Zusammenfassung der Ressource
Anxiety
- Anxiety Disorders
- seperation anxiety disorder, selective mutism,
specific phobia, social anxiety disorder, panic disorder,
panic attack specifier, agoraphobia, generalized
anxiety disorder, anxiety disorder due to another
medical condition, other specified anxiety disorder,
unspecified anxiety disorder
- Obsessive-Compulsive and Related Disorders
- OCD, body dysmorphic disorder,
hoarding, trichotillomania disorder ,
excoriation disorder,
substance/medication-induced OCD,
Other specified OC and related
disorder/Unspecified OC and related
disorder
- Trauma and Stressor Related Disorders
- Reactive attachment disorder, disinhibited
social engagement disorder, post traumatic
stress disorder (includes PTSD for those <6),
acute stress disorder, adjustment disorders,
other specified trauma and stressor-related
disorder, unspecified trauma and
stressor-related disorder
- Anxiety
- negative mood state, moderate
anxiety beneficial, apprehension
- Fear
- Intense neurobiological & cognitive features,
can be protective (e.g., evokes flight or fight)
- Panic
- Fear in the absence of a tangible stimulus
- Stress
- main sources are frustration, pressure &
conflict, defined as the point where ones’
demands exceeds ones’ resources 
- Causes of Anxiety Disorders
- Generalised Biological Vulnerability
- Genetic component
- Psychological Vulnerability
- Anxiety as a product of early classical
conditioning, modelling, or other forms of
learning
- Social Contribution
- Stressful life events (most are
interpersonal in nature e.g marriage,
divorce)
- What is the DSM - V?
- DSM-5 is a manual for assessment and diagnosis of mental disorders and
does not include information or guidelines for treatment of any disorder.
That said, determining an accurate diagnosis is the first step toward being
able to appropriately treat any medical condition, and mental disorders are
no exception. DSM-5 is helpful in measuring the effectiveness of treatment,
as dimensional assessments assist clinicians in assessing changes in severity
levels as a response to treatment
- Phobia
- Irrational fear of specific object or situation
- Out of proportion
- Avoidance/escape
- Recognition of extreme/excessive fear
- Typically function well in other areas
- Subtypes include: animals, natural
environment, blood/injections/injury/,
situational, other
- Phobia specific techniques
- Aim: decrease fear driven avoidance; anxiety
during exposure & anticipatory anxiety.
Exposure - systematic desensitisation
(graded) & flooding (ungraded) – In vivo or
imaginal • Modelling • Importance of
extinction • Coping self statements, adaptive
thinking training
- Psychoanalytic, behavioural and cognitive theories on aetiology
- Psychoanalytic therapy, (id, ego , superego)
- Behavioural therapy, (systematic desensitization, flooding)
- Cognitive therapy (catastrophe scale)
- Medical approach- anxiolytics, barbiturates, prozac, benzodiazepine 
- Aetiology
- Psychodynamic- id, ego , superego
- Realistic - genuine danger
- Neurotic - prevented from expressing id impulses
- Moral - punished or threatened for id impulses (anxiety at feeling this way)
- Psychodynamic views
- Anxiety & tension may result from:
- Id, ego, superego conflicts
- Fear caused as a result of past
experiences (conscious and/or
unconscious)
- Id impulses (e.g., sexual taboo)-
superego derived guilt
–inadequacies of ego to resolve
conflict
- Anxiety may be attached or ‘free floating’ 
- Generalised anxiety- breakdown of
defences under stress- overrun with
neurotic or moral anxiety
- Phobias-repression & displacement-Fears
transferred to neutral objects (Little Hans)
- Existensial & Humanistic views
- Anxiety arises when people
deny/distort true thoughts/emotions &
behaviour by not honestly viewing or
accepting themselves.
- Existential anxiety-meaningless
existence, mortality, responsibilities
- Cognitive Behavioural views
- Learned fear-Classical Conditioning
- Prepared conditioning (evolutionary)
- Social modeling
- Expectation & interpretation of events
- Biological explanations
- Familial/genetic--twin studies
- Neurotransmitter studies:
- abnormal serotonergic function. GABA
(gamma-aminobutyric acid)--low in anxiety
states--a feedback system normally
reduces level of excitability in
neurons--anxiety states--fear unchecked.
- Cerebral imaging
- PET scans--increased cerebral glucose
metabolic rate in caudate nuclei, orbital gyri,
lateral prefrontal areas OCD,
panic/agoraphobia--abnormalities in
parahyppocampal area.
- Panic--noradrenaline
(norepinephrine) activity
irregular; locus ceruleus
- Medication Treatments
- Benzodiazepines eg Valium; high potency
eg Xanax—effect GABA
neurotransmitters; suppress CNS
- Effective but problems with
tolerance & dependency; interfere
with cognitive & motor functioning,
especially if combined with alcohol
- Tricyclic Antidepressants-effect function
of norepinephrine & serotonin & other
neurotransmitters
- Psychological Treatments
- Make threats
understandable &
controllable
- De-arousal strategies (hyperventilation)
- Graded exposure
- Cognitive therapy
- Structured problem solving
- Arousal
Reduction—breath
control, exercise,
reducing stimulants,
- • Relaxation, Monitoring , Distraction,
Stimulus Control, Graded Exposure: Live or “in
vivo” if possible; presented hierarchically,
continue till 50% anxiety reduction.
- Respiratory Control: breathe out
slowly & pause between breaths
- Rehearsal of Coping Techniques
- Role Playing
- Thought Stopping
- Stress Management
- Flooding
- Panic
- Abrupt experience of intense fear/acute
discomfort plus physical symptoms.
- Out of control
- Urge to flee
- Cognitive appraisal of
danger + physiological
and behavioural
activation
- Anxiety over future attacks
- Avoidance of situations
with no escape
- Panic Disorder and Agoraphobia
- Clinical Description
- › Avoidance can be persistent › Use and abuse
of drugs and alcohol › Interoceptive avoidance
- Situationally bound
- Unexpected
- Situationally predisposed
- Peak within 10 minutes
- Average HR
increase of 49.2
BPM within 1-2
minutes
- Children
- Hyperventilation
- Cognitive development
- Elderly
- Health focus
- Changes in prevalence
- Cultural Influences
- Social/Gender roles
- 75% of those with agoraphobia are female
- Panic Therapy
- SSRIs less side effects-better compliance 60%
success whilst on medication but relapse high.
- Cognitive – Behavioural:
- relaxation;breathing retraining; cognitive
restructuring; progressive exposure,
especially if agoraphobic
- Exposure to interoceptive sensations that
remind them of panic attacks- HR,
dizziness
- Modification of attitudes
& perceptions of
dangerousness
- Relaxation & breathing retraining 
- General Anxiety Disorder
- Emotionally “on edge”
- Cognitive- expects something awful
- Physical- chronic overarousal
- Behavioural- avoidance readiness
- Clinically significant distress/impairment
- Therapy
- Aims: reduce impairment from cognitive & somatic
anxiety symptoms – Worry, tension & overarousal
- Education, & focus on beliefs,
attitudes & expectations re fears
- Cognitions re: threats, challenge
catastrophising thoughts, coping strategies
- Obsessive-Compulsive Disorder
- Obession
- repetitive unwelcome thoughts, ideas,
impulses or images arise from within--
intrusive, difficult to control ie thoughts re:
contamination, repeated doubts, need to have
things in order, need for symmetry, aggressive
impulses, sexual imagery.
- Compulsion
- repetitive behavioural response, unwanted
action/rituals; aim-- anxiety prevention or
reduction, not pleasurable. May increase anxiety.
- DSM-V
- – Either obsessions or compulsions –Adults
recognise excessive or unreasonable –Attempts to
ignore or neutralise –Cause marked distress, time
consuming, interfere with normal routine
- Etiology
- Psychoanalytic: (anal stage,
inferiority complex)
- Behavioural: (Operant cond., suppression)
- Cognitive: “if anything can go wrong it will”
- Biological: Encephalitis, head injuries,
brain tumors, serotonin levels.
- Treatment
- Psychoanalytic: difficult to assess
- Behavioural: exposure and
response prevention
- Cognitive: RET
- Biological: drugs used for
depression-Prozac (60%) etc.,
psychosurgery-cingulum (30%)
- Body Dysmorphic Disorder
- Excessive concern with real or
imagined defects in appearance,
especially facial marks or features.
- Frequent visits to plastic surgeons
- Culturally-influenced, but
not culture- bound
- May be a symptom of more pervasive disorders:
Obsessive-compulsive or delusional disorder, for example. 
- Post-Traumatic Stress Disorder (PTSD)
- Anxiety precipitated by a traumatic event:
- Experienced/witnessed/confronted
with actual/threatened death/serious
injury/threat to self or others,
- Response involved intense fear/ helplessness/ horror .
- DSM V
- AVOIDANCE of stimuli associated wit event & NEGATIVE
ALTERATIONS in cognitions mood- worsened
post-trauma- pervasive negative emotional state
- Symptoms
- hyperarousal--anxiety at
reminders of the event; insomnia
- re-experiencing/intrusions: dreams, flashbacks
- avoidance of reminders
- numb emotionally
- loss of interest in everyday events
- survivor guilt (no longer core symptom)
- Clinically significant distress
- Duration > 1 month. Can
be delayed onset.
- Short term:
- Acute Stress Disorder (2
days-4weeks) DSM- V; Acute
StressReaction (few hours-3 days)
May be maladaptive coping:
aggression, substance use, self harm.
- Treatment
- Exposure to extinguish fear
- Reduces fear by extinction & emotional
processing –Changes to traumatic memory
network & meaning
- Challenging distorted cognitions
- Management of ongoing life stress
- Debriefing
- Anxiety management of arousal & fear– Controlled
breathing, relaxation, exercise, reduced stimulants
- Cognitive – Thought stopping,
distraction, coping self statements
- Behavioural–Activity
scheduling, social reintegration