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.

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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 EditionCopyright © 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• GAD most likely in people faced with dangerous

social conditions.• 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 is caused by maladaptive assumptions• Albert Ellis identified basic irrational

assumptions.• When assumptions are applied to everyday

life, GAD may develop.

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GAD: COGNITIVE PERSPECTIVE

• Aaron Beck argued that those with GAD 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• Two kinds of cognitive approaches:

• 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 affecting these NT seem to lower anxiety

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GAD: BIOLOGICAL PERSPECTIVE

• Antianxiety drug therapy• Benzodiazepines• Antidepressant and antipsychotic

medications

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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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PHOBIAS

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

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

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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

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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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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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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 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

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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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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 anxiety-provoking stimuli and told to resist performing compulsions

• Therapists often model behavior while client watches

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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

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

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