Psychological approaches to anxiety disorder & OCD

What are the key diagnostic features of GAD?

• Chronic, uncontrollable, excessive worry for 6+ months

• Associated with 3+ symptoms: restlessness, fatigue, muscle tension, irritability, difficulty concentrating, sleep disturbance

• Causes significant distress or impairment

Behavioural explanation of GAD?

Learned anxiety through classical conditioning and maintained by avoidance via negative reinforcement.

Behavioural treatments for GAD?

Relaxation training and behavioural exposure (doing the behaviour despite worry)

• all about changing the behaviour not the thoughts (doesn’t address the deeper pattern thinking)

Cognitive explanation of GAD?

Overestimation of threats, intolerance of uncertainty, cognitive biases → catastrophising.

How does CBT help GAD?

Identifying anxious thoughts, challenging their realism, replacing them with balanced alternatives.

• addresses the root cause of the issue

Psychodynamic cause of GAD?

Unconscious conflict (ego–id struggle), early childhood experiences.

• anal retentive stage leading to perfectionism and overanxious

• ego becomes overwhelmed triggering anxiety

GAD – Psychodynamic Treatment

Free association + dream analysis to uncover repressed conflict.

Social perspective on GAD?

Environmental stressors (poverty, abuse, illness). Support systems, community interventions.

What defines a panic disorder diagnosis?

• Repeated, unexpected panic attacks

• 1+ month of persistent worry about future attacks AND/OR maladaptive behaviour change

How do expected vs unexpected panic attacks differentiate PD from phobias?

• Expected attacks → Phobia

• Unexpected attacks → Panic disorder

Behavioural cause of panic disorder?

Panic attack initially by stress but over time, Conditioned fear of bodily sensations → avoidance maintains panic.

Behavioural treatment of PD

Interoceptive exposure (exposure to bodily sensations to break fear association).

• done in a safe environment

Cognitive cause of PD?

Catastrophic misinterpretation of bodily sensations.

CBT for panic disorder?

Reinterpret symptoms

• hyperventilation exposure

• cognitive restructuring → links between behaviours and sensation

• relaxation + support.

Psychodynamic cause of PD

Early oral-stage issues, inadequate caregiver support → adult panic vulnerability

• lack of support as a child created a sense of panic

What is PFPP for panic disorder

Panic-Focused Psychodynamic Psychotherapy: explores repressed emotions + childhood links.

• progress for this may be slower but has found to be just as effective as CBT

Social contributors & treatments to PD

Stressful environments, low support → improved using group therapy and social connection.

Diagnostic features of a specific phobia?

• Fear of an object/situation for 6+ months

• Out of proportion to actual threat

• Consider cultural context

• Causes impairment

Diagnostic features of social anxiety disorder?

• Fear of social scrutiny for 6+ months

• Specifier: performance only

Requirements for agoraphobia diagnosis?

• Fear of public spaces for 6+ months

• Fear in 2+ situations (public transport, crowds, open spaces, etc.)

Behavioural explanation of phobias?

1. Avoidance- conditioning formulations

   • Learned through classical conditioning (something scary happen and a spider was there for example)

   • Maintained through operant conditioning

2. Modelling (Bandura, 1986) -> someone else screams when they see a spider so you scream

phobias - behavioural treatment

• Systematic desensitisation -> maintain relaxation while phobia is being introduced, gradual

• Flooding -> instantly introduced to scary stimuli until you can maintain relaxation

• Modelling -> therapist hold spider on hand -> see its not scary

Cognitive cause to phobias

Maladaptive beliefs and overestimating danger.

• irrational beliefs and catastrophic thinking

Cognitive treatment to phobias

CBT with cognitive restructuring + exposure therapy combined

• targets root cause of phobias = irrational thinking

Psychodynamic explanation to phobias

Displacement of unconscious conflict or avoiding anxiety

Phallic-stage conflict (Oedipus/Electra) → which is unresolved leads to displaced anxiety’s

What defines OCD?

• Obsessions: intrusive thoughts/images/urges

• Compulsions: behaviours to reduce anxiety (checking, counting, cleansing, avoidance)

• Time‑consuming, clinically impairing

Behavioural explanation for OCD

Fear learned via classical conditioning; compulsions maintained by negative reinforcement → by performing the ritual it reduces the fear but creates a cycle

OCD – Behavioural Treatment

Exposure and Response Prevention (ERP)

• exposing person to object of fear without allowing them to perform the ritual

OCD – Cognitive Aetiology

Misinterpretation of intrusive thoughts; catastrophic thinking; attentional bias to threat (focusing extensively on the threatening stimuli)

-use CBT and ERP to cognitive restructuring

OCD – Psychodynamic Aetiology

Anal‑stage fixation - need to be clean and intentive to keep everything in right place

defence mechanisms (reaction formation) - id‑related impulses → unconscious id wishes

Difference between fear and anxiety?

• Fear = response to a specific threat or danger

• Anxiety = diffuse worry without a clear stimulus