ANXIETY, AND RELATED DISORDERS Chapter 4

ANXIETY AND FEAR ARE NORMAL!! SERVES IMPORTANT ROLES: ADAPTATION, 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. 3

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. 4

ANXIETY DISORDERS Most common mental disorders in U.S. Most with 1 anxiety disorder also suffer from a 2 nd. 5

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 6

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 8

GAD: SOCIOCULTURAL PERSPECTIVE GAD most likely in people faced with dangerous social conditions. Poverty African Americans 30% more likely than Caucasians 9

GAD: COGNITIVE PERSPECTIVE Caused by dysfunctional ways of thinking 10

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. 11

GAD: COGNITIVE PERSPECTIVE Aaron Beck argued that those with GAD constantly hold silent assumptions that imply imminent danger. 12

GAD: COGNITIVE PERSPECTIVE Treatment: Changing maladaptive assumptions 13

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 14

GAD: BIOLOGICAL PERSPECTIVE GABA inactivity Benzodiazepines (Valium, Xanax) found to reduce anxiety 15

GAD: BIOLOGICAL PERSPECTIVE Root of GAD more complicated than single NT. Low levels of serotonin, norepinephrine Antidepressants affecting these NT seem to lower anxiety 16

GAD: BIOLOGICAL PERSPECTIVE Antianxiety drug therapy Benzodiazepines Antidepressant and antipsychotic medications 17

GAD: BIOLOGICAL PERSPECTIVE Relaxation training Physical relaxation will lead to psychological relaxation Best when used in combination with cognitive therapy or biofeedback 18

PHOBIAS Persistent and unreasonable fears of particular objects, activities, or situations People with a phobia often avoid object or thoughts about it 19

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 20

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 21

AGORAPHOBIA Afraid of being in situations where escape might be difficult, should they experience panic or become incapacitated 22

AGORAPHOBIA Avoid crowded places, driving, and public transportation Many experience panic attacks & may receive a second diagnosis of panic disorder 23

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 24

CLASSICAL CONDITIONING LITTLE ALBERT STUDY White rat no reaction (NS) Loud Noise Fear (UCS) (UCR) White Rat + Loud NoiseFear (NS) (UCS)(UCR) White ratFear (CS)(CR)

Focuses on significance of anxiety and fear. Helps person survive

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) 27

HOW ARE SPECIFIC PHOBIAS TREATED? Flooding Key to success is ACTUAL contact with feared object or situation Virtual reality as a useful exposure tool 29

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 30

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 31

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 32

TREATMENTS FOR SOCIAL ANXIETY DISORDER Antidepressants Psychotherapy: less likely to relapse than people treated with drugs alone 33

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 34

PANIC DISORDER Panic attacks repeatedly, unexpectedly, and without apparent reason Experience dysfunctional changes in thinking and behavior as a result of attacks 35

PANIC DISORDER Panic disorder often accompanied by agoraphobia 36

PANIC DISORDER: BIOLOGICAL PERSPECTIVE Norepinephrine Brain circuits and amygdala as more complex root of problem 37

PANIC DISORDER: BIOLOGICAL PERSPECTIVE Monozygotic (MZ, or identical) twins, ~31% Dizygotic (DZ, or fraternal) twins, ~11% 38

PANIC DISORDER: BIOLOGICAL PERSPECTIVE Drug therapies Antidepressants SSRI’s/SSNRI’s (Paxil, Zoloft, Effexor) Benzodiazepines (especially Xanax) 39

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 40

PANIC CYCLE 41

PANIC DISORDER: COGNITIVE PERSPECTIVE “Biological challenge” induce panic sensations Practice coping strategies and making more accurate interpretations 42