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									       Module Four
   Lesson 1: Anxiety and its manifestations

   Lesson 2: Disorders caused by anxiety

   Lesson 3: The causes and the treatment of Anxiety

   Lesson 4: Somatoform Disorders
           Lesson 1

Step 1: Introduction
     Anxiety, like sadness, is a normal emotion.
     Usually anxiety is a reaction to a stressful
     Normal anxiety is the one we feel when we are
      exposed to external stressful situations and
      remains until the solution of the problem.
     We are aware of anxiety both by psychological
      and somatic expression.
     Anxiety’s somatic symptoms derive from the
      hyperactivity of Autonomous Nervous System.
Step 4: Slide projection
 Slide 4.1.1: Anxiety’s manifestations
  Emotion of stress, uneasiness, fear, nervousness
  Irritability
  Impossible to relax
  Difficulties in concentration
  Muscles aches (headaches, abdominal pain)
  Poor appetite
  Restless sleep – difficulties to fall asleep
  Somatic symptoms from Autonomous Nervous
Step 4 (continued)
  Somatic symptoms from the Autonomous Nervous
   Dry mouth
   Fast breathing
   irregular heart beating
   Dizziness – feel faint
   Excitement
   Perspiration
   Fear
   Hyperactivity of cysts and intestines
Step 5: Theory presentation
     Normal anxiety becomes alarming when the
      symptoms are so intense or they last for so long
      that the person cannot accomplish its everyday
      tasks, because they are extremely painful and
      stressful. Then it is considered that the person
      shows an Anxiety Disorder.
     The Anxiety Disorders are many times described
      as “neurosis”. The term “neurosis” is used to
      distinguish “psychosis” from disorders where the
      person does not lose contact with reality (there
      are no delusions or aberrant ideas). Neurosis’
      symptoms are similar to experiences that all
      people have but more severe.
Step 6: Discussion

  Describe briefly a personal experience that
    made you feel anxious.
Step 7: Questions and comments
          Lesson 2

Step 1: Slide projection
  Slide 4.2.1: Anxiety Disorders
   Panic Attack
   Agoraphobia
   Specific Phobia
   Social Phobia
   Generalized Anxiety Disorder (GAD)
   Posttraumatic Stress Disorder
   Obsessive Compulsive Disorder
Step 2: Discussion
  What Anxiety Disorder do you usually
   encounter in your practice?
Step 3: Theory presentation
  Panic attack
   Recurrent panic attacks, usually under great
   The person needs to abandon the situation it is
   Because of the intensity of physical symptoms,
    the person believes that is going to die.
   Between the attacks the person might show
    milder anxiety symptoms.
Step 3 (continued)
   Intense anxiety when found in specific locations
    or situations or even thinking of these.
   Anxiety might be so intense that manifests Panic
   The person feels like loosing control of the
   Usually avoids these locations or situations or
    needs to be accompanied by another person.
   In Agoraphobia, fear is not related to a specific
    situation but to several.
Step 3 (continued)
  Specific Phobia
   The person fears of a specific object or situation and has
     the tendency to avoid it.
   The thing might be: a dog, a cockroach, other animal or
     blood, injections, etc.
   The specific situations include: enclosed spaces, height,
     airplanes, etc.
   The person fears that something bad is going to happen
     when he/ she meets the object or is found in a specific
   May be the person fears that he/she is going lose control
     (of the situation), have a panic attack or faint.
Step 3 (continued)

  Social Phobia
   Anxiety (or distress) is apparent to social or
     performance situations (to all or specific).
   The person is worried that might be the centre of
   Tends to avoid the situation that is afraid of.
Step 3 (continued)

 Generalized Anxiety Disorder (GAD)
  At this disorder the person experiences
   distress and anxiety for long periods of
   time, usually longer than 6 months.
  Along with anxiety emotion the person
   shows many other stress symptoms.
Step 4 (continued)
 Posttraumatic Stress Disorder (PTSD)
  Disorder developed after the person has
   experienced a severe traumatic event.
  The person might develop various symptoms in
   which there are included :
     Symptoms of anxiety and depression.
     Recurrent memory of the event in dreams or
        re-experiencing it (…? ).
     Tendency to avoid thoughts, conversations or
        activities that remind him/ her the event.
Step 4 (continued)
  Obsessive Compulsive Disorder
   Obsessions are uncontrollable intrusive thoughts
    or ideas, compulsions or images that come to the
    person’s mind.
   Distract his/her attention and prevent him/her
    from accomplishing their tasks.
   Compulsions are repeated actions that the person
    feels obligated to do even though these are
    opposite to his sense.
   In most of the cases the person feels obligated to
    execute them in order to eliminate the anxiety
    (distress) caused by a compulsive idea and
    prevent a horrible event.
Step 5: Questions and
          Lesson 3

Step 1: Slide projection
 Slide 4.3.1: rate of incidence of Anxiety Disorders
 Disorder                   % of General Population
 Anxiety Disorders in total             20
 Panic Attacks                           2
 Agoraphobia                             3
 Specific Phobia                         9
 Social Phobia                           8
 Generalized Anxiety Disorder            3
 Posttraumatic Stress Disorder
 (PTSD)                                  ?

 Obsessive Compulsive Disorder        2
Step 2: Brainstorming

  What factors you think contribute to anxiety
Step 3: Slide projection
  Slide 4.3.2: the causes of Anxiety Disorders

  Genetic Factors
   Hereditary predisposition
  Experiences in early age
   Parting
   High emphasis to achievements
   Pressure for compromises
  Recent experiences
   Stressful situations
   Incertitude
   Conflict
  Biological factors
   Dysfunction of Autonomous Nervous System
Step 4: Group discussion

  What are in your opinion the appropriate
   therapeutical interventions for treating
   the needs of the persons that suffer from
   each one of the Anxiety Disorders?
Step 5: Slide projection
  Slide 4.3.3: therapeutical interventions in Anxiety
   Psychotherapies
   Expression and discussion of the problem
   Psychoanalytic psychotherapy
   Person – behavior therapy?
   Cognitive –diagnostic Therapy
   Therapy with medication
   Antidepressants’ medication
   Tranquilizers
Step 6: Questions and
          Lesson 4

Step 1: Introduction
     The experience of manifestation of physical
      symptoms with absence of somatic disease is
      known to everybody. Many times these appear
      when the person is stressed or tired.
     People differ to the tendency to express the
      symptoms and to how much attention they give to
     In any place of the world, it is proved that 10 %
      to 30% of the persons that ask for help from the
      first aid services suffer from psychiatric
      problems and most of them arrive for somatic
Step 2: Slide projection
  Slide 4.4.1: relationship between physical and
     mental disorders

     Psychological factors as causing factors of the
      physical disease
     Psychiatric disorders can appear as physical
     Psychiatric consequences of physical illness
     Coexistence of physical and mental disorders
     Physical disturbances due to psychiatric
Step 3: Slide projection
  Slide 4.4.2: The most common Somatoform and
     related to them Disorders
  Somatoform Disorders
   Somatization Disorder
   Hypochondriasis
   Conversion Disorder
  Disorders related to Somatoform
   Incomprehensible Pretentious Disorder
   Pretention
Step 4: Theory presentation
  Somatoform Disorder
  It is the disorder during which the person
      shows various physical disturbances during
      many years. These symptoms cannot be
      justified/ explained from a physical illness.
Step 4 (continued)

 Is the obsessive occupation of the person with
     the fear or the idea that suffers from a
     serious disease. This is based on his
     personal explanation of physical symptoms
     or emotions which consider as proof to the
     physical disease.
Step 4 (continued)
Conversion Disorder
 It was called Hysteria in the past. This term is replaced by
    Conversion Disorder.
 A conversion (traversing) symptom can indicate physical
    disease, but it is manifested with out the presence of a
    disease coming from unconscientiously With the person
    being unaware of it or without doing it on purpose.
 These disorders can be manifested in various forms:
As movement dysfunction, for ex. Paralysis, fear, inability to
As senses dysfunction for example , pain, blindness, deafness.
As psychiatric symptoms, for example, memory loss, running
    away (wandering with loss of memory and lack of
    recognition of its personality).
Step 4 (continued)
  Incomprehensible Pretentious Disorder
   In incomprehensible pretentious disorder the
     person tries with the production of the symptoms
     to gain the medical attention and care with no
     external motives. They might pretend that they
     have depression, delusions, traverse symptoms or
     pains, nausea, skin rashes, bleedings etc
   There is a special case in incomprehensible
     pretentious disorder known as Munchausen's
     syndrome. People who have this syndrome
     usually are admitted to hospital for a disease they
     pretend to have and undertake tests and
     treatments, even surgical procedures.
Step 4 (continued)

  similar symptoms appear again in Pretension,
     but there is always an external Motive, as
     for example avoiding the military service,
     early retirement, etc.
  Pretention is no mental disorder.
Step 6: Brainstorming

  Describe what intervention(s) you consider
    necessary for the treatment of
    Somatoform and Related to these
Step 7: Questions and

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