Lecture 6: Anxiety and Stressor Related Problems

specific phobias

-marked fear or anxiety confined to a specific object or situation

sub-groups of specific phobias

1. animal phobias

2. natural environment phobias

3. blood-injection-injury phobias

4. situational phobias

5. other phobias

diagnosis of specific phobias

-DSM-5

• disproportionate fear relating to a specific object or situation

• actively avoided

• significant distress in important areas of functioning

• symptoms cannot be explained by other mental disorders

• persist for at least 6 months

psychodynamic account of specific phobias

-Freud

-phobias as defence mechanisms against anxiety produced by repressed id impulses

-this fear becomes associated with external events or situations that have symbolic relevance to that repressed id impulse

limitations of classical conditioning account (specific phobias)

-not all phobias are linked to traumatic experiences

-not everyone who has a traumatic experience with a specific object acquires a phobia

-specific phobias are not evenly distributed across all stimuli

-doesn’t take into account incubation

biological accounts of specific phobias

-biological preparedness theory → biologically pre-wired to acquire certain phobias

-Seligman proposed that we are born with the predisposition to learn to fear these stimuli

evolutionary perspective (biological account of specific phobias)

-biological predisposition to learn to associate fear with stimuli that have been hazardous for our ancestors

amygdala (biological account of specific phobias)

-mediates fearful responding to phobic stimuli located within the medial temporal lobes

-plays a significant role in the formation or storage of memories associated with emotionally relevant events

-acts as neural centre that identifies emotional input and then coordinates this information from higher cortical areas and subcortical nuclei

-linear relationship between subjective experience of fear and amygdala activation

neurocircuitry (biological account of specific phobias)

-amygdala processes sensory input

-amygdala then sends relevant signals to hypothalamus and PAG region

-this triggers sympathetic and behavioural response

cognitive theories of specific phobias

-phobias are acquired by cognitive biases or maladaptive thinking

attentional bias (cognitive theories of specific phobias)

-those with a phobias tend to attend to anything more threat-relevant compared to someone without a phobia

-pay more attention to words/pictures associated with the phobias in comparison to neutral stimuli

limitations of cognitive theories (specific phobias)

-not clear which comes first → phobia or cognitive bias

-could be the phobia was acquired independently of cognitive bias, then the phobia leads to the development of the cognitive bias

multiple pathways (specific phobias)

-different phobias may be acquired in different ways:

• traumatic experiences

• emotions → phobias linked to elevated disgust sensitivity

• disease-avoidance model → animal phobias linked to avoiding disease, linked to culture

interventions (specific phobias)

-largely based on exposure therapy

-recognise beliefs are dysfunctional and don’t match reality → therapists work to challenge beliefs

post traumatic stress disorder (PTSD)

-debate whether it is a phobia or anxiety disorder

-can develop from:

• direct experience

• witnessing a traumatic experience

• hearing about someone else’s traumatic experience

• repeated exposure to details

diagnosis of PTSD

• exposure → direct/witness

• intrusive symptoms → flashbacks/dreams

• avoid external/internal reminders

• negative changes in cognitions and mood

• increased arousal and reactivity

biological factors (PTSD)

-may have a genetic element/heritability component

-must have gene-environment interaction

hippocampus (biological factors of PTSD)

-people who develop PTSD have been shown to have a smaller or underdeveloped hippocampus

-plays a role in memory formation, may be memory not being processed properly

medial pre-frontal cortex (biological factors of PTSD)

-fail to control/regulate the amygdala

-medial pre-frontal cortex has top-down control over amygdala → controls emotional reactivity

-disconnect between the two allows the amygdala to become overreactive and takes away top-down control

vulnerability factors (PTSD)

-individual differences in vulnerability to developing PTSD

• people who have a tendency to feel overly responsible

• developmental factors → unstable family life, difficulties in childhood

• family history → genetic vulnerability

• highly anxious individuals → links to comorbidity

• low IQ → links to coping mechanisms

• mental defeat → tend to have a negative view of the world or themself

conditioning theory (PTSD)

-trauma becomes associated with situational cues present during traumatic event

-when those cues are encountered again elicits the same arousal

-may develop cognitive and physical avoidance responses that distract from fully processing these cues → associations cannot be extinguished and symptoms are reinforced

emotional processing theories (PTSD)

-memories formed from traumatic experiences are different from day-to-day memories

-ways memories are processed and stored are different

dual representation theory (PTSD)

-two types of memory systems:

• verbally accessible memory (VAM)

• situationally accessible memory (SAM)

verbally accessible memory (dual representation theory of PTSD)

-easily accessible information

-memory of trauma that is consciously processed at the time

-integrated with biographical memories

situationally accessible memory (dual representation theory of PTSD)

-perception based information received from sensory channels

-records information that is not consciously processed

-contribute to triggers and uncontrollable flashbacks

interventions (PTSD)

-main type is graded exposure → exposure therapies

-psychological debriefing

-cognitive restructuring

graded exposure (PTSD interventions)

-detailed narrative of the event with therapist

-look at computer generated images of the event

-once comfortable with this then asked to visualise trauma-related scenes

-then exposed to trauma cues

psychological debriefing (PTSD interventions)

-aim to prevent development of PTSD following trauma

-individual has debrief where they can talk about traumatic event with safe person before therapy

cognitive restructuring (PTSD interventions)

1. evaluate and replace intrusive or negative automatic thoughts

2. evaluate and change dysfunctional beliefs

obsessive compulsive disorder (OCD)

-based on:

• obsessions

• compulsions

-have intrusive thoughts → struggle to block out and causes emotional and physiological arousal

-then have to engage in compulsions to relieve anxiety

obsessions (OCD)

-intrusive and reoccurring thoughts that individuals find disturbing and uncontrollable

compulsions (OCD)

-repetitive actions and ritualised behaviour that individuals feel driven to perform to gain relief

OCD cycle

-obsessions cause severe anxiety that impacts daily life

-only way to gain relief is through compulsions

-relief from compulsions reinforces obsessive thoughts

types of OCD

• checking

• contamination

• symmetry and ordering

• ruminations/intrusive thoughts

diagnosis of OCD

• presence of obsessions

• presence of compulsions

• individual believes that the behaviour will prevent a catastrophic event

• obsessions and compulsions cause difficulty in performing other functions

biological factors (OCD)

-some theories only account for obsessions and others account for compulsions

-no universal explanation

-evidence of inherited components → twin and family studies

traumatic brain injury (OCD)

-onset of OCD linked to traumatic brain injury

-suggests a neuropsychological deficit

frontal lobe and basal ganglia (OCD)

-increased blood flow to these areas when sufferers are shown stimuli linked to their obsessions and compulsions

doubt (psychological factors of OCD)

-OCD may be characterised by memory deficits which gives rise to doubting

memory deficit model (psychological factors of OCD)

-three forms:

• general memory deficit → explains doubting behaviour

• less confident in validity of their memories

• deficit in ability to distinguish between reality and imagination

clinical construct (psychological factors of OCD)

-purpose of these constructs is to link the thoughts, beliefs and cognitive processes to subsequent symptoms

inflated responsibility (psychological factors of OCD)

-sufferers tend to have inflated conceptions of their own responsibility for preventing harm

-believe they gave the power to prevent the negative outcome

thought-action fusion (psychological factors of OCD)

-believe their thoughts can influence events in the world

mental contamination (psychological factors of OCD)

-feelings of dirtiness provoked without any physical contact with a contaminant

-caused by images, thoughts, memories

thought suppression (psychological factors of OCD)

-obsessive thoughts are intrusive and aversive

-may try to actively suppress them

pervasion and role of mood (psychological factors of OCD)

-mood as input hypothesis

-intrusive thoughts and taking part in compulsions is done in a negative mood state

-this negative mood is continually interpreted as providing feedback → once finished rituals and feel relief so then associate this mood with the process

interventions (OCD)

-graded exposure

-ritual prevention

-CBT

graded exposure (OCD interventions)

-exposed to situation and thoughts that trigger distress

-then have to think about stimuli that causes distress

-encouraged to work up a hierarchy of stimuli that causes distress

ritual prevention (OCD interventions)

-exposed to what causes OCD whilst also preventing rituals that relieve anxiety

-extinguishes relationship between obsessive thoughts and ritualised compulsions

CBT (OCD interventions)

-based on targeting and modifying dysfunctional beliefs that OCD sufferers hold about their fear, thoughts and the significance of their rituals