Anxiety and Related Disorders
GGZ2024
Lecture 1: Introduction
Task 1: Anxiety and hyperventilation
Lecture 2: Learning theory
Task 2: Fear!
Lecture 3: Anxiety and information processing
Task 3: How to improve exposure therapy
Lecture 4: Neuropharmacology of anxiety
Task 4: Biological substrate of panic and anxiety
Lecture 5: Neurobiology of anxiety
Task 5: Thought suppression & OCD
Lecture 6: Obsessive Compulsive Disorder
Task 6: Imagery, Imagery Treatments and PTSD
Lecture 7: Posttraumatic Stress Disorder
Glossary: Belangrijke begrippen
,Lecture 1: Introduction
Young children also channel their fears: little blanket, pacifier, soothed by caregiver,
channeled in games
How do you know you’re anxious?
Heart rate increases
Respiration increases
Sweating
Tense muscles
Tingling of hand and feet
Goosebumps
Feeling sick
Anxious thoughts
Ruminating
Worrying
Hiding
Getting away
Becoming upset and angry
Functionality anxiety
Approach situations that increase survival, avoid situations that decrease survival
Social function: Signaling danger and motivation for social adapt behaviour
Biological reactions
Parasympathetic down and sympathetic up
Adrenaline and noradrenaline
Parasympathetic: contraction of blatter and intestinals, digestion stops, feeling sick
Cognitive reactions
Hyperalert
Narrowing of attention
Idea that time goes slower
Present or actual situation seems unreal
Perception that you watch yourself from a distance
Think you might faint
Behavioral reactions
Protect oneself by safety behaviors
Urge to run
Urge to cry
Fight or flight
Fear Anxiety
Threat present Threat expected
Clear threat source No threat source
Short Long
High tension Discomfort
Clear start Unclear start
Emergency response Heightened vigilance
Sometimes the feelings of fear or anxiety continue after the difficult situation. Or you may feel
a stronger sense of fear than other people and this is when anxiety might become a problem
and can affect your life/functioning.
,Terror Management Theory: Humans are motivated to quell the potential for terror inherent
in the human awareness of vulnerability and mortality by investing in cultural belief systems.
Self-esteem consists of the perception that one is a valuable member of a meaningful
universe;
Around three years of age, children begin to learn about and become concerned with the
problem of death and anxieties around darkness and monsters. All children become aware
that the parent or caregiver are not omniscient and omnipotent but fallible and mortal;
Self-esteem functions as an anxiety buffer to maintain relative equanimity despite the
awareness of vulnerability and mortality.
Irvin Yalom: Death agony has been a taboo. People do experience this fear, some dream
about it, others try to suppress it.
Chaos, meaning of life, no connection to other people, death.
Culture comes into place to provide a secure base in which the virtuous are rewarded and
the evil are punished.
Psycho-analytic theory
Freud: Anxiety is an aversive inner state that people seek to avoid or escape.
Three major types: reality anxiety, neurotic anxiety (impulses from ID), moral anxiety (guilt
or shame)
The human is driven towards tension reduction through defense mechanisms
First, problem solving efforts are increased, and secondly, defense mechanisms are
triggered. These are tactics which the Ego develops to help deal with the ID and the Super
Ego.
Anna Freud: Did more research on defense mechanism.
Repression, denial (severe form of memory repression), projection (attributing own
repressed thoughts to someone else), rationalization (post-hoc), intellectualization
(repressing the emotions), regression (mature problem solving), displacement (shifting of
intented targets, when the initial target is threatening).
Learning theory
Classical conditioning (the meaning of stimuli)
Operant conditioning (how to cope with anxiety/fear response)
Joseph Ledoux: We are born knowing how to be afraid, but we learn what to be afraid of
1 in 5 eventually develops an anxiety disorder, the largest group in mental health care
For this course:
- Specific Phobia
- Social Anxiety Disorder
- Panic Disorder
- Agoraphobia
- Generalized Anxiety Disorder
- Post-Traumatic Stress Disorder
- Obsessive Compulsive Disorder
, Task 1: Anxiety and hyperventilation
What are the symptoms of generalized anxiety disorder?
In contrast to other anxiety syndromes, GAD is not characterized by motoric avoidance of
disorder-specific situations. Instead, current theoretical models conceptualize worry as
entailing cognitive avoidance of threatening material. Approaches to treating GAD rely on our
knowledge of chronic worriers’ nonadaptive patterns involving awareness, physiology,
behavior, cognition and emotion.
Nonadaptive awareness: Individuals with GAD are highly focused on repetitive verbal
activity regarding potential future negative events. Chronic worries do not recognize the
causal relationship between their cognitions, emotions, physiology, and behavior, and how
those interconnected elements influence both the internal and external problems in their
lives. This lack of awareness often leads chronic worriers to believe that their anxiety
escalates quickly and spontaneously. This lack of awareness inhibits individuals to focus on
the present moment.
Nonadaptive physiology: GAD does not entail sympathetic activation. The only
physiological symptom shown to be elevated in individuals with GAD is muscle tension.
Nonadaptive behavior: Many individuals with GAD show signs of behavioral avoidance of
various stimuli and situations. One potentially useful approach to helping chronic worries is
thus help them identify the core values in their lives, and to recognize ways in which their
behaviors are inconsistent with these values as well as ways in which their worries distract
them from being present during valued activities.
Nonadaptive cognition: Individuals with GAD evidence nonadaptive ways of perceiving,
interpreting, and predicting events in their lives. Chronic worries show biases in their
attention to threat cues, their interpretations of ambiguous information as threatening, and
their tendency to believe that bad things will happen in the future.
Nonadaptive emotion: Individuals with GAD often experience negative emotionality,
including high levels of both anxiety and depression. There is also evidence that they
experience emotions more intensely than others and that they have more negative attitudes
about emotions.
DSM-5 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 of 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
three (or more) of the following symptoms
(only one item required in children):
1. Restlessness, 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
GGZ2024
Lecture 1: Introduction
Task 1: Anxiety and hyperventilation
Lecture 2: Learning theory
Task 2: Fear!
Lecture 3: Anxiety and information processing
Task 3: How to improve exposure therapy
Lecture 4: Neuropharmacology of anxiety
Task 4: Biological substrate of panic and anxiety
Lecture 5: Neurobiology of anxiety
Task 5: Thought suppression & OCD
Lecture 6: Obsessive Compulsive Disorder
Task 6: Imagery, Imagery Treatments and PTSD
Lecture 7: Posttraumatic Stress Disorder
Glossary: Belangrijke begrippen
,Lecture 1: Introduction
Young children also channel their fears: little blanket, pacifier, soothed by caregiver,
channeled in games
How do you know you’re anxious?
Heart rate increases
Respiration increases
Sweating
Tense muscles
Tingling of hand and feet
Goosebumps
Feeling sick
Anxious thoughts
Ruminating
Worrying
Hiding
Getting away
Becoming upset and angry
Functionality anxiety
Approach situations that increase survival, avoid situations that decrease survival
Social function: Signaling danger and motivation for social adapt behaviour
Biological reactions
Parasympathetic down and sympathetic up
Adrenaline and noradrenaline
Parasympathetic: contraction of blatter and intestinals, digestion stops, feeling sick
Cognitive reactions
Hyperalert
Narrowing of attention
Idea that time goes slower
Present or actual situation seems unreal
Perception that you watch yourself from a distance
Think you might faint
Behavioral reactions
Protect oneself by safety behaviors
Urge to run
Urge to cry
Fight or flight
Fear Anxiety
Threat present Threat expected
Clear threat source No threat source
Short Long
High tension Discomfort
Clear start Unclear start
Emergency response Heightened vigilance
Sometimes the feelings of fear or anxiety continue after the difficult situation. Or you may feel
a stronger sense of fear than other people and this is when anxiety might become a problem
and can affect your life/functioning.
,Terror Management Theory: Humans are motivated to quell the potential for terror inherent
in the human awareness of vulnerability and mortality by investing in cultural belief systems.
Self-esteem consists of the perception that one is a valuable member of a meaningful
universe;
Around three years of age, children begin to learn about and become concerned with the
problem of death and anxieties around darkness and monsters. All children become aware
that the parent or caregiver are not omniscient and omnipotent but fallible and mortal;
Self-esteem functions as an anxiety buffer to maintain relative equanimity despite the
awareness of vulnerability and mortality.
Irvin Yalom: Death agony has been a taboo. People do experience this fear, some dream
about it, others try to suppress it.
Chaos, meaning of life, no connection to other people, death.
Culture comes into place to provide a secure base in which the virtuous are rewarded and
the evil are punished.
Psycho-analytic theory
Freud: Anxiety is an aversive inner state that people seek to avoid or escape.
Three major types: reality anxiety, neurotic anxiety (impulses from ID), moral anxiety (guilt
or shame)
The human is driven towards tension reduction through defense mechanisms
First, problem solving efforts are increased, and secondly, defense mechanisms are
triggered. These are tactics which the Ego develops to help deal with the ID and the Super
Ego.
Anna Freud: Did more research on defense mechanism.
Repression, denial (severe form of memory repression), projection (attributing own
repressed thoughts to someone else), rationalization (post-hoc), intellectualization
(repressing the emotions), regression (mature problem solving), displacement (shifting of
intented targets, when the initial target is threatening).
Learning theory
Classical conditioning (the meaning of stimuli)
Operant conditioning (how to cope with anxiety/fear response)
Joseph Ledoux: We are born knowing how to be afraid, but we learn what to be afraid of
1 in 5 eventually develops an anxiety disorder, the largest group in mental health care
For this course:
- Specific Phobia
- Social Anxiety Disorder
- Panic Disorder
- Agoraphobia
- Generalized Anxiety Disorder
- Post-Traumatic Stress Disorder
- Obsessive Compulsive Disorder
, Task 1: Anxiety and hyperventilation
What are the symptoms of generalized anxiety disorder?
In contrast to other anxiety syndromes, GAD is not characterized by motoric avoidance of
disorder-specific situations. Instead, current theoretical models conceptualize worry as
entailing cognitive avoidance of threatening material. Approaches to treating GAD rely on our
knowledge of chronic worriers’ nonadaptive patterns involving awareness, physiology,
behavior, cognition and emotion.
Nonadaptive awareness: Individuals with GAD are highly focused on repetitive verbal
activity regarding potential future negative events. Chronic worries do not recognize the
causal relationship between their cognitions, emotions, physiology, and behavior, and how
those interconnected elements influence both the internal and external problems in their
lives. This lack of awareness often leads chronic worriers to believe that their anxiety
escalates quickly and spontaneously. This lack of awareness inhibits individuals to focus on
the present moment.
Nonadaptive physiology: GAD does not entail sympathetic activation. The only
physiological symptom shown to be elevated in individuals with GAD is muscle tension.
Nonadaptive behavior: Many individuals with GAD show signs of behavioral avoidance of
various stimuli and situations. One potentially useful approach to helping chronic worries is
thus help them identify the core values in their lives, and to recognize ways in which their
behaviors are inconsistent with these values as well as ways in which their worries distract
them from being present during valued activities.
Nonadaptive cognition: Individuals with GAD evidence nonadaptive ways of perceiving,
interpreting, and predicting events in their lives. Chronic worries show biases in their
attention to threat cues, their interpretations of ambiguous information as threatening, and
their tendency to believe that bad things will happen in the future.
Nonadaptive emotion: Individuals with GAD often experience negative emotionality,
including high levels of both anxiety and depression. There is also evidence that they
experience emotions more intensely than others and that they have more negative attitudes
about emotions.
DSM-5 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 of 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
three (or more) of the following symptoms
(only one item required in children):
1. Restlessness, 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
