Transcript Chapter 4

ANXIETY, OBSESSIVE-COMPULSIVE,
AND RELATED DISORDERS
Chapter 4
ANXIETY AND FEAR ARE NORMAL!!
SERVES IMPORTANT ROLES:
ADAPTATION, INITIATION, MOTIVATION
ANXIETY PREPARES US TO TAKE ACTION
AND IS NORMAL IS MODERATE AMOUNTS
• What distinguishes fear from anxiety?
• Fear: body’s response to serious threat.
Experienced in face of real, immediate
danger.
• Anxiety: body’s response to vague sense of
being in danger. General feeling of
apprehension about possible danger. Prepares
us to take action.
• Both have same physiological features.
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ANXIETY
• Although unpleasant, experiences of fear and
anxiety often are useful.
• However, for some, discomfort is too severe or
too frequent, lasts too long, or is triggered too
easily.
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ANXIETY DISORDERS
• Most common mental disorders in U.S.
• Most with 1 anxiety disorder also suffer from a 2nd.
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ANXIETY DISORDERS AND OCD
• DSM-5 Anxiety Disorders:
• Generalized anxiety disorder (GAD)
• Phobias
• Agoraphobia
• Social anxiety disorder (social phobia)
• Panic disorder
• Separate: Obsessive-compulsive related disorders
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Table 4.2
Comer, Ronald J., Fundamentals of Abnormal Psychology, Seventh Edition
Copyright © 2014 by Worth Publishers
GENERALIZED ANXIETY DISORDER (GAD)
• Characterized by excessive “free floating” anxiety
under most circumstances and worry about
practically anything
• Symptoms: feeling restless, keyed up, or on
edge; fatigue; difficulty concentrating; muscle
tension, and/or sleep problems
• Must last at least 6 months
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GAD: SOCIOCULTURAL PERSPECTIVE
• Dangerous social conditions
GAD
• Poverty
• African Americans 30% more likely than Caucasians
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GAD: COGNITIVE PERSPECTIVE
• Caused by dysfunctional ways of thinking
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GAD: COGNITIVE PERSPECTIVE
• GAD caused by maladaptive assumptions
• Albert Ellis: basic irrational assumptions.
• When assumptions are applied to everyday
life, GAD may develop.
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GAD: COGNITIVE PERSPECTIVE
• Aaron Beck: constantly hold silent
assumptions that imply imminent
danger.
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GAD: COGNITIVE PERSPECTIVE
• Metacognitive theory
• Intolerance of uncertainty theory
• Avoidance theory
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GAD: COGNITIVE PERSPECTIVE
• Changing maladaptive assumptions
• Helping clients understand role that worrying
plays, and changing their views and reactions
to it
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GAD: BIOLOGICAL PERSPECTIVE
• Biological relatives more likely to have GAD
(~15%) than general population (~6%)
• Closer the relative, greater likelihood
• Competing explanation of shared environment
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GAD: BIOLOGICAL PERSPECTIVE
• GABA inactivity
• Benzodiazepines (Valium, Xanax) found to reduce
anxiety
• causes a neuron to stop firing
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GAD: BIOLOGICAL PERSPECTIVE
• Root of GAD more complicated than single
NT.
• Low levels of serotonin, norepinephrine
• Antidepressants (Paxil, Zoloft, Effexor)
seem to lower anxiety
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GAD: BIOLOGICAL PERSPECTIVE
• Relaxation training
• Physical relaxation will lead to
psychological relaxation
• Best when used in combination with
cognitive therapy or biofeedback
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SPECIFIC PHOBIAS
• Persistent and unreasonable fears of particular objects,
activities, or situations
• People often avoid object or thoughts about it -- when
exposed, sufferers experience immediate fear
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SPECIFIC PHOBIAS
• 5 categories in the DSM: Animal, NaturalEnvironmental, Situational,
Blood/Injury/Injection, Other
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SPECIFIC PHOBIAS
How do common fears differ from phobias?
• More intense and persistent fear
• Greater desire to avoid feared object or
situation
• Distress that interferes with functioning
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WHAT CAUSES PHOBIAS?
• Behavioral explanation:
• Develop through conditioning
• Once phobias are acquired, individuals
avoid dreaded object or situation,
permitting fears to become all more
rooted
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CLASSICAL CONDITIONING
LITTLE ALBERT STUDY
• White rat
no reaction
(NS)
• Loud Noise
Fear
(UCS)
(UCR)
• White Rat + Loud Noise
(NS)
• White rat
(CS)
(UCS)
Fear
(UCR)
Fear
(CR)
WHAT CAUSES PHOBIAS?
• Process of stimulus generalization: Responses to
one stimulus are also elicited by similar stimuli
• Can develop through modeling
• Maintained through avoidance
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• Focuses on significance of anxiety
and fear. Helps person survive
• Preparedness Model
• Conditioned responses to fear-relevant
stimuli (spiders, snakes) are more resistant
to extinction that those to fear-irrelevant
stimuli (flowers).
HOW ARE SPECIFIC PHOBIAS TREATED?
 Systematic desensitization
 Teach relaxation skills
 Create fear hierarchy
 Pair relaxation with feared objects or situations
 Since relaxation is incompatible with fear,
relaxation response is thought to substitute for fear
response
 Several types:
 In vivo desensitization (live)
 Covert desensitization (imaginal)
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HOW ARE SPECIFIC PHOBIAS TREATED?
• Flooding
• Modeling
• Key to success is ACTUAL contact with feared
object or situation
• Virtual reality as a useful exposure tool
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AGORAPHOBIA
• Afraid of being in situations where escape
might be difficult, should they experience
panic or become incapacitated
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AGORAPHOBIA
• Avoid crowded places, driving, and public
transportation
• Many experience panic attacks & may receive a
second diagnosis of panic disorder
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HOW IS AGORAPHOBIA TREATED?
• Situational Exposure
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SOCIAL ANXIETY DISORDER
(SOCIAL PHOBIA IN PREVIOUS DSMS)
 Severe, persistent, and irrational anxiety about social
or performance situations in which scrutiny by others
and embarrassment may occur
 May be narrow
 May be broad
 People judge themselves as performing less
competently than they actually do
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WHAT CAUSES SOCIAL ANXIETY
DISORDER?
Cognitive theorists:
• People hold beliefs and expectations that
consistently work against them, including:
• Unrealistically high social standards
• Views of themselves as unattractive and
socially unskilled
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TREATMENTS FOR SOCIAL ANXIETY
DISORDER
• Address fears behaviorally with exposure (group
therapy helpful)
• Lack of social skills
• Social skills and assertiveness trainings have
proved helpful
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TREATMENTS FOR SOCIAL ANXIETY
DISORDER
• Antidepressants
• Psychotherapy: less likely to relapse
than people treated with drugs alone
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PANIC DISORDER
• Panic attacks are periodic, short bouts of panic
that occur suddenly, reach a peak, and pass
• Sufferers often fear they will die, go crazy, or
lose control
• Attacks happen in absence of a real threat
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PANIC DISORDER
Panic attacks repeatedly, unexpectedly,
and without apparent reason
• Experience dysfunctional changes in
thinking and behavior as a result of
attacks
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PANIC DISORDER
Panic disorder often accompanied by
agoraphobia
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PANIC DISORDER:
BIOLOGICAL PERSPECTIVE
• Norepinephrine
• Irregular levels/activity in locus coeruleus
• Brain circuits and amygdala as more
complex root of problem
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PANIC DISORDER:
BIOLOGICAL PERSPECTIVE
• Monozygotic (MZ, or identical) twins, ~31%
• Dizygotic (DZ, or fraternal) twins, ~11%
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PANIC DISORDER:
BIOLOGICAL PERSPECTIVE
• Drug therapies
• Antidepressants SSRI’s/SSNRI’s (Paxil, Zoloft,
Effexor)
• Benzodiazepines (especially Xanax)
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PANIC DISORDER:
COGNITIVE PERSPECTIVE
People misinterpret bodily events
• Panic-prone people sensitive to
certain bodily sensations/may
misinterpret them as signs of a
medical catastrophe; this leads to
panic
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PANIC CYCLE
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PANIC DISORDER:
COGNITIVE PERSPECTIVE
“Biological challenge” induce panic sensations
• Practice coping strategies and making more
accurate interpretations
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OBSESSIVE-COMPULSIVE DISORDER
• Obsessions - Persistent thoughts, ideas, impulses, or
images that seem to invade a person’s consciousness
• Compulsions - Repetitive and rigid behaviors or mental
acts that people feel they must perform to prevent or
reduce anxiety
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OBSESSIVE-COMPULSIVE DISORDER
• Diagnosis is called for when symptoms:
• Feel excessive or unreasonable
• Cause great distress
• Take up much time
• Interfere with daily functions
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OBSESSIVE-COMPULSIVE DISORDER
• Equally common in men and women and
among different racial and ethnic groups
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WHAT ARE FEATURES OF OBSESSIONS AND
COMPULSIONS?
• Obsessions
• common themes - Dirt/contamination,
violence and aggression, orderliness,
religion, sexuality
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WHAT ARE FEATURES OF OBSESSIONS AND
COMPULSIONS?
• Compulsions
• Performing behaviors reduces anxiety
• Have common forms/themes: Cleaning, checking,
order or balance, touching, verbal, and/or counting
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OCD:
BEHAVIORAL PERSPECTIVE
 In fearful situation, perform a particular act
(washing hands)
 When threat lifts, associate improvement
with random act
 After repeated associations, believe
compulsion is changing situation
 Act becomes method to avoiding or
reducing anxiety
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OCD:
BEHAVIORAL PERSPECTIVE
• Behavioral therapy
• Exposure and response prevention (ERP)
• Clients are repeatedly exposed to anxietyprovoking stimuli and told to resist performing
compulsions
• Therapists often model behavior while client
watches
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OCD:
BIOLOGICAL PERSPECTIVE
Abnormal serotonin activity
Abnormal brain structure and functioning
 OCD linked to orbitofrontal cortex and caudate nuclei
 Converts sensory information into thoughts and actions
 Either area may be too active, letting through troublesome
thoughts and actions
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OCD:
BIOLOGICAL PERSPECTIVE
Serotonin-based antidepressants (Zoloft; Paxil)
• Bring improvement to 50–80% of those with
OCD
• Relapse occurs if medication is stopped
Research suggests that combination therapy
(medication + cognitive behavioral therapy
approaches) may be most effective
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OBSESSIVE-COMPULSIVE-RELATED
DISORDERS
• Some excessive behavior patterns (hoarding, hair
pulling, shopping, sex) linked to OCD
• DSM-5 created group name “ObsessiveCompulsive-Related Disorders” and assigned four
patterns to that group: hoarding disorder, hairpulling disorder, skin-picking disorder, and body
dysmorphic disorder
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