The Nature and Treatment of Anxiety Disorders

504 Pages·2017·3.73 MB·English

by  C. Barr Taylor

The Nature and Treatment of Anxiety
Disorders
C.BARR TAYLOR, M.D.
BRUCE ARNOW, Ph.D.
Copyright © 1988 C. Barr Taylor & Bruce Arnow
e-Book 2017 International Psychotherapy Institute
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Any unauthorized reprint or use of this material is prohibited. No part of this
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Created in the United States of America
Dedicated with love and appreciation to our wives, SUESAN
AND BETH
Table of Contents
Preface
One: What Is Anxiety?
DEFINING ANXIETY: SEMANTIC DIFFICULTIES
THE SUBJECTIVE DIMENSION
SOMATIC SYMPTOMS
THE COGNITIVE DIMENSION
PHYSIOLOGIC AND BIOCHEMICAL DIMENSIONS
THE BEHAVIORAL DIMENSION
Two: Theories of Anxiety
PSYCHODYNAMIC THEORIES
DEVELOPMENTAL THEORIES
LEARNING THEORIES
PSYCHOPHYSIOLOGIC MODELS
NEUROPHYSIOLOGIC MODELS
MOLECULAR MODELS
CONCLUSIONS
Three: Anxiety Syndromes and Disorders
A CONTINUUM OF ANXIETY OR SEPARATE DISORDERS?
THE DIAGNOSIS OF ANXIETY DISORDERS
HISTORY
PANIC DISORDER
SOCIAL PHOBIA
SIMPLE PHOBIA
OBSESSIVE COMPULSIVE DISORDER
POST-TRAUMATIC STRESS DISORDER
GENERALIZED ANXIETY DISORDER
OTHER DSM-III-R ANXIETY DIAGNOSES
ANXIETY STATES, TENSION, AND STRESS
OTHER DIAGNOSTIC SYSTEMS
FLOWCHART FOR CLINICAL DIAGNOSIS
SUMMARY
Four: Approaching the Anxious Patient: An Overview of Symptom-Focused Treatment
BEGINNING THERAPY WITH THE ANXIOUS PATIENT:FOCUS ON ENHANCING DAY-TO-DAY
FUNCTIONING
PATIENT RESPONSES TO SUCCESSFUL ATTEMPTS TO ACHIEVE SYMPTOM RELIEF
THERAPIST BEHAVIOR
ASSESSMENT
SUMMARY
Five: Acute Anxiety/Tension Disorders
CRISIS MANAGEMENT
STEPS IN CRISIS MANAGEMENT
PREVENTION OF LONG-TERM EFFECTS OF STRESS
BRIEF PSYCHOTHERAPY
PHARMACOTHERAPY
SUMMARY
Six: Chronic Anxiety and Generalized Anxiety Disorder
DIAGNOSIS
PREVALENCE
FAMILY STUDIES
COURSE
ETIOLOGY
ASSESSMENT
THE TREATMENT OF GENERALIZED ANXIETY DISORDER
Seven: Panic Disorder
DIAGNOSIS
PREVALENCE
GENETICS
COURSE
ETIOLOGY
ASSESSMENT
REVIEW OF TREATMENTS
COMPONENTS OF TREATMENT
SUMMARY
Eight: Agoraphobia
COURSE
PREVALENCE
FAMILY STUDIES
ETIOLOGY
DIAGNOSIS
ASSESSMENT
THE TREATMENT OF AGORAPHOBIA
EXPOSURE THERAPY: MODES OF DELIVERY
SPECIAL PROBLEMS ASSOCIATED WITH EXPOSURE THERAPY
CONCLUSIONS
Nine: Social Phobia
THE TREATMENT OF SOCIAL PHOBIA
SUMMARY
Ten: Simple Phobias
TREATMENT OF SIMPLE PHOBIAS
EXAMPLES OF THE TREATMENT OF SPECIFIC SIMPLE PHOBIAS
Eleven: Psychopharmacology
THE BENZODIAZEPINES
ANTIDEPRESSANTS
AZASPIRODECANEDIONES
BETA-ADRENERGIC BLOCKING DRUGS
CENTRAL ADRENERGIC AGONISTS
OTHER SEDATIVES
ANTIPSYCHOTIC DRUGS
ETHYL ALCOHOL
NEW NONBENZODIAZEPINE ANXIOLYTICS
Twelve: Medical Problems Associated with Anxiety Disorders
CARDIOVASCULAR DISORDERS
ENDOCRINE DISORDERS
NEUROLOGIC DISORDERS
Appendix One: Baseline Assessment
ANXIETY AND STRESS DISORDERS CLINIC
Brief Medical History
FEAR QUESTIONNAIRE
Appendix Two: Additional Assessment Instruments
Panic Attack Self-Efficacy Form
STANFORD PANIC DIARY INSTRUCTIONS
STANDFORD PANIC ATTACK DIARY
HAMILTON ANXIETY RATING SCALE
COMMON FEARS AND PHOBIAS
STANFORD PANIC APPRAISAL INVENTORY
PHOBIC AVOIDANCE INVENTORY
Appendix Three: The Stanford Agoraphobia Exposure Protocol
INTRODUCTION
SESSION 1
SESSION 2
SESSION 3
SESSION 4
SESSION 5
SESSION 6
DESCRIPTION OF THE TRANSITION PHASE
OUTLINE OF EDUCATION TOPICS
References
Preface
This is a book about understanding and treating patients whose primary
complaint involves an anxiety disorder. Over the past five years, together with
our colleagues at the Stanford University Anxiety Disorders Clinic, we have
treated over 500 such patients either through our outpatient clinic or through
our ongoing research program. We have collected extensive information on over
1,000 additional patients, many of whom had undertaken previous treatment for
their difficulties without benefit. Our experience with this group of patients has
led us to conclude that although effective clinical interventions for such
difficulties have been developed over the past 20 years, they are not widely
practiced.
There appear to be many reasons for this, not the least of which is that
effective treatment of many anxiety disorders often requires a combination, or
"package,” of clinical procedures, whose components fall into different
subspecialties. For example, individuals with agoraphobia often respond best to a
combination of medication, in vivo exposure therapy, and cognitive therapy.
While these interventions should not be considered mutually exclusive, few
therapists combine them. Psychiatrists, who may be knowledgeable about the
role of medication in the treatment of anxiety, rarely have the time or interest to
master the delivery of exposure-based therapy. Psychologists and social workers
may specialize in cognitive and/or behavioral therapies but are unable to
prescribe medication. Moreover, the techniques for treating anxiety disorder
patients were developed within a research literature in which presentation of
therapy procedures is often brief. Thus, there are few accounts regarding the
"nuts and bolts” of carrying out treatment.
We describe, in detail, a symptom-focused approach to the treatment of
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