Anxiety and OCD

• universal human experience and is the most basic of emotions 
• apprehension ,uneasiness, uncertainty, dread resulting from a real or perceived threat
• felt at a deep level 
• invades personality
• erodes self esteem
• erodes personal self worth

dysfunctional as defense against it

reaction to a specific danger

dread r/t an unknown danger 

body reacts the same way in fear or anxiety

• healthy reaction necessary for survival 
• provides energy needed to carry out the tasks involved in living and striving toward goals

• prompts constructive behavior..
• studying for exam
• being on time for job interview
• preparing for a presentation
• job promotion

on the most important concepts and developed a model that consists of four levels: mild, moderate, severe, panic

• NOT distinct
• behaviors/characteristics often overlap

interventions are based on the degree of anxiety

normal experience of everyday living and allows an individual to perceive reality in sharp focus

sees, hears, and grasps more info and problem solving becomes more effective

• slight discomfort
• restlessness
• irritability
• mild tension relieving behavior (nail biting, foot tapping, fidgeting)

• sees, hears, and grasps less info and may have 
• Selective attention: only certain things in environment are seen or heard unless they are pointed out

• thinking clearly is hampered
• learning and problem solving still occur but not at optimal level

symptoms: tension, pounding heart, increased pulse and resp., perspiration, and mild somatic symptoms (gastric distress, ha, urinary urgency) voice tremors, shaking

constructive: may signal that something needs attention or is dangerous

focus on one particular detail or many scattered details and have difficulty noticing what is going on in environment, even when another points  it out

severe panic level

HA, nausea, dizziness insomnia, trembling, pounding HR, hyperventilation, impending doom or dread

• most extreme level of anxiety and results in marked disturbed behavior 
• unable to process what is going on in evironment 
• lose touch with reality
• pacing, running, shouting, screaming, or withdrawal

panic level of anxiety

exhausation

Freud and his daughter Anna

automatic coping styles that protect people from anxiety and maintain self image by blocking feelings, conflicts, memories

occurs when one or several are used in excess particularly in the overuse of immature defenses

• sublimation 
• altruism

cardiovascular system related disorders

• devised a scale that is based on inventory symptoms 
• each symptom is number rated and the total score assists in assessing whether the individual is experiencing mild, moderate, severe, panic

*always remember to assess for medical conditions/substance/medication use

• counterbalance perceived deficiencies by emphasizing strengths 
• Adaptive: Shorter-than-avg man becomes assertively verbal and excels in business 
• Maladaptive: person drinks alcohol when self-esteem is low to temporarly diffuse discomfort

• unconscious transformation of anxiety into a physical symptom with no organic cause
• Adaptive: no example, ALWAYS pathological
• Maladaptive: Man becomes blind after seeing his wife flirt with other men

• escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their excistence
• Adaptive: Man reacts to death of loved one by saying "No i don't believe you" to initially protect himself from the news
• Maladaptive: Woman who husband died 3 years earlier still keeps his clothes in closet and talks about him in the present tense

• transference of emotions associated with particular person, object, or situation to another nonthreatening person, object, situation
• Adaptive: child yells at his teddy bear after being picked on by the school bully
• Maladaptive: Child who is unable to acknowledge fear of his father becomes fearful of animals

• disruption in consciousness, memory, idenity, perception of the environment that results in compartmentalizing uncomfortable aspects of oneself
• Adaptive: art student is able to mentally separate herself from noisy environment as she becomes absorbed in her work
• Maladaptive: result of abuse childhood and need to separate from its realities, a women finds herself perpetually disconnected from reality

• attributing oneself the characteristics of another person or group (con. or uncon.)
• Adaptive: 8yr girl dresses up like her teacher and puts together a pretend classroom
• Maladaptive: young boy thinks neighborhood pimp is someone to look up to

• process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the process
• Adaptive: man lost farm in tornado, he analyzes his options to lead his child to safety
• Maladaptive: man repsonds to death of his wife by focusing on details of day care and operating household rather than processing grief with his children

• unconscious rejection of emotionally unacceptable features and attributing them to others
• Adaptive: no example, immature defense
• Maladaptive: women who has repressed an attraction toward other women refuses to socialize. She fears another woman will make homosexual advances towards her

• justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener
• Adaptive: an employee says "i didn't get a raise because my boss doesn't like me"
• Maladaptive: a man who thinks his son was fathered by another man excuses his malicious treatment of the boy by saying"he is lazy and disobedient." when that is not the case

• unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior/emotion
• Adaptive: recovering alcoholic constantly talks above the evils of drinking
• Malapative: women who has an unconscious hostility toward her daughter is overprotective and hovers over her to protect her from harm, interfering with her normal growth

• revering to an earlier more primitive and childlike pattern of behavior that may or may have no been previously exhibited
• Adaptive: 4 yr old boy with a new baby brother temporarily starts sucking thumb and wanting bottle
• Maladaptive: man who loses a promotion starts complaining to toehrs, hands in sloppy work, misses apts., comes in late

• unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness
• Adaptive: man forgets wife's bday after a marital fight
• Malaptive: women is unable to enjoy sex after having pushed out of awareness a traumatic sexaul incidne t in childhood

• inabilyt to integrate the postive and negative qulaities of oneself or others into a cohesive image
• Adaptive: no ex, always pathological
• Malaptive: 26 yr old woman initially values her acquitances yet invaribly becomes disillusioned when they turn out to have flaws

• unconscious process of substituting mature and socially acceptable activity for immature and unacceptable impulses 
• Adaptive: women woh is angry with boss writes a short story about a heroic woman
• Malapative: always constructive!

• conscious denial of a disturbing situation or feeling 
• Adapative: a busiessness man who is preparing to make an important speech is todl by his wife that morning she wants a divorce, although he is upset.. he puts incident aside until after speech, when he can give matter more concentration
• Malaptive: women who feels lumps in her breast shorlty before leaving for 3 week vacation puts info in the back of her mind until after returning

• most common seen in children
• when a person makes up for an act or communication
• Adaptive: after flirting with her male secretary, a woman brings her husband tickets to a concert he wants to see
• Maladaptive: a man with rigid, moralistic beliefs and repressed sexuality is driven to wash is hands to gain composure when around attractive women

• dealing with anxiety by reaching out to others
• example: a nurse who lost a family member in a fire is a volunteer firefighter

• dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression
• example: a person who has feelings of anger toward boss, workouts out on his lunch break

• voluntarily denying unpleasant thoughts or feelings
• example: a person who lost his jobs states he will worry about his bills next week

• putting unacceptable ideas, thoughts, and emotions out of conscious awareness
• example: a person who has a fear of the dentist's drill continually "forgets" his dental appt

• developmentally inappropriate levels of concern over being away from a signficant other
• may think something horrible will happen to them
• diagnosed prior to 18 after about a month of symptoms

panic attacks.. Waaalaa!

sudden onset of extreme apprehension or fear, usually associated with feelings of impending doom

• palpitations
• chest pain
• breathing difficulty
• nausea
• feelings of choking
• chills
• hot flashes

• unpredicitability 
• out of nowhere lasts 10 min
• less able to articulate the psychological aspects, such as fear
• avoid situations
• hopelessness
• depression
• alcohol/substance abuse not uncommon

"fear the fear"

intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarassing or in which help might not be available

• being alone outside
• being alone at home
• traveling in car, bus, plane
• being on bridge
• riding elevator

persistent, irrational fear of a specific object, activity, or situation that leads to a desire for avoidance, or actual avoidance of the object, activity or situation

• severe anxiety or fear provoked by exposure to a social or a performance situation tha tcould be evaluated negatively by others
• *most common manifestation: public speaking

• excessive worry
• restless, irritable, muscle tension
• decision making difficult
• poor concentration
• put things off 
• avoidance
• sleep disturbance
• fatigue

symptoms of anxiety, panic attacks, obsessions, and compulsions with the use of substances

symptoms are a direct physiological result of medical condition

thoughts, impulses, or images that persist and recut, so that they cannot be dismissed from the mind even though the individual attempts to do so

rituatiualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety or prevent an imagined calamity

continuum

symptoms that occur on a daily basis and may involve issues of sexuality, violence, contamination, illness, or death

• "what evidence do you have?"
• "Explain that logic to me"
• "are you basing that conclusion on fact or feeling?"
• "what the worst thing that could happen?"

• normal appearance usually but preoccupied with an imagined defective body part results in obsessional thinking and compulsive behavior 
• mirror checking.. camouflaging..
• keep a secret
• don't respond to reassurance
• specify if muscle dysmorhia

• specify if excessive acquisition
• women more likely
• however men don't seek treatment

• hair pulling
• one of oldest recorded psych. problems 
• more often in kids 
• etiology r/t cutting..

skin picking

• more common in children
• may begin as early as 1 yr old

• swallowing hair
• can be fatal
• aka Rapunzel syndrome

example: drug to treat movement in Parkinson's = obsession with gambling, urges for sex, and out of control spending

determine whether symptoms are due to a medical condition, CAREFUL AND COMPREHENSIVE ASSESSMENT OF MULTIPLE FACTORS

21.5 years old

19

50%

amygdala

tremble severely

will likely have a sibling with it too

fear of dying

short-acting benzodiazepine

• substance abuse..
• way of coping

limit caffeine

sleep disturbance r/t excessive rituals

• normal from 18 mon
• peaking at 18 mon then declines
• symptoms: sleep problems, nightmares, GI upset, HA

• worry!! out of proportion
• anticatory, fear the worse
• tense, restless, irritable
• poor concentration, fear making decision
• wear people out, need reassurance!!
• sleep disturbance, fatigue!

• described over a century ago
• may see them in psych facility, plastic surgery
• thoughts may be secretive

• physiological
• postencephalatic syndrome
• postanoxic event
• traumatic brain injury
• Huntingtons
• seizures
• cerebral infarctions

• depression..
• anxiety symptoms comes first
• genetics/neurobio role

stores memories with emotional significance and have been implicated in phobic responses such as fears/snacks/heights

• anxiety-related responses
• regulate anxiety: E, NE, dopamine,serotonin, and GABA

• puts break on excitatory neurotransmitters
• common focus pharmacologically for anxiety
• benzodiazepine facilitates its action

• children develop OCD after strep infection
• *compulsive behavior and eating disorder have been known to develop after suffering from this bacterial infection

development of anxiety disorders suggest that unconscious childhood conflicts are the basis for future symptom development

unconscious mind into the conscious mind

• when early needs go unmet or disapproval is experienced (interpersonal theory)
• thinks its contagious
• felt early in life

suggest that anxiety is a learned response to specific environmental stimuli (classical conditioning)

boy who is anxious in the presence of his abusive mother, he then generalizes this anxiety as a response to all women

anxiety disorders are caused by distortions in an individual's thoughts and perceptions.

choking, smothering, numbness, tingling, fear of dying

fear of magic/witchcraft

individual's blushing, eye contact, or body odor is offensive to others

Hamilton Rating Scale  for Anxiety waalaa!

small, attainable steps

• Mild: 14-17
• Moderate: 18-24
• Severe: 25-30

• 1. primary or secondary?
• 2. what level?
• 3. asses for self-harm 
• 4. perform psychosocial assessment

• can't solve problems
• use firm, short, simple statements

NO!

• Duloxetine (Cymbalta):GAD
• Venlafaxine (Effexor): several anxiety disorders

• quick onset of action
• short periods, until meds/treatment reduce symptoms
• s.e.: sedation, ataxia, decrease cognitive
• don't give to: substance abusers, pregnant, breastfeeding

• no alcohol, caffeine (decreases effects)
• unsafe to handle machinery
• take with or shortly after meals to reduce GI upset

• antacids: delay absorption
• Cirmetidine: interferes with benzo metabolism, increased sedation
• alcohol/barbiturates: increase sedation
• serum phenytonin: may build up because of decreased metabolism

• doesn't cause dependence
• 2-4 weeks for required effect
• may be used longterm

• antibiotic used to treat TB
• helps patients unlearn fear responses

• south american plant used as sedative with antianxiety effects
• liver damage risk**
• especially with alcohol or other CNS depressants

• identify automatic negative beliefs that cause anxiety
• explore the basis for these thoughts 
• reevaluate the situation realistically 
• replace negative self-talk with supportive ideas