The Nature and Treatment of Anxiety Disorders Dr. Randi McCabe Associate Director, Anxiety Treatment & Research Centre St. Joseph’s Healthcare Assistant Professor, Department of Psychiatry & Behavioural Sciences, McMaster University McMaster Mini Med School
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The Nature and Treatment of Anxiety Disorders Dr. Randi McCabe Associate Director, Anxiety Treatment & Research Centre St. Joseph’s Healthcare Assistant.
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The Nature and Treatment of Anxiety Disorders
Dr. Randi McCabe
Associate Director, Anxiety Treatment & Research Centre St. Joseph’s Healthcare
Assistant Professor, Department of Psychiatry & Behavioural Sciences, McMaster University
McMaster Mini Med School
Objectives
• Understand different anxiety disorders
• Overview of treatment strategies
The Case of Jason S.
• 21-year-old college student referred to anxiety clinic for anxiety symptoms
• Varsity hockey player
• Applying to law school
• Stressful schedule
• Supportive relationship
Case of Jason S. continued…
• Acute episodes of intense physical symptoms• Difficult to maintain daily activities due to
symptoms• Weight loss 10-15 lbs.• Avoidance of a range of activities and
»Anxious Thoughts»Anxious Predictions»Anxious Beliefs and Interpretations»Biases in Attention and Memory»Mental Images
The Behavioural Component
• Avoidance of Situations and Activities• Subtle Avoidance Strategies, Safety
Signals, and Overprotective Behaviours• Alcohol, Drug, and Medication Use
An episode of intense fear or discomfort that peaks rapidly (within 10 minutes) and in which at least 4 of the following symptoms were experienced:
• palpitations, pounding or racing heart
• sweating
• trembling or shaking
• shortness of breath or smothering sensations
• feeling of choking
• chest pain or discomfort
• nausea or abdominal distress
• feeling dizzy, unsteady, faint or lightheaded
• feeling unreal or detached
• fear of losing control or going crazy
• fear of dying
• numbness or tingling sensations
• chills or hot flushes
What is a Panic Attack?
o Panic Disorder with or without Agoraphobia o Specific Phobiao Social Anxiety Disorder (Social Phobia)o Obsessive Compulsive Disorder (OCD)o Generalized Anxiety Disorder (GAD)o Post Traumatic Stress Disorder (PTSD)
The Anxiety Disorders
Prevalence and Age of Onset
Avg. Onset Prevalence
Panic Disorder late-teens/ mid-30’s 1.5 -3.5%
Specific Phobia 10 -11.3%
• situational childhood/ mid-20’s• natural environment childhood/ early adult
• animal childhood
• blood/injection childhood
Social Phobia mid-teens 3 -13%
OCD 6-15 yrs M/ 20-29 yrs F 2.5%
GAD childhood/ adolescence 5%
PTSD any age 1-14%
Recurrent, unexpected panic attacks and at least one month of:
• concern about additional attacks
• OR...worry about the implications of the attack or its consequences
• OR...a significant change in behaviour related to the attacks
Panic Disorder
Anxiety about being in places or situations from which escape might be difficult or
embarrassing in the event of a panic attack
Examples Enclosed Places
Standing in Lines
Driving
Public Transportation
Being Alone
Crowds
Shopping Malls and Supermarkets
Agoraphobia
Excessive fear of a specific object or situation causing significant distress or impairment
Common Specific Phobias
Animals and Insects Blood and Injections
Heights Storms or Water
Flying Enclosed Places
DrivingChokingVomiting
Specific Phobia
Social Anxiety Disorder(Social Phobia)
Intense fear of social or performance situations causing significant distress or impairment
In anxiety, thoughts revolve around:"probability overestimation”"catastrophizing the consequences”
That is people overestimate that something bad will happen, and that when it happens, they will be unable to cope.
BEHAVIOURAL STRATEGIES
• controlled exposure to the feared situation• anxiety responses are allowed to "habituate" or decrease without interference• teaches the person that the situation is not dangerous, and that anxiety will diminish.