PSY388 Lecture 3: Emotional Disorders 2: Anxiety Disorders; Obsessive-Compulsive and Related Disorders

Any 12-month Anxiety disorder, by age and sex, 2020-21

12-month Anxiety disorders, by type of disorder and sex, 2020-21

Anxiety Disorder

Panic Disorder (PD)

Agoraphobia (Ag)

Specific Phobia (SP)

Social Anxiety Disorder (SAD)

Generalised Anxiety Disorder (GAD)

• More environment trigger to intense emotions + more pre-exisiting cognitive style to interpret as bad and avoid/control

Aetiology of Anxiety Disorders

Biology, Psychology, Environment, Social

Aetiology of Anxiety Disorders - Biology

• Genetics/family history

• Disruptions to fear brain networks

• Heightened physiological sensitivity, more reactive, hypervigilant (HPA dysreg.)

• Tendency to experience more fear/anxiety “negative affectivity

Aetiology of Anxiety Disorders - Psychology

• Trait neuroticism

• Modelling

• Anxiety sensitivity, intolerance of uncertainty

• Learned helplessness (e.g., “I have no control over whether bad things happen to me”)

• Catastrophic thinking (e.g., “the world is a dangerous place”)

Aetiology of Anxiety Disorders - Environment

• Stressful life events as a trigger OR predisposition (e.g., conditioning)

Aetiology of Anxiety Disorders - Social

• Avoidance (negative Rft)

• Overprotective parents

• High “expressed emotion”

• Excessive parental criticism

Equifinality

Is the principle that various causes can lead to the same outcome or disorder, particularly within the context of anxiety disorders, where multiple factors can contribute to an individual's experience of anxiety.

Multifinality

Is the principle that the same cause can lead to a variety of outcomes or disorders, particularly in the context of anxiety disorders, where an individual may respond differently to similar experiences.

Differential Diagnosis - Panic Disorder

Fear of having panic attacks

Differential Diagnosis - Agoraphobia

Fear of no escape/no help

Differential Diagnosis - Specific Phobia

Fear of harm from object/situation

Differential Diagnosis - Social anxiety disorder

Fear of negative evaluation

Differential Diagnosis - Generalised Anxiety Disorder

Fear of the unknown future (e.g. worry)

Moderate-to-large assoc btwn experiential avoidance and:

• anxiety/depressive sx

• MDD, GAD, SAD, PD, Ag, SP, OCD, PTSD

diagnostic co-occurrence did not moderate assoc, supporting transdiagnostic role

Emotion-Driven Behaviours

Behaviours driven by strong emotions that are designed to reduce the intensity of that emotion

Overt Avoidance

Outright avoidance of situations, people, etc. that bring up strong emotions

Subtle Behavioural Avoidance

Behaviours that prevent fully experiencing an emotion when outright avoidance isn’t an option

Cognitive Avoidance

Cognitive strategies that are used to avoid thinking about something that is distressing

Safety Signals

Items that are used to feel more comfortable and/or keep an emotion from becoming overwhelming

Cognitive behavioural therapy (CBT) - Anxiety disorders

Cognitive Therapy for Interpret as bad

• Psychoeducation

• Reappraisal

• Increases Flexibility

Behaviour Therapy for avoid or control

• Exposure

• Activation

• Lowers avoidance

Other treatment for anxiety disorders

• Yoga (Hatha)

• Exercise/Physical activity

Obsessive Compulsive & Related Disorders

Obsessive-Compulsive Disorder (OCD)

Body Dysmorphic Disorder (BDD)

Hoarding Disorder

Excoriation (skin-picking) Disorder

Trichotillomania (hair-pulling disorder)

OCD

• Obsessions and/or Compulsions

• Time-consuming (more than 1hr/day) or distress/impairment

Obsessions

1. Recurrent, persistent, unwanted, intrusive thoughts, images, impulses

2. Attempts to ignore, suppress, neutralise (i.e., compulsions)

E.g., i. Doubts (e.g., locks, appliances) ii. Contamination/germs iii. Harming self/others iv. Horrific/violent thoughts/images/urges v. Unwanted sexual/religious/moral thoughts/images/urges vi. Nonsensical thoughts/images/urges

Compulsions

1. Driven to perform repetitive behaviours or mental acts

2. Aimed at reducing anxiety/distress (associated with obsessions) or preventing something from happening

E.g., i. Checking (e.g., locks, appliances) ii. Washing (e.g., self, house) iii. Counting iv. Internal repetition (e.g., words, phrases, prayers) v. Adhering to rules/behaviours (e.g., ordering/symmetry, routine, rituals)

Aetiology of OCD - Biology

• Genetics/family history

• Neuropsychological Model: failure of inhibitory pathways in the brain to stop “behavioural macros” in response to internal or external stimuli

Aetiology of OCD - Psychology

• Cognitive Model: obsessional thoughts interpreted as danger signals (i.e., threat)

• Intolerance of uncertainty → compulsions

• Compulsions reinforced by maladaptive beliefs that performing them will reduce/prevent threat (“magical thinking”)

Aetiology of OCD - Environment

None

Aetiology of OCD - Social

• High expressed emotion → signal threat, trigger need for control

Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment

• OCD and GAD are distinct disorders with significant phenomenological overlap.

• Intolerance of Uncertainty (IU) may account for some overlap between disorders.

• Neural circuitry underlying IU can be measured and may be altered in OCD and GAD.

• Focusing on IU may improve diagnostic conceptualization and treatment.

• Future research should examine whether focus on IU improves treatment outcomes.

Unwanted mental intrusions (non clinical)

• Less frequent

• Less unacceptable/distressing

• Little association

• Less resistance to the intrusion

• Some perceived control

• Considered meaningless, irrelevant to the self

• Brief intrusions that fail to dominate conscious awareness

• Less concern with thought control

• Less emphasis on neutralising distress

• Less interference in daily living

Clinical obsessions

• More frequent

• More unacceptable/distressing

• Significant feelings of guilt

• Strong resistance to the intrusion

• Diminished perceived control over the obsession

• Considered highly meaningful, threatening, important core values of the self (ego-dystonic)

• Time-consuming intrusions that dominate conscious awareness

• Heightened concern with thought control

• Strong focus on neutralising distress associated with the obsession significant interference in daily living

OCD Treatment

Exposure therapy