Anxiety Disorders
ANXIETY DISORDERS
01 - Separation Anxiety Disorder
02 - Selective Mutism
03 - Specific Phobia
04 - Social Anxiety Disorder
05 - Panic Disorder
06 - Agoraphobia
07 - Generalized Anxiety DisorderSEPARATION ANXIETY DISORDER
Signs & Symptoms
SEPARATION ANXIETY DISORDER
Signs & Symptoms
SEPARATION ANXIETY DISORDER
Treatment & Intervention
Cognitive Behavioral Therapy
Exposure Therapy
Systematic Desensitization
Family Therapy
SELECTIVE MUTISM
Signs & Symptoms
Is characterized in a child by persistent lack of speaking in one or more
specific social situations, most typically, the school setting.
A child with selective mutism may remain completely silent or near silent, in
some cases only whispering in a school setting.
Often begins before age 5 years, may not be apparent until the child is expected
to speak or read aloud in school.
Prevalence: Selective Mutism is a relatively rare disorder disorder and has not
been included as a diagnostic category in epidemiological studies of prevalence
of childhood disorders.
Point of prevalence ranges between 0.03 and 1%
The prevalence of the disorder does not seem to vary by sex or race/ethnicity
The disorder is more likely to manifest in young children than in adolescents
and adults
Etiology: (1) Genetic Contribution (2) Parental Interactions (3) Speech and
Language Factors
SELECTIVE MUTISM
Diagnostic Criteria
A. Consistent failure to speak in specific social situations in which there is
an expectation forspeaking (e.g., at school) despite speaking in other
situations.
B. The disturbance interferes with educational of occupational achievement or
with socialcommunication.
C. The duration of the disturbance is at least 1 month (not limited to the first
month ofschool)
D. The failure to speak is not attributable to a lsck of knowldege of, or
comfort with, thespoken language required in the social situation.
E. The disturbance is not better explained by a communication disorder (e.g.,
childhood-onset fluency disorder) and does not occur exclusively during the
course of autism spectrum disorder, schizophrenia, or another psychotic
disorder.
SELECTIVE MUTISM
Treatment & Intervention
Assertiveness Training
Systematic Desensitization
Exposure Therapy
Token Economy
SPECIFIC PHOBIA
Signs & Symptoms
Marked fear or anxiety about a specific object or situation (e.g., flying,
heights, animals, receiving an injection, seeing blood).
Note: In children, the fear or anxiety may be expressed by crying,
tantrums, freezing, or clinging
The phobic object or situation almost always provokes immediate fear or anxiety.
The phobic object or situation is actively avoided or endured with intense fear
or anxiety.
The fear or anxiety is out of proportion to the actual danger posed by the
specific object or situation and to the sociocultural context.
The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or
more. The fear, anxiety, or avoidance causes clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
SPECIFIC PHOBIA
Treatment & Intervention
Exposure Therapy
Systematic Desensitization
Cognitive Behavioral Therapy
Group Therapy
SOCIAL ANXIETY DISORDER
Signs & Symptoms
Marked fear or anxiety about one or more social situations in which the
individual is exposed to possible scrutiny by others. Examples include social
interactions (e.g., having a conversation, meeting unfamiliar people), being
observed (e.g., eating or drinking), and performing in front of others (e.g.,
giving a speech).
Note: In children, the anxiety must occur in peer settings and not just during
interactions with adults.
The individual fears that he or she will act in a way or show anxiety symptoms
that will be negatively evaluated (i.e., will be humiliating or embarrassing;
will lead to rejection or offend others).
The social situations almost always provoke fear or anxiety.
Note: In children, the fear or anxiety may be expressed by crying, tantrums,
freezing, clinging, shrinking, or failing to speak in social situations.
SOCIAL ANXIETY DISORDER
Signs & Symptoms
The social situations are avoided or endured with intense fear or anxiety.
The fear or anxiety is out of proportion to the actual threat posed by the
social situation and to the sociocultural context.
The fear, anxiety, or avoidance is persistent, typically lasting for 6 months
or more.
The fear, anxiety, or avoidance causes clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
The fear, anxiety, or avoidance is not attributable to the physiological
effects of a substance (e.g., a drug of abuse, a medication) or another medical
condition.
The fear, anxiety, or avoidance is not better explained by the symptoms of
another mental disorder, such as panic disorder, body dysmorphic disorder, or
autism spectrum disorder. If another medical condition (e.g., Parkinson's
disease, obesity, disfigurement from burns or injury) is present, the fear,
anxiety, or avoidance is clearly unrelated or is excessive.
Specify if: Performance only: If the fear is restricted to speaking or
performing in public.
SOCIAL ANXIETY DISORDER
Treatment & Intervention
Cognitive Behavioral Therapy
Exposure Therapy
Group Therapy
PANIC DISORDER
Signs & Symptoms
Palpitations, pounding heart, or accelerated heart rate.
Sweating.
Trembling or shaking.
Sensations of shortness of breath or smothering.
Feelings of choking.
Chest pain or discomfort.
Nausea or abdominal distress.
Feeling dizzy, unsteady, light-headed, or faint.
Chills or heat sensations.
Paresthesias (numbness or tingling sensations).
Derealization (feelings of unreality) or depersonalization (being detached from
oneself). Fear of losing control or "going crazy." Fear of dying.
PANIC DISORDER
Treatment & Intervention
Exposure therapy
Extinction and shaping
Systematic desensitization
Cognitive-behavioral therapy (CBT)
Rational emotive behavior therapy (REBT)
Metacognitive therapy
TREATMENT & INTERVENTION OF PANIC DISORDER
Exposure therapy
Emma experiences panic attacks when in crowded places like shopping malls.
Treatment: Her therapist starts with imagining being in a mildly crowded area
(Exposure). Emma practices deep breathing to manage anxiety (Shaping).
Progression: Over sessions, she visits slightly busier places (Systematic
Desensitization) and stays longer each time, realizing her panic has subsided
(Extinction).
Outcome: Eventually, Emma comfortably navigates crowded malls without panic.
TREATMENT & INTERVENTION OF PANIC DISORDER
Systematic desensitization
Sarah fears elevators, leading to panic attacks.
Assessment & Hierarchy:
Look at elevator pictures
Stand near an elevator
Step inside an empty elevator
Ride a few floors with door open Ride full length with door open
Ride full length with door closed Relaxation Training: Learn deep breathing.
Progression:
Sessions 1-2: Imagine elevator pictures and practice deep breathing.
Sessions 3-4: Stand near the elevator, focusing on relaxation.
Sessions 5-6: Step inside the empty elevator briefly.
Sessions 7-8: Ride a few floors with door open.
Sessions 9-10: Ride full length with door closed.
Outcome:
After 10 sessions, Sarah can ride elevators without panic attacks.
TREATMENT & INTERVENTION OF PANIC DISORDER
Cognitive-behavioral therapy (CBT)
John believes his panic attacks mean he's "going crazy" and avoids public
places.
Treatment: His therapist helps identify and challenge this belief (Cognitive
Restructuring).
Homework: John keeps a thought journal and practices replacing irrational
thoughts with more realistic ones.
Outcome: With CBT, John learns to view panic attacks as manageable and not a
sign of insanity.
TREATMENT & INTERVENTION OF PANIC DISORDER
Rational emotive behavior therapy (REBT)
Sarah experiences panic when she thinks about flying due to fear of crashing.
Treatment: Her therapist helps her dispute irrational beliefs (Disputing
Techniques).
Example: Sarah challenges "I will definitely crash if I fly" with
"There's no evidence to support that."
Outcome: Through REBT, Sarah learns to replace catastrophic thoughts with more
rational ones, reducing her fear of flying.
TREATMENT & INTERVENTION OF PANIC DISORDER
Metacognitive therapy
Alex worries about having panic attacks in social situations. Treatment:
His therapist focuses on how he relates to these worries (Detached Mindfulness).
Technique: Alex learns to observe his anxious thoughts without reacting.
Outcome: With MCT, Alex gains distance from his thoughts, reducing their impact
on his anxiety levels.
AGORAPHOBIA
Signs & Symptoms
Using public transportation (e.g., automobiles, buses, trains, ships, planes).
Being in open spaces (e.g., parking lots, marketplaces, bridges).
Being in enclosed places (e.g., shops, theaters, cinemas).
Standing in line or being in a crowd.
Being outside of the home alone.
AGORAPHOBIA
Treatment & Intervention
Exposure therapy
Extinction and shaping
Systematic desensitization,
Cognitive-behavioral therapy (CBT)
Rational emotive behavior therapy (REBT)
Metacognitive therapy
TREATMENT & INTERVENTION OF AGORAPHOBIA
Exposure therapy
Emily fears going outside due to agoraphobia.
Customized Hierarchy: Tailored to Emily's fears.
Supportive Therapist: Provides guidance and support.
Gradual Progress: Small, manageable steps.
Relaxation Techniques: Deep breathing during exposures.
Monitoring Progress: Journaling to track improvements.
TREATMENT & INTERVENTION OF AGORAPHOBIA
Systematic desensitization
Step 1: Imagine sitting by an open door at home.
Step 2: Practice relaxation while visualizing this.
Step 3: Move to sit by an open door in a public place.
Step 4: Gradually extend exposure to more crowded spaces.
Consistent Practice: Desensitization takes time; steady progress is key.
Adaptation: Adjust exposure pace based on comfort and progress.
Systematic desensitization helps reduce anxiety by gradually exposing to fears,
and building confidence in facing agoraphobia triggers.
TREATMENT & INTERVENTION OF AGORAPHOBIA
Cognitive-behavioral therapy (CBT)
Step 1: Challenge the thought "Crowded places will cause panic" with evidence.
Step 2: Replace with "Crowded places are uncomfortable but manageable." Step 3:
Gradually expose yourself to crowded places with new thoughts and relaxation.
Consistency: Regular sessions and homework are key for improvement. Gradual
Progress: Start with easier exposures and build up to more challenging
situations.
CBT helps change negative thought patterns and behaviors, reducing anxiety and
building confidence in facing agoraphobia triggers.
TREATMENT & INTERVENTION OF AGORAPHOBIA
Rational emotive behavior therapy (REBT)
Irrational Belief: "I must avoid crowded places or I'll panic." REBT Approach:
Challenge: "Is it realistic to fear every crowd?"
Replace: "I have coping skills; not every crowd is a threat." Active
Participation: Individuals actively challenge beliefs.
Shift in Thinking: REBT aims to change thought patterns to reduce anxiety.
Therapist Support: Work with an REBT therapist for guidance and support. REBT
helps change irrational beliefs, reducing anxiety and building confidence to
face agoraphobic situations.
TREATMENT & INTERVENTION OF AGORAPHOBIA
Metacognitive therapy
Worrying Thought: "Something terrible will happen if I go outside." MCT
Approach:
Detached Mindfulness: Observe thought without judgment.
Decentering: Treat thought as a passing mental event.
Attention Training: Focus on present, not future catastrophes.
Meta-Thinking Focus: Changing how thoughts are viewed, not just content.
Mindfulness Emphasis: Using mindfulness to detach from and observe thoughts.
Professional Guidance: Work with an MCT therapist for personalized
interventions.
MCT helps individuals change their relationship with anxious thoughts, reducing
worry and catastrophic thinking associated with agoraphobia.
GENERALIZED ANXIETY DISORDER
Signs & Symptoms
It involves anxiety and worry that is excessive and unrelenting
It is a condition characterized by excessive anxiety and worry, occuring more
days than not for a period of at least 6 months, about a number of events or
activities.
The individual finds it difficult to control the worry.
Point of prevalence ranges between 0.2% to 4.3%
The prevalence of the disorder seem to vary by sex but not in race/ethnicity
The disorder is more likely to have greater severity in younger adults than
older adults
Etiology: (1) Genetic Contribution (2) Environmental
By definition of GAD is chronic illness and may well be lifelong
GENERALIZED ANXIETY DISORDER
Psychological Symptoms
Irritability
Feelings of dread
Inability to control anxious thoughts
Inability to relax
Difficulty concentrating
Fear of losing control or being rejected
GENERALIZED ANXIETY DISORDER
Diagnostic Criteria
A. Excessive anxiety and worry (apprehensive expectation), occuring more days
than not for atleast 6 months, about a number of events or 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
six symptoms(with at least some symptoms, having been present for more days than
not for the past 6 months):
Note: Only one item is required in children
1.Restlessness or being keyed up or on edge
2.Being easily fatigued
3.Difficulty concentrating or mind going blank
4.Irritability
5.Muscle tension
6.Sleep disturbance
GENERALIZED ANXIETY DISORDER
Diagnostic Criteria
D. The anxiety, worry, or physical symptoms cause clinically significant
distress or impairmentin social, occupational, or other important areas of
functioning
E. The disturbance is not attributable to the physiological effects of a
substance (e.g., a drug ofabuse, a medication) or another medical condition
(e.g., hyperthyroidism)
F. The disturbance is not better explained by another mental disorder (e.g.,
anxiety or worryabout panic attacks in panic disorder, negative evaluation in
social anxiety disorder, contamination or other obsessions in obsessive-
compulsive disorder, separation from attachment figures in separation anxiety
disorder, reminders of traumatic events in posttraumatic stress disorder,
gaining weight in anorexia nervosa, physical complaints in somatic symptom
disorder, perceived appearance flaws in body dysmorphic disorder, having a
serious illness anxiety disorder, or the content of delusional beliefs in
schizophrenia or delusional disorder).
GENERALIZED ANXIETY DISORDER
Treatment & Intervention
Metacognitive Therapy
Rational Emotive Behavior Therapy
Systematic Desensitization
