances Personality
People who have low self-esteem and poor coping skills may be more prone

Certain drugs, both recreational and medicinal, can lead to symptoms of anxiety due to either side effects or withdrawal from the drug. In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may be the cause of anxiety.

Explaining anxiety disorders

Learning perspective Biological perspective

Learning perspective
Fear conditioning
One bad event can lead to classical conditioning of fear

Stimulus generalization
Fear may broaden: fear of heights fear of airplanes

Learning perspective
Reinforcement can help maintain fears.
Avoiding or escaping the feared situation reduces anxiety, so the avoiding or escaping behavior is reinforced

Learning perspective
Observational learning
We learn our fears by watching and listening to others

Biological perspective
We are biologically prepared to fear threats faced by ancestors
Spiders Snakes Darkness

Not computers or cars

Biological perspective
Genes
Some people seem genetically predisposed to particular fears and high anxiety

Biological perspective
35 year old identical twins who independently developed claustrophobia and fear of water

Biological perspective
Fearfulness runs in families in monkeys More strong reaction to stress if biological relatives are anxious.

Biological perspective
Physiology
Brain scans of people with OCD unusually high activity in certain parts of the frontal lobes

 Physiology Generalized anxiety, panic attacks, and OCD are linked with overarousal in brain areas linked with impulse control and habitual behaviors People cannot turn off these thoughts.

Symptoms of Anxiety
Anxiety is an emotion often accompanied by various physical symptoms, including:
Twitching or trembling Muscle tension Headaches Sweating Dry mouth Difficulty swallowing Abdominal pain (may be the only symptom of stress especially in a child)

Additional Symptoms of Anxiety

Sometimes other symptoms accompany anxiety:
Dizziness Rapid or irregular heart rate Rapid breathing Diarrhea or frequent need to urinate Fatigue Irritability, including loss of your temper Sleeping difficulties and nightmares Decreased concentration Sexual problems

Physical Reaction to Anxiety

Auditory and Visual Stimuli: sights and sounds are processed first by the thalamus, which filters the incoming cues and shunts them either directly to the amygdala or to the other parts of the cortex. Olfactory and tactile stimuli: Smells and touch sensations Bypass the thalamus altogether, Taking a shortcut directly to the Amygdala. Smells, therefore, Often evoke stronger memories Or feelings than do sights or Sounds.

Physical Reaction to Anxiety

Thalamus: The hub for sights and sounds, The thalamus breaks down Incoming visual ques by size, Shape and color, and auditory Cues, by volume and Dissonance, and then signals The appropriate part of the Cortex. Cortex: It gives raw sights and sounds meanings, enabling the brain to become conscious of what it Is seeing or hearing. One region, the prefrontal cortex, may be vital to turning off the anxiety response once a threat has passed.

Physical Reaction to Anxiety

Amygdala: emotional core of the brain, the amygdala has the primary role of triggering the fear response. information that passes through the amygdala is tagged with emotional significance. Bed Nucleus of Stria Terminalis: unlike the Amygdala, which sets off an immediate burst of fear, the BNST perpetuates the fear response, causing the longer term unease typical of anxiety.

Physical Reaction to Anxiety

Locus Ceruleus: It receives signals from the amygdala and is responsible for initiating many of the classic anxiety responses: rapid heartbeat, increased blood pressure, sweating and pupil dilation. Hippocampus: This is the memory center, vital to storing the raw information coming in from the senses along with the emotional baggage attached to the data during their trip through the amygdala.

Social Effects of Anxiety

Depression
Not as involved with family and friends the way you used to be Lowered quality of relationships Low energy Lack of motivation to do the things you once looked forward to doing

Fear and avoidance of situations where previous attacks occurred

Treatments
Medications (Drug Therapy): Behavioral Therapy Cognitive Behavioral Therapy Psychodynamic Psychotherapy

Alternative Treatments
Acupuncture Aromatherapy Breathing Exercises Exercise Meditation Nutrition and Diet Therapy Vitamins Self Love

Medications
Buspirone: shown to be effective but usually takes 3-4 weeks, particularly useful in elderly patients Benzodiazepines: include Xanax and Valium, act rapidly and successfully but can be addictive and loses effectiveness over time Side Effects: dizziness, headaches, nausea, impaired memory

Behavioral and Cognitive Therapy

Teaches patient to react differently to situations and bodily sensations that trigger anxiety Teaches patient to understand how thinking patterns that contribute to symptoms Patients learn that by changing how they perceive feelings of anxiety, the less likely they are to have them Examples: Hyperventilating, writing down list of top fears and doing one of them once a week, spinning in a chair until dizzy; after awhile patients learned to cope with the negative feelings associated with them and replace them with positive ones

Psychodynamic Psychotherapy
Psychodynamic therapy is a general name for therapeutic approaches which try to get the patient to bring to the surface their true feelings, so that they can experience them and understand them. Psychodynamic Psychotherapy uses the basic assumption that everyone has feelings held in the subconscious which are too painful to be faced. We then come up with defenses (such as denial) to protect us knowing about these painful feelings. Psychodynamic psychotherapy assumes that these defenses have gone wrong and are causing more harm than good, making you seek help. It tries to subdue them, with the intention that once you are aware of what is really going on in your mind the feelings will not be as painful. Takes an extremely long time and is labor intensive

Acupuncture
Caused by the imbalance of chi coming about by keeping emotions in for too long Emotion effects the chi to move in an abnormal way: when fearful it goes to the floor, when angry the neck and shoulders tighten Redirects the chi into a balanced flow, releases tension in the muscles, increases flow of blood, lymph, and nerve impulses to affected areas Takes 10-12 weekly sessions

Aromatherapy
Calming Effect: vanilla, orange blossom, rose, chamomile, and lavender Reducing Stress: Lavender, sandalwood, and nutmeg Uplifting Oils: Bergamot, geranium, juniper, and lavender Essential Oil Combination: 3 parts lavender, 2 parts bergamot, and 1 part sandalwood

Exercise
Benefits: symbolic meaning of the activity, the distraction from worries, mastery of a sport, effects on self image, biochemical and physiological changes associated with exercise, symbolic meaning of the sport Helps by expelling negative emotions and adrenaline out of your body in order to enter a more relaxed, calm state to deal with issues and conflicts

Meditation
Cultivates calmness to create a sense of control over life Practice: Sit quietly in a position comfortable to you and take a few deep breaths to relax your muscles, next choose a calming phrase (such as om or that with great significance to you), silently repeat the word or phrase for 20 minutes

Nutrition and Diet Therapy

Foods to Eat: whole grains, bananas, asparagus, garlic, brown rice, green and leafy veggies, soy products, yogurt Foods to Avoid: coffee, alcohol, sugar, strong spices, highly acidic foods, foods with white flour Keep a diary of the foods you eat and your anxiety attacks; after awhile you may be able to see a correlation East small, frequent meals

Vitamins
B-Vitamins stabilize the bodys lactate levels which cause anxiety attacks (B-6, B-1, B-3) Calcium (a natural tranquilizer) and magnesium relax the nervous system; taken in combination before bed improves sleep Vitamin C taken in large doses also has a tranquilizing effect Potassium helps with proper functioning of adrenal glands Zinc has a calming effect on the nervous system

Self Love
The most important holistic treatment of all Laugh: be able to laugh at yourself and with others; increases endorphin levels and decreases stress hormones Let go of frustrations Do not judge self harshly: dont expect more from yourself than you do others Accept your faults

End