1. ANXIETY, OBSESSIVE-COMPULSIVE, AND RELATED DISORDERS Chapter 4

2. ANXIETY AND FEAR ARE NORMAL!! SERVES IMPORTANT ROLES: ADAPTATION, INITIATION, MOTIVATION ANXIETY PREPARES US TO TAKE ACTION AND IS NORMAL IS MODERATE AMOUNTS

3. What distinguishes fear from anxiety? Fear : body’s response to serious threat. Experienced in face of real, immediate danger. Anxiety : body’s response to vague sense of being in danger. General feeling of apprehension about possible danger. Prepares us to take action. Both have same physiological features. 3

4. ANXIETY Although unpleasant, experiences of fear and anxiety often are useful. However, for some, discomfort is too severe or too frequent, lasts too long, or is triggered too easily. 4

5. ANXIETY DISORDERS Most common mental disorders in U.S. Most with 1 anxiety disorder also suffer from a 2 nd. 5

6. ANXIETY DISORDERS AND OCD DSM-5 Anxiety Disorders: Generalized anxiety disorder (GAD) Phobias Agoraphobia Social anxiety disorder (social phobia) Panic disorder Separate: Obsessive-compulsive related disorders 6

7. Table 4.2 Comer, Ronald J., Fundamentals of Abnormal Psychology, Seventh Edition Copyright © 2014 by Worth Publishers

8. GENERALIZED ANXIETY DISORDER (GAD) Characterized by excessive “free floating” anxiety under most circumstances and worry about practically anything Symptoms: feeling restless, keyed up, or on edge; fatigue; difficulty concentrating; muscle tension, and/or sleep problems Must last at least 6 months 8

9. GAD: SOCIOCULTURAL PERSPECTIVE GAD most likely in people faced with dangerous social conditions. Poverty African Americans 30% more likely than Caucasians 9

10. GAD: COGNITIVE PERSPECTIVE Caused by dysfunctional ways of thinking 10

11. GAD: COGNITIVE PERSPECTIVE GAD is caused by maladaptive assumptions Albert Ellis identified basic irrational assumptions. When assumptions are applied to everyday life, GAD may develop. 11

12. GAD: COGNITIVE PERSPECTIVE Aaron Beck argued that those with GAD constantly hold silent assumptions that imply imminent danger. 12

13. GAD: COGNITIVE PERSPECTIVE Metacognitive theory Intolerance of uncertainty theory Avoidance theory 13

15. GAD: COGNITIVE PERSPECTIVE Two kinds of cognitive approaches: Changing maladaptive assumptions Helping clients understand role that worrying plays, and changing their views and reactions to it 15

16. GAD: BIOLOGICAL PERSPECTIVE Biological relatives more likely to have GAD (~15%) than general population (~6%) closer the relative, greater likelihood Competing explanation of shared environment 16

17. GAD: BIOLOGICAL PERSPECTIVE GABA inactivity Benzodiazepines (Valium, Xanax) found to reduce anxiety causes a neuron to stop firing 17

18. GAD: BIOLOGICAL PERSPECTIVE Root of GAD more complicated than single NT. Low levels of serotonin, norepinephrine Antidepressants affecting these NT seem to lower anxiety 18

19. GAD: BIOLOGICAL PERSPECTIVE Antianxiety drug therapy Benzodiazepines Antidepressant and antipsychotic medications 19

20. GAD: BIOLOGICAL PERSPECTIVE Relaxation training Physical relaxation will lead to psychological relaxation Best when used in combination with cognitive therapy or biofeedback 20

21. PHOBIAS Persistent and unreasonable fears of particular objects, activities, or situations People with a phobia often avoid object or thoughts about it 21

22. SPECIFIC PHOBIAS Persistent fears of a specific object or situation When exposed to the object or situation, sufferers experience immediate fear 5 categories in the DSM: Animal, Natural-Environmental, Situational, Blood/Injury/Injection, Other 22

23. SPECIFIC PHOBIAS How do common fears differ from phobias? More intense and persistent fear Greater desire to avoid feared object or situation Distress that interferes with functioning 23

24. AGORAPHOBIA Afraid of being in situations where escape might be difficult, should they experience panic or become incapacitated 24

25. AGORAPHOBIA Avoid crowded places, driving, and public transportation Many experience panic attacks & may receive a second diagnosis of panic disorder 25

26. WHAT CAUSES PHOBIAS? Behavioral explanation: Develop through conditioning Once phobias are acquired, individuals avoid dreaded object or situation, permitting fears to become all more rooted 26

27. CLASSICAL CONDITIONING LITTLE ALBERT STUDY White rat no reaction (NS) Loud Noise Fear (UCS) (UCR) White Rat + Loud NoiseFear (NS) (UCS)(UCR) White ratFear (CS)(CR)

28. WHAT CAUSES PHOBIAS? Process of stimulus generalization: Responses to one stimulus are also elicited by similar stimuli Can develop through modeling Maintained through avoidance 28

29. Focuses on significance of anxiety and fear. Helps person survive

30. Preparedness Model Conditioned responses to fear-relevant stimuli (spiders, snakes) are more resistant to extinction that those to fear-irrelevant stimuli (flowers).

31. HOW ARE SPECIFIC PHOBIAS TREATED?  Systematic desensitization  Teach relaxation skills  Create fear hierarchy  Pair relaxation with feared objects or situations  Since relaxation is incompatible with fear, relaxation response is thought to substitute for fear response  Several types:  In vivo desensitization (live)  Covert desensitization (imaginal) 31

33. HOW ARE SPECIFIC PHOBIAS TREATED? Flooding Modeling Key to success is ACTUAL contact with feared object or situation Virtual reality as a useful exposure tool 33

34. HOW IS AGORAPHOBIA TREATED? Situational Exposure 34

35. SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA IN PREVIOUS DSMS)  Severe, persistent, and irrational anxiety about social or performance situations in which scrutiny by others and embarrassment may occur  May be narrow  May be broad  People judge themselves as performing less competently than they actually do 35

36. WHAT CAUSES SOCIAL ANXIETY DISORDER? Cognitive theorists: People hold beliefs and expectations that consistently work against them, including: Unrealistically high social standards Views of themselves as unattractive and socially unskilled 36

37. TREATMENTS FOR SOCIAL ANXIETY DISORDER Address fears behaviorally with exposure (group therapy helpful) Lack of social skills Social skills and assertiveness trainings have proved helpful 37

38. TREATMENTS FOR SOCIAL ANXIETY DISORDER Antidepressants Psychotherapy: less likely to relapse than people treated with drugs alone 38

39. PANIC DISORDER 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 absence of a real threat 39

40. PANIC DISORDER Panic attacks repeatedly, unexpectedly, and without apparent reason Experience dysfunctional changes in thinking and behavior as a result of attacks 40

41. PANIC DISORDER Panic disorder often accompanied by agoraphobia 41

42. PANIC DISORDER: BIOLOGICAL PERSPECTIVE Norepinephrine Irregular levels/activity in locus coeruleus Brain circuits and amygdala as more complex root of problem 42

43. PANIC DISORDER: BIOLOGICAL PERSPECTIVE Monozygotic (MZ, or identical) twins, ~31% Dizygotic (DZ, or fraternal) twins, ~11% 43

44. PANIC DISORDER: BIOLOGICAL PERSPECTIVE Drug therapies Antidepressants SSRI’s/SSNRI’s (Paxil, Zoloft, Effexor) Benzodiazepines (especially Xanax) 44

45. PANIC DISORDER: COGNITIVE PERSPECTIVE People misinterpret bodily events Panic-prone people sensitive to certain bodily sensations/may misinterpret them as signs of a medical catastrophe; this leads to panic 45

46. PANIC CYCLE 46

47. PANIC DISORDER: COGNITIVE PERSPECTIVE “Biological challenge” induce panic sensations Practice coping strategies and making more accurate interpretations 47

48. OBSESSIVE-COMPULSIVE DISORDER 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 48

49. OBSESSIVE-COMPULSIVE DISORDER Diagnosis is called for when symptoms: Feel excessive or unreasonable Cause great distress Take up much time Interfere with daily functions 49

50. OBSESSIVE-COMPULSIVE DISORDER Equally common in men and women and among different racial and ethnic groups 50

51. WHAT ARE FEATURES OF OBSESSIONS AND COMPULSIONS? Obsessions common themes - Dirt/contamination, violence and aggression, orderliness, religion, sexuality 51

52. WHAT ARE FEATURES OF OBSESSIONS AND COMPULSIONS? Compulsions Performing behaviors reduces anxiety Have common forms/themes: Cleaning, checking, order or balance, touching, verbal, and/or counting 52

53. OCD: BEHAVIORAL PERSPECTIVE  In fearful situation, perform a particular act (washing hands)  When threat lifts, associate improvement with random act  After repeated associations, believe compulsion is changing situation  Act becomes method to avoiding or reducing anxiety 53

54. OCD: BEHAVIORAL PERSPECTIVE Behavioral therapy Exposure and response prevention (ERP) Clients are repeatedly exposed to anxiety- provoking stimuli and told to resist performing compulsions Therapists often model behavior while client watches 54

55. OCD: BIOLOGICAL PERSPECTIVE Abnormal serotonin activity Abnormal brain structure and functioning  OCD linked to orbitofrontal cortex and caudate nuclei  Converts sensory information into thoughts and actions  Either area may be too active, letting through troublesome thoughts and actions 55

56. OCD: BIOLOGICAL PERSPECTIVE Serotonin-based antidepressants (Zoloft; Paxil) Bring improvement to 50–80% of those with OCD Relapse occurs if medication is stopped Research suggests that combination therapy (medication + cognitive behavioral therapy approaches) may be most effective 56

57. OBSESSIVE-COMPULSIVE-RELATED DISORDERS Some excessive behavior patterns (hoarding, hair pulling, shopping, sex) linked to OCD DSM-5 created group name “Obsessive- Compulsive-Related Disorders” and assigned four patterns to that group: hoarding disorder, hair- pulling disorder, skin-picking disorder, and body dysmorphic disorder 57