Anxiety Disorders: Theory, Research and Clinical Perspectives

Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 9
Foreword......Page 15
Preface......Page 17
1.1 Introduction......Page 19
1.2.1 Section 1: Evolving concepts of anxiety......Page 20
1.2.3 Section 3: Understanding the causes of anxiety......Page 21
1.2.4 Section 4: Treatment of anxiety: current status and controversial issues......Page 22
References......Page 23
2.1 Introduction......Page 24
2.2 Anxiety disorders in the general population......Page 25
2.2.2 Generalized anxiety disorder (GAD)......Page 26
2.2.3 Panic disorder (PD) with and without agoraphobia......Page 27
2.2.5 Posttraumatic stress disorder (PTSD)......Page 28
2.2.6 Separation anxiety disorder (SepAD)......Page 29
2.4 Anxiety disorders in primary care......Page 30
2.6 Conclusion and future directions......Page 31
References......Page 32
3.2 Historical conceptualiztions......Page 38
3.3 DSM-I......Page 39
3.4 DSM-II......Page 40
3.5 DSM-III......Page 41
3.6 DSM-III-R......Page 45
3.7 DSM-IV......Page 46
3.8 DSM-IV-TR......Page 52
3.9 DSM-5......Page 53
References......Page 55
4.1.2 My . rst anti-anxiety studies......Page 58
4.1.3 First review paper on social phobia......Page 59
4.1.4 Early clinical trials in social phobia......Page 60
4.2.1 Subsequent medication trials in social anxiety disorder......Page 62
4.2.3 New directions in treatment research......Page 63
4.3 Current controversy: is social anxiety disorder overdiagnosed and overmedicated?......Page 64
4.4 The future of social anxiety disorder......Page 65
References......Page 66
5.2 Psychodynamic theories of signal anxiety......Page 68
5.2.2 Freud’s structural model of signal anxiety and its elaboration in ego psychology......Page 69
5.2.3 Object relations theory and signal anxiety......Page 70
5.3 Neurobiological factors in anxiety as signal, symptom, and syndrome......Page 71
5.4 A clinical approach......Page 73
References......Page 75
6.2 New advances in understanding evolution and development......Page 77
6.2.2 Developmental plasticity and the......Page 79
6.3.1 The separation call......Page 81
6.4 Evolution and development of an anxious temperament......Page 82
References......Page 84
7.2.1.1 Age of onset......Page 87
7.2.1.3 Comorbid obsessive–compulsive personality disorder (OCPD)......Page 88
7.2.2 Dimensional approaches......Page 89
7.3.1 Potential neurocognitive measures......Page 91
7.3.2 Potential physiological measures......Page 92
7.4 Conclusions and future directions......Page 93
References......Page 94
8.1 Introduction......Page 98
8.2.3 Behavioral inhibition and SAD......Page 99
8.2.4 An evolutionary perspective......Page 100
8.3.2 Autism and Asperger’s syndrome......Page 101
8.3.6 Eating disorders......Page 102
8.4 Conclusions......Page 103
References......Page 104
9.2.2 Comorbid mood and anxiety disorders are extremely common......Page 108
9.2.3 Are those with “anxious depression” di. erent than those with depression alone?......Page 109
9.2.5.2 Is GAD distinct from MDD?......Page 110
9.3.3 Molecular genetic association studies......Page 111
9.4.1 Prognostic implications......Page 112
9.4.3.1 Differential antidepressant e. cacy in unipolar depression......Page 113
9.4.3.4 Second-generation antipsychotics......Page 114
9.4.5 Interaction with other depression subtypes......Page 115
9.5.2 Neurochemical . ndings......Page 116
References......Page 117
10.2 Conceptualization of health anxiety......Page 121
10.2.1 Diagnostic considerations......Page 124
10.4 Etiology......Page 125
10.5 Measures of health anxiety......Page 126
10.5.6 Heightened Illness Concern – Severity Scale......Page 127
10.7.1 Psychotherapies......Page 128
10.7.2 Medication......Page 129
10.8 Conclusion and future directions......Page 130
References......Page 131
11.2.2 DSM-IV personality disorders......Page 134
11.2.4 Interpreting comorbidity......Page 135
11.2.5 Etiologically determined comorbidity......Page 136
11.3.2 Panic disorder and PDs......Page 137
11.3.5 Obsessive–compulsive disorder and PDs......Page 139
11.3.6 Posttraumatic stress disorder and PDs......Page 140
11.4 Prognostic implications: toxic versus benign comorbidity......Page 141
References......Page 142
12.2 Types of idioms of distress......Page 145
12.2.1 Examples of idioms of distress: Caribbean Latino and Cambodian cases......Page 146
12.3.3 Indicators of life distress......Page 150
12.3.5 Causes of distress......Page 151
12.3.6 Indicators of past exposure to trauma......Page 152
12.4 Clinical evaluation of a patient with an idiom of distress......Page 153
12.5 Conclusions......Page 154
References......Page 155
13.2 Genetic study designs......Page 157
13.3.1 Panic disorder......Page 159
13.3.4 Generalized anxiety disorder......Page 162
13.3.6 Obsessive–compulsive disorder......Page 163
13.4 Genetic overlap among anxiety disorders and intermediary phenotypes......Page 164
13.5 Conclusions......Page 165
References......Page 166
14.2 Types of validity......Page 174
14.3 Animal models of anxiety disorders......Page 175
14.4 Behavioral models of anxiety......Page 176
14.5.1 Knockout and knock-in mice......Page 178
14.5.2 Transgenic mice......Page 179
14.6.1 Using tTA/tetO to “rescue” gene expression......Page 180
14.7 Conclusions......Page 182
References......Page 183
15.2 Neuroanatomy of fear and anxiety......Page 186
15.3 Role of the cortex in humans......Page 187
15.4 Role of the cortex in animal models......Page 188
15.5.2 The serotonin transporter (SERT)......Page 189
15.5.3 The 5-HT1A receptor......Page 190
15.5.4 The 5-HT2A receptor......Page 191
15.6 Conclusions......Page 192
References......Page 193
16.1 Introduction......Page 198
16.2 Once burned, twice shy: the amygdala at the center of a fear circuit......Page 199
16.2.1 Extinction: the neural substrates of overcoming fear learning involve cortical regulation of the amygdala......Page 200
16.2.2 Fear conditioning and extinction as models of anxiety disorders and their treatment......Page 201
16.3 What you already know can hurt you: innate anxiety paradigms reveal additional components of a defensive behavior circuit......Page 202
16.3.1 The effects of anxiolytic and anxiogenic drugs on innate anxiety tests in rodents......Page 203
16.3.2 Towards a neural circuitry of innate anxiety......Page 204
16.5 Future directions: relevance of the extended anxiety circuit to anxiety disorders in humans......Page 205
References......Page 206
17.2 The “neural reference space” for emotion......Page 210
17.3.1 Fear conditioning as a core model of negative emotional reactivity......Page 211
17.4 The executive working memory system......Page 212
17.5.1 Dissociable roles for the dmPFC and vmPFC in reactivity and regulation......Page 214
17.6 Clinical neuroimaging studies of anxiety disorders: a meta-analytic framework......Page 215
17.8 Treatment studies......Page 217
17.9 Conclusion......Page 218
References......Page 219
18.1 Origins of cognitive–behavioral therapy for anxiety disorders......Page 222
18.3 The role of anxious apprehension......Page 223
18.4 Extending the CBT model to emotion (dys)regulation......Page 225
18.5.1 Matters of measurement......Page 226
18.5.2 What works? Active components of CBT......Page 228
18.5.3 Goal of exposure: how does it work?......Page 229
18.5.5 Beyond the model: other contributors to outcome......Page 230
References......Page 231
19.3 Criterion A issues......Page 234
19.4.1 Are criterion A exposures necessary for the development of the PTSD symptom syndrome?......Page 235
19.4.1.3 Five studies focusing solely ( n = 4) or mainly ( n = 1) on psychiatric patients......Page 236
19.4.1.4 In summary......Page 237
19.4.3 The question of suffciency......Page 238
19.5.2 Major negative events in hazardous situations......Page 239
19.6 Implications......Page 240
References......Page 242
20.2 Defining attachment......Page 245
20.4 Correlates of attachment style......Page 246
20.5 The role of attachment in emotion regulation......Page 247
20.6.2 Anxiety sensitivity and anxiety disorders......Page 248
20.6.3 Cognitive response style as a mediator between attachment and anxiety disorders......Page 249
20.7.1 Separation anxiety disorder......Page 250
20.8 Conclusions......Page 252
References......Page 253
21.3 Parental separation models......Page 257
21.4 Variable foraging demand model......Page 258
21.5 Brain lesion model......Page 261
21.6 Stress inoculation and resilience......Page 262
References......Page 263
22.2.1 Which is the most efficacious treatment, SRI monotherapy, CBT (ERP) monotherapy, or combination therapy?......Page 267
22.2.3 What is known about time to response for SRI?......Page 268
22.2.5 What are psychopharmacological augmentation strategies for partial response to SRIs?......Page 269
22.3.2 How effective is ERP for OCD?......Page 270
22.3.4 Are there ways to enhance ERP to improve patient outcome?......Page 271
References......Page 273
23.2 Cognitive–behavioral therapy CBT) and other psychosocial treatments......Page 278
23.2.4 Group versus individual CBT......Page 279
23.3.1 Serotonergic medications......Page 280
23.3.4 Other medications......Page 281
23.4.1 Evidence from clinical trials......Page 282
23.4.2 Hypotheses and study design for combined treatment......Page 283
23.4.3 Studies of D-cycloserine as CBT enhancer......Page 284
References......Page 285
24.1 Introduction......Page 289
24.4.1 Which SSRI is most effective for PTSD?......Page 290
24.4.4 Tricyclic antidepressants and monamine oxidase inhibitors......Page 291
24.4.9 NMDA receptor system......Page 292
24.7 Psychotherapy questions and controversies......Page 293
24.7.2 Effectiveness of cognitive–behavioral approaches......Page 294
24.7.4 Current controversy over optimal psychotherapies for PTSD......Page 295
References......Page 296
25.2 Diagnostic and clinical overview......Page 302
25.3 Methodological issues in panic disorder treatment research......Page 303
25.4.2 Monoamine oxidase inhibitors MAOIs)......Page 304
25.4.4 Serotonin–norepinephrine reuptake inhibitors (SNRIs)......Page 305
25.4.5 Benzodiazepines......Page 306
25.6.2 Cognitive–behavioral therapy......Page 307
25.7 Direct comparisons of antidepressant pharmacotherapy and psychotherapy......Page 308
25.8.1 Combination of antidepressant pharmacotherapy and psychotherapy......Page 309
References......Page 310
26.2 Treatment of adults with generalized anxiety disorder......Page 315
26.4 Pharmacotherapy for late-life GAD......Page 316
26.5.1 Cognitive–behavioral therapy for late-life GAD......Page 318
26.5.2 Flexible, multimodal treatments......Page 319
References......Page 320
27.2 Child anxiety: what is normal and what is not......Page 324
27.3.1.1 CBT trials......Page 325
27.3.1.3 Trial comparing CBT and medication......Page 330
27.3.3.3 Trial comparing CBT and medication......Page 331
27.3.5.2 Medication trials......Page 332
27.3.7.1 CBT and BT......Page 333
27.4.2 Best medication practice......Page 334
27.5 Future directions......Page 335
References......Page 336
28.2 Electroconvulsive therapy (ECT)......Page 341
28.3.1 TMS and rTMS background......Page 342
28.3.2.2 Panic disorder......Page 343
28.3.2.4 Obsessive–compulsive disorder (OCD)......Page 344
28.4 Vagus nerve stimulation (VNS)......Page 345
28.5.1 DBS in the treatment of obsessive– compulsive disorder (OCD)......Page 346
28.6 Conclusions......Page 349
References......Page 350
29.2 Mind–body medicine......Page 354
29.2.3 Yoga......Page 355
29.2.7 Implications for clinical practice......Page 356
29.3.3 Passion flower......Page 358
29.4 Manipulative and body-based therapies......Page 359
29.5.2 Energy psychology approaches......Page 360
References......Page 362
30.2 Pharmacological treatments......Page 366
30.3 Pharmacotherapy and cognitive–behavioral therapy (CBT)......Page 367
30.4 Integrated treatments......Page 368
30.5 Other approaches......Page 370
30.8 Future directions......Page 371
References......Page 372
31.2 What is an anxiety disorder?......Page 374
31.3 What causes anxiety and anxiety disorders?......Page 375
31.4 Which treatments work?......Page 377
31.5 Concluding remarks......Page 379
Index......Page 380