Download Anxiety Disorders

Slides & Handouts by Karen Clay Rhines, Ph.D.
Seton Hall University
Chapter 5
Anxiety Disorders
Comer, Fundamentals of
Abnormal Psychology, 3e
1
Anxiety
• What distinguishes fear from anxiety?
– Fear is a state of immediate alarm in
response to a serious, known threat to
one’s well-being
– Anxiety is a state of alarm in response
to a vague sense of threat or danger
– Both have the same physiological features:
increase in respiration, perspiration, muscle
tension, etc.
Comer, Fundamentals of
Abnormal Psychology, 3e
2
Anxiety
• Is the fear/anxiety response
useful/adaptive?
– Yes, when the “fight or flight” response is
protective
– However, when it is triggered by
“inappropriate” situations, or when it is too
severe or long-lasting, this response can be
disabling
• Can lead to the development of anxiety disorders
Comer, Fundamentals of
Abnormal Psychology, 3e
3
Anxiety Disorders
• Most common mental disorders in the U.S.
– In any given year, 18% of the adult population in the
U.S. experiences one of the six DSM-IV-TR anxiety
disorders
• Close to 29% develop one of the disorders at some point in
their lives
• Only ~20% of these individuals seek treatment
• Most individuals with one anxiety disorder suffer
from a second disorder, as well
• Anxiety disorders cost $42 billion each year in
health care, lost wages, and lost productivity
Comer, Fundamentals of
Abnormal Psychology, 3e
4
Anxiety Disorders
• Six disorders:
– Generalized anxiety disorder (GAD)
– Phobias
– Panic disorder
– Obsessive-compulsive disorder (OCD)
– Acute stress disorder
– Posttraumatic stress disorder (PTSD)
Comer, Fundamentals of
Abnormal Psychology, 3e
5
Generalized Anxiety Disorder
(GAD)
• Characterized by excessive anxiety under most
circumstances and worry about practically
anything
– Vague, intense concerns and fearfulness
• Often called “free-floating” anxiety
• “Danger” not a factor
• Symptoms include restlessness, easy fatigue,
irritability, muscle tension, and/or sleep
disturbance
– Symptoms last at least six months
Comer, Fundamentals of
Abnormal Psychology, 3e
6
Comer, Fundamentals of
Abnormal Psychology, 3e
7
Generalized Anxiety Disorder
(GAD)
• The disorder is common in Western society
– Affects ~3% of the population in any given year and
~6% at sometime during their lives
• Usually first appears in childhood or
adolescence
• Women are diagnosed more often than men by
2:1 ratio
• Various theories have been offered to explain
the development of the disorder…
Comer, Fundamentals of
Abnormal Psychology, 3e
8
GAD: The Sociocultural
Perspective
• According to this theory, GAD is most likely to develop in
people faced with social conditions that truly are
dangerous
– Research supports this theory (example: Three Mile Island in
1979)
• One of the most powerful forms of societal stress is
poverty
– Why? Run-down communities, higher crime rates, fewer
educational and job opportunities, and greater risk for health
problems
– As would be predicted by the model, there are higher rates of
GAD in lower SES groups
Comer, Fundamentals of
Abnormal Psychology, 3e
9
GAD: The Sociocultural
Perspective
• Since race is closely tied to income and
job opportunities in the U.S., it is also tied
to the prevalence of GAD
– In any given year, ~6% of African Americans
and 3.1% of Caucasians suffer from GAD
• African American women have highest rates
(6.6%)
Comer, Fundamentals of
Abnormal Psychology, 3e
10
GAD: The Psychodynamic
Perspective
• Freud believed that all children experience
anxiety
– Realistic anxiety when faced with actual danger
– Neurotic anxiety when prevented from expressing id
impulses
– Moral anxiety when punished for expressing id
impulses
• One can use ego defense mechanisms to
control these forms of anxiety, but when they
don’t work or when anxiety is too high…GAD
develops
Comer, Fundamentals of
Abnormal Psychology, 3e
11
GAD: The Psychodynamic
Perspective
• Today’s psychodynamic theorists often disagree
with specific aspects of Freud’s explanation
• Researchers have found some support for the
psychodynamic perspective:
– People with GAD are particularly likely to use defense
mechanisms (especially repression)
– Children who were severely punished for expressing
id impulses have higher levels of anxiety later in life
• Are these results “proof” of the model’s validity?
Comer, Fundamentals of
Abnormal Psychology, 3e
12
GAD: The Psychodynamic
Perspective
• Not necessarily; there are alternative
explanations of the data:
– Discomfort with painful memories or
“forgetting” in therapy is not necessarily
defensive
• Also, some data actually contradict the
model
– Many (if not most) GAD clients report normal
childhood upbringings
Comer, Fundamentals of
Abnormal Psychology, 3e
13
GAD: The Psychodynamic
Perspective
• Psychodynamic therapies
– Use same general techniques for treating all
dysfunction
• Free association
• Therapist interpretation
– Specific treatments for GAD
• Freudians: focus less on fear and more on control
of id
• Object-relations therapists: help patients identify
and settle early relationship conflicts
Comer, Fundamentals of
Abnormal Psychology, 3e
14
GAD: The Humanistic Perspective
• Theorists propose that GAD, like other
psychological disorders, arises when people
stop looking at themselves honestly and
acceptingly
• This view is best illustrated by Carl Rogers’s
explanation:
– Lack of “unconditional positive regard” in childhood
leads to “conditions of worth” (harsh self-standards)
– These threatening self-judgments break through and
cause anxiety, setting the stage for GAD to develop
Comer, Fundamentals of
Abnormal Psychology, 3e
15
GAD: The Humanistic Perspective
• Therapy based on this model is “client-centered”
and focuses on creating an accepting
environment where clients can “experience”
themselves
– Although case reports have been positive, controlled
studies have only sometimes found client-centered
therapy to be more effective than placebo or no
therapy
– Only limited support has been found for Rogers’s
explanation of causal factors
Comer, Fundamentals of
Abnormal Psychology, 3e
16
GAD: The Cognitive Perspective
• Theorists believe that psychological
problems are caused by maladaptive and
dysfunctional thinking
• Since GAD is characterized by excessive
worry (cognition), this model is a good
start…
Comer, Fundamentals of
Abnormal Psychology, 3e
17
GAD: The Cognitive Perspective
• Theory: GAD is caused by maladaptive assumptions
– Albert Ellis identified basic irrational assumptions:
• It is necessary for humans to be loved by everyone
• It is catastrophic when things are not as one wants them to
be
• If something is dangerous, a person should be terribly
concerned and dwell on the possibility that it will occur
• One should be competent in all domains to be a worthwhile
person
– When these assumptions are applied to everyday life,
GAD may develop
Comer, Fundamentals of
Abnormal Psychology, 3e
18
GAD: The Cognitive Perspective
• Aaron Beck is another cognitive theorist
– Those with GAD hold unrealistic silent assumptions
that imply imminent danger:
• Any strange situation is dangerous
• A situation/person is unsafe until proven safe
• Research supports the presence of these types
of assumptions in GAD, particularly about
dangerousness
Comer, Fundamentals of
Abnormal Psychology, 3e
19
GAD: The Cognitive Perspective
• Second-Generation Cognitive Explanations
– In recent years, two promising explanations have
emerged:
• Metacognitive theory
– Worry about worrying (metaworrying)
• Avoidance theory
– worrying serves a “positive” function by reducing unusually high
levels of bodily arousal
– Both theories have received considerable research
support
Comer, Fundamentals of
Abnormal Psychology, 3e
20
GAD: The Cognitive Perspective
• Two kinds of cognitive therapy:
– Changing maladaptive assumptions
• Based on the work of Ellis and Beck
– Helping clients understand the special role
that worrying plays, and changing their views
about it
Comer, Fundamentals of
Abnormal Psychology, 3e
21
GAD: The Cognitive Perspective
• Cognitive therapies
– Focusing on worrying
• Therapists begin with psychoeducation about
worrying and GAD
– Assign self-monitoring of somatic arousal and cognitive
responses
• As therapy progresses, clients become
increasingly skilled at identifying their worrying and
its counterproductivity
Comer, Fundamentals of
Abnormal Psychology, 3e
22
GAD: The Biological
Perspective
• Theory holds that GAD is caused by
biological factors
– Supported by family pedigree studies
• Blood relatives more likely to have GAD (~15%)
than general population (~6%)
• The closer the relative, the greater the likelihood
– Issue of shared environment
Comer, Fundamentals of
Abnormal Psychology, 3e
23
GAD: The Biological
Perspective
• GABA inactivity
– 1950s – Benzodiazepines (Valium, Xanax)
found to reduce anxiety
– Why?
• Neurons have specific receptors (lock and key)
• Benzodiazepine receptors ordinarily receive
gamma-aminobutyric acid (GABA, a common NT
in the brain)
– GABA is an inhibitory messenger; when received, it
causes a neuron to stop firing
Comer, Fundamentals of
Abnormal Psychology, 3e
24
GAD: The Biological
Perspective
• Biological treatments
– Antianxiety drugs
• Pre-1950s: barbiturates (sedative-hypnotics)
• Post-1950s: benzodiazepines
– Provide temporary, modest relief
– Rebound anxiety with withdrawal and cessation of use
– Physical dependence is possible
– Undesirable effects (drowsiness, etc.)
– Multiply effects of other drugs (especially alcohol)
• 1980s: buspirone (BuSpar)
– Different receptors, same effectiveness, fewer problems
Comer, Fundamentals of
Abnormal Psychology, 3e
25
GAD: The Biological
Perspective
• Biological treatments
– Relaxation training
• Theory: physical relaxation leads to psychological
relaxation
• Research indicates that relaxation training is more
effective than placebo or no treatment
• Best when used in combination with cognitive
therapy or biofeedback
Comer, Fundamentals of
Abnormal Psychology, 3e
26
GAD: The Biological
Perspective
• Biological treatments
– Biofeedback
• Therapist uses electrical signals from the body to train people
to control physiological processes
• Electromyograph (EMG) is the most widely used; provides
feedback about muscle tension
• Found to be most effective when used as an
adjunct to other methods for the treatment of
certain medical problems (headache, back pain,
etc.)
Comer, Fundamentals of
Abnormal Psychology, 3e
27
Phobias
• From the Greek word for “fear”
– Formal names are also often from the Greek
(see Box 5-2)
• Persistent and unreasonable fears of
particular objects, activities, or situations
• Phobic people often avoid the object or
thoughts about it
Comer, Fundamentals of
Abnormal Psychology, 3e
28
Phobias
• We all have some fears at some points in
our lives; this is a normal and common
experience
– How do phobias differ from these “normal”
experiences?
• More intense fear
• Greater desire to avoid the feared object or situation
• Distress that interferes with functioning
Comer, Fundamentals of
Abnormal Psychology, 3e
29
Specific Phobias
• Persistent fear of specific objects or
situations
• When exposed to the object or situation,
sufferers experience immediate fear
• Most common: phobias of specific animals
or insects, heights, enclosed spaces,
thunderstorms, and blood
Comer, Fundamentals of
Abnormal Psychology, 3e
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Comer, Fundamentals of
Abnormal Psychology, 3e
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Specific Phobias
• ~9% of the U.S. population have symptoms
in any given year
– ~12% develop a specific phobia at some point in
their lives
• Many suffer from more than one phobia at a
time
• Women outnumber men 2:1
• Prevalence differs across racial and ethnic
minority groups
• Vast majority do NOT seek treatment
Comer, Fundamentals of
Abnormal Psychology, 3e
32
Social Phobias
• Severe, persistent, and unreasonable
fears of social or performance situations in
which embarrassment may occur
– May be narrow – talking, performing, eating,
or writing in public
– May be broad – general fear of functioning
inadequately in front of others
– In both cases, people rate themselves as
performing less adequately than they actually
did
Comer, Fundamentals of
Abnormal Psychology, 3e
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Comer, Fundamentals of
Abnormal Psychology, 3e
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Social Phobias
• Can greatly interfere with functioning
– Often kept a secret
• Affect ~7% of U.S. population in any given
year
• Women outnumber men 3:2
• Often begin in childhood and may persist
for many years
Comer, Fundamentals of
Abnormal Psychology, 3e
35
What Causes Phobias?
• Each model offers explanations, but
evidence tends to support the behavioral
explanations:
– Phobias develop through conditioning
• Once fears are acquired, they are
continued because feared objects are
avoided
• Behaviorists propose a classical
conditioning model…
Comer, Fundamentals of
Abnormal Psychology, 3e
36
What Causes Phobias?
• Other behavioral explanations
– Phobias may develop through modeling
• Observation and imitation
– Phobias are maintained through avoidance
– Phobias may develop into GAD when a
person acquires a large number of phobias
• Process of stimulus generalization: responses to
one stimulus are also elicited by similar stimuli
Comer, Fundamentals of
Abnormal Psychology, 3e
37
What Causes Phobias?
• Behavioral explanations have received some
empirical support:
– Classical conditioning study involving Little Albert
– Modeling studies
• Bandura, confederates, buzz, and shock
• Research conclusion is that phobias CAN be
acquired in these ways, but there is no evidence
that this is how the disorder is ordinarily
acquired
Comer, Fundamentals of
Abnormal Psychology, 3e
38
What Causes Phobias?
• A behavioral-evolutionary explanation
– Some phobias are much more common than
others…
Comer, Fundamentals of
Abnormal Psychology, 3e
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Comer, Fundamentals of
Abnormal Psychology, 3e
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What Causes Phobias?
• A behavioral-evolutionary explanation
– Theorists argue that there is a speciesspecific biological predisposition to develop
certain fears
• Called “preparedness”: humans are more
“prepared” to develop phobias around certain
objects or situations
• Model explains why some phobias (snakes,
heights) are more common than others (grass,
meat)
– Unknown if these predispositions are due to evolutionary
or environmental
Comer,factors
Fundamentals of
41
Abnormal Psychology, 3e
How Are Phobias Treated?
• Surveys reveal that ~19% of those with specific
phobia and 25% of those with social phobia
currently are in treatment
• Each model offers treatment approaches
– Behavioral techniques (exposure treatments) are
most widely used, especially for specific phobias
• Shown to be highly effective
• Fare better in head-to-head comparisons than other
approaches
• Include desensitization, flooding, and modeling
Comer, Fundamentals of
Abnormal Psychology, 3e
42
Treatments for Specific Phobias
• Systematic desensitization
– Technique developed by Joseph Wolpe
• Teach relaxation skills
• Create fear hierarchy
• Sufferers learn to relax while facing feared objects
– Since relaxation is incompatible with fear, the relaxation
response is thought to substitute for the fear response
– Several types:
• In vivo desensitization (live)
• Covert desensitization (imaginal)
Comer, Fundamentals of
Abnormal Psychology, 3e
43
Treatments for Specific Phobias
• Other behavioral treatments:
– Flooding
• Forced nongradual exposure
– Modeling
• Therapist confronts the feared object while the fearful person
observes
• Clinical research supports each of these
treatments
– The key to success is ACTUAL contact with the
feared object or situation
Comer, Fundamentals of
Abnormal Psychology, 3e
44
Treatments for Social Phobias
• Treatments only recently successful
– Two components must be addressed:
• Overwhelming social fear
– Address fears behaviorally with exposure
• Lack of social skills
– Social skills and assertiveness trainings have proved
helpful
Comer, Fundamentals of
Abnormal Psychology, 3e
45
Panic Disorder
• Panic, an extreme anxiety reaction, can
result when a real threat suddenly
emerges
• The experience of “panic attacks,”
however, is different
– 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 happenComer,
in the
absence
of a real threat46
Fundamentals
of
Abnormal Psychology, 3e
Comer, Fundamentals of
Abnormal Psychology, 3e
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Panic Disorder
• Anyone can experience a panic attack, but
some people have panic attacks
repeatedly, unexpectedly, and without
apparent reason
– Diagnosis: panic disorder
• Sufferers also experience dysfunctional changes in
thinking and behavior as a result of the attacks
– Example: sufferer worries persistently about having an
attack; plans behavior around possibility of future attack
Comer, Fundamentals of
Abnormal Psychology, 3e
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Comer, Fundamentals of
Abnormal Psychology, 3e
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Panic Disorder
• Often (but not always) accompanied by
agoraphobia
– From the Greek “fear of the marketplace”
– Afraid to leave home and travel to locations from
which escape might be difficult or help unavailable
– Intensity may fluctuate
– There has only recently been a recognition of the link
between agoraphobia and panic attacks (or panic-like
symptoms)
Comer, Fundamentals of
Abnormal Psychology, 3e
50
Panic Disorder
• Two diagnoses: panic disorder with
agoraphobia; panic disorder without
agoraphobia
– ~3% of U.S. population affected in a given year
– ~5% of U.S. population affected at some point in their
lives
• Likely to develop in late adolescence and early
adulthood
• Women are twice as likely as men to be affected
• Approximately 35% of those with panic disorder
are in treatment
Comer, Fundamentals of
Abnormal Psychology, 3e
51
Panic Disorder:
The Biological Perspective
• In the 1960s, it was recognized that people
with panic disorder were not helped by
benzodiazepines, but were helped by
antidepressants
– Researchers worked backward from their
understanding of antidepressant drugs
Comer, Fundamentals of
Abnormal Psychology, 3e
52
Panic Disorder:
The Biological Perspective
• What biological factors contribute to panic
disorder?
– NT at work is norepinephrine
• Irregular in people with panic attacks
– Research suggests that panic reactions are related to
changes in norepinephrine activity in the locus ceruleus
– Although norepinephrine is clearly linked to panic
disorder, what goes wrong isn’t exactly understood
• May be excessive activity, deficient activity, or some other
defect
• Other NTs and brain circuits seem to be involved
Comer, Fundamentals of
Abnormal Psychology, 3e
53
Panic Disorder:
The Biological Perspective
• It is also unclear why some people have
such abnormalities in norepinephrine
activity
– Inherited biological predisposition is one
possible reason
• If so, prevalence should be (and is) greater among
close relatives
– Among monozygotic (MZ, or identical) twins = 24%
– Among dizygotic (DZ, or fraternal) twins = 11%
• Issue is still open to debate
Comer, Fundamentals of
Abnormal Psychology, 3e
54
Panic Disorder:
The Cognitive Perspective
• Cognitive theorists and practitioners
recognize that biological factors are only
part of the cause of panic attacks
– In their view, full panic reactions are
experienced only by people who misinterpret
bodily events
– Cognitive treatment is aimed at correcting
such misinterpretations
Comer, Fundamentals of
Abnormal Psychology, 3e
55
Panic Disorder:
The Cognitive Perspective
• Misinterpreting bodily sensations
– Panic-prone people have a high degree of “anxiety
sensitivity”
• They focus on bodily sensations much of the time, are unable
to assess the sensations logically, and interpret them as
potentially harmful
• Examples include: overbreathing or hyperventilation,
excitement, fullness in the abdomen, acute anger, and heart
“palpitations”
Comer, Fundamentals of
Abnormal Psychology, 3e
56
Panic Disorder:
The Cognitive Perspective
• Cognitive therapy
– Attempts to correct people’s misinterpretations of their
bodily sensations
• Step 1: Educate clients
– About panic in general
– About the causes of bodily sensations
– About their tendency to misinterpret the sensations
• Step 2: Teach clients to apply more accurate interpretations
(especially when stressed)
• Step 3: Teach clients skills for coping with anxiety
– Examples: relaxation, breathing
Comer, Fundamentals of
Abnormal Psychology, 3e
57
Panic Disorder:
The Cognitive Perspective
• Cognitive therapy
– May also use “biological challenge”
procedures to induce panic sensations
• Induce physical sensations which cause feelings of
panic:
– Jump up and down
– Run up a flight of steps
• Practice coping strategies and making more
accurate interpretations
Comer, Fundamentals of
Abnormal Psychology, 3e
58
Obsessive-Compulsive Disorder
• Made up of two components:
– Obsessions
• Persistent thoughts, ideas, impulses, or images
that seem to invade a person’s consciousness
– Compulsions
• Repeated and rigid behaviors or mental acts that
people feel they must perform to prevent or reduce
anxiety
Comer, Fundamentals of
Abnormal Psychology, 3e
59
Obsessive-Compulsive Disorder
• Diagnosis may be called for when
symptoms:
– Feel excessive or unreasonable
– Cause great distress
– Consume considerable time
– Interfere with daily functions
Comer, Fundamentals of
Abnormal Psychology, 3e
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Comer, Fundamentals of
Abnormal Psychology, 3e
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Obsessive-Compulsive Disorder
• Classified as an anxiety disorder because
obsessions cause anxiety, while compulsions
are aimed at preventing or reducing anxiety
– Anxiety rises if obsessions or compulsions are
avoided
• ~2% of U.S. population has OCD in a given
year; between 2% and 3% over a lifetime
• Ratio of women to men is 1:1
• It is estimated that more than 40% of those with
OCD seek treatment
Comer, Fundamentals of
Abnormal Psychology, 3e
62
What Are the Features of
Obsessions and Compulsions?
• Obsessions
– Thoughts that feel intrusive and foreign
– Attempts to ignore or avoid them trigger
anxiety
– Take various forms:
•
•
•
•
•
Wishes
Impulses
Images
Ideas
Doubts
– Have common
themes:
• Dirt/contamination
• Violence and
aggression
• Orderliness
• Religion
• Sexuality
Comer, Fundamentals of
Abnormal Psychology, 3e
63
What Are the Features of
Obsessions and Compulsions?
• Compulsions
– “Voluntary” behaviors or mental acts
• Feel mandatory/unstoppable
– Person may recognize that behaviors are
irrational
• Believe, though, that catastrophe will occur if they don’t
perform the compulsive acts
– Performing behaviors reduces anxiety
• ONLY FOR A SHORT TIME!
– Behaviors often develop into rituals
Comer, Fundamentals of
Abnormal Psychology, 3e
64
What Are the Features of
Obsessions and Compulsions?
• Compulsions
– Common forms/themes:
•
•
•
•
Cleaning
Checking
Order or balance
Touching, verbal, and/or counting
Comer, Fundamentals of
Abnormal Psychology, 3e
65
What Are the Features of
Obsessions and Compulsions?
• Are obsessions and compulsions related?
– Most (not all) people with OCD experience
both
– Compulsive acts often occur in response to
obsessive thoughts
• Compulsions seem to represent a yielding to
obsessions
• Compulsions also sometimes serve to help control
obsessions
Comer, Fundamentals of
Abnormal Psychology, 3e
66
What Are the Features of
Obsessions and Compulsions?
• Are obsessions and compulsions related?
– Many with OCD are concerned that they will
act on their obsessions
• Most of these concerns are unfounded
• Compulsions usually do not lead to violence or
“immoral acts”
Comer, Fundamentals of
Abnormal Psychology, 3e
67
Obsessive-Compulsive Disorder
• OCD was once among the least
understood of the psychological disorders
• In recent years, however, researchers
have begun to learn more about it
• The most influential explanations are from
the psychodynamic, behavioral, cognitive,
and biological models…
Comer, Fundamentals of
Abnormal Psychology, 3e
68
OCD:
The Psychodynamic Perspective
• Anxiety disorders develop when children come
to fear their id impulses and use ego defense
mechanisms to lessen their anxiety
• OCD differs from anxiety disorders in that the
“battle” is not unconscious; it is played out in
explicit thoughts and action
– Id impulses = obsessive thoughts
– Ego defenses = counter-thoughts or compulsive
actions
• At its core, OCD is related to aggressive impulses
and the competing need to control them
Comer, Fundamentals of
Abnormal Psychology, 3e
69
OCD:
The Psychodynamic Perspective
• The battle between the id and the ego
– Three ego defenses mechanisms are common:
• Isolation: disown disturbing thoughts
• Undoing: perform acts to “cancel out” thoughts
• Reaction formation: take on lifestyle in contrast to
unacceptable impulses
– Freud believed that OCD was related to the anal
stage of development
• Period of intense conflict between id and ego
• Not all psychodynamic theorists agree
Comer, Fundamentals of
Abnormal Psychology, 3e
70
OCD:
The Psychodynamic Perspective
• Psychodynamic therapies
– Goals are to uncover and overcome
underlying conflicts and defenses
– Main techniques are free association and
interpretation
– Research evidence is poor
• Some therapists now prefer to treat these patients
with short-term psychodynamic therapies
Comer, Fundamentals of
Abnormal Psychology, 3e
71
OCD: The Behavioral
Perspective
• Behaviorists concentrate on explaining
and treating compulsions rather than
obsessions
• Although the behavioral explanation of
OCD has received little support,
behavioral treatments for compulsive
behaviors have been very successful
Comer, Fundamentals of
Abnormal Psychology, 3e
72
OCD: The Behavioral
Perspective
• Learning by chance
– People happen upon compulsions randomly:
• In a fearful situation, they happen to perform a particular act
(washing hands)
• When the threat lifts, they associate the improvement with
the random act
– After repeated associations, they believe the
compulsion is changing the situation
• Bringing luck, warding away evil, etc.
– The act becomes a key method to avoiding or
reducing anxiety
Comer, Fundamentals of
Abnormal Psychology, 3e
73
OCD: The Behavioral
Perspective
• Key investigator: Stanley Rachman
– Compulsions do appear to be rewarded by an
eventual decrease in anxiety
• Studies provide no evidence of the learning of
compulsions
Comer, Fundamentals of
Abnormal Psychology, 3e
74
OCD: The Behavioral
Perspective
• Behavioral therapy
– Exposure and response prevention (ERP)
• Clients are repeatedly exposed to anxiety-provoking stimuli
and prevented from responding with compulsions
• Therapists often model the behavior while the client watches
– Homework is an important component
• Treatment is offered in individual and group settings
• Treatment provides significant, long-lasting improvements for
most patients
– However, as many as 25% fail to improve at all and the
approach is of limited help to those with obsessions but no
compulsions
Comer, Fundamentals of
Abnormal Psychology, 3e
75
OCD: The Cognitive
Perspective
• Cognitive theory begins by pointing out
that everyone has repetitive, unwanted,
and intrusive thoughts
– People with OCD blame themselves for
normal (although repetitive and intrusive)
thoughts and expect that terrible things will
happen as a result
Comer, Fundamentals of
Abnormal Psychology, 3e
76
OCD: The Cognitive
Perspective
• Overreacting to unwanted thoughts
– To avoid such negative outcomes, they attempt to
neutralize their thoughts with actions (or other
thoughts)
– Neutralizing thoughts/actions may include:
• Seeking reassurance
• Thinking “good” thoughts
• Washing
• Checking
Comer, Fundamentals of
Abnormal Psychology, 3e
77
OCD: The Cognitive
Perspective
• When a neutralizing action reduces
anxiety, it is reinforced
– Client becomes more convinced that the
thoughts are dangerous
– As fear of thoughts increases, the number of
thoughts increases
Comer, Fundamentals of
Abnormal Psychology, 3e
78
OCD: The Cognitive
Perspective
• If everyone has intrusive thoughts, why do
only some people develop OCD?
– People with OCD tend:
• To be more depressed than others
• To have higher standards of morality and conduct
• To believe thoughts are equal to actions and are
capable of bringing harm
• To believe that they can and should have perfect
control over their thoughts and behaviors
Comer, Fundamentals of
Abnormal Psychology, 3e
79
OCD: The Cognitive
Perspective
• Cognitive therapies
– Focus on the cognitive processes that help to
produce and maintain obsessive thoughts and
compulsive acts
– May include:
• Psychoeducation
• Habituation training
Comer, Fundamentals of
Abnormal Psychology, 3e
80
OCD: The Cognitive
Perspective
• Cognitive-Behavioral Therapy (CBT)
– Research suggests that a combination of the
cognitive and behavioral models often is more
effective than either intervention alone
– These treatments typically include
psychoeducation and exposure and response
prevention exercises
Comer, Fundamentals of
Abnormal Psychology, 3e
81
OCD: The Biological
Perspective
• Family pedigree studies provided the first
clues that OCD may be linked in part to
biological factors
– Studies of twins found a 53% concordance
rate in identical twins versus 23% in fraternal
twins
– Currently, more direct genetic studies are
being conducted to try to pinpoint the cause of
the genetic predisposition
Comer, Fundamentals of
Abnormal Psychology, 3e
82
OCD: The Biological
Perspective
• Two additional lines of research:
– Role of NT serotonin
• Evidence that serotonin-based antidepressants reduce OCD
symptoms
– Brain abnormalities
• OCD linked to orbital region of frontal cortex and caudate
nuclei
– Frontal cortex and caudate nuclei compose brain circuit
that converts sensory information into thoughts and
actions
– Either area may be too active, letting through
troublesome thoughts and actions
Comer, Fundamentals of
Abnormal Psychology, 3e
83
OCD: The Biological
Perspective
• Some research provides evidence that
these two lines may be connected
– Serotonin plays a very active role in the
operation of the orbital region and the caudate
nuclei
• Low serotonin activity might interfere with the
proper functioning of these brain parts
Comer, Fundamentals of
Abnormal Psychology, 3e
84
OCD: The Biological
Perspective
• Biological therapies
– Serotonin-based antidepressants
• clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine
• 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
Comer, Fundamentals of
Abnormal Psychology, 3e
85