Comprise

a group of conditions that share a key feature of excessive anxiety with ensuing behavioral, emotional, cognitive, and physiologic responses.

 Are

diagnosed when anxiety no longer functions as a signal of danger or a motivation for needed change but becomes chronic and permeates major portions of the persons life, resulting in maladaptive behaviors and emotional disability.

 Clients

suffering from anxiety disorders can demonstrate unusual behaviors such as:
Panic

without reason Unwarranted fear of objects or life conditions Uncontrollable repetitive actions Re-experiencing of traumatic events Unexplainable or overwhelming worry

 Agoraphobia

with or without panic

disorder Panic disorder Specific phobia Social phobia Obsessive-Compulsive disorder (OCD) Generalized anxiety disorders (GAD) Acute stress disorder Posttraumatic stress disorder

 Agoraphobia

often, but not always, coincides with Panic Disorder. Agoraphobia is characterized by a fear of having a panic attack in a place from which escape is difficult. Many sufferers refuse to leave their homes, often for years at a time. Others develop a fixed route, or territory, from which they cannot deviate, for example the route between home and work. It becomes impossible for these people to travel beyond what they consider to be their safety zones without suffering severe anxiety.

Panic Attack is defined as the abrupt onset of an episode of intense fear or discomfort, which peaks in approximately 10 minutes, and includes at least four of the following symptoms:

a feeling of imminent danger or doom the need to escape palpitations sweating trembling shortness of breath or a smothering feeling a feeling of choking chest pain or discomfort

nausea or abdominal discomfort dizziness or lightheadedness a sense of things being unreal, depersonalization a fear of losing control or "going crazy" a fear of dying tingling sensations chills or hot flushes.

 There

are three types of Panic Attacks: Unexpected - the attack "comes out of the blue" without warning and for no discernable reason. Situational - situations in which an individual always has an attack, for example, upon entering a tunnel. Situationally Predisposed - situations in which an individual is likely to have a Panic Attack, but does not always have one. An example of this would be an individual who sometimes has attacks while driving.

 Is

characterized by recurrent, unexpected panic attacks that cause constant concern. Panic attack is the sudden onset of intense apprehension, fearfulness, or terror associated with feelings of impending doom.

Dyspnea or shortness of breath Palpitations Chest pain or discomfort Choking or smothering sensation Vertigo or unsteady feelings Diaphoresis Feelings of unreality or depersonalization Trembling or shaking Syncope Nausea or abdominal distress Hot and cold flashes Tingling in hands or feet (paresthesia) Fear of losing control or dying

Symptoms

of a panic attack develop suddenly and increase in intensity within ten minutes of awareness of the first sign; for example, chest pain occurs followed by three other symptoms that increase in intensity within ten minutes of the onset of chest pain.

 Separation

anxiety is the normal fear that babies and young children feel when they are separated from their parents or approached by strangers. It is not uncommon for children to have mild separation anxiety on the first day of school in kindergarten or first grade, or the first day of overnight camp.

 Usually,

this feeling goes away after a few days as a child gets used to a new situation, new friends, and new adults in charge. For most children, separation anxiety lessens with age and experience. In some children, however, this normal fear turns into separation anxiety disorder, which is extreme fearfulness anytime the children are away from their parents or home.

 Children

with this disorder may call their parents at work often, be afraid to sleep over at friends' houses, or suffer extreme homesickness at camp. Separation anxiety disorder can result in frequent absences from school and avoidance of participation in normal social activities of childhood that involve being without their parents. Children with separation anxiety disorder tend to worry and they may be very afraid that their parents will get sick or be injured, or they may have frequent nightmares about getting lost.

 Separation

anxiety can carry over into the teenage years as well. Teenagers with separation anxiety may be uneasy about leaving home, and they sometimes start refusing to go to school. Extreme separation anxiety may be triggered by a change in school, or it may occur after a stressful event at home, such as a divorce, illness, or death in the family.

 Social

Phobia is characterized by an intense fear of situations, usually social or performance situations, where embarrassment may occur. Individuals with the disorder are acutely aware of the physical signs of their anxiety and fear that others will notice, judge them, and think poorly of them.

 This

fear often results in extreme anxiety in anticipation of an activity, a Panic Attack when faced with an activity, or in the avoidance of an activity altogether. Adults usually recognize that their fears are unfounded or excessive, but suffer them nonetheless.

 Symptoms

of Social Phobia manifest themselves physically and can include:

palpitations tremors sweating diarrhea confusion blushing

Blushing

when in social situations is particularly common and often causes the sufferer further embarrassment.

 People

with Social Phobia tend to be sensitive to criticism and rejection, have difficulty asserting themselves, and suffer from low self-esteem. The abuse of alcohol and drugs may occur as the person with social phobia attempts to reduce anxiety.

 The

most common fears associated with the disorder are:

- a fear of speaking in public or to strangers - a fear of meeting new people - performance fears (activities that may potentially be embarrassing), such as writing, eating or drinking in public
Sufferers

usually fear more than one type of social setting.

 Onset

of the disorder is usually in mid to late adolescence, but children have also been diagnosed with Social Phobia. Children with the disorder are prone to excessive shyness, clinging behavior, tantrums and even mutism.

 There

is usually a marked decline in school performance and the child will often try to avoid going to school or taking part in age appropriate social activities. Their fears are centered on peer settings rather than social activities involving adults, with whom they may feel more comfortable. For a child to be diagnosed with Social Phobia, symptoms must persist for at least six months.

 Involves

obsessions (thoughts, impulses, or images) that caused marked anxiety and/or compulsions (repetitive behaviors or mental acts) that attempt to neutralize anxiety.

potentially disabling condition that can persist throughout a person's life. The individual who suffers from OCD becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. OCD occurs in a spectrum from mild to severe, but if severe and left untreated, can destroy a person's capacity to function at work, at school, or even in the home.

 People

with OCD are the slaves of their repetitive thoughts and behaviours. These people recognize the absurdity and senselessness of these worries and rituals, but giving them up would take so much time and energy that it would seriously compromise their ability to function at work, at school, and at home.

 Typically,

a distinction is made between obsessions, which are intrusive, undesired thoughts, and compulsions, which are repetitive, often stereotyped actions. But obsessions and compulsions are closely related: the latter represent an attempt to calm the former.

 OBSESSIONS,

then, are recurrent thoughts or mental images that impose themselves on an individual's consciousness. They resurface constantly and uncontrollably, so that the person's mind can never relax, and hence they constitute a major cause of distress. Common obsessive thoughts include topics such as: RELIGION, SEXUALITY, VIOLENCE, and CONTAMINATION.

 COMPULSIONS

are repetitive behaviours in which people with OCD engage to try to drive away their obsessions and reduce the anxiety that they cause. Compulsions tend to become stylized into sequences of elementary actions that the sufferer must perform at any cost in order to avoid anxiety and distress. Compulsions often resemble rituals in which the sequence and repetition of gestures is minutely codified and in extreme cases may even involve the patient's friends, family, and other people as well.

 Checking

rituals Counting rituals Washing and scrubbing until the skin is raw Praying or chanting Touching, rubbing or tapping Hoarding items Ordering Exhibiting rigid performance Having aggressive urges

Obsession Fear of being contaminated by dirt, dust, germs, bacteria Fear of losing control and hurting oneself or harming someone else Feeling of having forgotten to do something important (turn off the faucet, lock the door, etc.) Fear of having disgusting, violent, sexual, or sacrilegious thoughts Need for symmetry, need to organize and save even the most useless objects

Compulsion

Washing hands or entire body or cleaning objects excessively Engaging in slow, complex, time-consuming rituals revolving around organization and control Repeatedly checking whether you have done the thing in question (for instance, checking the door 100 times to see whether you have locked it) Reciting numbers, names, or phrases to drive away the undesired thoughts (for example, counting down from 10 then up to 10 a hundred times) Tidying the house and arranging things in a certain order, saving things and being unable to throw any of them away

 Is

characterized by at least 6 months of persistent and excessive worry and anxiety.

 is

manifested by worrying excessively over extended periods, about various things that are not necessarily interrelated. In other words, people with GAD worry about events that have a strong chance of never occurring. Thus, if someone with GAD has a headache, consults the doctor about it, and is told that nothing is wrong, he or she may still worry that the cause was actually a brain tumour, and the doctor simply missed it.

In addition to illness, the most typical subjects of concern for people with GAD include being short of money, losing their jobs, and not being able to take proper care of their families, as well as more routine matters such as being late for an appointment.

But in this last case, a person with GAD might reason as follows: If I'm late for this appointment, I might lose my job, and then I don't know how I'm going to make ends meet. I might be so broke that I'll have to sell my car. Such trains of thought can lead to ruminations that last anywhere from a few minutes to several hours.

 By

endlessly reviewing so many negative scenarios in this way, people with GAD become hypervigilant and highly vulnerable to environmental environmental stressors. People with GAD are also far more susceptible to health problems involving weakening of the immune system.

 Is

the development of anxiety, dissociation, and other symptoms within 1 month of exposure to an extremely traumatic stressor; it lasts 2 days to 4 weeks.

 Is

characterized by the reexperiencing of an extremely traumatic event, avoidance of stimuli associated with the event, numbing of responsiveness, and persistent increased arousal; it begins within 3 months to years after the event and may last a few months or years.

People

who experience events that involve loss of life or risk of death or serious physical injury may develop post-traumatic stress disorder (PTSD). The feelings of despair and horror associated with PTSD are manifested in the following three kinds of symptoms.

 Intrusion

Symptoms

When PTSD sufferers manifest intrusion symptoms, they do not simply experience memories of the traumatic eventthey cannot stop their memories from coming back to haunt them. Some of these people experience veritable flashbacks so invasive that it feels as if they are literally reliving the event. Nightmares are another form of intrusion symptoms.

Avoidance Symptoms
When PTSD sufferers show avoidance symptoms, they try to avoid conditions and situations that might trigger memories of the traumatic event. They also tend to avoid talking about this event, so that they do not have to confront it directly. Another avoidance symptom is a dulling of the emotions, sometimes so extreme that these individuals become emotionally deadened. They lose interest in activities that they used to love, stay away from friends and family, and turn inwards on themselves.

 Overstimulation

Symptoms

People with PTSD may experience many symptoms of hypervigilance that make it hard for them to concentrate and to finish the activities that they start. More specifically, these people may: experience insomnia and nervousness, tend to become frightened easily, have a constant sense of danger or imminent disaster, be highly irritable, and even engage in violent behaviour.

 It

was long thought that people could develop PTSD only if they were involved in disasters such as being in a plane crash, witnessing a homicide, or being trapped in a building that had collapsed in an earthquake or a bombing attack. War is in fact the main cause of PTSD, and in North America, the largest group of PTSD sufferers consists of Vietnam War veterans. Indeed, most of what we know about PTSD comes from studies of combat veterans.

 More

recently, however, the list of events that may cause someone to develop PTSD has been expanded to include such experiences as being raped or being in an automobile accident.

Is

characterized by significant anxiety provoked by a specific feared object or situation, which often leads to avoidance behavior.

phobia is defined as the unrelenting fear of a situation, activity, or thing that causes one to want to avoid it. Phobias are largely underreported, probably because many phobia sufferers find ways to avoid the situations to which they are phobic. Therefore, statistics that estimate how many people suffer from phobias vary widely, but at minimum, phobias afflict more than 6 million people in the United States.

Other

facts about phobias include that these illnesses have been thought to affect up to 28 out of every 100 people, and in all western countries, phobias strike 7%-13% of the population. Women tend to be twice as likely to suffer from a phobia compared to men.

 Having

a phobia about something is very different from everyday worry or stress. There are several types of phobias, including: social, situational, animal, and specific phobias (fear of particular items or objects). While the list of phobias is almost endless, we'll take a look at some of the most common phobias on the next slides.

 Agoraphobia

is a fear of being outside or otherwise being in a situation from which one either cannot escape or from which escaping would be difficult or humiliating. Although agoraphobia, like other mental disorders, is caused by a number of factors, it also tends to run in families and for some people, may have a clear genetic factor contributing to its development.

 Also

known as social anxiety disorder, social phobia is an excessive fear of embarrassment in social situations that is extremely intrusive and can have debilitating effects on personal and professional relationships. Examples include fears of public speaking, meeting new people, and other social situations.

Claustrophobia

is an abnormal and persistent fear of closed spaces, of being closed in or being shut in, as in elevators, tunnels, or any other confined space. The fear is excessive and quite common.

Zoophobia

is a term that encompasses fears of specific types of animals such as: spiders (arachnophobia), snakes (ophidiophobia), birds (ornithophobia), bees (apiphobia), etc. It is a zooful of beastly phobias.

Acrophobia

is an abnormally excessive and persistent fear of heights. Sufferers experience severe anxiety even though they usually realize that, as a rule, heights pose no real threat to them.

 An

abnormal and persistent fear of flying is called aerophobia. This phobia generally develops after a person witnesses a plane crash or loses a family member in a plane crash or accident. Sufferers experience severe anxiety even though they usually realize that flying does not pose a threat commensurate with their fear.

 Blood-injection-injury

phobias consist of several specific phobias including: fear of blood (hemophobia), injury phobia, and fear of receiving an injection (trypanophobia or aichmophobia) or other invasive medical procedures.

 If

left untreated, a phobia may worsen to the point at which the person's life is seriously affected, both by the phobia itself and/or by attempts to avoid or conceal it. In fact, some people have had problems with friends and family, failed in school, and/or lost jobs while struggling to cope with a severe phobia.

 There

may be periods of spontaneous improvement, but a phobia does not usually go away unless the person receives treatments designed specifically to help phobia sufferers. Alcoholics can be up to 10 times more likely to suffer from a phobia than those who are not alcoholics, and phobic individuals can be twice as likely to be addicted to alcohol than those who have never been phobic.

 While

there is no one specific known cause for phobias, it is thought that phobias run in families, are influenced by culture, and can be triggered by life events. Immediate family members of people with phobias are about three times more likely to also suffer from a phobia than those who do not have such a family history. Phobia sufferers have been found to be more likely to manage stress by avoiding the stressful situation and by having difficulty minimizing the intensity of the fearful situation.

 Symptoms

of phobias often involve having a panic attack -- in that they include: feelings of panic, dread, or terror, despite recognition that those feelings are excessive in relationship to any real danger -- as well as physical symptoms like shaking, sweating, rapid heartbeat, trouble breathing, and an overwhelming desire to escape the situation that is causing the phobic reaction. Also, extreme measures are sometimes taken to escape the situation.

 Many

health-care providers may help diagnose phobias, including licensed mentalhealth therapists, family physicians, or other primary-care medical providers, specialists whom you see for a medical condition, psychiatrists, psychologists, and social workers. If one of these professionals suspects that you may be suffering from a phobia, you will likely be asked a number of questions to understand all the symptoms you may be experiencing, and you may need to submit to a medical interview and physical examination.

phobia may be associated with a number of other mental -health conditions, especially other anxiety disorders. As anxiety disorders in general may be associated with a number of medical conditions or can be a side effect of various medications, routine laboratory tests are often performed during the initial evaluation to rule out other possible causes of the symptoms.

 Helping

those who suffer from phobias by supportively and gradually exposing them to circumstances that are increasingly close to the one they are phobic about (desensitization) is one way phobias are treated. A second method is cognitive behavioral therapy (CBT), which has been found to significantly decrease phobic symptoms by helping the phobia sufferer change his or her way of thinking. CBT uses three techniques to accomplish this goal:

 Didactic

component: This phase helps to set up positive expectations for therapy and promote the phobia sufferer's cooperation. Cognitive component: It helps to identify the thoughts and assumptions that influence the person's behavior, particularly those that may predispose him or her to being phobic. Behavioral component: This employs behavior-modifying techniques to teach the individual with a phobia more effective strategies for dealing with problems.

 Selective

serotonin reuptake inhibitor (SSRI) medications are often used to treat phobias, particularly when desensitization and CBT are inadequately effective. These medications affect levels of serotonin in the brain. Examples of these medications include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro).

 Phobias

are also sometimes treated using beta-blocker medications, which block the effects that adrenaline has on the body. An example of a beta blocker is propranolol (Inderal). These disorders are less commonly treated with drugs in a medication class known as benzodiazepines. This class of medications causes relaxation but is used much less often these days to treat anxiety due to the possibility of addiction and the risk of overdose, especially if taken when alcohol is also being consumed. Examples of medications from that group include diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin).

The definition of a phobia is the unrelenting fear of a situation, activity, or thing that causes one to want to avoid it. The three classes of phobias are social phobia (fear of public speaking, meeting new people or other social situations), agoraphobia (fear of being outside), and specific phobias (fear of other items or situations). Although phobias are largely underreported, the number of people who suffer from phobias is estimated at more than 6 million people in the United States. Women tend to be twice as likely to suffer from a phobia compared to men.

 While

there are nearly as many phobias as there are situations, the most common kinds of phobias include:

social phobia Agoraphobia Claustrophobia Coulrophobia Aerophobia Zoophobia Arachnophobia Dentophobia Aichmophobia Ophidiophobia Acrophobia mysophobia, and a fear of fear of blood.

 Agoraphobia

often

coexists

with

panic

disorder. If left untreated, a phobia may worsen to the point where the person's life is seriously affected by the phobia and by attempts to avoid or conceal it, leading to problems with friends and family, failures in school, and/or lost jobs while struggling to cope.

 Phobias

tend to run in families, are influenced by culture, and can be triggered by life events. Phobia sufferers have been found to be more likely to manage stress by avoiding the stressful situation and by having difficulty minimizing the intensity of the fearful situation. Symptoms of phobias often involve panic attacks.

 Assessment

of phobias often includes questions by a trained professional that explore the symptoms being experienced, a medical interview, and a physical examination. Phobias are often treated using desensitization, cognitive behavioral therapy, and/or medications.

 The

groups of medications doctors tend to choose from when treating a phobia include selective serotonin reuptake inhibitors, beta blockers, and occasionally, benzodiazepines. Phobia sufferers sometimes cope with their fears by talking about it, refraining from avoiding situations they find stressful, visualization, and making positive selfstatements.

Anxiety r/t impending divorce as evidenced by clients apprehension, lack of self-confidence, and statement of inability to relax Impaired Verbal Communication r/t decreased attention secondary to obsessive thoughts

Anxiety r/t impending divorce as evidenced by clients apprehension, lack of self-confidence, and statement of inability to relax Impaired Verbal Communication r/t decreased attention secondary to obsessive thoughts

Ineffective

Coping r/t poor selfesteem and feelings of hopelessness secondary to chronic anxiety Post-trauma Syndrome r/t physical and sexual assault Powerlessness r/t obsessivecompulsive behavior

Disturbed

Pattern r/t excessive hyperactivity secondary to recurring episodes of panic Impaired Social Interaction r/t high anxiety secondary to fear of open places

Sleep

 Acceptance

that the experience of anxiety is natural and inevitable Understanding that ones level of anxiety may fluctuate

Understanding

that shame is a selfimposed response to anxiety Ability to learn and apply self-help techniques to reduce anxiety Ability to remain calm in anxietyproducing situations Development of problem-solving and coping skills

 The

client will verbalize feelings related to anxiety The client will relate decreased frustration with communication The client will demonstrate an improved ability to express self The client will express optimism about the present

 The

client will socialize with at least one peer daily The client will express confidence in self The client will verbalize a reduction in frequency of flashbacks The client will identify factors that can be controlled by self The client will identify stimuli that precipitate the onset of acute anxiety

used effectively to reduce anxiety experienced by clients with cancer. As clients relax, they engage in a fantasy in which they visualize the identified cause of anxiety, such as pain due to cancer or the cancer itself. A person who has an unresolved conflict, such as not attending the funeral of a loved one, could use this technique in an attempt to work through guilt or unresolved grief.

VISUAL IMAGERY: This technique has been

 CHANGE

OF PACE OR SCENERY:

walking in the woods or along the beach, listening to music, caring for a pet, or engaging in a hobby are a few ways to change pace or scenery in an attempt to decrease anxiety by removing oneself from the source or cause of stress.

 EXERCISE

OR MASSAGE: exercise can be

a release or outlet for pent-up tension or anxiety. Massage is soothing and helps to relax ones muscles. Expectant mothers who practice the Lamaze technique for prepared childbirth use effleurage, or a massage of the abdominal muscles during uterine contractions, to promote relaxation.

 TRANSCENDENTAL

MEDITATION:

the four components of this relaxation technique include a quit environment. A passive state of mind, a comfortable position, and the ability to focus on a specific word or object. Physiologic, psychological, and spiritual relaxation occurs.

 BIOFEEDBACK:

in this technique, the client is able to monitor various physiologic processes by auditory or visual signals. This technique has proven effective in the management of conditions such as migraine headaches, essential hypertension, and pain that is the result of increased stress and anxiety.

SYSTEMATIC

simply stated, this technique refers to the exposure of a person to a fear-producing situation in a systematized manner o decrease a phobic disorder. A behavioral therapist usually works with the client.

DESENSITIZATION:

 RELAXATION

EXERCISE: various methods

are used to help people learn to relax. Common steps to relaxation include taking a deep breath and exhaling (similar to the cleansing or relaxing breathing of Lamaze technique); tensing and then relaxing individual muscles, starting with the head and progressing to the toes; and finally, relaxing all parts of the body simultaneously. Some methods suggest that the person imagine a peaceful scene before doing the exercise.

THERAPEUTIC
These

TOUCH (IT) OR HEALING TOUCH(HT).

techniques are designed to restore balance to a clients energy field (TT) and to consider how client empowerment, practitioner self-care, and the nature of the therapeutic relationship come to bear on healing (HT).

HYPNOSIS

- some behavioral therapists use hypnosis to enhance relaxation or imagery. People have also been taught self-hypnosis to decrease anxiety.

 IMPLOSION

THERAPY (FLOODING):

In this technique, the client imagines or participates in real-life situations that cause increased levels of anxiety or panic sensations. These therapy sessions are rather lengthy and are terminated when the client demonstrates considerably less anxiety than at the start of the session.

 Psychotrophic

drugs are generally reserved for moderate to severe symptoms of anxiety, especially when the disorder significantly impairs function. Classes of pharmacologic agents commonly prescribed include benzodiaphinesm nonbenzodiazephines anxiolytics, antidepressants, beta blockers, and, in some cases, neuroleptics.