Anxiety Disorders (Written Report) PDF

Preview

Summary

Download Anxiety Disorders (Written Report) PDF

Description

Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES - SANTA ROSA CAMPUS PSYC 30093 Abnormal Psychology

MODULE 4: ANXIETY DISORDERS

WRITTEN REPORT

Abnormal Psychology

Submitted by

Kimberly R. Cabral Kyra Janella V. Castrillo Michaella Marie C. Cayco Micah Ella D. Encina Frexie M. Olip Carlo A. Roldan Karren Kerly L. Villadiego

BSP 3-1

October 2020

Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES - SANTA ROSA CAMPUS PSYC 30093 Abnormal Psychology

LESSON 4: ANXIETY DISORDERS Learning Outcomes: • Describe how Generalized Anxiety Disorder presents itself, its comorbidity, etiology, and treatment options. • Describe how Specific Phobia presents itself, its comorbidity, etiology, and treatment options. • Describe how Agoraphobia presents itself, its comorbidity, etiology, and treatment options. • Describe how Social Anxiety Disorder presents itself, its comorbidity, etiology, treatment options. • Describe how Panic Disorder presents itself, its comorbidity, etiology, and treatment options.

Introduction The United Laboratories (UNILAB) reported that the National Statistics Office (NSO) ranked mental health illnesses as the third most common form of morbidity for Filipinos wherein 1 out of 5 suffers from such conditions. According to reports, the most prevalent mental health disorder around the globe is anxiety. Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes. People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat (Encyclopedia of Psychology (n.d.), as cited in the American Psychological Association (n.d.)). The National Broadcasting Company (NBC) reported that according to new research, colors that people use to describe emotions may be more useful. The study found that people with anxiety were more likely to associate their mood with the color gray, while others preferred yellow. The results, which are detailed today in the journal BMC Medical Research Methodology, could possibly help doctors gauge the moods of children and other patients who have trouble communicating verbally. Peter Whorwell, a co-author and gastroenterologist of the University Hospital South Manchester, told LiveScience that this is now a way of measuring anxiety and depression which gets away from language use. What is very interesting is that this might be a better way of capturing the mood of a patient than questions.

FACTS 1. Anxiety is more prevalent in developed countries & among women. 2. Anxiety can be helpful, but debilitating. 3. An estimated 284 million people worldwide experienced an anxiety disorder in 2017. 2

Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES - SANTA ROSA CAMPUS PSYC 30093 Abnormal Psychology

4. Anxiety disorders are treatable, yet only one third of those suffering receive treatment. Anxiety Disorders The hallmark symptoms of anxiety related disorders are excessive fear or anxiety related to behavioral disturbances. Fear is considered a versatile reaction for it frequently plans your body for a looming danger. Anxiety is more difficult to distinguish for it is the reaction to an unclear sense of risk. The two can be recognized from one another as fear is related to either a genuine or a seen risk, whereas anxiety is the expectation of a future threat (APA, 2013).

Etiology 1. Biological 1.1 Genetic influences. The interaction between genetics and stressful environmental influences seems to account for more of anxiety disorders than genetics alone (Bienvenu, Davydow, & Kendler, 2011). The quest to identify specific genes that may predispose individuals to develop anxiety disorders has led researchers to the serotonin transporter gene (5-HTTLPR). 1.2 Neurobiological structures. Researchers have identified brain structures and pathways that are responsible for anxiety responses. Among those structures is the amygdala which initiates a reaction in efforts to prepare the body for a response whenever it is presented with a fearful situation. First, the amygdala triggers the hypothalamic-pituitary-adrenal (HPA) axis to prepare for immediate action— either to fight or flight, which is a protective devise that the nervous system makes so that one can be ready for the danger or to run away from the said danger. The second pathway is activated by the feared stimulus itself, by sending a sensory signal to the hippocampus and prefrontal cortex, for determination if threat is real – the amygdala will be activated, producing a fear response, or imagined – the amygdala sends a calming response to the HPA axis, thus reducing the level of fear. •

Specific to panic disorder is the implication of the locus coeruleus – the brain structure that serves as an “on-off” switch for norepinephrine neurotransmitters.

•

It is believed that increased activation of the locus coeruleus results in panic like symptoms (Gorman, Kent, Sullivan, & Coplan, 2000).

•

Norepinephrine and the locus coeruleus failed to fully explain the development of panic disorder which resulted for the researchers to argue that a more complex neuropathway is likely implicated in the development of panic disorder. 3

Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES - SANTA ROSA CAMPUS PSYC 30093 Abnormal Psychology

•

Corticostriatal-thalamocortical (CSTC) circuit is theorized as a major contributor to panic symptoms (Gutman, Gorman, & Hirsch, 2004).

2. Psychological 2.1 Cognitive. The cognitive perspective on the development of anxiety related disorders centers around dysfunctional thought patterns. Maladaptive assumptions are routinely observed in individuals with anxiety related disorders, they often engage in interpreting events as dangerous or overreacting to potential stressful events, which lead them to negative appraisal or the dreading of situations or future happening. 2.2 Behavioral. The behavioral explanation for the development of anxiety disorders is largely reserved for specific and social phobias. Behavioral theorists focus on classical conditioning– when two events that occur close together become strongly associated with one another, despite their lack of causal relationship. 2.3 Modeling. An individual acquires a far though observation and imitation (Bandura & Rosenthal, 1966).

3. Sociological While characteristics such as living in poverty, experiencing significant daily stressors, and increased exposure to traumatic events are all identified as major contributors to anxiety disorders, additional sociocultural influences such as gender and discrimination have also received great attention, particularly because due to the epidemiological nature of the disorder. Other countries have a very strict idea and practice in shaping their discipline. In Japan, they have this syndrome called taijin kyo-fusho which is the fear of interpersonal relations. The Japanese people have this intense embarrassment of one’s body in relation to the eyes of others. On the other hand, in Western Greenland, they have kayak-angst, which is a disorder that is similar to panic disorder. These two cultures that reflect practices that resemble mental illnesses are not even considered as such. See how culture can shape one’s personality and how they can influence the possibility of developing anxiety? KEY TERMS 

Etiology is the study of origins; has something to do with why a disorder begins (what causes it) and includes 3 dimensions: biological, psychological, and social.



Diagnostic Criteria are a set of signs, symptoms, and tests developed for use in routine clinical care to guide the care of individual patients.



Comorbidity refers to the presence of more than one disorder in the same person.



Treatments are medical care given to a patient for a disorder. 4

Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES - SANTA ROSA CAMPUS PSYC 30093 Abnormal Psychology

I. Generalized Anxiety Disorder (GAD) It is a disorder characterized by underlying excessive worry related to a wide extend of events or activities. People with GAD experience worry of a greater intensity and for longer periods of times than the average person. They are often unable to control their worry through various coping strategies, which directly interferes with their ability to engage in daily social and occupational tasks

Etiology Numerous twin studies have found that genetic factors are influential in the transmission of anxiety disorders, especially those that involve the experience of panic attacks (Hettema, Prescott, Myers, Neale, & Kendler, 2005). The information demonstrate that GAD is to some degree less heritable than other shapes of anxiety. Studies of the distribution of mental disorders in families moreover propose that the etiology of some anxiety and depression forms may be related.

Diagnostic Criteria for Generalized Anxiety Disorder A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months about a number of events or activities (such as work or school performance). B. The individual finds it difficult to control the worry. C. The anxiety and worry are associated with at least three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months) [Note: Only one item is required in children]: 1. Restlessness or feeling keyed up or on edge 2. Being easily fatigued. 3. Difficulty concentrating or mind going blank 4. Irritability 5. Muscle tension 6. Sleep disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep) D. The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism). 5

Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES - SANTA ROSA CAMPUS PSYC 30093 Abnormal Psychology

F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder). Comorbidity There is a high comorbidity between generalized anxiety disorder and the other anxiety related disorders, as well as major depressive disorder, proposing they all share common organic and mental vulnerabilities.

Treatments 1. Psychopharmacology - Benzodiazepines, a class of sedative-hypnotic drugs originally replaced barbiturates as the leading anti-anxiety medication due to their less addictive nature, yet equally effective ability to calm individuals at low dosages. 2. Rational-Emotive Therapy - The goal of rational emotive therapy is to identify irrational, selfdefeating assumptions, challenge the rationality of those assumptions, and to replace them with new more productive thoughts and feelings. 3. Cognitive Behavioral Therapy – the goal is a combination of cognitive and behavioral strategies aimed to identify and restructure maladaptive thoughts while also providing opportunities to utilize these more effective thought patterns through exposure-based experiences. 4. Biofeedback - provides a visual representation of a patient’s physiological arousal. To achieve this, a patient is connected to a computer that provides continuous information of their physiological states.

GAD: Clinical Case Joe, a 24-year-old mechanic, had been referred for psychotherapy by his physician, whom he had consulted because of difficulty falling asleep. He was visibly distressed during the entire initial interview, gulping before he spoke and continually fidgeting in his chair. Although he described his physical concerns first, a picture of pervasive anxiety soon emerged. He reported that he nearly always felt tense. He seemed to worry about everything. He was apprehensive of disasters that could befall him as he interacted with other people and worked, and he described worrying much of the time about his finances, his inability to establish a romantic relationship, and other issues. He reported a long history of difficulties relating to others, which had led to his being fired from several jobs. As he put it, “I really like people and try to get along with them, but it seems like I fly off the handle too easily. Little things upset me too much. I just can’t cope 6

Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES - SANTA ROSA CAMPUS PSYC 30093 Abnormal Psychology

unless everything is going exactly right.” Joe reported that he had always felt more nervous than other people but that his anxiety had become much worse after a romantic breakup 1 year ago (Kring et al., 2012).

II. Specific Phobia An individual’s fear or anxiety particular to a situation or object. The amount of fear or anxiety related to the specific object or situation varies related to proximity. Immediate fear is present when people are face-to-face with their specific phobia. These fears are more excessive and persistent than a “normal” fear, frequently affecting one’s everyday life (APA, 2013).

Etiology Psychological – Behavioral. The behavioral explanation for the development of anxiety disorders is largely reserved for specific and social phobias. The exact cause of specific phobias is not known, but most appear to be associated with a traumatic experience or a learned reaction.

Diagnostic Criteria for Specific Phobia A. Marked fear or anxiety about a specific object or situation. B. The phobic object or situation almost always provokes immediate fear or anxiety. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging. C. The phobic object or situation is actively avoided or endured with intense fear or anxiety. D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation, and to the sociocultural context. E. The fear, anxiety or avoidance is persistent F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning. G. The disturbance is not better explained by the symptoms of another mental disorder , including fear, anxiety and avoidance of: situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder). Specify type: 1. Animal 2. Natural environment (e.g., heights, storms, and water) 7

Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES - SANTA ROSA CAMPUS PSYC 30093 Abnormal Psychology

3. Blood–injection–injury 4. Situational (e.g., planes, elevators, or enclosed places) 5. Other (e.g., phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness; or in children, avoidance of loud sounds or costumed characters) Comorbidity Seeing as the onset of specific phobias occurs at a younger age than most other anxiety disorders, it is generally the primary diagnosis with the occasional generalized anxiety disorder comorbid diagnosis. Children/teens diagnosed with a specific phobia are at an increased risk for additional psychopathology later in life such as other anxiety disorders, depressive disorders, substance related disorders and somatic symptom disorders.

Treatments 1. Exposure Treatments - An individual is exposed to their feared stimuli. This can be done in several different approaches: systematic desensitization, flooding, and modeling.

Specific Phobia: Clinical Case Jan was a 42-year-old woman who was offered a high-paying job in Florida. She was considering turning the position down because it would force her to live in an area known for having snakes. Before making this decision, she decided to see a therapist. During her first meeting with the therapist, she described a litany of ways she had avoided any contact with anything remotely resembling a snake. She had steered clear of outdoor activities, TV programs on nature, and even her children’s books on nature. Although she had been able to cope with her fears without too many negative consequences so far, the idea of living in an area with snakes had greatly increased her apprehension. Aside from her phobia, Jan reported that she had always been a bit of a nervous person, and in that way, she was like her mother (Kring et al., 2012).

III. Agoraphobia It is defined as an intense fear triggered by a wide range of situations. Its fears are related to situations in which the individual is in public situations where escape may be difficult. In order to receive a diagnosis of agoraphobia, there must be a presence of fear in at least two of the following situations: using public transportation; being in large, open spaces; being in enclosed spaces; being in a large crowd; or being outside of the home in general (APA, 2013).

8

Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES - SANTA ROSA CAMPUS PSYC 30093 Abnormal Psychology

People with agoraphobia often have a hard time feeling safe in any public place. One may feel that they need a companion to go with them to public places. The fear can be so overwhelming that one may feel unable to leave their home. When an individual is in such situations, they experience significant fear, often reporting panic-like symptoms. The fear and anxiety related symptoms are present every time the individual is presented with these situations. Should symptoms only occur occasionally, a diagnosis of agoraphobia is not warranted. Etiology The anxiety is caused by fear that there's no easy way to escape or get help if the anxiety intensifies. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack and avoid places where it may happen again.

Diagnostic Criteria for Agoraphobia A. Marked fear or anxiety about two or more of the following five situations: Public transportation, open spaces, enclosed places, standing in line or being in a crowd, being outside the home alone. B. The individual fears or avoids these situations due to thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly, fear of incontinence). C. The agoraphobic situations almost always provoke fear or anxiety. D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations, and to the sociocultural context. F. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more. G. The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning. H. If another medical condition is present (e.g., inflammatory bowel disease, Parkinson’s disease) is present, the fear, anxiety or avoidance is clearly excessive. I. The fear, anxiety or avoidance is not better explained by the symptoms of another mental disorder, e.g., the symptoms are not confined to specific phobia, situational t...