Chp. 5: Anxiety, Obsessive Compulsive, and Related Disorders

Fear

The central nervous system’s physiological and emotional response to a serious threat to one’s well-being.

Anxiety

The central nervous system’s physiological and emotional response to a vague sense of threat or danger. Similar to fear, but is not from life or death situation

Generalized Anxiety Disorder

A disorder marked by persistent and excessive feelings of anxiety and worry about numerous events and activities.

Symptoms of Generalized Anxiety Disorder

• For 6 months or more, person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about multiple matters.

• The symptoms include at least three of the following: edginess, fatigue, poor concentration, irritability, muscle tension, sleep problems.

• Significant distress or impairment.

Socialcultural perspective of Generalized Anxiety

Is most likely developed by faced with ongoing societal conditions that are dangerous. Person is in a highly threatening environment.

Psychodynamic perspective of Generalized Anxiety

Children believe their id impulses are very dangerous, and may feel overwhelming anxiety when they have such impulses, setting the stage for generalized anxiety disorder.

Humanistic Perspectives of Generalized Anxiety

Anxiety arises when people stop looking at themselves honestly and acceptingly. Could also be caused by children who fail to receive unconditional positive regard from parents and threatening self-judgment/harsh self-standards/perfectionism break through and cause anxiety.

Cognitive-behavioral perspective of Generalized Anxiety (older)

Caused by maladaptive assumptions, people are guided by irrational beliefs that lead them to act and react in inappropriate ways (basic irrational assumptions). Problematic behaviors and dysfunctional thinking often cause psychological disorders

Rational emotive therapy (generalized anxiety)

A cognitive therapy, that helps clients identify and change the irrational assumptions and thinking that contribute to their psychological disorder.

Cognitive-behavioral perspective of generalized anxiety (newer)

metacognitive theory

• people hold positive and negative beliefs about worrying 

• meta-worrying: worrying about broad/basic thing

intolerance of uncertainty

• people cannot tolerate knowledge that negative events may occur

• don’t want to do things unless they know what is going to happen

Mindfullness based cognitive therapy (generalized anxiety)

Engaging in all senses and being in the moment

Acceptance and commitment therapy (generalized anxiety)

Clients become aware of their streams of thoughts, including their worries, as those thoughts are occurring and accept such thoughts as mere events of the mind.

Benzodiazepine for GAD

The most common group of antianxiety drugs, which includes Valium and Xanax.

• designed for acute onset of symptoms

• prominent addiction loop

• bind to receptors - allow GABA to come in

Gamma-aminobutyric acid (GABA)

A neurotransmitter whose low activity in the brain’s fear circuit has been linked to anxiety.

Gabapentinoids

Have significant anxiety-reducing affect: act to increase GABA levels throughout brain

• less addictive than benzos

Fear circuit in GAD

Fear circuit is hyperactive in people with generalized anxiety disorder that could have to do with low GABA levels

Phobia

Persistent and unreasonable fear of a particular object, activity, or situation.

Specific Phobia

A severe and persistent fear of a specific object or situation.

Specific phobia symptoms

• Marked, persistent, and disproportionate fear of a particular object or situation; usually lasting at least 6 months.

• Exposure to the object produces immediate fear.

• Avoidance of the feared situation.

• Significant distress or impairment.

Agoraphobia

An anxiety disorder in which a person is afraid to be in public situations from which escape might be difficult or help unavailable if panic-like or embarrassing symptoms were to occur.

Symptoms of Agoraphobia

• Pronounced, disproportionate, or repeated fear about being in at least two of the following situations:

  Public transportation (e.g., auto or plane travel)

  Parking lots, bridges, or other open spaces

  Shops, theaters, or other confined places

  Lines or crowds

  Away from home unaccompanied

• Fear of such agoraphobic situations derives from a concern that it would be hard to escape or get help if panic, embarrassment, or disabling symptoms were to occur.

• Avoidance of the agoraphobic situations.

• Symptoms usually continue for at least 6 months.

• Significant distress or impairment.

How fears are learned

• learned fear through association (classical conditioning)

• modeling (observing - develops same entrenchment and imitation)

• after acquiring fear response, they try to avoid the fear

Treatments for Specific Phobia: Systematic desensitization

An exposure treatment that uses relaxation training and a fear hierarchy to help clients with phobias react calmly to the objects or situations they dread.

Treatments for Specific Phobia: Flooding

An exposure treatment for phobias in which clients are exposed repeatedly and intensively to a feared object and made to see that it is actually harmless.

• can heighten fear

• doesn’t build trust between clients and therapist

Treatments for Specific Phobia: Modeling

Therapist who confronts the feared object or situation while the fearful person observes

Treatments for Specific Phobia: Newer Successful Treatments

Support groups and home-based self-help programs

• Group members can support and encourage each other

Social Anxiety Disorder

A psychological disorder in which people fear social situations. Begins in late childhood/adolescence and into adulthood

Social Anxiety Disorder symptoms

• Pronounced, disproportionate, and repeated anxiety about social situation(s) in which the individual could be exposed to possible scrutiny by others; typically lasting 6 months or more.

• Fear of being negatively evaluated by or offensive to others.

• Exposure to the social situation almost always produces anxiety.

• Avoidance of feared situations.

• Significant distress or impairment.

Social Media Jitters

Computer and mobile devices can unintentionally produce various forms of anxiety (social and generalized anxiety)

• Social media invites social comparison

• Consuming content that is not real

• Can experience more criticism

Causes of Social Anxiety Disorder

• Believing they are unattractive social beings

• Believing they are socially unskilled and inadequate

• Believing they’re always in danger of behaving incompetently

• Believing that inept behaviors in social situations will inevitably lead to terrible consequences

• Believing they have no control over feelings of anxiety that emerge

Treatment for Social Anxiety Disorder

• Medication: benzodiazepine or antidepressant drugs

• cognitive-behavioral therapy: exposure to unwanted social situations

• group therapy: working with others through social interactions

Social skills training

A therapy approach that helps people learn or improve social skills and assertiveness through role-playing and rehearsing of desirable behaviors.

Panic Attacks

Periodic, short bouts of panic that occur suddenly, reach a peak within minutes, and gradually pass.

Symptoms of Panic Attacks

• Heart palpitations

• Tingling w/ hands or feet

• Shortness of breath

• Sweating

• Hot and cold flashes

• Trembling

• Chest pains

• Choking sensations

• Faintness

• Dizziness

• Feeling of unreality

Feature at least 4 symptoms

Panic Disorder

An anxiety disorder marked by recurrent and unpredictable panic attacks. May be accompanied by agoraphobia

Symptoms of Panic Disorder

• Unforeseen panic attacks occur repeatedly.

• One or more of the attacks precede either of symptoms

        - at least a month of continual concern about having additional attacks

       - at least a month of dysfunctional behavior changes associated with the attacks (e.g. avoiding new experiences)

Contributing biological factors of Panic Disorder

• hyperactive panic circuit (amygdala, hippocampus, ventromedial nucleus of hypothalamus)

• predisposition to develop such irregularities is inherited

Locus coerulus

A small area of the brain that seems to be active in the regulation of emotions. Many of its neurons use norepinephrine. Has an important part in the panic circuit

Drug therapies for Panic Disorder

• fast acting

• various antidepressants increase activity of serotonin and norepinephrine in locus coeruleus

• Some benzodiazepines have proved helpful

Cognitive Behavioral Perspective of Panic Disorder

Corrects people’s misinterpretations of bodily sensations

• educate nature of panic attacks

• teach coping skills for anxiety

• induce panic sensations so clients can apply new skills under watchful supervision (biological challenge test)

Biological challenge test

A procedure used to produce panic in participants or clients by having them exercise vigorously or perform some other potentially panic-inducing task in the presence of a researcher or therapist.

Anxiety sensitivity

A tendency to focus on one’s bodily sensations, assess them illogically, and interpret them as harmful.

Obsessive-compulsive disorder

A disorder in which a person has recurrent obsessions, compulsions, or both.

Symptoms of OCD

• Occurrence of repeated obsessions, compulsions, or both

• The obsessions or compulsions take up considerable time

• Significant distress or impairment

• Obsessions or compulsions interfere with daily functions

Obsessions

Persistent thoughts, ideas, impulses, or images that seem to invade a person’s consciousness

Compulsions

Repetitive and rigid behaviors or mental acts that people feel they must perform to prevent or reduce anxiety

Features of Obsessions

• thoughts that feel both intrusive (popping up) and foreign

• attempts to ignore or resist them trigger anxiety

• awareness that thoughts are excessive

• Basic themes of dirt/contamination, violence and aggression, orderliness, religion, sexuality

Features of Compulsions

• various forms of voluntary behaviors (fueled by anxiety)

• feel mandatory/unstoppable

• recognition that behaviors are unreasonable

• performing behaviors reduces anxiety for short time

• behaviors often develop into rituals

• Themes of cleaning, checking, order or balance seeking, touching, verbalizing, or counting compulsions

Psychodynamic Perspective of OCD

Traced to anal stage of development (2 years old). Children may experience intense rage and shame as a result of negative toilet-training experience that causes them need to express strong/aggressive id impulses.

Cognitive-Behavioral Perspective of OCD

• human tendencies to have unwanted, intrusive, unpleasant thoughts (avoid negative outcomes, exceptionally high standards of conduct)

• educate clients and how misinterpretations of unwanted thoughts, neutralizing acts, and more have helped produce and maintain symptoms

• guide clients to identify and challenge their distorted cognitions

Neutralizing

A person’s attempt to eliminate unwanted thoughts by thinking or behaving in ways that put matters right internally, making up for the unacceptable thoughts. Used in OCD cognitive-behavioral treatment

Exposure and response prevention

cognitive-behavioral technique used to treat obsessive-compulsive disorder that exposes clients to anxiety-arousing thoughts or situations and then prevents them from performing their compulsive acts. Also called exposure and ritual prevention.

Biological Perspective

• Genetic studies identified gene anomalies

• brain scan procedures reveal hyper brain circuit

Cortico-striato-thalamo-cortical circuite

A brain circuit that is seen to be hyperactive in people with OCD

Biological Treatments for OCD

Antidepressant drugs increase activity of serotonin (corrects hyperactivity)

Obsessive-compulsive related disorders

Disorders in which obsessive-like concerns drive people to repeatedly and excessively perform certain pathological patterns of behavior.

Hoarding Disorder

A disorder in which individuals feel compelled to save items and become very distressed if they try to discard them, resulting in an excessive accumulation of items.

Trichotillomania

A disorder in which people repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other parts of the body. Also called hair-pulling disorder.

Excoriation (skin-picking) disorder

A disorder in which people repeatedly pick at their skin, resulting in significant sores or wounds. Also called skin-picking disorder.

Body dysmorphic disorder

A disorder in which individuals become preoccupied with the belief that they have certain defects or flaws in their physical appearance. Such defects or flaws are imagined or greatly exaggerated.