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PSYCH205: Clinical Psychology

Unit 5: Anxiety Disorders   Now that you have a broad understanding of the whats and hows of clinical psychology and mental health treatment, this unit will discuss the mental illnesses that clinical psychologists most commonly focus on understanding and treating. Over the course of the next few units, you will learn about some common disorders, their specifications, and their treatments. In this unit, you will take a close look at anxiety disorders. Anxiety can be a normal, natural, and appropriate reaction to a stressful situation, but this sort of anxiety is not the anxiety present in an anxiety disorder. An anxiety disorder often involves anxiety that is either disproportionate to the situation at hand, or is the result of an otherwise benign situation. In this unit, you will look at different types of anxiety disorders and their respective behaviors, etiologies, and treatments as they relate to specific populations across the lifespan. First, this unit will address information regarding anxiety disorders in adults. Second, the unit will address issues specific to anxiety disorders in children. Finally, you will learn how anxiety disorders are manifested and treated in older adults.

Unit 5 Time Advisory
Completing this unit should take you approximately 9.75 hours.

☐    Introduction: 6.75 hours

☐    Subunit 5.1.2: 2.5 hours

☐    Subunit 5.2: 15 minutes

☐    Subunit 5.3: 15 minutes

Unit5 Learning Outcomes
Upon successful completion of this unit, you will be able to:
- describe the various symptoms associated with each type of anxiety disorder;
  - identify relevant research/theories on the etiology of anxiety disorders;
  - compare and contrast the manifestation of anxiety disorders in children and older adults as compared to adults; and
  - identify the precipitating factors of suicide and the treatment of suicidality.

5.1 Types of Anxiety Disorders   - Reading: United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 4: Adults and Mental Health” Link: United States Department of Health and Human Services’ Mental *Health: A Report of the Surgeon General* (1999): “Chapter 4: Adults and Mental Health” (PDF)
 
Instructions: Read the section titled “Anxiety Disorders.” Please note that the pages in the PDF bar at the top of the document do not match the pages in the table of contents section on the first page. 
 
This reading covers all of the topics listed under Subunits 5.1, which are related to anxiety disorders in the adult population; however, there are mandatory additional readings listed under Subunits 5.1 that will further develop your understanding of particularly common anxiety disorders in the adult population. In addition, under subunit 5.1.2, you will read an empirical journal article related to the treatment of anxiety disorders in an adult population and look at a university-supported web page on relaxation techniques—a method commonly used in order to reduce anxiety.
 
Reading of and note taking for this text should take approximately 45 minutes.
 
Terms of Use: Please respect the copyright and terms of use displayed on the webpage above.

  • Lecture: Open Yale Courses: "What Happens When Things Go Wrong: Mental Illness, Part II" Link: Open Yale Courses: "What Happens When Things Go Wrong: Mental Illness, Part II"

    Instructions: Follow the link; under "Lecture Chapters" on the right side of the page, select "Anxiety Disorders" and watch through "Question and Answer on Schizophrenia and Anxiety Disorders" (24:51 to 34:36). You may wish to watch other parts of the lecture for greater context or for review of additional content. Note that this lecture is available in a number of audio and video formats.

    Terms of Use: Please respect the copyright and terms of use displayed on the webpage above.

  • Reading: National Institute of Mental Health’s “What is Panic Disorder?” Link: National Institute of Mental Health’s “What is Panic Disorder?” (PDF)
     
    Instructions: Read this section located on pages 3–4, including the quote at the top of the page.
     
    This provides a brief, common-sense explanation of panic disorder and will help you consolidate the information you learned in your previous readings. Although some of this material may seem redundant, it will provide you with a big picture overview of panic disorder. 
     
    Reading this text and taking notes should take approximately 30 minutes.
     
    Terms of Use: The above material is in the Public Domain.

  • Reading: National Institute of Mental Health’s “What Is Social Anxiety Disorder?” Link: National Institute of Mental Health’s “What Is Social Anxiety Disorder?” (PDF)
     
    Instructions: Read this section located on pages 9–10, including the quote at the top of the page.
     
    Reading this text and taking notes should take approximately 15 minutes.
     
    Terms of Use: Please respect the copyright and terms of use displayed on the webpage above.

  • Reading: National Institute of Mental Health’s “What Is Generalized Anxiety Disorder?” (PDF) Link: National Institute of Mental Health’s “What Is Generalized Anxiety Disorder?” (PDF)

    Instructions: Please click on the above link titled “What Is Generalized Anxiety,” and read this brief section (p. 12–13), including the quote at the top of the page.

    Reading this text and taking notes should take approximately 30 minutes.

    Terms of Use: Please respect the copyright and terms of use displayed on the webpage above.

  • Reading: Pubmed Central’s version of Dr. Judd Marmor’s (1962) “Anxiety and Worry as Aspects of Normal Behavior” Link: Pubmed Central’s version of Dr. Judd Marmor’s (1962) “Anxiety and Worry as Aspects of Normal Behavior” (PDF)

    Instructions: Please click on the above link titled “Anxiety and Worry as Aspects of Normal Behavior,” select the “complete text” link to download the PDF, and read this article (four pages). Note that this article highlights that anxiety serves an adaptive and normative function. Generalized anxiety occurs when anxiety becomes excessive and interferes with functioning.

    Reading this text and taking notes should take approximately 30 minutes.
     
    Terms of Use: Please respect the copyright and terms of use displayed on the webpage above.

  • Reading: National Institute of Mental Health’s “What is Obsessive-Compulsive Disorder?” Link: National Institute of Mental Health’s “What is Obsessive-Compulsive Disorder?” (PDF)

    Instructions: Please click on the above link and read this brief section (p. 5–6) including the quote at the top of the page.

    Reading this text and taking notes should take approximately 15 minutes. 
     
    Terms of Use:This material is part of the public domain. 

5.1.1 Diagnoses   *Anxiety disorders are the most common occurring mental disorders in the adult population. In order to better understand the various types of anxiety disorders (i.e., panic attacks, panic disorder, agoraphobia, specific phobias, social phobias, GAD, OCD, acute and PTSD), it is necessary to understand each illness and symptom manifestation to properly diagnose the correct disorder.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 4: Adults and Mental Health,” pages 233–237 for additional information, as well as the related articles from the National Institute of Mental Health on panic disorder, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder, as well as Dr. Judd Marmor’s article on “Anxiety and Worry as Aspects of Normal Behavior.”*

5.1.2 Etiology of Anxiety Disorders   *The etiology of anxiety disorders likely involves a combination of life experiences, psychological traits, and genetic factors. Acute stress reactions to anxiety and the physiological systems involve focus on the fight or flight response. Likewise, there are new views on the anatomical and biochemical bases of anxiety (e.g., HPA axis system, internal/external triggers) and neurotransmitter alterations (complexity of serotonin, norepinephrine, GABA, CRH, and cholecystokinin), in addition to psychological views (i.e., differences between psychoanalytic and psychodynamic theories, and behavioral and cognitive theories).

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 4: Adults and Mental Health,” pages 237–241 for additional information, as well as the related articles from the National Institute of Mental Health on panic disorder, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder, and Dr. Judd Marmor’s article on “Anxiety and Worry as Aspects of Normal Behavior.”*

  • Reading: Trials: An Open Access Publication: Dr. Alessandra Gorini and Dr. Giuseppe Riva’s (2008) “The Potential of Virtual Reality as Anxiety Management Tool: A Randomized Controlled Study in a Sample of Patients Affected by Generalized Anxiety Disorder” Link: Trials: An Open Access Publication: Dr. Alessandra Gorini and Dr. Giuseppe Riva’s (2008) “The Potential of Virtual Reality as Anxiety Management Tool: A Randomized Controlled Study in a Sample of Patients Affected by Generalized Anxiety Disorder” (PDF)
     
    Instructions: Read this article. Focus on the Introduction, Methods, and Conclusion sections. You may skip the Results section, as the details of the analysis are not pertinent to this course.

    Reading this text and taking notes should take approximately 2 hours to complete.
     
    Terms of Use: This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • Web Media: Hobart and William Smith College Center for Counseling and Student Wellness’s “Relaxation Techniques” Link: Hobart and William Smith College Center for Counseling and Student Wellness’s “Relaxation Techniques” (HTML)
     
    Instructions: Read the section titled “relaxation techniques” and the adjoining section entitled “tips.” Optionally, you can click on the link titled “Progressive Relaxation Exercises” and “Combination Relaxation Exercises” to hear a recorded version of guided relaxation techniques. These two exercises are 9 minutes and 14 minutes, respectively.
     
    These techniques are frequently used in cognitive-behavioral therapy and other eclectic treatments for anxiety. The goal is to have clients/patients learn to use these relaxation techniques on their own so that they become a part of their coping repertoire. 
     
    Studying this resource should take approximately 30 minutes.
     
    Terms of Use: Please respect the copyright and terms of use displayed on the webpage above. 

5.1.3 Treatment of Anxiety Disorders   *Anxiety disorders are treated with counseling/psychotherapy (e.g., cognitive-behavioral therapy), pharmacotherapy (e.g., benzodiazepines, antidepressants, buspirone), or a combination of both (i.e., using multimodal therapies and future implications in treatment).

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 4: Adults and Mental Health,” pages 237–241 for additional information, as well as the related articles from the National Institute of Mental Health on panic disorder, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder, and Dr. Judd Marmor’s article on “Anxiety and Worry as Aspects of Normal Behavior.” Drs. Gorini and Riva’s article on “The Potential of Virtual Reality as Anxiety Management Tool: A Randomized Controlled Study in a Sample of Patients Affected by Generalized Anxiety Disorder” and Hobart and William Smith College Center for Counseling and Student Wellness’s “Relaxation Techniques” are equally informative regarding treatment techniques.*

5.2 Anxiety Disorders in Children   - Reading: United States Department of Health and Human Services’ MentalHealth: A Report of the Surgeon General (1999): "Chapter 3: Children and Mental Health" Link: United States Department of Health and Human Services’ MentalHealth: A Report of the Surgeon General** (1999): "Chapter 3: Children and Mental Health" (PDF)

 Instructions: Read the section titled “Anxiety Disorders,” which is
a subsection of “Other Mental Disorders in Children and
Adolescents.” Please note that the pages in the PDF bar at the top
of the document do not match the pages in the table of contents
section on the first page. This reading will cover all topics listed
under subunit 5.2.   
    
 Reading this text and taking notes should take approximately 15
minutes.  
    
 Terms of Use: Please respect the copyright and terms of use
displayed on the webpage above.

5.2.1 Separation Anxiety Disorder   *Separation anxiety disorder in children can develop through identified and unidentified causes/risk factors, associated symptoms, and manifestations. The prevalence and remission rates of this disorder are high, and there may be a relational predisposition to panic disorder or agoraphobia.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 3: Children and Mental Health,” pages 160–161 for additional information.*

5.2.2 Generalized Anxiety Disorder   *Children with generalized anxiety disorder worry excessively about events and situations. This undue worry can lead to overly conforming perfectionism or approval-seeking behavior.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 3: Children and Mental Health,” pg. 161 for additional information.*

5.2.3 Social Phobia   *Children with social phobia have a persistent fear of embarrassment in social situations. Symptom manifestation may be difficult to determine as young children may have trouble articulating their fears. There is a lifetime prevalence of this disorder though it may become less severe or completely remit.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 3: Children and Mental Health,” pages 161–162 for additional information.*

5.2.4 Obsessive-Compulsive Disorder   *Obsessive-compulsive disorder is characterized by repetitive behaviors or obsessions that often attempt to displace obsessive thoughts. There is a strong familial component of this disorder as noted by twin studies, as well as evidence suggesting Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) affect development.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 3: Children and Mental Health,” pages 162–163 for additional information.*

5.2.5 Treatment of Anxiety   *There is relatively little research on the efficacy of psychodynamic and behavioral therapies in the treatment of anxiety in children.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 3: Children and Mental Health,” pg. 162 for additional information.*

5.3 Anxiety Disorders in Older Adults   - Reading: United States Department of Health and Human Services’ MentalHealth: A Report of the Surgeon General (1999): “Chapter 5: Older Adults and Mental Health” Link: United States Department of Health and Human Services’ MentalHealth: A Report of the Surgeon General (1999): “Chapter 5: Older Adults and Mental Health”  **(PDF)
 
Instructions: Read the section titled “Anxiety Disorders,” which is under “Other Mental Disorders in Older Adults.” Please note that the pages in the PDF bar at the top of the document do not match the pages in the table of contents section on the first page. This reading will cover all topics outlined for subunits 5.3.1 and 5.3.2.
 
Reading this text and taking notes should take fewer than 15 minutes.
 
Terms of Use: Please respect the copyright and terms of use displayed on the webpage above.

5.3.1 Prevalence of Anxiety   *Older adults can experience various types of anxiety later in life. Phobic anxiety disorders are more common during this phase and worry or nervous tension (rather than specific anxiety syndromes) might be more significant. There are several disorders (e.g., PTSD) that have been less studied in the aging population.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 5: Older Adults and Mental Health,” pg. 364 for additional information.*

5.3.2 Treatment of Anxiety   *The treatment of anxiety in older adults can range in variability including the use of pharmacotherapies. Benzodiazepines are used to treat acute and chronic anxiety (although there is an issue with toxicity) and buspirone is an anxiolytic that is comparable to that of benzodiazepines in terms of efficacy.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 5: Older Adults and Mental Health,” pages 364–365 for additional information.*

The Saylor Foundation’s “Unit 5 Assessment”   - Assessment: The Saylor Foundation’s “Unit 5 Assessment” Link: The Saylor Foundation’s “Unit 5 Assessment”

 Instructions: Complete this unit assessment. For each question,
pick the best possible answer. The correct answers will be displayed
when you click the "Submit" button.  

 You must be logged into your Saylor Foundation School account in
order to access this quiz.  If you do not yet have an account, you
will be able to create one, free of charge, after clicking the
link.  
 Completing this assessment should take approximately 15 minutes.