ANXIETY, OBSESSIVE-COMPULSIVE, AND RELATED DISORDERS Chapter 4.

transcript

ANXIETY, OBSESSIVE-COMPULSIVE, AND RELATED DISORDERS

Chapter 4

ANXIETY AND FEAR ARE NORMAL!!

SERVES IMPORTANT ROLES: ADAPTATION, INITIATION, MOTIVATION

ANXIETY PREPARES US TO TAKE ACTIONAND 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.

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.

ANXIETY DISORDERS

• Most common mental disorders in U.S.• Most with 1 anxiety disorder also suffer from a

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

Table 4.2

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

GAD: SOCIOCULTURAL PERSPECTIVE• GAD most likely in people faced with dangerous

social conditions.• Poverty• African Americans 30% more likely than

Caucasians

GAD: COGNITIVE PERSPECTIVE

• Caused by dysfunctional ways of thinking

• GAD is caused by maladaptive assumptions• Albert Ellis identified basic irrational

assumptions.• When assumptions are applied to everyday

life, GAD may develop.

• Aaron Beck argued that those with GAD constantly hold silent assumptions that imply imminent danger.

• Metacognitive theory

• Intolerance of uncertainty theory

• Avoidance theory

GAD: COGNITIVE PERSPECTIVE• Two kinds of cognitive approaches:

• Changing maladaptive assumptions• Helping clients understand role that worrying plays, and changing their views and reactions to it

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

• GABA inactivity• Benzodiazepines (Valium, Xanax) found to reduce

anxiety • causes a neuron to stop firing

• Root of GAD more complicated than single NT.

• Low levels of serotonin, norepinephrine• Antidepressants affecting these NT seem to lower anxiety

• Antianxiety drug therapy• Benzodiazepines• Antidepressant and antipsychotic

medications

GAD: BIOLOGICAL PERSPECTIVE• Relaxation training

• Physical relaxation will lead to psychological relaxation

• Best when used in combination with cognitive therapy or biofeedback

PHOBIAS

• Persistent and unreasonable fears of particular objects, activities, or situations

• People with a phobia often avoid object or thoughts about it

SPECIFIC PHOBIAS

• Persistent fears of a specific object or situation

• When exposed to the object or situation, sufferers experience immediate fear

• 5 categories in the DSM: Animal, Natural-Environmental, Situational, Blood/Injury/Injection, Other

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

AGORAPHOBIA

• Afraid of being in situations where escape might be difficult, should they experience panic or become incapacitated

AGORAPHOBIA

• Avoid crowded places, driving, and public transportation

• Many experience panic attacks & may receive a second diagnosis of panic disorder

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

CLASSICAL CONDITIONINGLITTLE ALBERT STUDY

• White rat no reaction (NS)

• Loud Noise Fear

(UCS) (UCR)

• White Rat + Loud Noise Fear (NS) (UCS) (UCR)

• White rat Fear (CS) (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

•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)

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

HOW IS AGORAPHOBIA TREATED?• Situational Exposure

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

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

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

TREATMENTS FOR SOCIAL ANXIETY DISORDER

• Antidepressants• Psychotherapy: less likely to relapse than people treated with drugs alone

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

PANIC DISORDER

Panic attacks repeatedly, unexpectedly, and without apparent reason

• Experience dysfunctional changes in thinking and behavior as a result of attacks

PANIC DISORDER

Panic disorder often accompanied by agoraphobia

PANIC DISORDER: BIOLOGICAL PERSPECTIVE

• Norepinephrine• Irregular levels/activity in locus coeruleus

• Brain circuits and amygdala as more complex root of problem

• Monozygotic (MZ, or identical) twins, ~31%• Dizygotic (DZ, or fraternal) twins, ~11%

• Drug therapies• Antidepressants SSRI’s/SSNRI’s (Paxil,

Zoloft, Effexor)• Benzodiazepines (especially Xanax)

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

PANIC CYCLE

PANIC DISORDER: COGNITIVE PERSPECTIVE

“Biological challenge” induce panic sensations

• Practice coping strategies and making more accurate interpretations

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

• Diagnosis is called for when symptoms:• Feel excessive or unreasonable• Cause great distress• Take up much time• Interfere with daily functions

• Equally common in men and women and among different racial and ethnic groups

WHAT ARE FEATURES OF OBSESSIONS AND COMPULSIONS?

• Obsessions• common themes - Dirt/contamination,

violence and aggression, orderliness, religion, sexuality

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

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

OCD: BEHAVIORAL PERSPECTIVE

• Behavioral therapy• Exposure and response prevention (ERP)

• Clients are repeatedly exposed to anxiety-provoking stimuli and told to resist performing compulsions

• Therapists often model behavior while client watches

OCD: BIOLOGICAL PERSPECTIVE

Abnormal serotonin activityAbnormal 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

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

OBSESSIVE-COMPULSIVE-RELATED DISORDERS

• Some excessive behavior patterns (hoarding, hair pulling, shopping, sex) linked to OCD

• DSM-5 created group name “Obsessive-Compulsive-Related Disorders” and assigned four patterns to that group: hoarding disorder, hair-pulling disorder, skin-picking disorder, and body dysmorphic disorder

ANXIETY, OBSESSIVE-COMPULSIVE, AND RELATED DISORDERS Chapter 4.

Documents