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Anxiety and Related Disorder s How do we identify and treat anxiety disorders?
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Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Dec 19, 2015

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Page 1: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Anxiety and Related Disorders

How do we identify and treat anxiety disorders?

Page 2: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Anxiety Disorders• Affects 2–5% of the child population.• Affects 20–30% of students referred to

clinics for behavior problems.• Equal prevalence in boys and girls.• Have both social and biological causes.• Appear amenable to social learning

approaches.

Page 3: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Interventions for School Phobia• Desensitize the child’s fear by role

playing.• Reinforce school attendance, even for

brief periods.• Include matter-of-fact parental

statements that child will go back to school.

• Remove reinforcers for staying home.

Page 4: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Obsessive Compulsive

Disorder

Dr. Aubrey H. Fine

Page 5: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Obsessive Compulsive Disorder• OCD may include:

– Washing, checking, or other repetitive motor behavior

– Cognitive compulsions consisting of words, phrases, prayers, or sequences of numbers

– Obsessional slowness– Doubts and questions that elevate

anxiety

Page 6: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Facts and Figures• Prevalence

– Originally believed to be rare• >0.1%

– Recent evidence suggests 1-3% Onset / Characteristics:

– Males:, high prevalence of checking– Females:, high prevalence of washing

Page 7: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

OCD Diagnosis (1): DSM IV• Obsessions defined by all of the following:

– Recurrent and persistent thoughts, impulses or images experience at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.

– The thoughts/impulses/images are not simply excessive worries about real life problems.

– The person attempts to ignore or suppress such thoughts/impulses/images, or neutralize them with some other thought or action.

– The person recognizes that the obsessional thoughts/impulses/images are a product of their own mind (not imposed from without).

Page 8: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

OCD Diagnosis (2): DSM IV• Compulsions defined by:

– Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules which must be applied rigidly

– The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

• Not better accounted for by other diagnosis

Page 9: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

What is an Obsession?

• Involuntary intrusive cognition

• Types

• Doubts (74%)

• Thinking (34%)

• Fears (26%)

• Impulses (17%)

• Images (7%)

• Other (2%)

Page 10: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Examples of Obsessions• Doubt “Did I lock the door”• Thought that he had cancer• Thought / Image that he had

knocked someone down in his car• Impulse + thought to shout

obscenities in church• Image of corpse rotting away• Impulse to drink from inkpot and to

strangle son

Page 11: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Themes in Obsessions• Obsessions often have common themes

– Contamination, dirt, disease, illness (46%)– Violence and aggression (29%)– Moral and religious topics (11%)– Symmetry and sequence (27%)– Sex (10%)– Other (22%)

• The themes often reflect contemporary concerns (the devil, germs, AIDS)

Page 12: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Examples of Compulsions• Scanning text for “life” having read

“death”

• Touching the ground after swallowing saliva

• Driving back to check he hadn’t knocked someone down in his car

• Counting 6,5,8,3,7,4 in your head

• Hand washing

Page 13: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Linking Obsessions and Compulsions

Page 14: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

OCD and “Normal” Experience• Obsessional thoughts found in 90% of

people– It is well replicated that 80%+ of normal people

have intrusive thoughts– There thoughts are similar in content and form

to OCD patients

• Compulsions– Many people have compulsions such as

stereotyped or superstitious behaviors– 66% of normal people report some form of

checking behavior

• Is OCD qualitatively distinct?

Page 15: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

OCD Experiences OCD Not OCD

A man who washes his hands 100 times a day until they are

red and raw

A woman who unfailingly washer her hands before

every meal

A women who locks and relocks her door before going to work every day – for half an hour

A woman who double-checks that her apartment

door and windows are locked each night before

she goes to bed.

A college student who must tap on the door frame of every classroom 14 times before

entering

A musician who practices a difficult passage over and over again until its perfect

A man who stores 19 years of newspapers “just in case” – with no system for filling or retrieving

A woman who dedicates all her spare time and money

to building her record collection

Page 16: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Cognitive Aspects of OCD• Responsibility for harm to self/others

– Any influence over outcome = responsibility for outcome

– Omission: “I will omit to do something that leads to myself/others being hurt”

– Magical thinking• Thought Action Fusion

– Thought = action “I will harm my child”• Obsessions = “going crazy”• Control: “Trying to hard”

– Suppression: “white bears”– Pre-Occupation: “Looking for trouble”

Page 17: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

OCD: Therapy • Exposure and Response Prevention (ERP)• Responsibility

– Am I a murderer or just worried about being one?

– Normalizing / Other explanations

• Thought = action– Can I think myself to death?

• Neutralizing– Experiment to show how thought suppression

increases thought frequency

• Exposure: Cued Intrusions

Page 18: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Key Issues• What are the strengths and limitations of

behavioral models of OCD?– Think about the empirical findings of current

psychological models such as Salkovskis’

• Have cognitive models of obsessions and compulsions helped us understand OCD and how it should be treated?

• How are intrusive thoughts in OCD different from “normal” intrusive thoughts?– Are they different at all?

Page 19: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Posttraumatic Stress Disorder• Repeatedly perceived memories of the

trauma.• Repetitive behaviors that may be

similar to obsessions or compulsions.• Fears linked to the traumatic event.• Altered attitudes toward people, life, or

the future, reflecting feelings of vulnerability.

Page 20: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Stereotyped Movement Disorders• Involuntary, repetitious, persistent,

nonfunctional acts over which the individual can exert at least some voluntary control.

• Self-stimulation• Self-injury• Tics• Tourette’s syndrome

Page 21: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Selective Mutism• Children who are reluctant to speak although

they know how to converse normally.• May be a response to:

– Trauma – Abuse– Social Anxiety

• Most effective interventions incorporate social learning principles.

Page 22: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Eating Disorders

• Anorexia

• Bulimia

• Pica

• Rumination

• Highly exclusive food preferences

• Obesity

Page 23: Anxiety and Related Disorders How do we identify and treat anxiety disorders?

Elimination Disorders

• Enuresis

• Encopresis