Chapter Five: Anxiety, Obsessive-Compulsive, and Related Disorders
- Fear: State of immediate alarm
- Anxiety: Vague sense of being in danger
- Anxiety Disorders: When people have discomfort from fear and anxiety is too severe, too frequent, lasts too long, or is triggered too easily
- Most common mental disorders in the us
- Most people with one anxiety disorder suffer from a second
- Generalized Anxiety Disorder: Experience general and persistent feelings of worry and anxiety
- Specific Phobias: Persistent and irrational fear of a particular object, activity, or situation
- Agoraphobia: Fear traveling to public places
- Social Anxiety Disorder: Intense fear of social or performance situations in which they may become embarrassed
- Panic Disorder: Recurrent attacks of terror
Generalized Anxiety Disorder
- People experience excessive anxiety under most circumstances and worry about anything
- Symptoms: restlessness, on edge, tire easily, have difficulty concentrating, suffer from muscle tension, have sleep problems
- Last at least 6 months
- Lead to a reduced quality of life
- Common in Western society
- May emerge at any age
- Twice as common in women
The Sociocultural Perspective: Societal and Multicultural Factors
- GAD is most likely to develop in people who are faced with ongoing societal conditions that are dangerous
- ex - poverty: as wages decrease, the rate of GAD steadily increases
- Race and ethnicity can also affect GAD
The Psychodynamic Perspective
- Freud: Early developmental experiences may produce an unusually high level of anxiety in certain children
- Today: GAD can be traced to inadequacies in the early relationships between children and their parents
- Therapies
- Psychodynamic Methods: free association and therapist’s interpretations of transference, resistance, and dreams
- Freudian Psychodynamic Therapists: help clients with gad become less afraid of their id impulses and more successful in controlling them
- object relations therapists: help anxious patients identify and settle the childhood relationship problems that continue to produce anxiety in adulthood
- short-term psychodynamic therapy has significantly reduced the levels of anxiety, worry, and social difficulty of patients
The Humanistic Perspective
The Cognitive-Behavioral Perspective
- GAD is primarily caused by maladaptive assumptions
- Albert Ellis: Many people are guided by irrational beliefs that lead them to act and react in inappropriate ways (basic irrational assumptions)
- Aaron Beck: Ppl with GAD constantly hold silent assumptions that imply they’re in imminent danger
- Adrian Wells’ Metacognitive Theory: Ppl with GAD implicitly hold positive and negative beliefs about worrying
- Positive: Believe worrying is a useful way of appraising and coping with threats in life, so they worry constantly
- Negative: Believe their repeated worrying is harmful and uncontrollable, so they meta-worry
- Intolerance of Uncertainty Theory: Certain individuals can’t tolerate the knowledge that negative events can occur, even if the possibility is small
- Avoidance Theory: Thomas Borkovec
- People with GAD have greater bodily arousal and worrying serves to reduce that arousal
- People with GAD worry repeatedly in order to reduce or avoid uncomfortable states of bodily arousal
- Therapies:
- Ellis’ Rational-Emotive Therapy: Therapists point out the irrational assumptions held by clients, and suggest more appropriate assumptions
- Breaking Down Worrying: Therapists guide clients to recognize and change their dysfunctional worrying
- Educate clients about the role of worrying
- Have clients observe their bodily arousal and cognitive responses
- Clients are expected to see the world as less threatening and try out more constructive ways of dealing with arousal
- Mindfulness-based Cognitive-Behavioral Therapy
- Therapists help clients become aware of their stream of thoughts as they’re happening and to accept such thoughts are mere events of the mind
- Borrows heavily from mindfulness meditation
The Biological Perspective
- GABA plays a key role in the reduction of normal, everyday fear reactions
- Low GABA activity can help produce circuit hyperactivity
- Fear reactions are tied to brain circuits
- The fear circuit is excessively active in people with GAD
- Drug Therapies
- Sedative-hypnotic Drugs: Drugs that calm people at lower doses and help them to fall asleep at higher doses
- Benzodiazepines, while helpful, pose significant problems
- Effects are short-lived and anxiety comes back full-force
- Ppl who take them in large doses for an extended time can become physically dependent
- Can produce undesirable effects: drowsiness, lack of coordination, memory loss, depression, aggressive behavior
- Drugs mix badly with certain other drugs / substances
- Antidepressants and antipsychotics are both used for GAD
Phobias
- Phobias: Persistent and unreasonable fears
Specific Phobia
- Specific Phobia: Persistent fear of a specific object or situation (ex: animals/insects, heights, flying, etc)
Agoraphobia
Agoraphobia: Fear of being in public places or situations where escape might be difficult or help unavailable
Twice as common among women, twice as common among poor ppl
Intensity fluctuates
May also have panic disorder
Support-Group Approach: A small number of ppl with agoraphobia go out together for exposure sessions
Home-based Self-help Programs: Clinicians give clients and their families detailed instructions for carrying out exposure treatments themselves
What Causes Phobias?
- Cognitive-Behavioral: Ppl learn their fears
- Classical Conditioning (two events repeatedly occur close together)
- Modeling (through observation and imitation)
- Behavioral-Evolutionary: Some phobias are much more common than others
- Humans have a predisposition to develop certain fears
- Preparedness: Human beings are prepared to acquire some phobias and not others
How Are Phobias Treated?
- Exposure Treatments: People are exposed to the objects / situations they dread
- Systematic Desensitization: An exposure treatment that uses relaxation training and a fear hierarchy to help clients with phobias react calmly to their fear
- Relaxation Training: Teaching clients how to bring on a state of deep muscle relaxation at will
- Fear Hierarchy: A list of feared objects / situations
- In Vivo Desensitization: Actual confrontation
- Covert Desensitization: Confrontation may be imagined
- Flooding: Clients are exposed repeatedly and intensively to a feared object and made to see that it is actually harmless
- Modeling: The therapist confronts the feared object / situation while the fearful person observes
Social Anxiety Disorder
What Causes Social Anxiety Disorder?
- Ppl have dysfunctional beliefs that make them anticipate social disasters and dread social situations
- Those beliefs are reinforced by reducing feelings of anxiety
- Ppl with social anxiety disorder manifest the dysfunctional beliefs
Treatments for Social Anxiety Disorder
- Medications
- Cognitive-Behavioral Therapy
- Exposure Therapy: Expose themselves to their dreaded social situations, re-examine and challenge maladaptive beliefs
- Social Skills Training: Modeling, role-playing, rehearsing, feedback, reinforcement
- Assertiveness Training Groups: Members try out and rehearse new social behaviors with other group members
Panic Disorder
Panic Disorder: An anxiety disorder marked by recurrent and unpredictable panic attacks
Panic Attacks: Periodic, short bouts of panic that occur suddenly, reach a peak within minutes, and gradually pass
â…“ of ppl have one or more panic attacks at some point in their lives
Often accompanied by agoraphobia
The Biological Perspective
Panic disorder might be caused by abnormal norepinephrine activity
Locus Coeruleus: A small area of the brain that seems to be active in the regulation of emotions
Panic reactions are produced by a brain circuit
The panic circuit tends to be hyperactive in people who suffer from panic disorder
Panic circuit seems to be more extensive than the fear circuit - panic responses are more complex reactions than fear responses
A predisposition to hyperactive panic circuits may be inherited
Antidepressants are used
The Cognitive-Behavioral Perspective
- Panic prone people may be very sensitive to certain bodily sensations and misinterpret them as signs of a medical catastrophe
- Biological Challenge Tests: Researchers produce hyperventilation / other biological sensations by administering drugs / instructing clinical research participants to breathe, exercise, or think in certain ways
- High degree of anxiety sensitivity: A tendency to focus on one’s bodily sensations, assess them illogically, and interpret them as harmful
- Therapy
- Educate clients about the general nature of panic attacks, causes of bodily sensations, and the tendency for clients to misinterpret their sensations
- Teach clients to apply more accurate interpretations during stressful situations
- Teach the clients better ways to cope with anxiety
- Use biological challenge procedures to induce panic sensations so clients can apply their new interpretations and skills
- Cognitive-Behavioral Therapy
Obsessive-Compulsive Disorder
- Obsessive Compulsive Disorder: A disorder in which a person has recurrent obsessions, compulsions, or both
What Are the Features of Obsessions and Compulsions?
- Obsessions: Persistent thoughts, ideas, impulses, or images that seem to invade a person’s consciousness
- Feel intrusive and foreign to the ppl who experience them
- Ppl w obsessions are aware that their thoughts are excessive
- Common themes: contamination, violence, orderliness, religion, sexuality
- Compulsions: Repetitive and rigid behaviors / mental acts that people feel they must perform in order to prevent or reduce anxiety
- Technically under voluntary control, but the person doesn’t feel like they have a choice
- For some people the compulsive acts develop into detailed rituals
- Common themes: cleaning, checking, order, counting
- Anxiety plays a major role in this disorder
- Obsessions cause intense anxiety
- Compulsions prevent / reduce anxiety
The Psychodynamic Perspective
- The Id impulses take the form of obsessive thoughts
- The Ego defenses appear as counter-thoughts or compulsive actions
- Freud traced OCD to the anal stage of development
- Children repeatedly feel the need to express their strong aggressive Id impulses while also feeling they should try to restrain and control the impulses
- If the conflict between the Id and the Ego continues, it may eventually turn into OCD
The Cognitive-Behavioral Perspective
- Everyone has repetitive, unwanted, and intrusive thoughts
- Those with OCD blame themselves for those thoughts and expect that something bad will happen, so they try to neutralize the thoughts
- 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
- Eventually the neutralizing thought or act is used so often that it becomes an obsession or compulsion
- Those with OCD find their thoughts to be so disturbing because they
- Tend to have exceptionally high standards of conduct and morality
- Tend to believe that intrusive negative thoughts are equivalent to actions and capable of causing harm (thought-action fusion)
- Tend to believe that they should have perfect control over all their thoughts and behaviors in life
- Exposure and Response Prevention: Clients are repeatedly exposed to objects or situations that produce anxiety and obsessive fears but they are told to resist performing their compulsive behaviors
The Biological Perspective
- Some genetic studies have identified clusters of gene abnormalities
- Researchers have identified a brain circuit that helps regulate our primitive impulses. hyperactive in ppl with OCD
- Antidepressants are used
- Hoarding Disorder: People feel compelled to save items and become very distressed if they try to discard them
- Trichotillomania: Hair pulling disorder. ppl repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other parts of the body. They often try to reduce / stop the behavior
- Excoriation Disorder: Skin picking disorder. Ppl keep picking at their skin, resulting in significant sores or wounds. They often try to reduce / stop the behavior
- Body Dysmorphic Disorder: People become preoccupied with the belief that they have a particular defect / flaw in their physical appearance
- The perceived defect / flaw is imagined or greatly exaggerated in the person’s mind
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