Abnormal Psychology Chapter 7 (Anxiety Disorders)

Anxiety Disorders

A group of mental disorders in which fear or anxiety and related maladaptive behaviors are the core of disturbance.

Specific phobias, social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder.

Obsessive-compulsive and related disorders and trauma and stressor related disorders are closely related to anxiety disorders.

thoughts, sensations, and behaviors.

Fear

A set of emotional, behavioral, and physical responses to impending danger.

Biological alarm system.

An abrupt response to real danger that prepares us for immediate action via our fight-or-flight-or-freeze response.

Fight-Or-Flight-Or-Freeze Response:

The immediate response to a stressor in which the individual’s autonomic nervous system is activated to fight or to flee from the stressor or into a state of reactive immobility (freeze).

Triggered by the hypothalamic-pituitary-adrenal (HPA) axis and neurotransmitters such as norepinephrine.

Panic:

Fear when no actual or severe danger is present.

Anxiety:

A diffuse or vague sense of apprehension (worry) about the future, accompanied by anxious or avoidant behavior and physiological arousal.

Phobia

An irrational, excessive fear that causes intense emotional distress and interferes significantly with everyday life.

Usually ends in a fight-or-flight-or-freeze physiological symptom; trembling, racing heart, sweating, choking, dizziness, or light-headedness.

Specific Phobias

Intense, persistent fear of specific objects or situations that pose little or no actual threat.

It must cause intense distress (anxiety/worry) each time the person is, or anticipates being, exposed to the feared situation.

Also must interfere significantly with the person’s educational, occupational, or social life.

Social Anxiety Disorder (SAD)

A mental disorder that involves intense fear/panic and anxiety related to social situations in which the individual may be scrutinized by others.

Scared they might be humiliated or embarrassed.

Systematic Desensitization

Teaching the person with the phobia to become proficient at muscle relaxation. Then the client and therapist construct an anxiety hierarchy.

Anxiety Hierarchy

A graded list of fear-provoking stimuli or situations, ranging from the least to most threatening; used in systematic desensitization.

Exposure Procedures

Associating a conditioned fear-provoking stimulus with a previously neutral stimulus.

Extinction is the basis for exposure procedures.

Graduated Exposure

A treatment technique for extinguishing phobias in which an individual is exposed to progressively more frightening items from an anxiety hierarchy.

Flooding

A treatment technique to extinguish phobias or overcome anxiety by exposing persons to prolonged presentations of the most intense version of the feared stimulus.

Participant Modeling

A treatment technique in which a model demonstrates fearless behavior while a client is given increasingly close contact with the feared situation under protected circumstances.

The therapist demonstrates the feared behavior (i.e. someone climbing a ladder if the client is scared of heights) until the client’s fear has diminished somewhat.

Then, the therapist helps the client approach the feared stimulus step by step

Cognitive-Behavioral Therapy

May teach clients to improve their social skills. Can be in a group format.

Self-Efficacy

A person’s belief that they can successfully perform a given behavior.

Should help reduce fear behavior by giving them confidence in a feared situation.

Panic Disorder

An anxiety disorder marked by periodic and unexpected attacks of intense, terrifying fear, called panic attacks, that eventually develops into a fear of the panic attacks themselves.

Panic Attack:

A period of unexpected, intense, terrifying anxiety that leaves victims feeling as if they are going crazy or are about to die.

They come on suddenly.

Agoraphobia

A fear of open spaces or of being separated from a safe place related to a fear of having a panic attack while away from a safe place.

They typically have a fear of leaving their home, being in public, and/or traveling.

Sleep Paralysis

A symptom associated with panic disorder; it occurs when a person is waking up or falling asleep, and involves a brief inability to move.

Accompanied by visual hallucinations, hyperventilation, and acute fear.

Locus Coeruleus (LC)

A small area of the brain stem in which abnormalities are associated with alarm or panic.

Panic disorder could be, in part, due to a hypersensitivity of the LC.

Amygdala, hypothalamus, and frontal & temporal lobes are also involved in panic and anxiety due to their involvement in a circuit with the LC.

Cognitive-Behavioral Treatments: Comes in 3 basic elements

Breathing/Relaxation Retraining -Teaches clients how to slow their breathing. Combats hyperventilation.

Cognitive Restructuring - Teaches clients to use logic and evidence.

Interoceptive Exposure - Encourages clients to have panic-type symptoms during sessions.

Drug Treatments

Antidepressants, benzodiazepines, SSRI’s, or tricyclics

Generalized Anxiety Disorder

A mental disorder in which anxiety is experienced as “free floating” (not connected to any specific stimulus) and is pervasive enough to interfere with daily functioning and cause physical symptoms.

Could develop from another mental disorder, such as major depressive disorder.

GAD is strongly associated with social and economic factors in the U.S

GAD involves the frontal lobe circuits more than the amygdala.

Psychosocial Causes

The cognitive avoidance theory of worry. Posits that images of negative future events during worry are avoided by engaging in worrisome verbal thoughts instead.

Contrast Avoidance Model (CAM):

Suggests that worry is used as a way to avoid a sharp increase in unpleasant emotions by sustaining a baseline, lower level of negative emotion.

Uses worry as a coping mechanism, because they prefer to feel distressed to prepare them for the worst outcome

Cognitive-Behavioral Treatment

Includes cognitive restructuring (clients are trained to identify and challenge irrational anxiety-generating thoughts and to replace them with more rational beliefs that they apply in everyday life).

Treatment aims to increase a person’s resting state via relaxation training, acceptance, and mindful awareness of interoceptive states.

Conducting exposure exercises targeted at emotional contrast avoidance.

Drug Treatments

Benzodiazepines (valium, Xanax, Ativan, & klonopin).

These begin to relieve symptoms of anxiety in 20 minutes. It helps in short-term, not long-term.

Recommended to use SSRIs/SNRIs for first-line medication in adults and pediatric populations with GAD.