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    Anxiety Disorders: Treatment

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    Sónia Alves
    Obsessive-compulsive disorder (OCD) is characterized by obsessions (unwanted, intrusive thoughts) and compulsions (repetitive behaviors performed to reduce anxiety). Cognitive-behavioral therapy techniques like exposure and response prevention are effective treatments, where the individual is exposed to the obsession but prevented from performing compulsions. Medications like SSRIs can also help by modifying brain chemistry. While OCD was once seen as a psychological problem, research shows it involves biological abnormalities in brain regions involved in fear and anxiety.

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    Anxiety Disorders: Treatment

    Uploaded by

    Sónia Alves
    54 views23 pages
    Obsessive-compulsive disorder (OCD) is characterized by obsessions (unwanted, intrusive thoughts) and compulsions (repetitive behaviors performed to reduce anxiety). Cognitive-behavioral therapy techniques like exposure and response prevention are effective treatments, where the individual is exposed to the obsession but prevented from performing compulsions. Medications like SSRIs can also help by modifying brain chemistry. While OCD was once seen as a psychological problem, research shows it involves biological abnormalities in brain regions involved in fear and anxiety.

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    Anxiety DisordersObsessive-Compulsive Disorder

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    Obsessive-compulsive disorder (OCD) is characterized by obsessions (unwanted, intrusive thoughts) and compulsions (repetitive behaviors performed to reduce anxiety). Cognitive-behavioral therapy techniques like exposure and response prevention are effective treatments, where the individual is exposed to the obsession but prevented from performing compulsions. Medications like SSRIs can also help by modifying brain chemistry. While OCD was once seen as a psychological problem, research shows it involves biological abnormalities in brain regions involved in fear and anxiety.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    54 views23 pages

    Anxiety Disorders: Treatment

    Uploaded by

    Sónia Alves
    Obsessive-compulsive disorder (OCD) is characterized by obsessions (unwanted, intrusive thoughts) and compulsions (repetitive behaviors performed to reduce anxiety). Cognitive-behavioral therapy techniques like exposure and response prevention are effective treatments, where the individual is exposed to the obsession but prevented from performing compulsions. Medications like SSRIs can also help by modifying brain chemistry. While OCD was once seen as a psychological problem, research shows it involves biological abnormalities in brain regions involved in fear and anxiety.

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    Anxiety Disorders

    Obsessive-Compulsive Disorder

    Characteristics
    Obsession: a recurring
    idea, thought, or image that
    they realize, at least initially,
    is senseless.
    Compulsion: Repetitive
    behavior performed
    according to certain rules or
    in a stereotyped fashion.

    Treatment
    Cognitive therapy.
    Behavioral therapy.
    Medications.

    OBSESSIVE COMPULSIVE DISORDER:


    OBSESSIONS
    Intrusive, unwanted thoughts, images or
    impulses
    Not simply excessive everyday worries
    Recognized as irrational - attempts to
    suppress or neutralize

    TYPICAL OBSESSIONS

    Contamination
    Doubts
    Orderliness
    Aggressive, Horrific Impulses
    Sexual Images
    Disasters

    OBSESSIVE COMPULSIVE DISORDER:


    COMPULSIONS
    Ritualistic, repeated behaviors or mental
    acts
    Usually performed to ward off an
    obsession or to prevent a dreaded event

    TYPICAL COMPULSIONS

    Cleaning
    Checking
    Counting
    Repeating
    Seeking reassurance
    Ordering

    OBSESSIVE COMPULSIVE DISORDER:


    ASSOCIATED SYMPTOMS

    Avoidance of situations that trigger an


    obsession or compulsion
    Hypochondriasis
    Guilt, over-responsibility
    Sleep disturbance
    Skin conditions from excessive washing
    or picking

    ANXIETY DISORDERS ARE ASSOCIATED


    WITH BIOLOGICAL CHANGES
    Brain Imaging Abnormalities
    Autonomic Activation
    Neuroendocrine Changes
    Early Bio-behavioral Changes

    Brain Fear Circuitry


    Amorapanth P, et. al. Nature Neuroscience 2000; 3:74-79
    LeDoux JE: The Emotional Brain. New York, Simon and Schuster, 1996

    Behavioral and neurobiological responses to

    fear-arousing stimuli

    Freezing (periqueductal gray)


    Autonomic activation (lateral hypothalamus)
    Neuroendocrine response (paraventricular
    hypothalamus)

    Associative learning couples these responses


    to otherwise meaningless stimuli

    Amygdala
    Lateral Nucleus
    Creates link between conditioned and unconditioned
    stimulus
    Exposure to subsequent relevant stimulus, activates
    Central Nucleus: (coordinates fear response)
    periaqueductal gray region - freezing or immobility
    lateral hypothalamus - autonomic responses
    paraventricular hypothalamus neuroendocrine

    Passive and Active Responding

    Automatic (Involuntary,Passive) Response


    Lateral nucleus
    Central nucleus
    Deliberate (Voluntary, Active) Response
    Lateral nucleus
    Basal nucleus

    Shift From Passive Fear to Active Coping in the Brain


    LeDoux J and Gorman J Am J Psychiatry 158:1953-1955, December 2001

    TREATMENT OF ANXIETY DISORDERS

    Promote active coping


    MEDICATION: Provide information, directly
    moderate neurobiology
    COGNITIVE BEHAVIORAL TREATMENT:
    Provide information, Change neural circuitry
    through exposure, Teach specific coping
    techniques

    PATIENTS AND FAMILY NEED INFORMATION


    About the illness: symptoms and course
    Biological aspects of anxiety
    Psychological components of symptoms
    Simple principles of conditioned responses
    Role of thoughts and behaviors in affecting
    emotions

    Relationship between physiology, psychology


    and treatment

    COGNITIVE BEHAVIORAL TREATMENTS


    ARE EQUALLY EFFICACIOUS AS
    MEDICATION FOR ANXIETY DISORDERS
    Preferred by many patients
    Associated with improvement in
    biological as well as psychological
    abnormalities

    Psychological Treatment of OCD

    exposure with response prevention


    person is gradually and systematically
    exposed to the feared thought or situation
    promotes habituation to the feared stimulus
    prevents negative reinforcement of
    compulsive behavior
    facilitates reality testing
    effective

    Cognitive Therapy
    Target Negative Thinking and Logical Errors
    Overestimation of Probability of Negative
    Consequences
    Catastrophizing
    Techniques
    Identify and Challenge Negative Thoughts
    Provide Alternative Explanations

    Thought Stopping.
    The patient dwells on their obsessive
    thoughts
    Therapist shouts stop
    Patient repeats the command out loud, and
    eventually repeats it subvocally.
    This technique was used mainly with patients
    suffering from Obsessive Compulsive
    Disorder (OCD).

    Medical Treatment of OCD

    antidepressant medications are most


    common
    SSRIs
    clomipramine (Anafranil)
    60% of patients benefit
    relapse rate (after go off drug) is high
    in rare cases, brain surgery may be required

    WHAT TO REMEMBER ABOUT ANXIETY


    DISORDERS
    Common and debilitating conditions
    Often co-occur with other medical and
    psychiatric conditions
    Characterized by
    prominent somatic symptoms
    catastrophic misinterpretations
    escape and avoidance behaviors

    WHAT TO REMEMBER ABOUT ANXIETY


    DISORDERS
    Avoidance
    Can prevent help-seeking
    Inhibits reporting of symptoms
    Highly treatable
    Medication, especially serotonin active
    antidepressants
    Cognitive behavioral treatment

    Behavior Therapy

    Negative reinforcement:
    -obsession ritual reduced anxiety

    Exposure with response prevention (ERP):


    -Individual is exposed to obsession and is prevented from performing
    ritual
    -Over time individual learns that nothing untoward happens which
    causes anxiety reduction

    Efficacy of ERP:
    -ERP found to be effective for 75% of individuals with OCD (Marks,
    1981)

    Cognitive Therapy

    Cognitive techniques aim to control obsessions


    Compulsions or rituals are performed to reduce doubt
    Anxiety stems not from content of obsessions but from thinking the
    thought
    Most common cognitive techniques are thought stopping and
    thought replacement
    No empirical support for the inclusion of these techniques
    Cognitive therapy did not differ in effect size from placebo (van
    Blakom et al., 1994)

    Group Therapy

    Limited data on the effectiveness of group interventions


    Fals-Stewart et al. (1993) found that individual and group
    therapy were equally effective
    Sample was limited to those with mild to moderate OCD
    symptoms
    Group treatment of OCD may be limited to less complicated
    clinical presentations (Kabak et al., 1995)

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