Posted: September 18th, 2022

Psychology of Abnormal Behavior Please view Family Secrets: Battling OCD video. What is your reactions to the video? What did you learn about obsessive compulsive disorder? Who in the video did you find most interesting and why? https://abcnews.go.c

Kearney_3e_PPT_Ch05.pptxKearney_3e_PPT_Ch05.pptx
 

Psychology of Abnormal Behavior 

Please view Family Secrets: Battling OCD video.

What is your reactions to the video? What did you learn about obsessive compulsive disorder? Who in the video did you find most interesting and why?

https://abcnews.go.com/2020/video/family-secrets-full-episode-battling-ocd-21008984

At least 275 words response.

     

Anxiety,

Obsessive Compulsive,

and

Trauma Related

Disorders

: Features and Epidemiology

Anxiety, Obsessive Compulsive, and Trauma Related Disorders: Causes and Prevention

Anxiety, Obsessive Compulsive, and Trauma Related Disorders: Assessment and Treatment

Stigma Associated with Anxiety, Obsessive Compulsive, and Trauma Related Disorders:

Worry, Anxiety, Fear and Anxiety; Obsessive-Compulsive; and

Trauma-Related

Disorders: What are They

Anxiety,

Obsessive-Compulsive,

and
Trauma-Related
Disorders

Anxiety disorders involve excessive worry, anxiety, or fear.

Jeanette (jg) – Change this chapter title??
Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
Introduction
Anxiety
An emotional state that occurs as a threatening event draws close
Three key elements
Physical feelings
Thoughts
Behaviors
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Worry is a largely cognitive or “thinking” concept that refers to concerns about possible future threat.

Anxiety is an emotional state that occurs as a threatening event draws close.

Fear is an intense emotional state that occurs as a threat is imminent or actually occurring.

Worry, anxiety, and fear may even become severe and create enormous trouble for a person—this could be an anxiety, obsessive-compulsive, or trauma-related disorder (we sometimes refer to these collectively as anxiety-related disorders in this chapter).

DSM-5: Panic Attack

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

1
2
Intense physical feelings such as heart racing, sweating, and dizziness
Thoughts that one will lose control, go crazy, or die
Panic Attack

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) separated the anxiety-related disorders into smaller diagnostic groups labeled anxiety, obsessive-compulsive, and trauma- and stressor-related disorders.

Anxiety is composed of three parts: physical feelings, thoughts, and behaviors.

Panic attacks involve (1) intense physical feelings such as heart racing, sweating, and dizziness, and (2) thoughts that one will lose control, go crazy, or die. Panic attacks may be uncued, situationally predisposed, or situationally bound.

Jeanette (jg) – Is “Anxiety Disorders” okay in the footer as the name for the chapter?

Panic Attack (cont’d.)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Panic Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Agoraphobia

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Agoraphobia refers to anxiety about being in places where panic symptoms may occur, especially places where escape might be difficult. Agoraphobia also refers to avoiding those places or enduring them with great anxiety or dread.

Social Phobia

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Social phobia refers to intense and ongoing fear of potentially embarrassing situations in the form of situationally bound panic attacks.

A diagnosis of social phobia involves the DSM-5 criteria in Table 5.4 (APA, 2013) shown here.

DSM-5: Specific Phobia

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?
Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Specific Phobia

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Specific phobia refers to excessive, unreasonable fear of an object or situation.

DSM-5: Generalized Anxiety Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?
Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Generalized Anxiety Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Generalized anxiety disorder refers to extreme levels of persistent, uncontrollable worry that is not in proportion to the situation or problem. For adults, at least three of these six symptoms listed here must be present more days than not for the past six months. As you can see, this list does NOT include panic attacks. This is something that distinguishes Generalized Anxiety Disorder from phobia—it is far more of a cognitive experience, and the physical and behavioral aspects in this disorder are less noticeable and pronounced than in panic disorder or any phobia.

DSM-5: Obsessive-Compulsive Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?
Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Many people with obsessive-compulsive disorder will perform certain rituals more than usual, such as this woman, who trims her grass with a pair of scissors several hours every day.

Obsessive-Compulsive Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Obsessive-compulsive disorder refers to the presence of obsessions, or troublesome and recurring thoughts, and compulsions, or physical or mental acts performed in response to an obsession to lessen distress.
Some related disorders to OCD include body dysmorphic disorder, hoarding disorder, trichotillomania (hair pulling), and excoriation disorder (skin picking). Body dysmorphic disorder involves preoccupation with a perceived defect on one’s body manifested in constant checking, grooming, and perhaps even plastic surgeries.

Obsessions
Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted

Compulsions
Repetitive behaviors (e.g., hand washing) or mental acts (e.g., repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
With or Without
Obsessive-Compulsive Disorder (cont’d.)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Obsessive-compulsive disorder involves (1) obsessions, or troublesome thoughts, impulses, or images, and/or (2) compulsions, or ritualistic acts done repeatedly to reduce anxiety from the obsessions.

DSM-5: Body Dysmorphic Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

A diagnosis of body dysmorphic disorder involves the DSM -5 criteria in Table 5.8 (APA, 2013) as shown here.
16

DSM-5: Posttraumatic Stress Disorder (Part 1)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Posttraumatic Stress Disorder (Part 2)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Posttraumatic Stress Disorder (Part 3)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Posttraumatic Stress Disorder for Children (Part 1)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Posttraumatic Stress Disorder for Children (Part 2)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Posttraumatic Stress Disorder for Children (Part 3)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

People react in the aftermath of the Paris attacks. Trauma from events such as terrorism can cause posttraumatic stress disorder in some people.

Posttraumatic Stress Disorder and Acute Stress Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Posttraumatic stress disorder refers to constant reexperiencing of a traumatic event through images, memories, nightmares, flashbacks, illusions, or other ways.

Acute stress disorder refers to short-term anxiety and dissociative symptoms following a trauma.

Posttraumatic Stress Disorder
A traumatic event involves actual or threatened death, serious injury or sexual violence in one (or more) of the following ways
Directly experiencing the event
Witnessing the event
Learning that an event occurred to a close friend or family member
Repeated exposure to details of traumatic events (e.g., police officers, first responders)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Posttraumatic stress disorder refers to constant reexperiencing of a traumatic event through images, memories, nightmares, flashbacks, illusions, or other ways.

Acute stress disorder refers to short-term anxiety and dissociative symptoms following a trauma.

Intrusion
Effortful
avoidance
Changes in
cognition
and mood
Arousal or
anxiety
Four clusters of symptoms
Categories of Posttraumatic Stress Disorder Symptoms

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Posttraumatic stress disorder refers to constant reexperiencing of a traumatic event through images, memories, nightmares, flashbacks, illusions, or other ways.

Acute stress disorder refers to short-term anxiety and dissociative symptoms following a trauma.

DSM-5: Acute Stress Disorder (Part 1)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Acute Stress Disorder (Part 2)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Acute Stress Disorder (Part 3)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Acute Stress Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Presence of nine (or more) of symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred is identified with acute stress disorder. Refer to Table 5.10.

Intrusion Symptoms

Dissociative Symptoms

Avoidance Symptoms

Negative Mood

Arousal Symptoms

Posttraumatic Stress Disorder vs. Acute Stress Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Posttraumatic stress disorder refers to constant reexperiencing of a traumatic event through images, memories, nightmares, flashbacks, illusions, or other ways.

Acute stress disorder refers to short-term anxiety and dissociative symptoms following a trauma.

DSM-5: Separation Anxiety Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Separation Anxiety Disorder and School Refusal Behavior

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Separation anxiety disorder refers to children with excessive worry about being away from home or from close family members. The disorder may be associated with school refusal behavior.

School refusal behavior may also occur for reasons besides separation anxiety, such as fear of a bully, anxiety about performance and testing situations at school, desire to stay with parents for attention, and tangible rewards like getting to stay home and play video games.

Epidemiology of Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Anxiety disorders are common to the general population and especially females. Many anxiety disorders develop at age 19-31 years. Anxiety disorders are often associated with other anxiety disorders, depression, and substance abuse.

Focus on College Students:
Trauma and PTSD

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Addressing Stigma
People with an anxiety-related disorder
May feel stigma or negative judgment from others
May be less likely to admit a problem or to seek treatment because of associated stigma
People sometimes have negative attitudes toward those with generalized anxiety disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Unfortunately, military personnel often avoid treatment for PTSD because of self-stigma. Greden and colleagues (2010) tried to address this issue by training “soldier peers” who encourage military personnel to enter treatment and then monitor adherence to treatment. A key aspect of this program is to convey the idea that seeking treatment is a sign of strength and to remove military cultural barriers such as stigma that prevent seeking treatment.

Biological Risk Factors for Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Figure 5.4 Key Brain Areas Implicated in the Anxiety-Related Disorders. © 2010 Plush Studios/Bill Reitzel/Jupiterimages Corporation

Several brain areas have been implicated in anxiety disorders, especially the amygdala and septal-hippocampal regions, which are associated with physical arousal, emotion, and memories surrounding fearful and anxiety provoking stimuli. Other brain areas are specific to certain anxiety disorders, such as the anterior cingulate in obsessive-compulsive disorder and the locus coeruleus in panic disorder.

Environmental Risk Factors for Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Anxiety may be influenced by evolutionary processes in that some avoidance behaviors seem adaptive in certain contexts.

Cognitive risk factors include distorted thinking about the dangerousness of various stimuli, assumptions that something bad will happen, assumptions of terrible consequences, and assumptions that others can easily notice one’s anxiety.

Fear of the potential
dangerousness of one’s
own internal sensations
such as dizziness and
increased heart rate.

What is anxiety sensitivity?
Anxiety Sensitivity

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Anxiety sensitivity refers to fear of the potential dangerousness of one’s own internal sensations such as dizziness and increased heart rate.

Family factors may contribute to anxiety disorders, especially overcontrolling, affectionless, overprotective, rejecting, and demanding parents. Parents may also model anxiety-based responses or induce anxiety by maltreating their children.

People can learn aspects of fear and anxiety through direct experience, information transfer, or reinforcement for fear of strangers or other stimuli.

Cultural factors influence the development of anxiety disorders, particularly in people more commonly exposed to neighborhood or mass traumas.

All of these risk factors work together as a person’s life unfolds to create the conditions in which an anxiety-related disorder can develop. Here is just one developmental pathway that illustrates this point.

Cognitive Distortions
Jumping to Conclusions
Catastrophizing
Emotional Reasoning
Environmental Risk Factors

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

People with anxiety-related disorders often have ongoing thoughts about potential or actual threat from external events. We mentioned that people with generalized anxiety disorder often scan their environment looking for threats or things to worry about.

Common cognitive distortions in people with anxiety- related disorders include jumping to conclusions, catastrophizing, and emotional reasoning. Someone who jumps to conclusions assumes something bad will happen or has happened despite lack of evidence to support this assumption. A person may wrongly assume that speaking before a small group will result in a poor performance. Similarly, someone may assume terrible but incorrect consequences will result from an event—this is catastrophizing. A person who makes mistakes in a speech may thus wrongly assume he will lose his job. A person may also assume her physical feelings reflect how things truly are—this is emotional reasoning. People who are nervous speaking before others, and who have strong physical feelings of anxiety, may wrongly assume everyone can tell how nervous they are.

Learning Experiences
Classical conditioning leads to pairing things from the trauma with fear/anxiety
Someone attacked in a park feels anxious in that park, or when they are near that park
Operant conditioning (i.e., negative reinforcement) maintains the fear
This person avoids the park or that part of town, and continues to be afraid of it

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

People can learn aspects of fear and anxiety through direct experience, information transfer, or reinforcement for fear of strangers or other stimuli.

Cultural factors influence the development of anxiety disorders, particularly in people more commonly exposed to neighborhood or mass traumas.

All of these risk factors work together as a person’s life unfolds to create the conditions in which an anxiety-related disorder can develop. Here is just one developmental pathway that illustrates this point.

Biological vulnerabilities/early predispositions: (Genetic contributions,
brain and neurochemical changes, behavioral inhibition
Causes of Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Family factors may contribute to anxiety disorders, especially overcontrolling, affectionless, overprotective, rejecting, and demanding parents. Parents may also model anxiety-based responses or induce anxiety by maltreating their children.

People can learn aspects of fear and anxiety through direct experience, information transfer, or reinforcement for fear of strangers or other stimuli.

Cultural factors influence the development of anxiety disorders, particularly in people more commonly exposed to neighborhood or mass traumas.

All of these risk factors work together as a person’s life unfolds to create the conditions in which an anxiety-related disorder can develop. Here is just one developmental pathway that illustrates this point.

Prevention of Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Biological and environmental risk factors can make a person vulnerable to anxiety disorder.

Preventing anxiety involves building ability to control situations that might lead to anxiety, education about dangerous and non-dangerous situations, changing negative thoughts, coping better with stress, and practicing skills in real-life situations.

Assessment of Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Interviews, self-report questionnaires, and observations are used to collect information about people with anxiety disorders because of the internal nature of the symptoms.

Physiological assessment of anxiety disorders can consist of determining heart rate, muscle tension, sweat gland activity, and other symptoms to measure their severity.

Medication (e.g., benzodiazepines, anti-depressants)
Pros

Quick relief from anxiety
Cons
Does not change root of
problem
Many side effects
High rate of relapse
Risk of substance abuse
and dependence
Biological Treatment of Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Effective treatment for anxiety disorders addresses unpleasant physical feelings, negative thoughts, and avoidant behaviors. Biological treatment for anxiety disorders includes medications such as benzodiazepines and antidepressants. This table shows you some of the common names for the drugs in these classes that might be prescribed for an anxiety-related disorder.

Psychological Treatments of Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Psychoeducation helps patients learn about the three main aspects of anxiety—the feelings of anxiety trigger unpleasant thoughts, and then finally behavioral avoidance.

Once a patient understands these, he or she can learn to manage those feelings more effectively through somatic control exercises. One common such exercise is relaxation training. A person in this training squeezes and releases different muscle groups until overall body relaxation occurs.

The table on this slide shows the wide range of possibilities using this treatment approach for many different anxiety-related disorders.

Cognitive Therapy
Examining the evidence
Hypothesis testing
Decatastrophizing

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Psychological treatments for people with anxiety disorders often begin with psychoeducation and somatic control exercises like relaxation training or breathing retraining.

Cognitive therapy can involve techniques such as examining the evidence, hypothesis testing, and decatastrophizing.

Exposure-Based Practices

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Exposure-based practices are important to help a person reduce anxious avoidance.

Exposure may be done quickly or more gradually through systematic desensitization.

Exposure for posttraumatic stress disorder can be supplemented as well with a technique known as eye movement desensitization and reprocessing (EMDR).

Exposure-based therapies are useful for all anxiety-related disorders. This is true even for obsessive-compulsive disorder, for which exposure and response (or ritual) prevention are often used (Zandberg et al., 2015).

Exposure-based practices are often integrated with other behavioral procedures such as modeling and biofeedback. Clients during biofeedback are attached to a device that gives them visual feedback about heart rate, respiration rate, or brain wave activity and then learn how to respond to these changes.

Mindfulness
A newer set of therapies that focus on:
Greater daily awareness and acceptance of one’s symptoms and how the symptoms can be experienced without severe avoidance or other impairment
How the anxiety can be “set aside” or how to allow thoughts to “pass through their body”

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Psychological treatments for people with anxiety disorders often begin with psychoeducation and somatic control exercises like relaxation training or breathing retraining.

Cognitive therapy can involve techniques such as examining the evidence, hypothesis testing, and decatastrophizing.

What If I Have Anxiety or an
Anxiety-Related Disorder?

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

People are often screened for anxiety-related disorders, and the answers to some basic questions may indicate whether further assessment or even treatment is warranted. Some of these questions are listed in Table 5.18. If you find yourself answering “yes” to most of these questions, then you may wish to consult a clinical psychologist, psychiatrist, or other mental health professional (see also Chapter 15). Cognitive-behavioral therapy and/or medication for your anxiety may be best.

If you feel you have unpleasant anxiety but not necessarily an anxiety-related disorder, then teaching yourself to relax,
changing your thoughts, and facing your fears may be best.

Long-Term Outcome for People with Anxiety Disorders
Factors predicting better treatment outcomes
Treatment compliance and completion
Longer treatment (especially exposure)
Better social skills and social support
Less severe trauma and anxiety symptoms
Fewer stressful life events

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Chapter Reflections
What would you say to a friend who might be very anxious?
What separates “normal” anxiety from “abnormal” anxiety?
What social mechanisms can help reduce anxiety in people?

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

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Anxiety,

Obsessive Compulsive,

and

Trauma Related

Disorders

: Features and Epidemiology

Anxiety, Obsessive Compulsive, and Trauma Related Disorders: Causes and Prevention

Anxiety, Obsessive Compulsive, and Trauma Related Disorders: Assessment and Treatment

Stigma Associated with Anxiety, Obsessive Compulsive, and Trauma Related Disorders:

Worry, Anxiety, Fear and Anxiety; Obsessive-Compulsive; and

Trauma-Related

Disorders: What are They

Anxiety,

Obsessive-Compulsive,

and
Trauma-Related
Disorders

Anxiety disorders involve excessive worry, anxiety, or fear.

Jeanette (jg) – Change this chapter title??
Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
Introduction
Anxiety
An emotional state that occurs as a threatening event draws close
Three key elements
Physical feelings
Thoughts
Behaviors
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Worry is a largely cognitive or “thinking” concept that refers to concerns about possible future threat.

Anxiety is an emotional state that occurs as a threatening event draws close.

Fear is an intense emotional state that occurs as a threat is imminent or actually occurring.

Worry, anxiety, and fear may even become severe and create enormous trouble for a person—this could be an anxiety, obsessive-compulsive, or trauma-related disorder (we sometimes refer to these collectively as anxiety-related disorders in this chapter).

DSM-5: Panic Attack

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

1
2
Intense physical feelings such as heart racing, sweating, and dizziness
Thoughts that one will lose control, go crazy, or die
Panic Attack

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) separated the anxiety-related disorders into smaller diagnostic groups labeled anxiety, obsessive-compulsive, and trauma- and stressor-related disorders.

Anxiety is composed of three parts: physical feelings, thoughts, and behaviors.

Panic attacks involve (1) intense physical feelings such as heart racing, sweating, and dizziness, and (2) thoughts that one will lose control, go crazy, or die. Panic attacks may be uncued, situationally predisposed, or situationally bound.

Jeanette (jg) – Is “Anxiety Disorders” okay in the footer as the name for the chapter?

Panic Attack (cont’d.)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Panic Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Agoraphobia

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Agoraphobia refers to anxiety about being in places where panic symptoms may occur, especially places where escape might be difficult. Agoraphobia also refers to avoiding those places or enduring them with great anxiety or dread.

Social Phobia

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Social phobia refers to intense and ongoing fear of potentially embarrassing situations in the form of situationally bound panic attacks.

A diagnosis of social phobia involves the DSM-5 criteria in Table 5.4 (APA, 2013) shown here.

DSM-5: Specific Phobia

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?
Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Specific Phobia

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Specific phobia refers to excessive, unreasonable fear of an object or situation.

DSM-5: Generalized Anxiety Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?
Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Generalized Anxiety Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Generalized anxiety disorder refers to extreme levels of persistent, uncontrollable worry that is not in proportion to the situation or problem. For adults, at least three of these six symptoms listed here must be present more days than not for the past six months. As you can see, this list does NOT include panic attacks. This is something that distinguishes Generalized Anxiety Disorder from phobia—it is far more of a cognitive experience, and the physical and behavioral aspects in this disorder are less noticeable and pronounced than in panic disorder or any phobia.

DSM-5: Obsessive-Compulsive Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?
Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Many people with obsessive-compulsive disorder will perform certain rituals more than usual, such as this woman, who trims her grass with a pair of scissors several hours every day.

Obsessive-Compulsive Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Obsessive-compulsive disorder refers to the presence of obsessions, or troublesome and recurring thoughts, and compulsions, or physical or mental acts performed in response to an obsession to lessen distress.
Some related disorders to OCD include body dysmorphic disorder, hoarding disorder, trichotillomania (hair pulling), and excoriation disorder (skin picking). Body dysmorphic disorder involves preoccupation with a perceived defect on one’s body manifested in constant checking, grooming, and perhaps even plastic surgeries.

Obsessions
Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted

Compulsions
Repetitive behaviors (e.g., hand washing) or mental acts (e.g., repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
With or Without
Obsessive-Compulsive Disorder (cont’d.)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Obsessive-compulsive disorder involves (1) obsessions, or troublesome thoughts, impulses, or images, and/or (2) compulsions, or ritualistic acts done repeatedly to reduce anxiety from the obsessions.

DSM-5: Body Dysmorphic Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

A diagnosis of body dysmorphic disorder involves the DSM -5 criteria in Table 5.8 (APA, 2013) as shown here.
16

DSM-5: Posttraumatic Stress Disorder (Part 1)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Posttraumatic Stress Disorder (Part 2)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Posttraumatic Stress Disorder (Part 3)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Posttraumatic Stress Disorder for Children (Part 1)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Posttraumatic Stress Disorder for Children (Part 2)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Posttraumatic Stress Disorder for Children (Part 3)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

People react in the aftermath of the Paris attacks. Trauma from events such as terrorism can cause posttraumatic stress disorder in some people.

Posttraumatic Stress Disorder and Acute Stress Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Posttraumatic stress disorder refers to constant reexperiencing of a traumatic event through images, memories, nightmares, flashbacks, illusions, or other ways.

Acute stress disorder refers to short-term anxiety and dissociative symptoms following a trauma.

Posttraumatic Stress Disorder
A traumatic event involves actual or threatened death, serious injury or sexual violence in one (or more) of the following ways
Directly experiencing the event
Witnessing the event
Learning that an event occurred to a close friend or family member
Repeated exposure to details of traumatic events (e.g., police officers, first responders)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Posttraumatic stress disorder refers to constant reexperiencing of a traumatic event through images, memories, nightmares, flashbacks, illusions, or other ways.

Acute stress disorder refers to short-term anxiety and dissociative symptoms following a trauma.

Intrusion
Effortful
avoidance
Changes in
cognition
and mood
Arousal or
anxiety
Four clusters of symptoms
Categories of Posttraumatic Stress Disorder Symptoms

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Posttraumatic stress disorder refers to constant reexperiencing of a traumatic event through images, memories, nightmares, flashbacks, illusions, or other ways.

Acute stress disorder refers to short-term anxiety and dissociative symptoms following a trauma.

DSM-5: Acute Stress Disorder (Part 1)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Acute Stress Disorder (Part 2)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

DSM-5: Acute Stress Disorder (Part 3)

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Acute Stress Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Presence of nine (or more) of symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred is identified with acute stress disorder. Refer to Table 5.10.

Intrusion Symptoms

Dissociative Symptoms

Avoidance Symptoms

Negative Mood

Arousal Symptoms

Posttraumatic Stress Disorder vs. Acute Stress Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Posttraumatic stress disorder refers to constant reexperiencing of a traumatic event through images, memories, nightmares, flashbacks, illusions, or other ways.

Acute stress disorder refers to short-term anxiety and dissociative symptoms following a trauma.

DSM-5: Separation Anxiety Disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Separation Anxiety Disorder and School Refusal Behavior

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Separation anxiety disorder refers to children with excessive worry about being away from home or from close family members. The disorder may be associated with school refusal behavior.

School refusal behavior may also occur for reasons besides separation anxiety, such as fear of a bully, anxiety about performance and testing situations at school, desire to stay with parents for attention, and tangible rewards like getting to stay home and play video games.

Epidemiology of Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Anxiety disorders are common to the general population and especially females. Many anxiety disorders develop at age 19-31 years. Anxiety disorders are often associated with other anxiety disorders, depression, and substance abuse.

Focus on College Students:
Trauma and PTSD

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Addressing Stigma
People with an anxiety-related disorder
May feel stigma or negative judgment from others
May be less likely to admit a problem or to seek treatment because of associated stigma
People sometimes have negative attitudes toward those with generalized anxiety disorder

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Unfortunately, military personnel often avoid treatment for PTSD because of self-stigma. Greden and colleagues (2010) tried to address this issue by training “soldier peers” who encourage military personnel to enter treatment and then monitor adherence to treatment. A key aspect of this program is to convey the idea that seeking treatment is a sign of strength and to remove military cultural barriers such as stigma that prevent seeking treatment.

Biological Risk Factors for Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Figure 5.4 Key Brain Areas Implicated in the Anxiety-Related Disorders. © 2010 Plush Studios/Bill Reitzel/Jupiterimages Corporation

Several brain areas have been implicated in anxiety disorders, especially the amygdala and septal-hippocampal regions, which are associated with physical arousal, emotion, and memories surrounding fearful and anxiety provoking stimuli. Other brain areas are specific to certain anxiety disorders, such as the anterior cingulate in obsessive-compulsive disorder and the locus coeruleus in panic disorder.

Environmental Risk Factors for Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Anxiety may be influenced by evolutionary processes in that some avoidance behaviors seem adaptive in certain contexts.

Cognitive risk factors include distorted thinking about the dangerousness of various stimuli, assumptions that something bad will happen, assumptions of terrible consequences, and assumptions that others can easily notice one’s anxiety.

Fear of the potential
dangerousness of one’s
own internal sensations
such as dizziness and
increased heart rate.

What is anxiety sensitivity?
Anxiety Sensitivity

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Anxiety sensitivity refers to fear of the potential dangerousness of one’s own internal sensations such as dizziness and increased heart rate.

Family factors may contribute to anxiety disorders, especially overcontrolling, affectionless, overprotective, rejecting, and demanding parents. Parents may also model anxiety-based responses or induce anxiety by maltreating their children.

People can learn aspects of fear and anxiety through direct experience, information transfer, or reinforcement for fear of strangers or other stimuli.

Cultural factors influence the development of anxiety disorders, particularly in people more commonly exposed to neighborhood or mass traumas.

All of these risk factors work together as a person’s life unfolds to create the conditions in which an anxiety-related disorder can develop. Here is just one developmental pathway that illustrates this point.

Cognitive Distortions
Jumping to Conclusions
Catastrophizing
Emotional Reasoning
Environmental Risk Factors

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

People with anxiety-related disorders often have ongoing thoughts about potential or actual threat from external events. We mentioned that people with generalized anxiety disorder often scan their environment looking for threats or things to worry about.

Common cognitive distortions in people with anxiety- related disorders include jumping to conclusions, catastrophizing, and emotional reasoning. Someone who jumps to conclusions assumes something bad will happen or has happened despite lack of evidence to support this assumption. A person may wrongly assume that speaking before a small group will result in a poor performance. Similarly, someone may assume terrible but incorrect consequences will result from an event—this is catastrophizing. A person who makes mistakes in a speech may thus wrongly assume he will lose his job. A person may also assume her physical feelings reflect how things truly are—this is emotional reasoning. People who are nervous speaking before others, and who have strong physical feelings of anxiety, may wrongly assume everyone can tell how nervous they are.

Learning Experiences
Classical conditioning leads to pairing things from the trauma with fear/anxiety
Someone attacked in a park feels anxious in that park, or when they are near that park
Operant conditioning (i.e., negative reinforcement) maintains the fear
This person avoids the park or that part of town, and continues to be afraid of it

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

People can learn aspects of fear and anxiety through direct experience, information transfer, or reinforcement for fear of strangers or other stimuli.

Cultural factors influence the development of anxiety disorders, particularly in people more commonly exposed to neighborhood or mass traumas.

All of these risk factors work together as a person’s life unfolds to create the conditions in which an anxiety-related disorder can develop. Here is just one developmental pathway that illustrates this point.

Biological vulnerabilities/early predispositions: (Genetic contributions,
brain and neurochemical changes, behavioral inhibition
Causes of Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Family factors may contribute to anxiety disorders, especially overcontrolling, affectionless, overprotective, rejecting, and demanding parents. Parents may also model anxiety-based responses or induce anxiety by maltreating their children.

People can learn aspects of fear and anxiety through direct experience, information transfer, or reinforcement for fear of strangers or other stimuli.

Cultural factors influence the development of anxiety disorders, particularly in people more commonly exposed to neighborhood or mass traumas.

All of these risk factors work together as a person’s life unfolds to create the conditions in which an anxiety-related disorder can develop. Here is just one developmental pathway that illustrates this point.

Prevention of Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
Causes and
Prevention
What Are They?

Assessment and
Treatment

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Biological and environmental risk factors can make a person vulnerable to anxiety disorder.

Preventing anxiety involves building ability to control situations that might lead to anxiety, education about dangerous and non-dangerous situations, changing negative thoughts, coping better with stress, and practicing skills in real-life situations.

Assessment of Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Interviews, self-report questionnaires, and observations are used to collect information about people with anxiety disorders because of the internal nature of the symptoms.

Physiological assessment of anxiety disorders can consist of determining heart rate, muscle tension, sweat gland activity, and other symptoms to measure their severity.

Medication (e.g., benzodiazepines, anti-depressants)
Pros

Quick relief from anxiety
Cons
Does not change root of
problem
Many side effects
High rate of relapse
Risk of substance abuse
and dependence
Biological Treatment of Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Effective treatment for anxiety disorders addresses unpleasant physical feelings, negative thoughts, and avoidant behaviors. Biological treatment for anxiety disorders includes medications such as benzodiazepines and antidepressants. This table shows you some of the common names for the drugs in these classes that might be prescribed for an anxiety-related disorder.

Psychological Treatments of Anxiety Disorders

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Psychoeducation helps patients learn about the three main aspects of anxiety—the feelings of anxiety trigger unpleasant thoughts, and then finally behavioral avoidance.

Once a patient understands these, he or she can learn to manage those feelings more effectively through somatic control exercises. One common such exercise is relaxation training. A person in this training squeezes and releases different muscle groups until overall body relaxation occurs.

The table on this slide shows the wide range of possibilities using this treatment approach for many different anxiety-related disorders.

Cognitive Therapy
Examining the evidence
Hypothesis testing
Decatastrophizing

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Psychological treatments for people with anxiety disorders often begin with psychoeducation and somatic control exercises like relaxation training or breathing retraining.

Cognitive therapy can involve techniques such as examining the evidence, hypothesis testing, and decatastrophizing.

Exposure-Based Practices

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Exposure-based practices are important to help a person reduce anxious avoidance.

Exposure may be done quickly or more gradually through systematic desensitization.

Exposure for posttraumatic stress disorder can be supplemented as well with a technique known as eye movement desensitization and reprocessing (EMDR).

Exposure-based therapies are useful for all anxiety-related disorders. This is true even for obsessive-compulsive disorder, for which exposure and response (or ritual) prevention are often used (Zandberg et al., 2015).

Exposure-based practices are often integrated with other behavioral procedures such as modeling and biofeedback. Clients during biofeedback are attached to a device that gives them visual feedback about heart rate, respiration rate, or brain wave activity and then learn how to respond to these changes.

Mindfulness
A newer set of therapies that focus on:
Greater daily awareness and acceptance of one’s symptoms and how the symptoms can be experienced without severe avoidance or other impairment
How the anxiety can be “set aside” or how to allow thoughts to “pass through their body”

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Psychological treatments for people with anxiety disorders often begin with psychoeducation and somatic control exercises like relaxation training or breathing retraining.

Cognitive therapy can involve techniques such as examining the evidence, hypothesis testing, and decatastrophizing.

What If I Have Anxiety or an
Anxiety-Related Disorder?

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

People are often screened for anxiety-related disorders, and the answers to some basic questions may indicate whether further assessment or even treatment is warranted. Some of these questions are listed in Table 5.18. If you find yourself answering “yes” to most of these questions, then you may wish to consult a clinical psychologist, psychiatrist, or other mental health professional (see also Chapter 15). Cognitive-behavioral therapy and/or medication for your anxiety may be best.

If you feel you have unpleasant anxiety but not necessarily an anxiety-related disorder, then teaching yourself to relax,
changing your thoughts, and facing your fears may be best.

Long-Term Outcome for People with Anxiety Disorders
Factors predicting better treatment outcomes
Treatment compliance and completion
Longer treatment (especially exposure)
Better social skills and social support
Less severe trauma and anxiety symptoms
Fewer stressful life events

Features and
Epidemiology
Stigma Associated
with Anxiety
Disorders
What Are They?
Assessment and
Treatment

Causes and
Prevention

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

Chapter Reflections
What would you say to a friend who might be very anxious?
What separates “normal” anxiety from “abnormal” anxiety?
What social mechanisms can help reduce anxiety in people?

Anxiety,
Obsessive-Compulsive,
and
Trauma-Related
Disorders

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