Transcript Chapter 21 Anxiety Disorders - McGraw Hill Higher Education

CHAPTER 2
ANXIETY DISORDERS
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AIMS AND OBJECTIVES
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Describe the nature of fear and anxiety disorders
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Discuss the range of anxiety disorders
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Provide information about diagnosis, epidemiology, and
treatment for each disorder
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
THE NATURE OF FEAR AND ANXIETY
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Flight or fight response (Cannon, 1929)
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Body reacts to danger by releasing adrenaline through blood
stream Related behaviours include:
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Freezing – to appraise danger
Flight – escape
Fight – if danger is unavoidable
“True alarms” (direct danger) versus “false alarms” (no
immediate threat)
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False alarms are the hallmark of anxiety disorders
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
THE NATURE OF FEAR AND ANXIETY
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Triple vulnerability model (Barlow, 2002)
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
THE NATURE OF FEAR AND ANXIETY
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Fear can be acquired in several ways:
Conditioning – pairing of a conditioned stimulus with an aversive
event
 Informational pathway
 Vicarious acquisition
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These all contribute to the expectation that an aversive
outcome is probable
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
THE NATURE OF FEAR AND ANXIETY
Conditioning
US (bitten
by dog)
UR (fear)
pair with
CS (dog)
CR (fear)
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SPECIFIC PHOBIA
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DSM-IV-TR Diagnosis includes:
Marked fear that is excessive or unreasonable
 Cued by presence or anticipation of phobic object/situation
 Causes interference/impairment in life or marked distress
 Four subtypes:
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Animal
Natural Environment (i.e., storms, heights, water)
Blood-Injection – Injury (i.e., blood, operation scenes, injections,
fainting common)
Situational (i.e., planes, elevators)
Epidemiology
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Lifetime prevalence 4-8%, female to male ratio 2:1
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
SPECIFIC PHOBIA
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Aetiology
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Phobias may be acquired by classical conditioning
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E.g., A neutral CS (white rat) is paired with a US (loud noise) that
produces fear
Problems with classical conditioning account
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Many people with specific phobias do not remember an initial
traumatic event (Menzies & Clark, 1993)
Preparedness: Some stimulus can be conditioned more easily
(Seligman, 1971)
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
SPECIFIC PHOBIA
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Treatment
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Exposure-based treatments are the most effective (Choy et al.,
2007)
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Exposures may work through extinction
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In vivo exposure – facing phobic stimulus in real life
Imaginal or virtual exposure
Fear decreases over repeated presentations of the CS in the absence
of the US
They may also work by challenging expectations of danger,
increasing self-efficacy, and increasing perception of control
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PANIC DISORDER AND AGORAPHOBIA
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DSM-IV-TR Diagnosis for Panic Disorder includes:
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Recurrent, unexpected panic attacks
At least one attack has been followed by >1 month of:
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Persistent concern about having additional attacks
Worry about the implications/consequences of the attack, e.g., losing
control, dying
A significant change in behavior
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Agoraphobia – anxiety about being in places from which escape
might be difficult or embarrassing in the event of having a panic
attack
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Panic disorder can occur with or without agoraphobia
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Lifetime prevalence of panic disorder = 5%
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PANIC DISORDER AND AGORAPHOBIA
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Aetiology
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Generalised psychological vulnerability
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Specific psychological vulnerability
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High anxiety sensitivity – fear of sensations
Catastrophic misinterpretation of physical sensations
Treatment
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Pharmacological – SSRIs, benzodiazepines
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Psychological – Cognitive behaviour therapy
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Address avoidance of internal and external cues using behavioural
and cognitive techniques
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SOCIAL PHOBIA
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DSM-IV-TR Diagnosis includes:
Marked, persistent fear of social situations
 Person recognises the fear as unreasonable
 Feared social situations are avoided
 Interference or distress
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Epidemiology
Lifetime prevalence 10-16%, female to male ratio 1:1
 Chronic course
 Delay in seeking treatment
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SOCIAL PHOBIA
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Aetiology
Genetic vulnerability: 2-3x increased risk among relatives
 Psychosocial factors
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Excessive parental criticism
Cognitive dysfunctions
Hypersensitivity to criticism
Treatment
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Psychological– Cognitive behaviour therapy
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Cognitive restructuring of negative thoughts (e.g., I am boring)
Exposure to feared social situations
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OBSESSIVE COMPULSIVE DISORDER
(OCD)
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DSM-IV-TR Diagnosis includes:
Obsessions – recurrent thoughts, images or impulses
experienced as inappropriate or distressing
 Compulsions – repetitive behaviours that the person feels
compelled to perform in response to obsession or according to
rigid rules
 Person recognizes that obsessions or compulsions are
excessive/irrational
 Marked distress/interference, time-consuming (>1 hour/day)
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Several subtypes:
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Washing
Checking
Hoarding
Obsessional slowness
Epidemiology
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Lifetime prevalence 2-3%
Often chronic if untreated
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OBSESSIVE COMPULSIVE DISORDER
(OCD)
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Aetiology
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Neuropsychological model (Baxter et al., 2000)
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Cognitive model
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Failure of inhibitory pathways in the basal ganglia to stop
“behavioural macros” in response to internal/external stimuli
OCD thoughts not different from those in general population
Difference is how OCD sufferers interpret the thoughts
Treatment
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Psychological– Cognitive behaviour therapy
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Exposure and response prevention
Cognitive restructuring
Pharmacological therapy
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POSTTRAUMATIC STRESS DISORDER
(PTSD)
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DSM-IV-TR Diagnosis includes:
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Exposure to a traumatic event
Re-experiencing symptoms
Avoidance symptoms
Arousal symptoms
Symptoms present for at least one month
Epidemiology
Despite high frequency of exposure to traumatic stressors,
relatively few develop PTSD (4%)
 Research attempts to identify who is at risk for developing PTSD
after exposure to a trauma
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POSTTRAUMATIC STRESS DISORDER
(PTSD)
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Aetiology
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Cognitive models
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Learning accounts
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Focus on individual’s maladaptive appraisals of the event, his/her
response to the event, and the environment
Emphasis on classical conditioning
Biological accounts
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Propose that extreme sympathetic arousal at the time of trauma results
in strong fear conditioning
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Across accounts, avoidance of trauma reminders maintains
PTSD
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Treatment
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Pharmacological therapy
Cognitive-behavioural therapy
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Psychoeducation, anxiety management, cognitive restructuring,
imaginal / in vivo exposure, and relapse prevention
Prevention of PTSD – applying CBT to survivors after trauma
exposure
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GENERALISED ANXIETY DISORDER
(GAD)
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DSM-IV-TR Diagnosis includes:
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Excessive worry about a number of events or activities
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E.g, health, finances, relationships
Worries are difficult to control
 Present on most days for at least 6 months
 Associated symptoms such as irritability, fatigue, difficulty
concentrating, and muscle tension
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Epidemiology
Commonly experienced, lifetime prevalence of 5%
 Early age of onset and chronic course
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
GENERALISED ANXIETY DISORDER
(GAD)
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Aetiology
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Moderate genetic predisposition
Cognitive models
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Information processing model – biased toward threat
Metacognitive model – positive and negative meta-beliefs about worry
Avoidance theory– worry to avoid imagery and underlying concerns
Intolerance of uncertainty model – need to control
Treatment
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Pharmacological therapy
Cognitive-behavioural therapy
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Cognitive restructuring, relaxation, behavioural experiments
Some symptom improvement, yet only 50% of sufferers end up in
non-clinical range
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
SUMMARY
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Nature of Fear and Anxiety
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Flight or fight response
Triple vulnerability model
Acquisition of expectation of fear
Diagnosis, Epidemiology, Aetiology, and Treatment of:
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Specific Phobia
Panic Disorder and Agoraphobia
Social Phobia
Obsessive-Compulsive Disorder
Posttraumatic Stress Disorder
Generalised Anxiety Disorder
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