Transcript Anxiety Disorders

Slides & Handouts by Karen Clay Rhines, Ph.D.
Seton Hall University
Chapter 5
Anxiety Disorders
Comer, Fundamentals of
Abnormal Psychology, 3e
1
Anxiety
• What distinguishes fear from anxiety?
– Fear is a state of immediate alarm in
response to a serious, known threat to
one’s well-being
– Anxiety is a state of alarm in response
to a vague sense of threat or danger
– Both have the same physiological features:
increase in respiration, perspiration, muscle
tension, etc.
Comer, Fundamentals of
Abnormal Psychology, 3e
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Anxiety
• Is the fear/anxiety response
useful/adaptive?
– Yes, when the “fight or flight” response is
protective
– However, when it is triggered by
“inappropriate” situations, or when it is too
severe or long-lasting, this response can be
disabling
• Can lead to the development of anxiety disorders
Comer, Fundamentals of
Abnormal Psychology, 3e
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Anxiety Disorders
• Most common mental disorders in the U.S.
– In any given year, 18% of the adult population in the
U.S. experiences one of the six DSM-IV-TR anxiety
disorders
• Close to 29% develop one of the disorders at some point in
their lives
• Only ~20% of these individuals seek treatment
• Most individuals with one anxiety disorder suffer
from a second disorder, as well
• Anxiety disorders cost $42 billion each year in
health care, lost wages, and lost productivity
Comer, Fundamentals of
Abnormal Psychology, 3e
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Anxiety Disorders
• Six disorders:
– Generalized anxiety disorder (GAD)
– Phobias
– Panic disorder
– Obsessive-compulsive disorder (OCD)
– Acute stress disorder
– Posttraumatic stress disorder (PTSD)
Comer, Fundamentals of
Abnormal Psychology, 3e
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Generalized Anxiety Disorder
(GAD)
• Characterized by excessive anxiety under most
circumstances and worry about practically
anything
– Vague, intense concerns and fearfulness
• Often called “free-floating” anxiety
• “Danger” not a factor
• Symptoms include restlessness, easy fatigue,
irritability, muscle tension, and/or sleep
disturbance
– Symptoms last at least six months
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Abnormal Psychology, 3e
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Comer, Fundamentals of
Abnormal Psychology, 3e
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Generalized Anxiety Disorder
(GAD)
• The disorder is common in Western society
– Affects ~3% of the population in any given year and
~6% at sometime during their lives
• Usually first appears in childhood or
adolescence
• Women are diagnosed more often than men by
2:1 ratio
• Various theories have been offered to explain
the development of the disorder…
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Sociocultural
Perspective
• According to this theory, GAD is most likely to develop in
people faced with social conditions that truly are
dangerous
– Research supports this theory (example: Three Mile Island in
1979)
• One of the most powerful forms of societal stress is
poverty
– Why? Run-down communities, higher crime rates, fewer
educational and job opportunities, and greater risk for health
problems
– As would be predicted by the model, there are higher rates of
GAD in lower SES groups
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Sociocultural
Perspective
• Since race is closely tied to income and
job opportunities in the U.S., it is also tied
to the prevalence of GAD
– In any given year, ~6% of African Americans
and 3.1% of Caucasians suffer from GAD
• African American women have highest rates
(6.6%)
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Psychodynamic
Perspective
• Freud believed that all children experience
anxiety
– Realistic anxiety when faced with actual danger
– Neurotic anxiety when prevented from expressing id
impulses
– Moral anxiety when punished for expressing id
impulses
• One can use ego defense mechanisms to
control these forms of anxiety, but when they
don’t work or when anxiety is too high…GAD
develops
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Psychodynamic
Perspective
• Today’s psychodynamic theorists often disagree
with specific aspects of Freud’s explanation
• Researchers have found some support for the
psychodynamic perspective:
– People with GAD are particularly likely to use defense
mechanisms (especially repression)
– Children who were severely punished for expressing
id impulses have higher levels of anxiety later in life
• Are these results “proof” of the model’s validity?
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Psychodynamic
Perspective
• Not necessarily; there are alternative
explanations of the data:
– Discomfort with painful memories or
“forgetting” in therapy is not necessarily
defensive
• Also, some data actually contradict the
model
– Many (if not most) GAD clients report normal
childhood upbringings
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Psychodynamic
Perspective
• Psychodynamic therapies
– Use same general techniques for treating all
dysfunction
• Free association
• Therapist interpretation
– Specific treatments for GAD
• Freudians: focus less on fear and more on control
of id
• Object-relations therapists: help patients identify
and settle early relationship conflicts
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Humanistic Perspective
• Theorists propose that GAD, like other
psychological disorders, arises when people
stop looking at themselves honestly and
acceptingly
• This view is best illustrated by Carl Rogers’s
explanation:
– Lack of “unconditional positive regard” in childhood
leads to “conditions of worth” (harsh self-standards)
– These threatening self-judgments break through and
cause anxiety, setting the stage for GAD to develop
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Humanistic Perspective
• Therapy based on this model is “client-centered”
and focuses on creating an accepting
environment where clients can “experience”
themselves
– Although case reports have been positive, controlled
studies have only sometimes found client-centered
therapy to be more effective than placebo or no
therapy
– Only limited support has been found for Rogers’s
explanation of causal factors
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Cognitive Perspective
• Theorists believe that psychological
problems are caused by maladaptive and
dysfunctional thinking
• Since GAD is characterized by excessive
worry (cognition), this model is a good
start…
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Cognitive Perspective
• Theory: GAD is caused by maladaptive assumptions
– Albert Ellis identified basic irrational assumptions:
• It is necessary for humans to be loved by everyone
• It is catastrophic when things are not as one wants them to
be
• If something is dangerous, a person should be terribly
concerned and dwell on the possibility that it will occur
• One should be competent in all domains to be a worthwhile
person
– When these assumptions are applied to everyday life,
GAD may develop
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Cognitive Perspective
• Aaron Beck is another cognitive theorist
– Those with GAD hold unrealistic silent assumptions
that imply imminent danger:
• Any strange situation is dangerous
• A situation/person is unsafe until proven safe
• Research supports the presence of these types
of assumptions in GAD, particularly about
dangerousness
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Cognitive Perspective
• Second-Generation Cognitive Explanations
– In recent years, two promising explanations have
emerged:
• Metacognitive theory
– Worry about worrying (metaworrying)
• Avoidance theory
– worrying serves a “positive” function by reducing unusually high
levels of bodily arousal
– Both theories have received considerable research
support
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Cognitive Perspective
• Two kinds of cognitive therapy:
– Changing maladaptive assumptions
• Based on the work of Ellis and Beck
– Helping clients understand the special role
that worrying plays, and changing their views
about it
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Cognitive Perspective
• Cognitive therapies
– Focusing on worrying
• Therapists begin with psychoeducation about
worrying and GAD
– Assign self-monitoring of somatic arousal and cognitive
responses
• As therapy progresses, clients become
increasingly skilled at identifying their worrying and
its counterproductivity
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Biological
Perspective
• Theory holds that GAD is caused by
biological factors
– Supported by family pedigree studies
• Blood relatives more likely to have GAD (~15%)
than general population (~6%)
• The closer the relative, the greater the likelihood
– Issue of shared environment
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Biological
Perspective
• GABA inactivity
– 1950s – Benzodiazepines (Valium, Xanax)
found to reduce anxiety
– Why?
• Neurons have specific receptors (lock and key)
• Benzodiazepine receptors ordinarily receive
gamma-aminobutyric acid (GABA, a common NT
in the brain)
– GABA is an inhibitory messenger; when received, it
causes a neuron to stop firing
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Abnormal Psychology, 3e
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GAD: The Biological
Perspective
• Biological treatments
– Antianxiety drugs
• Pre-1950s: barbiturates (sedative-hypnotics)
• Post-1950s: benzodiazepines
– Provide temporary, modest relief
– Rebound anxiety with withdrawal and cessation of use
– Physical dependence is possible
– Undesirable effects (drowsiness, etc.)
– Multiply effects of other drugs (especially alcohol)
• 1980s: buspirone (BuSpar)
– Different receptors, same effectiveness, fewer problems
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Abnormal Psychology, 3e
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GAD: The Biological
Perspective
• Biological treatments
– Relaxation training
• Theory: physical relaxation leads to psychological
relaxation
• Research indicates that relaxation training is more
effective than placebo or no treatment
• Best when used in combination with cognitive
therapy or biofeedback
Comer, Fundamentals of
Abnormal Psychology, 3e
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GAD: The Biological
Perspective
• Biological treatments
– Biofeedback
• Therapist uses electrical signals from the body to train people
to control physiological processes
• Electromyograph (EMG) is the most widely used; provides
feedback about muscle tension
• Found to be most effective when used as an
adjunct to other methods for the treatment of
certain medical problems (headache, back pain,
etc.)
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Abnormal Psychology, 3e
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Phobias
• From the Greek word for “fear”
– Formal names are also often from the Greek
(see Box 5-2)
• Persistent and unreasonable fears of
particular objects, activities, or situations
• Phobic people often avoid the object or
thoughts about it
Comer, Fundamentals of
Abnormal Psychology, 3e
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Phobias
• We all have some fears at some points in
our lives; this is a normal and common
experience
– How do phobias differ from these “normal”
experiences?
• More intense fear
• Greater desire to avoid the feared object or situation
• Distress that interferes with functioning
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Abnormal Psychology, 3e
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Specific Phobias
• Persistent fear of specific objects or
situations
• When exposed to the object or situation,
sufferers experience immediate fear
• Most common: phobias of specific animals
or insects, heights, enclosed spaces,
thunderstorms, and blood
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Abnormal Psychology, 3e
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Abnormal Psychology, 3e
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Specific Phobias
• ~9% of the U.S. population have symptoms
in any given year
– ~12% develop a specific phobia at some point in
their lives
• Many suffer from more than one phobia at a
time
• Women outnumber men 2:1
• Prevalence differs across racial and ethnic
minority groups
• Vast majority do NOT seek treatment
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Abnormal Psychology, 3e
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Social Phobias
• Severe, persistent, and unreasonable
fears of social or performance situations in
which embarrassment may occur
– May be narrow – talking, performing, eating,
or writing in public
– May be broad – general fear of functioning
inadequately in front of others
– In both cases, people rate themselves as
performing less adequately than they actually
did
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Abnormal Psychology, 3e
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Social Phobias
• Can greatly interfere with functioning
– Often kept a secret
• Affect ~7% of U.S. population in any given
year
• Women outnumber men 3:2
• Often begin in childhood and may persist
for many years
Comer, Fundamentals of
Abnormal Psychology, 3e
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What Causes Phobias?
• Each model offers explanations, but
evidence tends to support the behavioral
explanations:
– Phobias develop through conditioning
• Once fears are acquired, they are
continued because feared objects are
avoided
• Behaviorists propose a classical
conditioning model…
Comer, Fundamentals of
Abnormal Psychology, 3e
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What Causes Phobias?
• Other behavioral explanations
– Phobias may develop through modeling
• Observation and imitation
– Phobias are maintained through avoidance
– Phobias may develop into GAD when a
person acquires a large number of phobias
• Process of stimulus generalization: responses to
one stimulus are also elicited by similar stimuli
Comer, Fundamentals of
Abnormal Psychology, 3e
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What Causes Phobias?
• Behavioral explanations have received some
empirical support:
– Classical conditioning study involving Little Albert
– Modeling studies
• Bandura, confederates, buzz, and shock
• Research conclusion is that phobias CAN be
acquired in these ways, but there is no evidence
that this is how the disorder is ordinarily
acquired
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Abnormal Psychology, 3e
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What Causes Phobias?
• A behavioral-evolutionary explanation
– Some phobias are much more common than
others…
Comer, Fundamentals of
Abnormal Psychology, 3e
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Comer, Fundamentals of
Abnormal Psychology, 3e
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What Causes Phobias?
• A behavioral-evolutionary explanation
– Theorists argue that there is a speciesspecific biological predisposition to develop
certain fears
• Called “preparedness”: humans are more
“prepared” to develop phobias around certain
objects or situations
• Model explains why some phobias (snakes,
heights) are more common than others (grass,
meat)
– Unknown if these predispositions are due to evolutionary
or environmental
Comer,factors
Fundamentals of
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Abnormal Psychology, 3e
How Are Phobias Treated?
• Surveys reveal that ~19% of those with specific
phobia and 25% of those with social phobia
currently are in treatment
• Each model offers treatment approaches
– Behavioral techniques (exposure treatments) are
most widely used, especially for specific phobias
• Shown to be highly effective
• Fare better in head-to-head comparisons than other
approaches
• Include desensitization, flooding, and modeling
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Abnormal Psychology, 3e
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Treatments for Specific Phobias
• Systematic desensitization
– Technique developed by Joseph Wolpe
• Teach relaxation skills
• Create fear hierarchy
• Sufferers learn to relax while facing feared objects
– Since relaxation is incompatible with fear, the relaxation
response is thought to substitute for the fear response
– Several types:
• In vivo desensitization (live)
• Covert desensitization (imaginal)
Comer, Fundamentals of
Abnormal Psychology, 3e
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Treatments for Specific Phobias
• Other behavioral treatments:
– Flooding
• Forced nongradual exposure
– Modeling
• Therapist confronts the feared object while the fearful person
observes
• Clinical research supports each of these
treatments
– The key to success is ACTUAL contact with the
feared object or situation
Comer, Fundamentals of
Abnormal Psychology, 3e
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Treatments for Social Phobias
• Treatments only recently successful
– Two components must be addressed:
• Overwhelming social fear
– Address fears behaviorally with exposure
• Lack of social skills
– Social skills and assertiveness trainings have proved
helpful
Comer, Fundamentals of
Abnormal Psychology, 3e
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Panic Disorder
• Panic, an extreme anxiety reaction, can
result when a real threat suddenly
emerges
• The experience of “panic attacks,”
however, is different
– 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 happenComer,
in the
absence
of a real threat46
Fundamentals
of
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Abnormal Psychology, 3e
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Panic Disorder
• Anyone can experience a panic attack, but
some people have panic attacks
repeatedly, unexpectedly, and without
apparent reason
– Diagnosis: panic disorder
• Sufferers also experience dysfunctional changes in
thinking and behavior as a result of the attacks
– Example: sufferer worries persistently about having an
attack; plans behavior around possibility of future attack
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Panic Disorder
• Often (but not always) accompanied by
agoraphobia
– From the Greek “fear of the marketplace”
– Afraid to leave home and travel to locations from
which escape might be difficult or help unavailable
– Intensity may fluctuate
– There has only recently been a recognition of the link
between agoraphobia and panic attacks (or panic-like
symptoms)
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Abnormal Psychology, 3e
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Panic Disorder
• Two diagnoses: panic disorder with
agoraphobia; panic disorder without
agoraphobia
– ~3% of U.S. population affected in a given year
– ~5% of U.S. population affected at some point in their
lives
• Likely to develop in late adolescence and early
adulthood
• Women are twice as likely as men to be affected
• Approximately 35% of those with panic disorder
are in treatment
Comer, Fundamentals of
Abnormal Psychology, 3e
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Panic Disorder:
The Biological Perspective
• In the 1960s, it was recognized that people
with panic disorder were not helped by
benzodiazepines, but were helped by
antidepressants
– Researchers worked backward from their
understanding of antidepressant drugs
Comer, Fundamentals of
Abnormal Psychology, 3e
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Panic Disorder:
The Biological Perspective
• What biological factors contribute to panic
disorder?
– NT at work is norepinephrine
• Irregular in people with panic attacks
– Research suggests that panic reactions are related to
changes in norepinephrine activity in the locus ceruleus
– Although norepinephrine is clearly linked to panic
disorder, what goes wrong isn’t exactly understood
• May be excessive activity, deficient activity, or some other
defect
• Other NTs and brain circuits seem to be involved
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Abnormal Psychology, 3e
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Panic Disorder:
The Biological Perspective
• It is also unclear why some people have
such abnormalities in norepinephrine
activity
– Inherited biological predisposition is one
possible reason
• If so, prevalence should be (and is) greater among
close relatives
– Among monozygotic (MZ, or identical) twins = 24%
– Among dizygotic (DZ, or fraternal) twins = 11%
• Issue is still open to debate
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Abnormal Psychology, 3e
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Panic Disorder:
The Cognitive Perspective
• Cognitive theorists and practitioners
recognize that biological factors are only
part of the cause of panic attacks
– In their view, full panic reactions are
experienced only by people who misinterpret
bodily events
– Cognitive treatment is aimed at correcting
such misinterpretations
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Abnormal Psychology, 3e
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Panic Disorder:
The Cognitive Perspective
• Misinterpreting bodily sensations
– Panic-prone people have a high degree of “anxiety
sensitivity”
• They focus on bodily sensations much of the time, are unable
to assess the sensations logically, and interpret them as
potentially harmful
• Examples include: overbreathing or hyperventilation,
excitement, fullness in the abdomen, acute anger, and heart
“palpitations”
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Abnormal Psychology, 3e
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Panic Disorder:
The Cognitive Perspective
• Cognitive therapy
– Attempts to correct people’s misinterpretations of their
bodily sensations
• Step 1: Educate clients
– About panic in general
– About the causes of bodily sensations
– About their tendency to misinterpret the sensations
• Step 2: Teach clients to apply more accurate interpretations
(especially when stressed)
• Step 3: Teach clients skills for coping with anxiety
– Examples: relaxation, breathing
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Abnormal Psychology, 3e
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Panic Disorder:
The Cognitive Perspective
• Cognitive therapy
– May also use “biological challenge”
procedures to induce panic sensations
• Induce physical sensations which cause feelings of
panic:
– Jump up and down
– Run up a flight of steps
• Practice coping strategies and making more
accurate interpretations
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Abnormal Psychology, 3e
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Obsessive-Compulsive Disorder
• Made up of two components:
– Obsessions
• Persistent thoughts, ideas, impulses, or images
that seem to invade a person’s consciousness
– Compulsions
• Repeated and rigid behaviors or mental acts that
people feel they must perform to prevent or reduce
anxiety
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Abnormal Psychology, 3e
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Obsessive-Compulsive Disorder
• Diagnosis may be called for when
symptoms:
– Feel excessive or unreasonable
– Cause great distress
– Consume considerable time
– Interfere with daily functions
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Obsessive-Compulsive Disorder
• Classified as an anxiety disorder because
obsessions cause anxiety, while compulsions
are aimed at preventing or reducing anxiety
– Anxiety rises if obsessions or compulsions are
avoided
• ~2% of U.S. population has OCD in a given
year; between 2% and 3% over a lifetime
• Ratio of women to men is 1:1
• It is estimated that more than 40% of those with
OCD seek treatment
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Abnormal Psychology, 3e
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What Are the Features of
Obsessions and Compulsions?
• Obsessions
– Thoughts that feel intrusive and foreign
– Attempts to ignore or avoid them trigger
anxiety
– Take various forms:
•
•
•
•
•
Wishes
Impulses
Images
Ideas
Doubts
– Have common
themes:
• Dirt/contamination
• Violence and
aggression
• Orderliness
• Religion
• Sexuality
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Abnormal Psychology, 3e
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What Are the Features of
Obsessions and Compulsions?
• Compulsions
– “Voluntary” behaviors or mental acts
• Feel mandatory/unstoppable
– Person may recognize that behaviors are
irrational
• Believe, though, that catastrophe will occur if they don’t
perform the compulsive acts
– Performing behaviors reduces anxiety
• ONLY FOR A SHORT TIME!
– Behaviors often develop into rituals
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Abnormal Psychology, 3e
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What Are the Features of
Obsessions and Compulsions?
• Compulsions
– Common forms/themes:
•
•
•
•
Cleaning
Checking
Order or balance
Touching, verbal, and/or counting
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Abnormal Psychology, 3e
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What Are the Features of
Obsessions and Compulsions?
• Are obsessions and compulsions related?
– Most (not all) people with OCD experience
both
– Compulsive acts often occur in response to
obsessive thoughts
• Compulsions seem to represent a yielding to
obsessions
• Compulsions also sometimes serve to help control
obsessions
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Abnormal Psychology, 3e
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What Are the Features of
Obsessions and Compulsions?
• Are obsessions and compulsions related?
– Many with OCD are concerned that they will
act on their obsessions
• Most of these concerns are unfounded
• Compulsions usually do not lead to violence or
“immoral acts”
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Abnormal Psychology, 3e
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Obsessive-Compulsive Disorder
• OCD was once among the least
understood of the psychological disorders
• In recent years, however, researchers
have begun to learn more about it
• The most influential explanations are from
the psychodynamic, behavioral, cognitive,
and biological models…
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Abnormal Psychology, 3e
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OCD:
The Psychodynamic Perspective
• Anxiety disorders develop when children come
to fear their id impulses and use ego defense
mechanisms to lessen their anxiety
• OCD differs from anxiety disorders in that the
“battle” is not unconscious; it is played out in
explicit thoughts and action
– Id impulses = obsessive thoughts
– Ego defenses = counter-thoughts or compulsive
actions
• At its core, OCD is related to aggressive impulses
and the competing need to control them
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Abnormal Psychology, 3e
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OCD:
The Psychodynamic Perspective
• The battle between the id and the ego
– Three ego defenses mechanisms are common:
• Isolation: disown disturbing thoughts
• Undoing: perform acts to “cancel out” thoughts
• Reaction formation: take on lifestyle in contrast to
unacceptable impulses
– Freud believed that OCD was related to the anal
stage of development
• Period of intense conflict between id and ego
• Not all psychodynamic theorists agree
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Abnormal Psychology, 3e
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OCD:
The Psychodynamic Perspective
• Psychodynamic therapies
– Goals are to uncover and overcome
underlying conflicts and defenses
– Main techniques are free association and
interpretation
– Research evidence is poor
• Some therapists now prefer to treat these patients
with short-term psychodynamic therapies
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Abnormal Psychology, 3e
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OCD: The Behavioral
Perspective
• Behaviorists concentrate on explaining
and treating compulsions rather than
obsessions
• Although the behavioral explanation of
OCD has received little support,
behavioral treatments for compulsive
behaviors have been very successful
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Abnormal Psychology, 3e
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OCD: The Behavioral
Perspective
• Learning by chance
– People happen upon compulsions randomly:
• In a fearful situation, they happen to perform a particular act
(washing hands)
• When the threat lifts, they associate the improvement with
the random act
– After repeated associations, they believe the
compulsion is changing the situation
• Bringing luck, warding away evil, etc.
– The act becomes a key method to avoiding or
reducing anxiety
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Abnormal Psychology, 3e
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OCD: The Behavioral
Perspective
• Key investigator: Stanley Rachman
– Compulsions do appear to be rewarded by an
eventual decrease in anxiety
• Studies provide no evidence of the learning of
compulsions
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Abnormal Psychology, 3e
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OCD: The Behavioral
Perspective
• Behavioral therapy
– Exposure and response prevention (ERP)
• Clients are repeatedly exposed to anxiety-provoking stimuli
and prevented from responding with compulsions
• Therapists often model the behavior while the client watches
– Homework is an important component
• Treatment is offered in individual and group settings
• Treatment provides significant, long-lasting improvements for
most patients
– However, as many as 25% fail to improve at all and the
approach is of limited help to those with obsessions but no
compulsions
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Abnormal Psychology, 3e
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OCD: The Cognitive
Perspective
• Cognitive theory begins by pointing out
that everyone has repetitive, unwanted,
and intrusive thoughts
– People with OCD blame themselves for
normal (although repetitive and intrusive)
thoughts and expect that terrible things will
happen as a result
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OCD: The Cognitive
Perspective
• Overreacting to unwanted thoughts
– To avoid such negative outcomes, they attempt to
neutralize their thoughts with actions (or other
thoughts)
– Neutralizing thoughts/actions may include:
• Seeking reassurance
• Thinking “good” thoughts
• Washing
• Checking
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Abnormal Psychology, 3e
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OCD: The Cognitive
Perspective
• When a neutralizing action reduces
anxiety, it is reinforced
– Client becomes more convinced that the
thoughts are dangerous
– As fear of thoughts increases, the number of
thoughts increases
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Abnormal Psychology, 3e
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OCD: The Cognitive
Perspective
• If everyone has intrusive thoughts, why do
only some people develop OCD?
– People with OCD tend:
• To be more depressed than others
• To have higher standards of morality and conduct
• To believe thoughts are equal to actions and are
capable of bringing harm
• To believe that they can and should have perfect
control over their thoughts and behaviors
Comer, Fundamentals of
Abnormal Psychology, 3e
79
OCD: The Cognitive
Perspective
• Cognitive therapies
– Focus on the cognitive processes that help to
produce and maintain obsessive thoughts and
compulsive acts
– May include:
• Psychoeducation
• Habituation training
Comer, Fundamentals of
Abnormal Psychology, 3e
80
OCD: The Cognitive
Perspective
• Cognitive-Behavioral Therapy (CBT)
– Research suggests that a combination of the
cognitive and behavioral models often is more
effective than either intervention alone
– These treatments typically include
psychoeducation and exposure and response
prevention exercises
Comer, Fundamentals of
Abnormal Psychology, 3e
81
OCD: The Biological
Perspective
• Family pedigree studies provided the first
clues that OCD may be linked in part to
biological factors
– Studies of twins found a 53% concordance
rate in identical twins versus 23% in fraternal
twins
– Currently, more direct genetic studies are
being conducted to try to pinpoint the cause of
the genetic predisposition
Comer, Fundamentals of
Abnormal Psychology, 3e
82
OCD: The Biological
Perspective
• Two additional lines of research:
– Role of NT serotonin
• Evidence that serotonin-based antidepressants reduce OCD
symptoms
– Brain abnormalities
• OCD linked to orbital region of frontal cortex and caudate
nuclei
– Frontal cortex and caudate nuclei compose brain circuit
that converts sensory information into thoughts and
actions
– Either area may be too active, letting through
troublesome thoughts and actions
Comer, Fundamentals of
Abnormal Psychology, 3e
83
OCD: The Biological
Perspective
• Some research provides evidence that
these two lines may be connected
– Serotonin plays a very active role in the
operation of the orbital region and the caudate
nuclei
• Low serotonin activity might interfere with the
proper functioning of these brain parts
Comer, Fundamentals of
Abnormal Psychology, 3e
84
OCD: The Biological
Perspective
• Biological therapies
– Serotonin-based antidepressants
• clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine
• 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
Comer, Fundamentals of
Abnormal Psychology, 3e
85