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Fundamentals of Abnormal Psychology Ronald Comer Chapter 4 Anxiety, ObsessiveCompulsive, and Related Disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Fear and Anxiety Response Patterns source of danger is obvious or not? Less obvious danger leads to anxiety (futureoriented) © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Obvious danger leads to fear (in the present) The Fear and Anxiety Response Patterns Fear or panic © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Activation of “fight-orflight” response Anxiety disorders Unrealistic, irrational fears or anxieties Disabling intensity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Cultural Differences in Sources of Worry How would you describe these sources of worry? Yoruba culture of Nigeria Koro in China © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Taijin kyofusho in Japan Overview of the Anxiety Disorders and Their Commonalities Commonalities Basic biological causes Basic psychological causes Effective treatments © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2013 Pearson Education, Inc. All rights reserved. Comorbidity with Other Disorders GAD Experience occasional panic attacks © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 11 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 12 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Treatments Anxiolytic drugs Cognitivebehavioral therapy Relaxation Training Biofeedback © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Specific Phobias Specific Phobias Specific phobia • Strong and persistent fear usually recognized as excessive or unreasonable • Triggered by a specific object or situation • Avoidance © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Prevalence, Age of Onset, and Gender Differences © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Psychological Causal Factors Psychoanalytic viewpoint Learned behavior/classical conditioning Psychological Causes Modeling Individual differences in learning Evolutionary preparedness © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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) 27 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 28 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Prevalence, Age of Onset, and Gender Differences © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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” © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Biological Causal Factors Genetics Temperament © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Treatments Cognitive therapy Behavior therapy & social skills training Medications © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Biological Causal Factors Genetics Biochemical agents Neural regions © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Figure 6.1: A Biological Theory of Panic, Anxiety, and Agoraphobia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Biological Causal Factors True or false? Neurobiological factors implicated in panic disorders and GAD are the same. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. The Panic Circle © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Treatments Medications Behavioral treatments Cognitivebehavioral treatments © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Obsessive-Compulsive Disorder (OCD) Occurrence of unwanted and intrusive obsessive or distressing images • Usually accompanied by compulsive behaviors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Obsessive-Compulsive Disorder Obsessions • Contamination fears • Fears of harming oneself or others • Lack of symmetry • Pathological doubt Compulsions • • • • • Cleaning Checking Repeating Ordering/arranging Counting © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Treatments Exposure and response prevention Medications that affect neurotransmitter serotonin © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Obsessive-Compulsive-Related Disorders” hoarding disorder hair-pulling disorder skin-picking disorder body dysmorphic disorder © 2013 Pearson Education, Inc. All rights reserved. Body Dysmorphic Disorder BDD • Obsessed with perceived or imagined flaw in appearance • Causes clinically significant distress • May focus on any body part © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Prevalence, Age of Onset, and Gender Differences © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Relationship to OCD and Other Disorders Similar behaviors and causes as OCD Shares body image distortions with eating disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Treatments Antidepressants Cognitivebehavioral therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Trichotillomania Trichotillomania • Urge to pull out hair from any body location • Preceded by tension and followed by pleasure • Must cause clinically significant distress © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.