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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