Anxiety, Obsessive-Compulsive, and Related Disorders Chapter 4

Anxiety and Fear ARE normal Anxiety and Fear ARE normal!! Serves important roles: Adaptation, initiation, motivation Anxiety prepares us to take action and 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 2nd.

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 Comer, Ronald J., Fundamentals of Abnormal Psychology, Seventh Edition Copyright © 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

GAD: Sociocultural Perspective Dangerous social conditions GAD Poverty African Americans 30% more likely than Caucasians

GAD: Cognitive Perspective Caused by dysfunctional ways of thinking

GAD: Cognitive Perspective GAD caused by maladaptive assumptions Albert Ellis: basic irrational assumptions. When assumptions are applied to everyday life, GAD may develop.

GAD: Cognitive Perspective Aaron Beck: constantly hold silent assumptions that imply imminent danger.

GAD: Cognitive Perspective Metacognitive theory Intolerance of uncertainty theory Avoidance theory

GAD: Cognitive Perspective 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

GAD: Biological Perspective GABA inactivity Benzodiazepines (Valium, Xanax) found to reduce anxiety causes a neuron to stop firing

GAD: Biological Perspective Root of GAD more complicated than single NT. Low levels of serotonin, norepinephrine Antidepressants (Paxil, Zoloft, Effexor) seem to lower anxiety

GAD: Biological Perspective Relaxation training Physical relaxation will lead to psychological relaxation Best when used in combination with cognitive therapy or biofeedback

Specific Phobias Persistent and unreasonable fears of particular objects, activities, or situations People often avoid object or thoughts about it -- when exposed, sufferers experience immediate fear

Specific Phobias 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

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 Conditioning Little 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

Evolutionary perspective Focuses on significance of anxiety and fear. Helps person survive

Evolutionary Prospective 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?

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

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

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

Panic Disorder: Biological Perspective Monozygotic (MZ, or identical) twins, ~31% Dizygotic (DZ, or fraternal) twins, ~11%

Panic Disorder: Biological Perspective 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

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

Obsessive-Compulsive Disorder Equally common in men and women and among different racial and ethnic groups

What Are Features of Obsessions and Compulsions? common themes - Dirt/contamination, violence and aggression, orderliness, religion, sexuality

What Are Features of Obsessions and 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 activity Abnormal 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