27/2/22

COUN6041
MENTAL HEALTH IN
COUNSELLING AND
PSYCHOTHERAPY

Week 4 – Anxiety Disorders

OVERVIEW
–Introduction to anxiety disorders
–Anxiety disorders in the DSM-5
–Panic disorder, agoraphobia, generalised anxiety
disorder, social anxiety disorder, specific phobia, and
separation anxiety disorder
–Assessment of anxiety disorders
–Treatment of anxiety disorders

1
 27/2/22

INTRODUCTION
–Some degree of anxiety is helpful, as it helps people avoid
danger
–Experiencing anxiety now and then is normal
–A person might have an anxiety disorder, if
- anxiety occurs in response to non-threatening events
- the fear persists over long periods of time
- the fear affects a person’s everyday functioning

(Fassnacht et al., 2020; Hungerford, et al., 2018)

CAUSES
–Anxiety disorders can be caused by a number of predisposing
and precipitating factors, including
- Underlying temperament (trait)
- Genetic predisposition
- Modelling by parents
- Parental overprotection or coldness
- Parental loss or separation
- Adverse life events
- Smoking and drugs (for panic attacks)

(APA, 2013)

2
 27/2/22

PREVALENCE
–Anxiety disorders are the most common mental health condition
in Australia, followed by post-traumatic stress and related
disorders, depressive disorders and substance use disorders
–Women are 50% more likely to develop anxiety as compared to
men (ABS, 2008)
–The most common anxiety disorders affecting Australian adults
over a 12-month period are:
- Social anxiety disorder (4.7%)
- Agoraphobia (2.8%)
- Generalised Anxiety Disorder (2.7%)
- Panic disorder (2.6%)

HOW ABOUT OCD AND PTSD?

–The 2008 ABS census also lists post-traumatic stress disorder
(PTSD) and obsessive-compulsive disorder (OCD) as anxiety
disorders
–However, more recently, OCD and PTSD are no longer
understood as anxiety disorders (APA, 2013)
–People diagnosed with these conditions may also experience
anxiety, however, the course of OCD and PTSD is different to
that of anxiety disorders
–OCD will be addressed separately in another section of this unit
–PTSD will be addressed in another unit (trauma)

3
 27/2/22

ANXIETY DISORDERS IN THE DSM-5

In the DSM-5 (APA, 2013) the following anxiety
disorders are identified:
–Panic disorder
–Agoraphobia
–Generalised anxiety disorder
–Social anxiety disorder
–Specific phobia
–Separation anxiety disorder
–Selective mutism
(APA, 2013)

PANIC DISORDER (1)

–Panic disorder involves recurrent unexpected panic attacks.
A panic attack is a discrete period of intense fear or discomfort,
where four (or more) of the following symptoms occur:
- palpitations, pounding heart, or accelerated heart rate
- sweating
- trembling or shaking
- sensations of shortness of breath or smothering
- feeling of choking
- chest pain or discomfort
(APA, 2013)

4
 27/2/22

PANIC DISORDER (2)

- nausea or abdominal distress
- feeling dizzy, unsteady, light-headed, or faint
- chills or heat sensations
- paresthesias (numbness or tingling sensations)
- derealisation (feelings of unreality) or depersonalisation
(feeling detached from oneself)
- fear of losing control or ‘going crazy’
- fear of dying

(APA, 2013)

PANIC DISORDER (3)

–At least one of the panic attacks has been followed by one
month (or more) of one or both of the following:
- worry about additional panic attacks or the consequences
(e.g., losing control, having a heart attack)
- significant maladaptive change in behaviour related to
the attacks (e.g., behaviours designed to avoid having a
panic attack)

(APA, 2013)

10

5
 27/2/22

AGORAPHOBIA (1)
Agoraphobia consists of both anxiety and avoidance and can
co-occur with panic disorder.
Agoraphobia is characterised by a marked fear or anxiety
about two (or more) of the following five situations:
–using public transportation (e.g., cars, buses, trains, planes)
–being in open space (e.g., marketplaces, bridges)
–being in enclosed places (e.g., shops, theatres, cinemas)
–standing in line or being in a crowd
–being outside of the home alone
(APA, 2013)

11

AGORAPHOBIA (2)
People with agoraphobia fear or avoid these situations
because of thoughts that, in the event of developing
panic-like symptoms or other incapacitating or
embarrassing symptoms,
–escape might be difficult, or
–help might not be available

(APA, 2013)

12

6
 27/2/22

GENERALISED ANXIETY DISORDER

(GAD) (1)
–Causes people to worry excessively about a number
of aspects of their lives
– Occurs more days than not for at least six months,
with the worry being hard to control

(APA, 2013)

13

GAD (2)
–The DSM-5 criteria associate the experience of anxiety and worry
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 six months):
- restlessness or feeling keyed up or on edge
- being easily fatigued
- difficulty concentrating or the mind going blank
- irritability
- muscle tension
(APA, 2013)
- sleep disturbance

14

7
 27/2/22

SOCIAL ANXIETY DISORDER (SAD) (1)

Social anxiety disorder has the following characteristics:
–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., meeting unfamiliar people)
>being observed (e.g., eating or drinking)
>performing in front of others (e.g., giving a speech)

(APA, 2013)

15

SAD (2)
–The individuals 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 provide fear or anxiety.
–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
(APA, 2013)

16

8
 27/2/22

SAD (3)
–The fear or avoidance extends over a period of six months or
more
–The fear, anxiety, or avoidance causes significant distress or
impairment in social, occupational, or other important areas
of functioning

(APA, 2013)

17

SPECIFIC PHOBIA (1) (APA, 2013)

–A specific phobia involves:

–Marked fear or anxiety about a specific object or situation, e.g.,
- Flying
- Heights
- Animals
- Receiving an injection
- Seeing blood
–The phobic object or situation almost always provides
immediate fear or anxiety and is actively avoided or endured
with intense fear or anxiety

18

9
 27/2/22

SPECIFIC PHOBIA (2)

–The phobic object or situation almost always provides
immediate fear or anxiety and 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
–The fear anxiety or avoidance is persistent, typically lasting for
six months or more
–Some of the most common phobias are fear of heights, flying,
spiders, snakes, dogs, injection, thunder and lightning.
(APA, 2013)

19

SEPARATION ANXIETY DISORDER (1)

–Separation anxiety disorder is a developmentally inappropriate
and excessive fear or anxiety concerning separation from
those to whom the individual is attached, as evidenced by at
least three of the following:
- recurrent excessive distress when anticipating or
experiencing separation from home or from major
attachment figures
- persistent and excessive worry about losing major
attachment figures or about possible harm to them (e.g.,
illness or disaster)
(APA, 2013)

20

10
 27/2/22

SEPARATION ANXIETY DISORDER (2)

- persistent and excessive worry about experiencing an
untoward event (e.g., getting lost, becoming ill) that causes
separation from a major attachment figure
- persistent reluctance or refusal to go out, away from home,
to school, to work, or elsewhere because of fear of
separation
- persistent and excessive fear of or reluctance about being
alone or without major attachment figures at home or in
other settings
- persistent reluctance or refusal to sleep away from home
want to go to sleep without being near a major attachment
figure (APA, 2013)

21

SEPARATION ANXIETY DISORDER (3)

- repeated nightmares involving the theme of separation
- repeated complaints about physical symptoms (e.g.,
headaches nausea vomiting) and separation from major
attachment figures anticipated

–The fear anxiety or avoidance is persistent, lasting at least four

weeks in children and adolescents and typically six months or
more in adults
–Separation anxiety disorder can be diagnosed in adults

(APA, 2013)

22

11
 27/2/22

CASE FORMULATION (1)

Psychodynamic
– Anxiety is seen as a fundamental experience in infancy, involving
preverbal experiences of relations with main caregivers
– Intra-psychic representations of these relations are formed and
carried into childhood and adulthood

Person-centred
– To become fully functioning, a child needs to develop an image of
themselves (self-concept) that is congruent with their felt
experience
– If the self-image does not align with the conditions of worth the child
grows up with, anxiety develops as a natural human response to
the threat that is posed to the self-concept
(Kaposi, 2020; Sims et al., 2020 )

23

CASE FORMULATION (2)

Cognitive-behavioural
–Not events cause anxiety but the person’s interpretation of the
event (the meaning they attach to it)
–Anxiety arises from an event that is interpreted unnecessarily
negative

Pluralistic
–Open to insights from a number of approaches, including
counselling/psychology, sociology, and neuroscience

(Clarke, 2020; Mcleod & Mcleod, 2020 )

24

12
 27/2/22

CASE STUDIES (POST-LEARNING

ACTIVITIES)

25

CASE STUDY
(POST-LEARNING
ACTIVITIES)

26

13
 27/2/22

ASSESSMENT OF ANXIETY DISORDERS (1)

– Many screening tests detect anxiety, as well as depression and other
mental disorders
– One example of a screening test discussed in section 2 of this unit is
the DSM-5 Self-Rated Level-1 Cross-Cutting Symptom Measure (APA,
2015)

– However, screening for specific anxiety disorders is more complex

– The accurate diagnosis of anxiety disorders requires differentiation
between the symptom groupings of discrete anxiety disorders
– Specialised tests need to be used to screen for particular anxiety
disorders

27

ASSESSMENT OF ANXIETY DISORDERS (2)

Following on from the DSM-5 Self-Rated Level-1 Cross-Cutting
Symptom Measure (APA, 2015), several screening tests were
developed:
–Severity Measure for Panic Disorder
–Severity Measure for Agoraphobia
–Severity Measure for Generalized Anxiety Disorder
–Severity Measure for Social Anxiety Disorder (Social Phobia)
–Severity Measure for Specific Phobia
–Severity Measure for Separation Anxiety Disorder

(APA, 2015)

28

14
 27/2/22

TREATMENT OF ANXIETY DISORDERS

The most evidence-based psychological treatments for anxiety
disorders include
–Level 1 (most evidence-based) for all anxiety disorders:
cognitive behavioural therapy (CBT)
–Level 2
- Social anxiety disorder
>ACT
>Interpersonal Psychotherapy (IPT)
>MBSR
>Psychodynamic therapy (APS, 2018)

29

TREATMENT OF ANXIETY DISORDERS

–Level 2 cont’d
- GAD
>Acceptance commitment therapy (ACT)
>Mindfulness-based cognitive therapy (MBCT)
>Mindfulness-based stress reduction (MBSR)
>Psychodynamic therapy
- Panic disorder
>ACT
>Psychodynamic therapy
(APS, 2018)

30

15
 27/2/22

TREATMENT OF ANXIETY DISORDERS

If you like to explore these further, please read pp. 5-17 in:

Australian Psychological Society. (2018). Evidence based

psychological interventions in the treatment of mental disorders:
A review of the literature. https://www.psychology.org.au/
getmedia/23c6a11b-2600-4e19-9a1d-6ff9c2f26fae/Evidence-
based-psych-interventions.pdf

31

CONCLUSION
–Experiencing anxiety now and then is normal
–If anxiety occurs in response to non-threatening events, and
persists over long periods of time, it could be an anxiety disorder
–Anxiety disorders are the most common mental health conditions
in Australia
–The DSM-5 includes the following anxiety disorders: panic
disorder, agoraphobia, generalised anxiety disorder, social
anxiety disorder, specific phobia, separation anxiety, and
selective mutism
–Specialised screening tests exist for these anxiety disorders
–There are many highly evidence-based treatment options

32

16
 27/2/22

33

REFERENCES (1)
– Aderka., I. & Hofman, S. (2020). Social anxiety: A process-based treatment
approach. In D. Barlow (Ed.), Clinical handbook of psychological
disorders: A step-by-step treatment manual (6th ed., pp. 108-
128). Guilford.
– American Psychiatric Association. (2013). Diagnostic and statistical
manual of mental disorders (5th
ed.). https://doi.org/10.1176/appi.books.9780890425596.dsm05
– American Psychiatric Association. (2015). DSM-5 Self-Rated Level 1
Cross-Cutting Symptom Measure. https://www.psychiatry.org/psychiatrists/practice
/dsm/educational-resources/assessment-measures
– Australian Bureau of Statistics. (2008). National survey of mental health
and well-being: Summary of results, 2007.
https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4326.0Main+Features32007?Open
Document

34

17
 27/2/22

REFERENCES (2)
– Australian Psychological Society. (2018). Evidence based psychological
interventions in the treatment of mental disorders: A review of the
literature. https://www.psychology.org.au/ getmedia/23c6a11b-2600-4e19-
9a1d-6ff9c2f26fae/Evidence-based-psych-interventions.pdf
– Clarke, S. P. (2020). The cognitive-behavioural understanding of mental
health. In N. Moller, A. Vossler, D. Jones, & D. Kaposi
(Eds.), Understanding mental health and counselling (pp. 292-295). Sage
Publications.
– Fassnacht, D., Parker, E., Barry, M., Banfield, M., Jiggins, D., Clark, D., &
Kyrios, M.(2020). Anxiety, fear, obsessive-compulsive, stress related and
dissociative disorders. In G. Meadows, B. Happell, & V. Edan
(Eds.), Mental health and collaborative community practice: An Australian
perspective (4th ed., pp. 662-700). Oxford University Press.

35

REFERENCES (3)
– Hungerford, C., Hodgson, D., Murphy, G., de Jong, G., Ngune, I.,
Bostwick, R., & Clancy, R. (2018). Mental health care (3rd ed.) Wiley.
– Kaposi, D. (2020). The psychodynamic understanding of mental health. In
N. Moller, A. Vossler, D. Jones, & D. Kaposi (Eds.), Understanding mental
health and counselling (pp. 261-265). Sage Publications.
– McLeod, J., & McLeod, J. (2020). The pluralistic understanding of mental
health: The case of anxiety. N. In Moller, A. Vossler, D. Jones, & D.
Kaposi (Eds.), Understanding mental health and counselling (pp. 350-
354). Sage Publications.
– Roemer, L., Eustis, E., & Orsillo, S. (2020). Generalised anxiety disorder:
An acceptance-based behavioural therapy. In
D. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-
step treatment manual (6th ed., pp. 184-211). Guilford.

36

18
 27/2/22

REFERENCES (4)
– Sims, M., & Di Malta, G. (2020). The person-centred understanding of
mental health. In N. Moller, A. Vossler, D. Jones,& D. Kaposi, D.
(Eds.), Understanding mental health and counselling (pp. 323-327). Sage
Publications.

37

38

19