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Chapter 6: Anxiety Disorders
Abnormal Psychology, Eighth Edition
by
Gerald C. Davison and John M. Neale
Lecture notes created by Paul J. Wellman, Texas A&M University
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6
Anxiety Disorders
• Anxiety refers to an unpleasant feeling of fear
and apprehension
– Neuroses is a former term that refers to a group of
disorders involving unrealistic anxiety, assumed to be
due to unconscious conflicts
• Anxiety disorders reflect the clear presence of
symptoms of anxiety
– Anxiety is not specific to anxiety disorders
– Comorbidity: A person may be diagnosed with more
than one disorder
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.1
Phobias
• A phobia is a fear-mediated avoidance
that is out of proportion to the object or
situation
– Phobias involve intense distress
– Phobias are disruptive
– Person recognizes that the fear is
groundless
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.2
Examples of Phobias
Phobia
Agoraphobia
Acrophobia
Pnigophobia
Taphephobia
Hellenologophobia
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Involves Fear of:
Enclosed Places
Heights
Choking
Being Buried Alive
Pseudoscientific Terms
Ch 6.3
Classes of Phobias
• Specific phobias are unwarranted fears
caused by the presence of a specific object
or situation
– Blood, injuries, or injections
– Situations (planes, elevators)
– Animals
– Natural environment (water, heights)
• Social phobia involves a persistent fear
linked to the presence of other people
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.4
Etiology of Phobias
• Psychoanalytic theory: phobias result from anxiety
produced by repressed id impulses
• Behavioral theories: focus on learning as the
etiological basis of phobias
– Phobias are learned avoidance responses
– Phobias may be acquired through modeling
– We are biologically prepared to learn certain fears (e.g.
taste with nausea)
• Cognitive theory: Thought processes result in high
levels of anxiety
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.5
Treating Phobias
• Psychoanalytic therapy attempts to uncover
repressed conflicts using free association
• Behavioral approaches use systematic
desensitization to reduce anxiety responses to
phobic stimuli and situations
– Flooding: exposure to a phobic stimulus at full
intensity
• Cognitive approaches focus on altering irrational
beliefs
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.6a
Treating Phobias
• Biological approach uses drugs to eliminate
anxiety symptoms
– Anxiolytic drugs such as the benzodiazepines (Valium)
can reduce anxiety but are also addictive and give rise
to withdrawal symptoms upon termination
– MAO inhibitors such as phenelzine reduce the
degradation of norepinephrine and serotonin
• MAO inhibitors can have adverse side effects
– Selective serotonin reuptake inhibitors (SSRI’s)
(fluoxetine) increase brain serotonin
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.6b
Panic Disorder
• Panic disorder involves
– an attack of labored breathing, nausea, chest pain,
dizziness and intense apprehension (terror)
– Depersonalization: the feeling of being outside of
one’s body
– Derealization: the feeling that the world is not real
• Lifetime prevalence for panic disorder is 2% for
men and 5% for women
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.7
Etiology of Panic Disorder
• Biological theories focus on the
observations
– that panic disorder runs in families
– that panic disorder can be induced
experimentally using
• Hyperventilation may activate the autonomic
nervous system
• Infusions of lactate can induce panic attack
• Panic attack may result from an
exaggerated central response to arousal
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.8
Etiology of Panic Disorder
• The Fear-of-fear hypothesis of panic
disorder suggests that some people have
an overly aroused nervous system and a
tendency to be upset by the sensations
generated by their nervous system
– Eventually, worry about a panic attack makes
a future attack more likely (vicious circle)
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.9
Panic Disorder Treatments
• Biological treatments include use of
antidepressant and anxiolytic drugs
– Require long-term use, symptoms return upon drug
cessation
• Psychological treatments emphasize exposure to
stimuli that accompany panic
– Barlow’s therapy includes a combination of relaxation
training, cognitive interventions and exposure to the
internal cues that elicit panic
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.10
Generalized Anxiety Disorder
• Generalized Anxiety Disorder (GAD)
involves persistent anxiety and chronic
(uncontrollable) worry
• The lifetime prevalence of GAD is 5%
• Women are twice as likely to develop GAD
as are men
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.11
Etiology of GAD
• Psychoanalytic view: generalized anxiety results
from unconscious conflicts between ego and id
impulses
• Cognitive behavioral view: anxiety results from
conditioning of anxiety to external stimuli
• Biological view: the transmitter GABA inhibits
anxiety, anxiolytic drugs enhance the release of
GABA in brain
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.12
Therapies for GAD
• Psychoanalytic therapy for GAD is similar
to that of phobia (reveal sources of conflict)
• Behavioral therapy involves a combination
of relaxation training and cognitive
intervention
• Biological therapy uses administration of
anxiolytic drugs to reduce anxiety
– Drug therapy is effective while the drugs are
taken
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.13
Obsessive-Compulsive
Disorder (OCD)
• Obsessions are intrusive and recurring
thoughts
• Compulsions are repetitive behaviors or
mental actions that are repeated over and
over in order to reduce anxiety
• The lifetime prevalence of OCD is 1-2 %
– Women are more likely than men to develop
OCD
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.14
Common Compulsions
• Pursuing cleanliness
• Avoiding particular objects (e.g. cracks in a
sidewalk)
• Performing repetitive, magical, protective
practices
• Checking (e.g. “is the gas off?”)
• Performing a particular act (e.g. chewing
slowly)
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.15
Etiology of OCD
• The psychoanalytic view is that OCD reflects
arrest of personality development at the anal
stage
• Behavioral accounts of OCD point to learned
behaviors reinforced by fear reduction
• The biological view of OCD has focused on
activation of the frontal lobes and basal ganglia
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.16
The Basal Ganglia
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.17
OCD Therapy
• Psychoanalytic procedures are not effective
• ERP: Exposure and Response Prevention
involves exposing the OCD client to
situations that elicit a compulsion and then
restraining the client from performing the
compulsion
• Biological treatment involves drugs that
increase brain serotonin activity (Prozac)
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.18
Posttraumatic Stress Disorder
• Posttraumatic Stress Disorder (PTSD)
refers to an extreme response to an
extreme stressor
• PTSD symptoms may include:
– Increased anxiety and arousal
– Reexperiencing the traumatic event
– Avoidance of stimuli associated with the
trauma
© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e
Ch 6.19
Copyright
Copyright 2000 by John Wiley & Sons, New York, NY. All
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copyright may be reproduced or utilized in any form or by
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© 2000 John Wiley & Sons, Inc.
Davison and Neale: Abnormal Psychology, 8e