ANXIETY AND RELATED
DISORDERS
2324-GGZ2024
,Content
Lecture 1: Opening lecture and introduction in anxiety disorders ................................................. 2
Task 1: Anxiety and hyperventilation ................................................................................................. 6
Lecture 2: Anxiety and information processing .............................................................................. 19
Task 2: Fear! ....................................................................................................................................... 21
Extra assignment ............................................................................................................................ 36
Self-assignment .............................................................................................................................. 37
Lecture 3: Learning theory ................................................................................................................ 38
Task 3: How to improve exposure therapy: What about a cognitive approach and safety
behaviours? ......................................................................................................................................... 42
Critical reading assignment ........................................................................................................... 54
Lecture 4: Neurobiology of anxiety .................................................................................................. 56
Task 4: Biological substrate of panic and anxiety.......................................................................... 61
Lecture 5: Obsessive Compulsive Disorder (OCD) ....................................................................... 75
Task 5: Thought suppression & Obsessive compulsive disorder ............................................... 78
Lecture 6: Neuropharmacology of anxiety ...................................................................................... 87
Task 6: Imagery, Imagery Treatments and PTSD ......................................................................... 96
Lecture 7: Post-traumatic Stress Disorder (PTSD) ..................................................................... 105
Practical’s ........................................................................................................................................... 110
Mowrer............................................................................................................................................ 110
Project work Cognitive theory ..................................................................................................... 115
Assessing cognitive bias ............................................................................................................. 118
Exposure therapy.......................................................................................................................... 121
1
,Lecture 1: Opening lecture and introduction in anxiety disorders
How do you know you are anxious?
- Heartrate increases
- Respiration increases
- Sweating (cold hands)
- Tense muscle: trembling of hands, other parts
- Tingling of hands and feet
- Hairs upright (goose bumps)
- Feel sick
- Anxious thoughts
- Rumination
- Worry
- Hide
- Get away
- Become upset or angry
Functionality anxiety
- To survive:
o Approach situations that increase survival
o Avoid situations that decrease survival
- Social function:
o Signalling danger
o Motivation of social adapt behaviour
Conceptualization of anxiety
- Common sense
- James and Lange: viscera are the centre of
emotion: senses cortex muscles viscera
response perceived as emotion reaction
- Canon and Bard: thalamus is the key, bodily changes and emotional experience occur separately and
independently of one another
- Schachter and Singer: 2 factor
theory of emotion. A person uses
the immediate environment to
search for emotional cues to label
the arousal.
Anxiety: Reaction to threat:
Danger freeze defence fight/flight
- Function: prepare for fight/flight
decrease change for detection
Physiology:
- Parasympathetic down and
sympathetic up
- Adrenalin (epinephrine)
- Noradrenalin (norepinephrine)
Physiological reaction:
- Sympathetic:
o Blood pressure increases
o Heartrate increases
o Respiration increases
o Sweating (cold hands)
o Increase of blood in
muscle
o Tense muscle: trembling
of hands, other parts
o Tingling of hand and feet
o Pupils enlarge (see more
light)
o Hairs upright
- Parasympathetic:
2
, o Contradiction of blatter and intestinal (urge to go to the toilet)
o Digestion stops: dry mouth and throat
o Feel sick
Cognitive reaction:
- Hyper alert
- 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
Behavioural reactions
- Protect oneself (safety behaviours)
- Urge to run
- Urge to cry
- Fight
Fear vs anxiety:
Fear Anxiety
Threat present Threat expected
Clear threat source No threat source
Short Long
High tension Discomfort
Clear start Unclear
Emergency response Heighted vigilance
What is anxiety?
Anxiety is the feeling of fear or panic. Most people feel anxious, panicky or fearful about situation in life, such as
money problems or exams but often once the difficult situation is over, you feel better and calmer. Sometimes…
the feelings of fear or anxiety continue after the difficult situation or sometimes… you may feel a stronger sense of
fear than other people and this is when anxiety might become a problem and can affect your daily life/functioning
Terror management theory:
The basic gist of the theory is that humans are motivated to quell the potential for terror inherent in the human
awareness of vulnerability and mortality by investing in cultural belief generated empirical research into not just the
nature of self-esteem motivation and prejudice, but also host of other forms of human social behaviour… depression
and psychopathology
- Self-esteem consists of the perception that one is valuable of a meaningful universe
- Anxiety: usually around 3 years of age children begin to learn about and become concerned with the
problem of death and anxieties regarding darkness and monsters become more and more linked to real
threats… that culminate with the realization of the inevitability death
- So a child becomes aware that the parents or caregivers are not omniscient and omnipotent but fallible
and mortal
- Self-esteem thus functions as an anxiety buffer to maintain relative equanimity despite the awareness of
vulnerability and mortality
Irvin Yalom:
- Death agony has been a taboe even under psychotherapists. But people do experience this fear, some
dream about it, others try to supress it which leads to psychological symptoms
- Culture comes into play to provide a secure base (stories, myths, religious doctrines) in which the virtuous
are rewarded and the evil are punished.
Psycho-analitic view
- Moving a bit more to the extreme side of the continuum
- Freud:
o Freud recognizes the importance of anxiety. He was one of the first writers to argue that anxiety
was a critical component of neurosis.
o Anxiety is an aversive inner state that people seek to avoid or escape
o 3 major types of anxiety
Reality anxiety: the most basic form, rooted in reality. Fear of a dog bite, fear arising
from an impending accident
Neurotic anxiety: anxiety which arises from an unconscious fear that the libidinal
impulses of the ID will take control at an in opportune time. This type of anxiety is driven
by a fear of punishment that will result from expressing the ID’s desires without proper
sublimation
3
DISORDERS
2324-GGZ2024
,Content
Lecture 1: Opening lecture and introduction in anxiety disorders ................................................. 2
Task 1: Anxiety and hyperventilation ................................................................................................. 6
Lecture 2: Anxiety and information processing .............................................................................. 19
Task 2: Fear! ....................................................................................................................................... 21
Extra assignment ............................................................................................................................ 36
Self-assignment .............................................................................................................................. 37
Lecture 3: Learning theory ................................................................................................................ 38
Task 3: How to improve exposure therapy: What about a cognitive approach and safety
behaviours? ......................................................................................................................................... 42
Critical reading assignment ........................................................................................................... 54
Lecture 4: Neurobiology of anxiety .................................................................................................. 56
Task 4: Biological substrate of panic and anxiety.......................................................................... 61
Lecture 5: Obsessive Compulsive Disorder (OCD) ....................................................................... 75
Task 5: Thought suppression & Obsessive compulsive disorder ............................................... 78
Lecture 6: Neuropharmacology of anxiety ...................................................................................... 87
Task 6: Imagery, Imagery Treatments and PTSD ......................................................................... 96
Lecture 7: Post-traumatic Stress Disorder (PTSD) ..................................................................... 105
Practical’s ........................................................................................................................................... 110
Mowrer............................................................................................................................................ 110
Project work Cognitive theory ..................................................................................................... 115
Assessing cognitive bias ............................................................................................................. 118
Exposure therapy.......................................................................................................................... 121
1
,Lecture 1: Opening lecture and introduction in anxiety disorders
How do you know you are anxious?
- Heartrate increases
- Respiration increases
- Sweating (cold hands)
- Tense muscle: trembling of hands, other parts
- Tingling of hands and feet
- Hairs upright (goose bumps)
- Feel sick
- Anxious thoughts
- Rumination
- Worry
- Hide
- Get away
- Become upset or angry
Functionality anxiety
- To survive:
o Approach situations that increase survival
o Avoid situations that decrease survival
- Social function:
o Signalling danger
o Motivation of social adapt behaviour
Conceptualization of anxiety
- Common sense
- James and Lange: viscera are the centre of
emotion: senses cortex muscles viscera
response perceived as emotion reaction
- Canon and Bard: thalamus is the key, bodily changes and emotional experience occur separately and
independently of one another
- Schachter and Singer: 2 factor
theory of emotion. A person uses
the immediate environment to
search for emotional cues to label
the arousal.
Anxiety: Reaction to threat:
Danger freeze defence fight/flight
- Function: prepare for fight/flight
decrease change for detection
Physiology:
- Parasympathetic down and
sympathetic up
- Adrenalin (epinephrine)
- Noradrenalin (norepinephrine)
Physiological reaction:
- Sympathetic:
o Blood pressure increases
o Heartrate increases
o Respiration increases
o Sweating (cold hands)
o Increase of blood in
muscle
o Tense muscle: trembling
of hands, other parts
o Tingling of hand and feet
o Pupils enlarge (see more
light)
o Hairs upright
- Parasympathetic:
2
, o Contradiction of blatter and intestinal (urge to go to the toilet)
o Digestion stops: dry mouth and throat
o Feel sick
Cognitive reaction:
- Hyper alert
- 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
Behavioural reactions
- Protect oneself (safety behaviours)
- Urge to run
- Urge to cry
- Fight
Fear vs anxiety:
Fear Anxiety
Threat present Threat expected
Clear threat source No threat source
Short Long
High tension Discomfort
Clear start Unclear
Emergency response Heighted vigilance
What is anxiety?
Anxiety is the feeling of fear or panic. Most people feel anxious, panicky or fearful about situation in life, such as
money problems or exams but often once the difficult situation is over, you feel better and calmer. Sometimes…
the feelings of fear or anxiety continue after the difficult situation or sometimes… you may feel a stronger sense of
fear than other people and this is when anxiety might become a problem and can affect your daily life/functioning
Terror management theory:
The basic gist of the theory is that humans are motivated to quell the potential for terror inherent in the human
awareness of vulnerability and mortality by investing in cultural belief generated empirical research into not just the
nature of self-esteem motivation and prejudice, but also host of other forms of human social behaviour… depression
and psychopathology
- Self-esteem consists of the perception that one is valuable of a meaningful universe
- Anxiety: usually around 3 years of age children begin to learn about and become concerned with the
problem of death and anxieties regarding darkness and monsters become more and more linked to real
threats… that culminate with the realization of the inevitability death
- So a child becomes aware that the parents or caregivers are not omniscient and omnipotent but fallible
and mortal
- Self-esteem thus functions as an anxiety buffer to maintain relative equanimity despite the awareness of
vulnerability and mortality
Irvin Yalom:
- Death agony has been a taboe even under psychotherapists. But people do experience this fear, some
dream about it, others try to supress it which leads to psychological symptoms
- Culture comes into play to provide a secure base (stories, myths, religious doctrines) in which the virtuous
are rewarded and the evil are punished.
Psycho-analitic view
- Moving a bit more to the extreme side of the continuum
- Freud:
o Freud recognizes the importance of anxiety. He was one of the first writers to argue that anxiety
was a critical component of neurosis.
o Anxiety is an aversive inner state that people seek to avoid or escape
o 3 major types of anxiety
Reality anxiety: the most basic form, rooted in reality. Fear of a dog bite, fear arising
from an impending accident
Neurotic anxiety: anxiety which arises from an unconscious fear that the libidinal
impulses of the ID will take control at an in opportune time. This type of anxiety is driven
by a fear of punishment that will result from expressing the ID’s desires without proper
sublimation
3
