Download Realistic anxiety

Fundamentals of Abnormal Psychology
Ronald Comer
Chapter 4
Anxiety, ObsessiveCompulsive, and Related
Disorders
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Fear and Anxiety Response Patterns
source of danger
is obvious or not?
Less obvious
danger leads to
anxiety (futureoriented)
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Obvious danger
leads to fear (in
the present)
The Fear and Anxiety
Response Patterns
Fear or panic
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Activation of
“fight-orflight”
response
Anxiety disorders
Unrealistic, irrational fears or
anxieties
Disabling intensity
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Overview of the Anxiety Disorders
and Their Commonalities
1. Generalized anxiety disorder
2. Specific phobia
3. Agoraphobia
4. Social anxiety disorder (social phobia)
5. Panic disorder
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Cultural Differences
in Sources of Worry
How would you
describe these
sources of worry?
Yoruba
culture of
Nigeria
Koro in
China
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Taijin
kyofusho in
Japan
Overview of the Anxiety Disorders and
Their Commonalities
Commonalities
Basic biological causes
Basic psychological causes
Effective treatments
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Generalized
anxiety disorder (GAD)
• Chronic or excessive worry about
multiple events and activities
• Free floating anxiety
• Occurs more days than not for 6month period
• Difficult to control
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Usually first appears in childhood or
adolescence
Women are diagnosed more often
than men by a 2:1 ratio
Around ¼ with GAD are in treatment
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Comorbidity with Other Disorders
GAD
Experience
occasional
panic attacks
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Especially other
anxiety
disorders and
mood disorders
GAD: The Sociocultural Perspective
 GAD is most likely to develop in people faced
with social conditions that truly are dangerous
 Hurricane Katrina in 2005,
 Haitian earthquake in 2010
 societal stress of poverty
higher crime rates
fewer educational and job opportunities
health problems
 in lower SES groups
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Comer, Fandamentals of Abnormal
Psychology, 7e
GAD: The Psychodynamic Perspective
 Freud believed that all children experience
anxiety
 Realistic anxiety when they face actual
danger
 Neurotic anxiety when they are prevented
from expressing id impulses
 Moral anxiety when they are punished for
expressing id impulses
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Comer, Fandamentals of Abnormal
Psychology, 7e
GAD: The Humanistic Perspective
 GAD arises when people stop looking at
themselves honestly and acceptingly
 Lack of “unconditional positive regard”
 threatening self-judgments break through and
cause anxiety
13
Comer, Fandamentals of Abnormal
Psychology, 7e
Cognitive Causal Factors
Perceptions of
uncontrollability and
unpredictability
Causal Factors
Worry, positive or
negative
Automatic attentional
bias toward
threatening information
in environment
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GAD: The Cognitive Perspective
• Cognitive therapies
– Changing maladaptive assumptions
• Ellis’s rational-emotive therapy (RET)
–
–
–
–
15
Point out irrational assumptions
Suggest more appropriate assumptions
Assign related homework
Studies suggest at least modest relief from treatment
Comer, Fandamentals of Abnormal
Psychology, 7e
Biological Causal Factors
Genetics
Neurotransmitters
CRH
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Treatments
Anxiolytic
drugs
Cognitivebehavioral
therapy
Relaxation
Training
Biofeedback
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Specific
Phobias
Specific
Phobias
Specific phobia
• Strong and persistent fear usually
recognized as excessive or
unreasonable
• Triggered by a specific object or
situation
• Avoidance
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Some phobias (from phobialist.com)
Iatrophobia- Fear of going to the doctor or of doctors.
Ichthyophobia- Fear of fish.
Ideophobia- Fear of ideas.
Illyngophobia- Fear of vertigo or feeling dizzy when looking down.
Iophobia- Fear of poison.
Insectophobia - Fear of insects.
Isolophobia- Fear of solitude, being alone.
Isopterophobia- Fear of termites, insects that eat wood.
Ithyphallophobia- Fear of seeing, thinking about or having an erect penis.
Japanophobia- Fear of Japanese.
Judeophobia- Fear of Jews.
Radiophobia- Fear of radiation, x-rays.
Ranidaphobia- Fear of frogs.
Rectophobia- Fear of rectum or rectal diseases.
Rhabdophobia- Fear of being severely punished or beaten by a rod, or of being severely
criticized. Also fear of magic.(wand)
Rhypophobia- Fear of defecation.
Rhytiphobia- Fear of getting wrinkles.
Rupophobia- Fear of dirt.
Russophobia- Fear of Russians.
Specific Phobias
Subtypes identified in DSM-5
• Animal
• Natural environment
• Blood-injection-injury
• Situational
• Other
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Prevalence, Age of Onset,
and Gender Differences
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Agoraphobia (separate diagnosis in DSM-5)
• Anxiety about being in places from which
escape might be difficult or embarrassing:
• 2 of the following:
•
•
•
•
•
•
Public transportation
Being in open spaces (bridges, parking lots)
Malls
Being in enclosed spaces (movies, shops)
Standing in line or in a crowd
Being outside of the home alone
6 months or more
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Psychological Causal Factors
Psychoanalytic
viewpoint
Learned
behavior/classical
conditioning
Psychological
Causes
Modeling
Individual
differences in
learning
Evolutionary
preparedness
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Classical Conditioning of Phobia
UCS
UCR
Entrapment
Fear
Running +
water
26
UCS
UCR
Entrapment
Fear
CS
CR
Running water
Fear
Comer, Fandamentals of Abnormal
Psychology, 7e
How Are Specific Phobias Treated?
 Systematic desensitization
 Teach relaxation skills
 Create fear hierarchy
 Pair relaxation with the feared objects or situations
 Several types:
 In vivo desensitization (live)
 Covert desensitization (imaginal)
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Comer, Fandamentals of Abnormal
Psychology, 7e
How Are Specific Phobias Treated?
 Other behavioral treatments:
 Flooding
 Forced non-gradual exposure
 Modeling
 Therapist confronts the feared object while the
fearful person observes
 The key to success is ACTUAL contact with
the feared object or situation
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Comer, Fandamentals of Abnormal
Psychology, 7e
How Is Agoraphobia Treated?
 exposure approach
 60-80% get better and the improvement
lasts for years
29
Comer, Fandamentals of Abnormal
Psychology, 7e
Biological Causal Factors
Genetics
Temperament
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Social Anxiety Disorder (DSM-5)
• Disabling fears of one or more
specific social situations
• Fear of exposure to scrutiny and
potential negative evaluation of
others
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Prevalence, Age of Onset,
and Gender Differences
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What Causes Social Anxiety Disorder?
• social beliefs and expectations that
consistently work again them, including:
• Unrealistically high social standards
• Views of themselves as unattractive and socially
unskilled
• Believer that inept behaviors in social situations lead
to terrible consequences
33
Comer, Fandamentals of Abnormal
Psychology, 7e
Psychological Causal Factors
Learned behavior
Evolutionary factors
Causal
Factors
Perceptions of
uncontrollability and
unpredictability
Cognitive biases
toward “danger
schemes”
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Biological Causal Factors
Genetics
Temperament
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Treatments
Cognitive
therapy
Behavior
therapy &
social skills
training
Medications
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Panic Attacks
• What is a panic attack?
– Abrupt experience of intense fear or
discomfort with no real threat
– Several physical symptoms
(e.g., breathlessness, chest pain)
– Fear as an alarm response
DSM-5 for Panic Attack
• Intense fear or discomfort, in which four (or more) symptoms
developed abruptly and reached a peak within minutes:
•
•
•
•
•
•
•
•
•
•
•
•
•
1) palpitations, pounding heart, or accelerated heart rate
2) sweating
3) trembling or shaking
4) sensations of shortness of breath or smothering
5) feeling of choking
6) chest pain or discomfort
7) nausea or abdominal distress
8) feeling dizzy, unsteady, lightheaded, or faint
9) derealization (feelings of unreality) or depersonalization (being
detached from oneself)
10) fear of losing control or going crazy
11) fear of dying
12) paresthesias (numbness or tingling sensations)
13) chills or hot flushes
Panic Disorder
•
•
•
•
come “out of the blue”
Recurrent, unexpected attacks
Worry about additional attacks
Must be abrupt onset of 4 out of 13
symptoms
• Concern about future panic attacks
• Change in behavior
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Prevalence, Age of Onset,
and Gender Differences
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Comorbidity with Other Disorders
83% of people with
panic disorder have
at least one
comorbid disorder
50–70% will
experience serious
depression at some
point in their lives
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Biological Causal Factors
Genetics
Biochemical
agents
Neural
regions
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Figure 6.1: A Biological Theory of Panic,
Anxiety, and Agoraphobia
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Biological Causal Factors
True or false?
Neurobiological factors implicated in panic
disorders and GAD are the same.
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Psychological Causal Factors
Comprehensive learning
theory of panic disorder
Cognitive theory of panic
Causal
Factors
Safety behaviors and
persistence of panic
Cognitive biases and
maintenance of panic
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The Panic
Circle
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Treatments
Medications
Behavioral
treatments
Cognitivebehavioral
treatments
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Obsessive-Compulsive Disorder (OCD)
Occurrence of unwanted and intrusive
obsessive or distressing images
• Usually accompanied by compulsive
behaviors
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Obsessive-Compulsive
Disorder
Obsessions
• Contamination fears
• Fears of harming
oneself or others
• Lack of symmetry
• Pathological doubt
Compulsions
•
•
•
•
•
Cleaning
Checking
Repeating
Ordering/arranging
Counting
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Prevalence, Age of Onset,
and Gender Differences
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Comorbidity with Other Disorders
Frequently cooccurs with other
anxiety disorders
and mood
disorders
Also co-occurs with
body dysmorphic
disorder
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OCD:
The Psychodynamic Perspective
– Goals are to uncover and overcome
underlying conflicts and defenses
– Main techniques are free association and
interpretation
– Research has offered little evidence
52
Comer, Fandamentals of Abnormal
Psychology, 7e
Psychological Causal Factors
Mowrer developed the
two-process theory of
avoidance learning
Neutral stimuli become
associated with fearful
thoughts via classical
conditioning
Compulsion reduces
obsessions
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OCD:
The Cognitive Perspective
• If everyone has intrusive thoughts, why do
only some people develop OCD?
– People with OCD tend to:
• Have exceptionally high standards of conduct and
morality
• Believe thoughts are equal to actions and are
capable of bringing harm
• Believe that they can, and should, have perfect
control over their thoughts and behaviors
54
Comer, Fandamentals of Abnormal
Psychology, 7e
Biological Causal Factors
Genetics
Brain function
abnormalities
Serotonin
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Treatments
Exposure and
response
prevention
Medications that
affect
neurotransmitter
serotonin
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Obsessive-Compulsive-Related
Disorders”
hoarding disorder
hair-pulling disorder
skin-picking disorder
body dysmorphic disorder
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Body Dysmorphic Disorder
BDD
• Obsessed with perceived or imagined
flaw in appearance
• Causes clinically significant distress
• May focus on any body part
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Prevalence, Age of Onset,
and Gender Differences
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Relationship to OCD and Other Disorders
Similar
behaviors and
causes as OCD
Shares body
image
distortions with
eating disorders
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Treatments
Antidepressants
Cognitivebehavioral
therapy
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Hoarding Disorder
Hoarding
• Acquire and fail to discard limited
value possessions
• Disorganization in living space
interferes with daily life
• Poorer prognosis for treatment than
OCD
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Trichotillomania
Trichotillomania
• Urge to pull out hair from any body
location
• Preceded by tension and followed by
pleasure
• Must cause clinically significant
distress
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