Anxiety Disorders, Part IV (Chapter 5) February 28, 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D.

From Last Class Panic disorder PTSD

Specific Phobias Defining features Extreme and irrational fear of a specific object or situation Interferes with one's ability to function and/or is highly distressing Feared stimulus is avoided or endured with great distress

Specific Phobias Facts and statistics Affects 12.5% of the general population Sex ratio = 4:1 female to male Chronic course Onset usually between age 15-20

Types of Specific Phobias Situational phobias Claustrophobia Flying Driving Natural environment phobia Heights Storms Water (swimming)

Types of Specific Phobias Animal phobias Snakes Spiders Mice Blood-injection-injury phobia With or without vasovagal (fainting) reaction

Specific Phobias I’ve Treated Common Fears Injections Snakes Spiders Insects Enclosed spaces Driving Flying Unusual fears Vomiting Own navel Food allergy Aliens Demons

Treating Specific Phobias Cognitive-behavioral therapy: exposure Applied muscle tension for blood-injection-injury phobias involving fainting Modeling helps Medications? Not for phobias.

Case Examples Series of real examples of how exposure therapy was used to treat specific phobias…

Treating Specific Phobias Lisa, 33-year-old woman with fear of vomiting History Current symptoms

Lisa’s Fear Hierarchy Exposure Situation 1. Vomiting 2. Watching people vomit 3. Drinking alcohol 4. Overeating 5. Eating undercooked meat

Treating Specific Phobias Exposure hierarchy for a 28-year-old pregnant woman in her 2 nd trimester with Needle Phobia Each of the following were done in a 3-hour session… Exposure Situation Giving blood in inside of elbow Having finger pricked Watching others give blood in inside of elbow Watching others get finger pricked Touching and feeling and examining different types of needles

Social Phobia Fear of social or performance situation(s) involving exposure to scrutiny by others Fear of embarrassment/humiliation Interferes with functioning or highly distressing Situation is avoided or endured with great distress Generalized subtype (fear most social situations)

Fear-Evoking Stimuli in Social Phobia Social settings Performance situations (any context in which one’s behavior can be evaluated by others) Being the center of attention Experiencing observable body sensations or anxiety reactions Blushing, trembling, sweating

Safety Behaviors in Social Phobia Avoidance of social situations Escape from social situations when one’s anxiety gets too high In-situation safety behaviors Avoiding eye contact, prematurely terminating conversations, excessive rehearsal, wearing hat/beard/sunglasses, drinking alcohol, requiring presence of “safe persons”

Maladaptive Beliefs in Social Phobia Feared outcomes: 1. Making a mistake, appearing foolish 2. Having this be observed by others 3. Being negatively evaluated by others Socially phobic people overestimate the probability and cost (badness) of these outcomes

Maladaptive Beliefs in Social Phobia Social phobia is unique in that people fear outcomes that are objectively less severe that in most other anxiety disorders Embarrassment vs. death/illness/assault Treatment implications….

Study conducted with undergraduates at UW: Nelson, E. O., Deacon, B. J., Lickel, J. J., & Sy, J. T. (2010). Targeting the probability versus cost of feared outcomes in public speaking anxiety. Behaviour Research and Therapy, 48,

Participants 926 undergraduate students completed Speech Anxiety Thoughts Inventory (SATI; Cho et al., 2004 ) Recruited those with scores > 1 SD above published mean (n = 154) Final N = 37 (75.7% women)

Procedure Assessments at pre, post, and 1-week follow-up Treatment: Procedures common to both conditions Probability exposure condition Cost exposure condition Stuttering, hand shaking, mumbling, pausing, making foolish statements

Fear of Public Speaking Time x Condition Interaction: F (2, 70) = 3.22, p <.05; between-group d = 1.57

Cost of Feared Social Outcomes Time x Condition Interaction: F (2, 70) = 3.15, p <.05; between-group d =.56

“Social Cost” Exposures in the Clinic Treatment examples: Dropping change Shaking hands Asking others to open the door for you…

“Social Cost” Exposures Why would committing social mishaps be therapeutic? Why would committing social mishaps be therapeutic?

Social Cost Exposures on TV Impractical Jokers on TruTV Example social cost exposure:

Rejection Therapy Jia Jiang’s 100 days of rejection therapy: rejection-therapy/ rejection-therapy/ TED talk:

Treating Social Phobia Antidepressant medications: As effective as CBT (depending on the study) while medication is being taken Rate of improvement somewhat more rapid Moderate relapse rates upon drug discontinuation

Treating Social Phobia Exposure-based CBT Facing feared social situations and eliminating safety behaviors As effective as medication in short-term More effective in long-term after treatment is done Addition of medication conveys no benefit beyond CBT alone (generally true for all anxiety disorders)

Andrea’s Exposure Hierarchy Exposure Situation Estimated Anxiety Giving a speech at work100 Making mistakes around other people 95 Having others notice my sweaty armpits 95 Making conversation with strangers 85 Going dancing with boyfriend 70 Getting together with classmates on weekend 65 Eating lunch alone in crowded place 60 Asking people for the time 50 Making eye contact with strangers 45

Obsessive-Compulsive Disorder Obsessions Compulsions What is OCD and what is not

Obsessions Obsessions – unwanted, distressing, intrusive thoughts, images, or urges Obsessions cause anxiety

Obsessions Common types of obsessions Contamination Aggressive Symmetry/order Religious/morality Somatic Hoarding/saving

Obsessions: A Case Example On leaving work at the end of the day… “Have I left anything? Do I have my wallet? Do I have my pager? Have I left any notes out? Should I look under the chair? Should I look under the table? Is the phone on the hook? Touch it. Did you knock it off the hook? Should I touch it again? Will somebody know that I’ve been touching my phone compulsively? Turn the light off. Did I leave any lights on? Did I leave the light switch in an “in-between” position that could cause a short and cause a fire? Should I go back and check? Did I step on anything? Will I ever get out of here?” -Patient with OCD

Obsessions Not obsessions Any thought that is not distressing or inconsistent with your beliefs/values Being “obsessed” with sex, grades, high performance, perfection, morality, etc.