Anxiety Disorders

Margaretha, S.Psi., G.Dip.Psych.

Universitas Airlangga, Surabaya, 2007

OUTLINE
Anxiety

Definisi & Terminologi terkait

Manifestasi
Karakteristik dasar
Etiologi

Klasifikasi dan diagnosis

Phobia
Post Traumatic Stress Disorders (PTSD)
Panic
Generalized Anxiety Disorders (GAD)
Obsessive Compulsive Disorders (OCD)

Diskusi
06/17/15

 Takut (fear) : ada object spesifik yang jelas

menyebabkan rasa takut
Ex: takut terlambat takut dimarahi karena ada guru
yang galak

Cemas (anxiety) : Kondisi cemas, takut tapi

obyek tidak jelas, atau rasa takut tidak bisa
dijelaskan atau dipahami
Ex: takut pada ruang gelap

06/17/15

Definition of Anxiety
Emosi negatif yang muncul karena
antisipasi kejadian mendatang yang
dibayangkan akan menyakitkan
Sifat Anxiety patologis
Intensitas rasa takut tinggi, durasi lama, dan
berpengaruh pada perilaku

Dapat menghasilkan gejala emosi,

kognitif, fisik dan perilaku
06/17/15

Anxiety: Where to find it

Buku psikologi abnormal: anxiety

PPDGJ: neurosa, somatoform & stress (F.4)
DSM: Anxiety disorders
ICD: Neurotic, stress related and somatoform
disorders
Neurosis William Cullen
Defisiensi general sistem saraf pusat (nervous
system)

Psychoneurosis Sigmund Freud 1900

Tension seksual yang tak terlepaskan hypochondriasis
Pikiran yang direpresi - phobias
06/17/15

Manifestasi Anxiety
Physical
Anorexia, sakit di perut, sakit dada, mulut kering,
pusing, sakit kepala, disfungsi seksual, tangan
berkeringat

Affective
Dari rasa gamang hingga perasaan diteror

Cognitive
Pikiran mengenai hal negatif yang dapat dialami

Behavioral
Macam-macam respon yang dilakukan individu untuk
mengurangi atau menghindari kecemasan
06/17/15

Karakteristik dasar Anxiety

Etiologi gangguan terkait dengan stress
Kemampuan menjelaskan realita tetap
baik (intact)
Memunculkan gejala-gejala penderitaan
(distressing)
Gangguan terjadi terus menerus/persisten
Tapi tidak memiliki dasar gangguan medis
nyata
06/17/15

Sisi positif Anxiety

Yerkes-Dodson law:
Performance improves as a
function of anxiety up to a
threshold beyond which there
is a fall off in performance

06/17/15

Etiology Social & Biological

SOCIAL
Social factors: peristiwa traumatis, masa kecil yang sulit,
kurangnya support sosial

BIO
Genetic, dibuktikan lewat: twin studies
Ketidakseimbangan hormonal
ABNORMALITIES
1. Nor-Adrenergic (NA) for
melepaskan adrenalin
2. Gamma-aminobutyric acid
(GABA) for excitatory
actions
06/17/15

Aktivasi struktur
limbic:
hippocampus
/amygdala

generalized/
anticipatory
anxiety
9

Etiology Psychological
Personality factors
Some personality traits predispose to certain anxiety disorders
avoidant, perfectionist

Psycho-analytic theories - unconscious defence

mechanisms
Phobia - displacement
OCD - reaction formation, undoing
PTSD - denial, repression

Cognitive theories
Berpikir selektif dan cenderung melebih-lebihkan (selective
attention and catastrophic thinking)

Behaviour
Perilaku yang dipelajari (learned behaviour)
06/17/15

10

Terminologi Anxiety
Neurosis William Cullen
Defisiensi general sistem saraf pusat (nervous
system)

Psychoneurosis Sigmund Freud 1900

Tension seksual yang tak terlepaskan hypochondriasis
Pikiran yang direpresi - phobias

ICD10 Neurotic, stress related and

somatoform disorders.
DSM IV Anxiety disorders
06/17/15

11

General medical conditions

causing anxiety
Cardiovascular conditions, ex: jantung
Respiratory conditions, ex: sesak napas
Metabolic conditions: ex: gangguan
kelenjar, diabetes
Neurological conditions, ex: Traumatic
brain injury
06/17/15

12

Substances that cause anxiety

Medications
Antipsychotics, Antidepressants, Heavy
metals, Toxins (gasoline, paint, insecticides,
nerve gases, carbon monoxide, carbon
dioxide), Insulin

Intoxication
Alcohol, Amphetamines, Caffeine, Cannabis,
Cocaine, Hallucinogens, Inhalants
06/17/15

13

PHOBIA

06/17/15

14

Definisi
Anxietas oleh karena adanya
situasi/obyek yang jelas dari luar individu,
yang sebenarnya pada saat ini tidak
membahayakan
Sebagai akibatnya, individu menghindari
atau dihadapi dengan rasa terancam
Seringkali co-exist dengan episode
depresif
06/17/15

15

Macam
Agora phobia
Anxietas timbul pada situasi berikut: banyak orang, keramaian,
tempat umum, bepergian keluar rumah, bepergian sendiri

Social phobia
Anxietas muncul dan menghindari situasi sosial, di luar konteks
perilaku
Ex: takut dipermalukan
Anxiety provoked by social or performance situations
Feared situations are avoided or endured with marked anxiety
E.g., public speaking, going to parties, meeting new people, eating
in public
Person fears will act in a way that will be humiliating or
embarrassing
06/17/15

16

Specific Phobia
Ditandai dengan rasa takut menetap yang
excessive, irasional, karena hadirnya
suatu stimulus/obyek/kondisi tertentu
Specific phobia / phobia khas
Animal: laba-laba (Arachnophobia)
Natural environment : Darkness
(Nyctophobia)
Situational: closed place (Claustrophobia)
Other: death (Thanatophobia)
06/17/15

17

Terapi

Sistematis desentisasi
Exposure
Modelling
Obat

06/17/15

18

Prognosis
Cukup baik
Dapat dimodifikasi perilakunya
Restrukturisasi kognitif

06/17/15

19

PTSD

06/17/15

20

PTSD
Respon akibat suatu stress yang
diakibatkan peristiwa traumatis
Meliputi timbulnya rasa takut, hellplessness
Seperti merasakan ulang pengalaman
traumatis
Menghindari stimulus/ timbul penghindaran
dengan cara psychological numbing
Muncul respon arousal
Gajala timbul lebih dari 1 bulan
06/17/15

21

 Unlike other anxiety disorders, PTSD is

directly tied to a traumatic incident
E.g., Torture victims, accident survivors,
assault victims

May see onset immediately after traumatic

event, or may be delayed onset
Seems to be particularly likely to occur if a
person cannot make sense of a trauma
06/17/15

22

Contoh
PTSD setelah
Bencana alam
Perang
Meninggalnya orang terdekat
Ditinggal significant others
Rape
Melihat pembunuhan

06/17/15

23

Treatment
Medikamentosa
Prognosis membaik 60% (moderately
improved, Seligman, 1994)

Exposure
Disclosure / opeing up

06/17/15

24

PANIC

06/17/15

25

Definisi
PPDGJ (F 41.0)
Ditemukan adanya beberapa serangan
anxietas berat, dalam masa 1 bulan,
dimana:
Pada keadaan secara obyektif tidak bahaya
Tidak terbatas pada situasi yang telah dapat
diprediksikan sebelumnya (unpredictable
situations)
Muncul setelah membayangkan sesuatu yang
mengkhawatirkan terjadi
06/17/15

26

Panic attack
Characterized by recurrent attacks of overwhelming
anxiety that usually occur suddenly and unexpectedly
Last several minutes, often accompanied by high
physiological arousal (rapid heart rate, shortness of
breath) and fear of losing control
Become apprehensive about when next attack will occur
May lead to agoraphobia: fear of going out in public
places
Fear may be general or limited to certain situations

06/17/15

Public transportation
Tunnels or bridges
Crowds
Going out by oneself
27

Treatment
Obat: antianxiety drugs, antidepressan
Prognosis membaik 80% (improved,
Seligman, 1994)

Kognitif
Reinterpretasi gejala panic Prognosis
membaik 75% (improved, Seligman, 1994)

06/17/15

28

GAD

06/17/15

29

GAD
Gangguan cemas menyeluruh (F 41.1)
DSM-IVR criteria for GAD
Excessive or ongoing anxiety and worry for at least 6
months about numerous events or activities
Difficulty controlling the worry
At least 3 of the following symptoms: restlessness,
easy fatigue, irritability, muscle tension, sleep
disturbance
Significant distress or impairment
06/17/15

30

GAD

Marked by a chronic, high level of anxiety

that is not tied to any specific threat
Free-floating anxiety
Worry constantly about yesterday's mistakes,
tomorrows problems
Worry about family, finances, work, personal
illness more than others
May see muscle tension, poor concentration,
irritability, sleep disturbance, feeling on edge

06/17/15

31

GAD : treatments by perspectives

Psychodynamic therapy
Free association, Transference, Resistance
17 Research shows that psychodynamic therapy (psychoanalysis) is not consistently
helpful for GAD

Cognitive
GAD is the result of dysfunctional ways of thinking about the world.

Albert Ellis: Rational Emotive therapy

Persons with GAD make these types of irrational assumptions
Ex: It is catastrophic when things are not going the way I would like them to.

Aaron Beck
People with GAD see the world as more dangerous than it actually is It is always best
to assume the worst
Ex: My safety depends on anticipating and preparing myself for any possible danger that
might occur.
Cognitive therapies for GAD

Keeping a journal
Recognizing maladaptive, dysfunctional assumptions.
Challenging old assumptions and substituting new beliefs
Developing new coping skills

Behavioral perspective on GAD

GAD is learned through classical conditioning and generalization.
06/17/15

32

Prognosis
Antidepresan
moderate

CBT
50% improved (Roy-Byrne & Cowley, 1998)

06/17/15

33

OCD

06/17/15

34

Definisi
Obsesi: pikiran yang berulang
Compulsi: perilaku yang berulang
Gejala anxietas yang muncul 2 minggu
berturut-turut
Harus disadari sebagai pikiran sendiri
Tidak berhasil dilawan
Bukan hal yang memberikan kepuasan
pengulangan
06/17/15

35

Contoh
Selalu was-was belum mengunci pintu
Selalu mencuci tangan
Compulsions are responses to obsessions
and often reduce anxiety associated with
the thoughts in the short term
Common compulsions: cleaning, counting,
checking, asking for reassurance, ordering
Usually has onset during adolescence
06/17/15

36

Treatment

CBT
Behavior therapy
Drug therapy: serotoni inhibition
Prognosis: 40-60% moderate (Foa, 1998)

06/17/15

37

Diskusi 1
Mr. A menyaksikan teman karibnya meninggal
karena kecelakaan motor 6 minggu yang lalu.
Setelah itu ia mengalami mimpi buruk setiap
malam, sulit tidur, dan selalu terbayang-bayang
kecelakaan itu
Ia jadi takut mengendarai motor, bahkan timbul
kecemasan ketika melihat jalan raya
Ia juga tidak lagi bisa menunjukkan afeksi pada
pacarnya, dan pacarnya juga merasa sejak
kecelakaan itu ia menjadi orang yang sangat
mudah terkejut dan sering marah-marah
06/17/15

38

Diskusi 2
Mrs. B c/o a long h/o episodes of anxiety,
racing heart, sweating, CP, and fears that
she is having a MI and will die.
These last 30 minutes and are
unexpected. She c/o anxiety while in
malls and traveling alone to new places for
fear of having another attack. Despite a
negative medical w/u, she still worries
about having a MI during anattack.
06/17/15

39

Diskusi 3
Ms. D has a chief c/o worrying about
everything for the last year.
She also c/o frequent headaches, fatigue
and insomnia secondary to the anxiety.
These symptoms have worsened to the
point where she has been distracted and
making mistakes at work.

06/17/15

40

Diskusi 4
Dr. E memiliki riwayat sejak kecil takut berbicara
di depan kelas
Ia selalu takut jika ia akan melakukan hal yang
salah di depan orang banyak, lalu dipermalukan
Oleh karena itu ia selalu menghindari
komunikasi dengan rekan profesionalnya,
namun akhir-akhir ini ia merasa perilaku ini akan
memperngaruhi negatif karir akademisnya

06/17/15

41