1. Anxiety, Obsessive-Compulsive, and Related Disorders
Chapter 4

2. 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

3. 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.

4. 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.

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

6. 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

7. Table 4.2
Comer, Ronald J., Fundamentals of Abnormal Psychology, Seventh Edition Copyright © 2014 by Worth Publishers

8. 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

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

10. GAD: Cognitive Perspective
Caused by dysfunctional ways of thinking

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

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

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

15. GAD: Cognitive Perspective
Changing maladaptive assumptions
Helping clients understand role that worrying plays, and changing their views and reactions to it

16. 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

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

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

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

20. 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

21. Specific Phobias
5 categories in the DSM: Animal, Natural- Environmental, Situational, Blood/Injury/Injection, Other

22. 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

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 Noise Fear
(NS) (UCS) (UCR)
White rat Fear
(CS) (CR)

25. What Causes Phobias?
Process of stimulus generalization: Responses to one stimulus are also elicited by similar stimuli
Can develop through modeling
Maintained through avoidance

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

27. Evolutionary Prospective
Preparedness Model
Conditioned responses to fear-relevant stimuli (spiders, snakes) are more resistant to extinction that those to fear-irrelevant stimuli (flowers).

28. 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)

29. How Are Specific Phobias Treated?

30. 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

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

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

33. How Is Agoraphobia Treated?
Situational Exposure

34. 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

35. 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

36. 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

37. Treatments for Social Anxiety Disorder
Antidepressants
Psychotherapy: less likely to relapse than people treated with drugs alone

38. 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

39. Panic Disorder
Panic attacks repeatedly, unexpectedly, and without apparent reason
Experience dysfunctional changes in thinking and behavior as a result of attacks

40. Panic Disorder
Panic disorder often accompanied by agoraphobia

41. Panic Disorder: Biological Perspective
Norepinephrine
Irregular levels/activity in locus coeruleus
Brain circuits and amygdala as more complex root of problem

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

43. Panic Disorder: Biological Perspective
Drug therapies
Antidepressants SSRI’s/SSNRI’s (Paxil, Zoloft, Effexor)
Benzodiazepines (especially Xanax)

44. 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

45. Panic Cycle

46. Panic Disorder: Cognitive Perspective
“Biological challenge” induce panic sensations
Practice coping strategies and making more accurate interpretations

47. 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

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

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

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

51. 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

52. 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

53. 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

54. 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

55. 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

56. 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