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Anxiety Disorders


Anxiety Disorders Chapter 5 Slides & Handouts by Karen Clay Rhines, Ph.D. Northampton Community College Comer, Abnormal Psychology, 8e Three ego defense mechanisms ... – PowerPoint PPT presentation

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Title: Anxiety Disorders

Anxiety Disorders
  • Chapter 5

Slides Handouts by Karen Clay Rhines,
Ph.D. Northampton Community College
  • What distinguishes fear from anxiety?
  • Fear state of immediate alarm in response to a
    serious, known threat to ones well-being
  • Anxiety state of alarm in response to a vague
    sense of being in danger
  • Both have the same physiological features fight
    or flight
  • an anxiety or related disorder exists if the
    discomfort is too severe or too frequent, lasts
    too long, or is triggered too easily

Anxiety Disorders
  • Most common mental disorders in the U.S.
  • Common co-morbidities
  • Another anxiety disorder
  • Depression

Anxiety Disorders
  • Six disorders
  • Generalized anxiety disorder (GAD)
  • Phobias
  • Panic disorder
  • Obsessive-compulsive disorder (OCD)
  • Acute stress disorder
  • Posttraumatic stress disorder (PTSD)

Generalized Anxiety Disorder (GAD)
  • excessive anxiety under most circumstances and
    worry about practically anything
  • uncued, free-floating or diffuse anxiety
  • Symptoms feeling restless, keyed up, or on edge
    fatigue difficulty concentrating muscle
    tension, and/or sleep problems
  • Symptoms must last at least six months
  • Usually first appears in childhood or adolescence
  • Women to men 21

GAD The Sociocultural Perspective
  • At risk populations
  • people faced with social conditions that truly
    are dangerous
  • High rates following disasters (Three mile
    Island hurricane Katrina)
  • Poverty
  • Run-down communities, higher crime rates, fewer
    educational and job opportunities, and greater
    risk for health problems
  • As would be predicted by the model, there are
    higher rates of GAD in lower SES groups
  • In any given year, African Americans are 30 more
    likely than white Americans to suffer from GAD

GAD The Psychodynamic Perspective
  • Not everyone living in a dangerous situation
    develops GAD what else may be at work?
  • Freud believed that all children experience
  • Realistic anxiety when they face actual danger
  • Neurotic anxiety when they are prevented from
    expressing id impulses
  • Moral anxiety when they are punished for
    expressing id impulses
  • Some children experience particularly high levels
    of anxiety, or their defense mechanisms are
    particularly inadequate, and they may develop GAD

GAD The Psychodynamic Perspective
  • Psychodynamic therapists use the same general
    techniques to treat all psychological problems
  • Free association
  • Therapist interpretations of transference,
    resistance, and dreams
  • Specific treatments for GAD
  • Freudians focus less on fear and more on control
    of id
  • Object-relations therapists attempt to help
    patients identify and settle early relationship

GAD The Psychodynamic Perspective
  • Controlled studies have typically found
    traditional psychodynamic treatments to be of
    only modest help to persons with GAD
  • Short-term, problem focused, psychodynamic
    therapy seem to be the exception to this trend

GAD The Humanistic Perspective
  • Theorists propose that GAD, like other
    psychological disorders, arises when people stop
    looking at themselves honestly and acceptingly
  • This view is best illustrated by Carl Rogerss
  • Lack of unconditional positive regard in
    childhood leads to conditions of worth (harsh
  • These threatening self-judgments break through
    and cause anxiety, setting the stage for GAD to
  • Little support for theory or treatment

GAD The Cognitive Perspective
  • Since worry is a cognitive function, this
    perspective makes sense
  • Maladaptive assumptions (Beck) A
    situation/person is unsafe until proven safe It
    is always best to assume the worst
  • Irrational assumptions
  • Everyone must love and approve of me
  • It is catastrophic when things are not the way
    one would very much like them to be

GAD The Cognitive Perspective
  • New wave cognitive explanations
  • In recent years, several new explanations have
  • Metacognitive theory worry about worry
  • Intolerance of uncertainty theory (something
    negative may happen)
  • Avoidance theory
  • Developed by Borkovec holds that worrying serves
    a positive function for those with GAD by
    reducing unusually high levels of bodily arousal
  • All of these theories have received considerable
    research support

GAD The Biological Perspective
  • GABA inactivity
  • GABA carries inhibitory messages when received,
    it causes a neuron to stop firing
  • Biological relatives more likely to have GAD
    (15) than general population (6) The closer
    the relative, the greater the likelihood
  • There is, however, a competing explanation of
    shared environment
  • 1950s Benzodiazepines (Valium, Xanax) found to
    reduce anxiety

Biological Treatments
  • Antianxiety drugs Early 1950s Barbiturates
    (sedative-hypnotics) Late 1950s
    Benzodiazepines Antidepressant and antipsychotic
    medications (most recently)
  • Relaxation training
  • Biofeedback

  • Persistent and unreasonable fears of particular
    objects, activities, or situations (the object or
    thoughts about it are avoided)
  • Differ from common fears phobias are
  • More intense and persistent
  • Greater desire to avoid the feared object or
  • Distress that interferes with functioning
  • Specific/social phobia/agoraphobia

What Causes Specific Phobias?
  • evidence tends to support the behavioral
  • Phobias develop through conditioning
  • Once fears are acquired, they become all the more
  • Behaviorists propose a classical conditioning

What Causes Specific Phobias?
  • Other behavioral explanations
  • Phobias develop through modeling/Observation and
    imitation/stimulus generalization
  • maintained through avoidance
  • may develop into GAD when a person acquires a
    large number of them
  • Evolutionary predisposed to develop some fears
    more easily

Treatments for Phobia
  • behavioral techniques are most widely used
  • Include desensitization, flooding, and modeling
    together called exposure treatments

Social Phobia
  • Severe, persistent, and irrational fears of
    social or performance situations in which
    embarrassment may occur
  • May be narrow talking, performing, eating, or
    writing in public
  • May be broad general fear of functioning poorly
    in front of others
  • In both forms, people rate themselves as
    performing less competently than they actually do
  • Given its broad scope, this disorder is also
    known as social anxiety disorder

What Causes Social Phobia?
  • Cognitive theory prominent explanation
  • people with this disorder hold a group of social
    beliefs and expectations that consistently work
    again them, including
  • Unrealistically high social standards
  • Views of themselves as unattractive and socially

Treatment for Social Phobia
  • Unlike specific phobias, social phobias are often
    reduced through medication (particularly
  • People treated with psychotherapy are less likely
    to relapse than people treated with drugs alone
  • Social skills training

Panic Disorder
  • The experience of panic attacks, however, is
  • Panic attacks are periodic, short bouts of panic
    that occur suddenly, reach a peak, and pass
  • Sufferers often fear they will die, go crazy, or
    lose control
  • Attacks happen in the absence of a real threat
  • Panic Disorder when panic attacks occur
    frequently, unexpectedly and disrupt life
  • Often accompanied by agoraphobia.

Epidemiology of Panic Disorder
  • Panic Disorder either with or without agoraphobia
    is likely to develop in late adolescence and
    early adulthood
  • Women are twice as likely as men to be diagnosed
  • Twin studies suggest a genetic predisposition

Panic Disorder Biological and cognitive
  • Drug therapies
  • Antidepressants are effective at preventing or
    reducing panic attacks norepinephrine agonists
  • Bring at least some improvement to 80 of
    patients with panic disorder
  • Improvements require maintenance of drug therapy
  • Some benzodiazepines (especially Xanax
    alprazolam) have also proved helpful
  • Cognitive misinterpretation of bodily
  • Biological challenge

Obsessive-Compulsive Disorder
  • Made up of two components
  • Obsessions
  • Persistent thoughts, ideas, impulses, or images
    that seem to invade a persons consciousness
  • Compulsions
  • Repetitive and rigid behaviors or mental acts
    that people feel they must perform to prevent or
    reduce anxiety

Obsessive-Compulsive Disorder
  • Diagnosis is called for when symptoms
  • Feel excessive or unreasonable
  • Cause great distress
  • Take up much time
  • Interfere with daily functions
  • Equally common among men and women
  • Support for the psychodynamic, behavioral,
    cognitive, and biological models

  • Psychodynamic
  • Id impulses obsessive thoughts
  • Ego defenses counter-thoughts or compulsive
    actions (isolation, undoing, reaction formation)
  • Behavioral
  • Associate a particular act with reduction in
  • Treatment exposure and response prevention
  • Cognitive
  • Thoughts gt maladaptive anxiety gt ritual to reduce
  • Biological Serotonin abnormality

  • Most people have some anxiety and have some
    rituals so why OCD for some?
  • People with OCD tend to
  • Be more depressed than others
  • Have exceptionally high standards of conduct and
  • Believe thoughts are equal to actions and are
    capable of bringing harm
  • Believe that they can, and should, have perfect
    control over their thoughts and behaviors