1. Copyright © 2010 Allyn & Bacon This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission over any network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. ISBN: 0-205-50294-6 PowerPoint for Abnormal Psychology Fourteenth Edition James N. Butcher Susan Mineka Jill M. Hooley Prepared by Andy Pomerantz Southern Illinois University Edwardsville

2. Copyright © 2010 Allyn & Bacon Chapter 6 Panic, Anxiety, and Their Disorders

3. Copyright © 2010 Allyn & Bacon 3 The Fear and Anxiety Response Patterns  It is difficult to completely distinguish between fear and anxiety  Historically, the distinction has centered on whether the source of danger is obvious  Obvious danger leads to fear  Less obvious danger leads to anxiety  It is difficult to completely distinguish between fear and anxiety  Historically, the distinction has centered on whether the source of danger is obvious  Obvious danger leads to fear  Less obvious danger leads to anxiety

4. Copyright © 2010 Allyn & Bacon 4 The Fear and Anxiety Response Patterns  Fear or panic is a basic emotion that involves activation of the “fight-or-flight” response of the autonomic nervous system

5. Copyright © 2010 Allyn & Bacon 5 The Fear and Anxiety Response Patterns  Anxiety is a general feeling of apprehension about possible danger  Anxiety is more oriented to the future and more diffuse than fear  It has cognitive/subjective, physiological, and behavioral components  Anxiety is a general feeling of apprehension about possible danger  Anxiety is more oriented to the future and more diffuse than fear  It has cognitive/subjective, physiological, and behavioral components

6. Copyright © 2010 Allyn & Bacon 6 Overview of the Anxiety Disorders and Their Commonalities  Anxiety disorders have unrealistic, irrational fears or anxieties of disabling intensity as their most obvious manifestation

7. Copyright © 2010 Allyn & Bacon  The DSM-IV-TR recognizes seven primary types of anxiety disorders:  Specific phobia  Social phobia  Panic disorder with or without agoraphobia  Generalized anxiety disorder  Obsessive-compulsive disorder  Acute stress disorder  Post-traumatic stress disorder  The DSM-IV-TR recognizes seven primary types of anxiety disorders:  Specific phobia  Social phobia  Panic disorder with or without agoraphobia  Generalized anxiety disorder  Obsessive-compulsive disorder  Acute stress disorder  Post-traumatic stress disorder 7 Overview of the Anxiety Disorders and Their Commonalities

8. Copyright © 2010 Allyn & Bacon 8 Overview of the Anxiety Disorders and Their Commonalities  There are some important similarities among  The basic biological causes of these disorders  The basic psychological causes of these disorders  The effective treatments for these disorders  There are some important similarities among  The basic biological causes of these disorders  The basic psychological causes of these disorders  The effective treatments for these disorders

9. Copyright © 2010 Allyn & Bacon 9 Specific Phobias  A specific phobia is a strong and persistent fear that is recognized as excessive or unreasonable and is triggered by a specific object or situation  Subtypes identified in DSM-IV-TR include:  Animal  Natural environment  Blood-injection-injury  Situational  Other  A specific phobia is a strong and persistent fear that is recognized as excessive or unreasonable and is triggered by a specific object or situation  Subtypes identified in DSM-IV-TR include:  Animal  Natural environment  Blood-injection-injury  Situational  Other

10. Copyright © 2010 Allyn & Bacon 10 Prevalence, Age of Onset, and Gender Differences  Quite common mental disorders  Lifetime prevalence rate of about 12%  More common in women than men  Blood-injection-injury phobia occurs in about 3-4% of the population  The age of onset for different phobias varies widely  Quite common mental disorders  Lifetime prevalence rate of about 12%  More common in women than men  Blood-injection-injury phobia occurs in about 3-4% of the population  The age of onset for different phobias varies widely

11. Copyright © 2010 Allyn & Bacon 11 Psychological Causal Factors  Psychoanalytic viewpoint—a defense against anxiety stemming from repressed id impulses  Learned behavior/classical conditioning  Vicarious conditioning  Individual differences in learning  Evolutionary preparedness  Psychoanalytic viewpoint—a defense against anxiety stemming from repressed id impulses  Learned behavior/classical conditioning  Vicarious conditioning  Individual differences in learning  Evolutionary preparedness

12. Copyright © 2010 Allyn & Bacon Biological Causal Factors  Genetics  Monozygotic twins are more likely to share phobias than dizygotic twins  Temperament  Behaviorally inhibited temperament is linked to higher vulnerability to phobias  Genetics  Monozygotic twins are more likely to share phobias than dizygotic twins  Temperament  Behaviorally inhibited temperament is linked to higher vulnerability to phobias 12

13. Copyright © 2010 Allyn & Bacon 13 TreatmentsTreatments  Exposure therapy is the treatment of choice for specific phobias  Can involve participant modeling or virtual reality components  Can also be combined with cognitive techniques  Exposure therapy is the treatment of choice for specific phobias  Can involve participant modeling or virtual reality components  Can also be combined with cognitive techniques

14. Copyright © 2010 Allyn & Bacon 14 Social Phobias  Social phobia involves disabling fears of one or more specific social situations in which a person fears that she or he may be exposed to the scrutiny and potential negative evaluation of others and to humiliation or embarrassment  Also known as social anxiety disorder  Social phobia involves disabling fears of one or more specific social situations in which a person fears that she or he may be exposed to the scrutiny and potential negative evaluation of others and to humiliation or embarrassment  Also known as social anxiety disorder

15. Copyright © 2010 Allyn & Bacon Prevalence, Age of Onset, and Gender Differences  Common mental disorder  Lifetime prevalence around 12%  Somewhat more common in women than men  Typically begin during adolescence or early adulthood  Many have comorbid disorders such as other anxiety disorders or depression  Common mental disorder  Lifetime prevalence around 12%  Somewhat more common in women than men  Typically begin during adolescence or early adulthood  Many have comorbid disorders such as other anxiety disorders or depression 15

16. Copyright © 2010 Allyn & Bacon Psychological Causal Factors  Learned behavior  Classical conditioning that is direct or vicarious in nature  Evolutionary factors  Predisposition based on social hierarchies  Perceptions of uncontrollability and unpredictability  Cognitive biases toward “danger schemas” in social situations  Learned behavior  Classical conditioning that is direct or vicarious in nature  Evolutionary factors  Predisposition based on social hierarchies  Perceptions of uncontrollability and unpredictability  Cognitive biases toward “danger schemas” in social situations 16

17. Copyright © 2010 Allyn & Bacon Biological Causal Factors  Genetics  Twin studies suggest about 30% of variance in liability to social phobia is due to genetic factors  Temperament  Behavioral inhibition correlates with social phobia  Genetics  Twin studies suggest about 30% of variance in liability to social phobia is due to genetic factors  Temperament  Behavioral inhibition correlates with social phobia 17

18. Copyright © 2010 Allyn & Bacon 18 TreatmentsTreatments  Treatments for social phobias include:  Cognitive therapy  Cognitive restructuring to change distorted automatic thoughts  Behavior therapy  Exposure to social situations that evoke fear  Medications  Antidepressants  Relapse rate with medication is higher than with therapy  Treatments for social phobias include:  Cognitive therapy  Cognitive restructuring to change distorted automatic thoughts  Behavior therapy  Exposure to social situations that evoke fear  Medications  Antidepressants  Relapse rate with medication is higher than with therapy

19. Copyright © 2010 Allyn & Bacon 19 Panic Disorder with and without Agoraphobia  Panic Disorder  Agoraphobia  Prevalence, Age of Onset, and Gender Differences  Comorbidity with Other Disorders  The Timing of a First Panic Attack  Biological Causal Factors  Psychological Causal Factors  Treatments  Panic Disorder  Agoraphobia  Prevalence, Age of Onset, and Gender Differences  Comorbidity with Other Disorders  The Timing of a First Panic Attack  Biological Causal Factors  Psychological Causal Factors  Treatments

20. Copyright © 2010 Allyn & Bacon 20 Panic Disorder  Characterized by the occurrence of panic attacks that often seem to come “out of the blue”  Recurrent, unexpected attacks and worry about additional attacks  13 possible symptoms of panic attacks, 10 of which are physical and 3 of which are cognitive  Attacks are brief but intense  Characterized by the occurrence of panic attacks that often seem to come “out of the blue”  Recurrent, unexpected attacks and worry about additional attacks  13 possible symptoms of panic attacks, 10 of which are physical and 3 of which are cognitive  Attacks are brief but intense

21. Copyright © 2010 Allyn & Bacon AgoraphobiaAgoraphobia  Anxiety about being in places from which escape might be difficult or embarrassing:  Crowds  Theaters  Malls  Cars, buses, trains, planes  Standing in line  Elevators  Other similar situations  Anxiety about being in places from which escape might be difficult or embarrassing:  Crowds  Theaters  Malls  Cars, buses, trains, planes  Standing in line  Elevators  Other similar situations 21

22. Copyright © 2010 Allyn & Bacon 22 Prevalence, Age of Onset, and Gender Differences  3.5 percent of the adult population have had panic disorder at some time in their lives  Twice as prevalent in women as men  Average age of onset is 23-34 years  3.5 percent of the adult population have had panic disorder at some time in their lives  Twice as prevalent in women as men  Average age of onset is 23-34 years

23. Copyright © 2010 Allyn & Bacon Comorbidity with Other Disorders  83% of people with panic disorder have at least one comorbid disorder  50-70% will experience serious depression at some point in their lives  83% of people with panic disorder have at least one comorbid disorder  50-70% will experience serious depression at some point in their lives 23

24. Copyright © 2010 Allyn & Bacon The Timing of a First Panic Attack  First attack frequently follows feelings of distress or highly stressful life circumstance  Many adults who experience a single panic attack do not develop panic disorder  First attack frequently follows feelings of distress or highly stressful life circumstance  Many adults who experience a single panic attack do not develop panic disorder 24

25. Copyright © 2010 Allyn & Bacon 25 Biological Causal Factors  Panic disorder has a moderate heritable component  There is a broad range of biochemical panic provocation agents  There are also several areas of the brain implicated in panic attacks  Panic disorder has a moderate heritable component  There is a broad range of biochemical panic provocation agents  There are also several areas of the brain implicated in panic attacks

26. Copyright © 2010 Allyn & Bacon 26 Figure 6.1: A Biological Theory of Panic, Anxiety, and Agoraphobia

27. Copyright © 2010 Allyn & Bacon 27 Psychological Causal Factors  Behavioral and cognitive causal factors include:  Comprehensive learning theory of panic disorder  Cognitive theory of panic  Anxiety sensitivity and perceived control  Safety behaviors and the persistence of panic  Cognitive biases and the maintenance of panic  Behavioral and cognitive causal factors include:  Comprehensive learning theory of panic disorder  Cognitive theory of panic  Anxiety sensitivity and perceived control  Safety behaviors and the persistence of panic  Cognitive biases and the maintenance of panic

28. Copyright © 2010 Allyn & Bacon Figure 6.2: The Panic Circle 28

29. Copyright © 2010 Allyn & Bacon  Medications  Anxiolytics  Antidepressants  Behavioral and cognitive-behavioral treatments  Medications  Anxiolytics  Antidepressants  Behavioral and cognitive-behavioral treatments 29 TreatmentsTreatments

30. Copyright © 2010 Allyn & Bacon 30 Generalized Anxiety Disorder  Generalized anxiety disorder is characterized by chronic or excessive worry about a number of events and activities  Must occur more days than not for a 6-month period  Generalized anxiety disorder is characterized by chronic or excessive worry about a number of events and activities  Must occur more days than not for a 6-month period

31. Copyright © 2010 Allyn & Bacon Prevalence, Age of Onset, and Gender Differences  Each year 3% of the population experiences GAD  Lifetime prevalence is 5.7%  Twice as common in women as in men  60-80% report having been anxious nearly all their lives, so age of onset is difficult to determine  Each year 3% of the population experiences GAD  Lifetime prevalence is 5.7%  Twice as common in women as in men  60-80% report having been anxious nearly all their lives, so age of onset is difficult to determine 31

32. Copyright © 2010 Allyn & Bacon Comorbidity with Other Disorders  GAD often co-occurs with other Axis I disorders  Especially other anxiety disorders and mood disorders  GAD often co-occurs with other Axis I disorders  Especially other anxiety disorders and mood disorders 32

33. Copyright © 2010 Allyn & Bacon 33 Psychological Causal Factors  According to the psychoanalytic viewpoint, the disorder results from conflict between the id and the ego  Perceptions of uncontrollability and unpredictability  A sense of mastery can help  Worry can be positive but is often negative  Anxiety is associated with an automatic attentional bias toward threatening information in the environment  According to the psychoanalytic viewpoint, the disorder results from conflict between the id and the ego  Perceptions of uncontrollability and unpredictability  A sense of mastery can help  Worry can be positive but is often negative  Anxiety is associated with an automatic attentional bias toward threatening information in the environment

34. Copyright © 2010 Allyn & Bacon 34 Biological Causal Factors  It is modestly heritable  The neurotransmitters GABA, serotonin, and perhaps norepinephrine all play a role in anxiety  CRH also plays a role  Neurobiological factors implicated in panic disorders and GAD are not the same  It is modestly heritable  The neurotransmitters GABA, serotonin, and perhaps norepinephrine all play a role in anxiety  CRH also plays a role  Neurobiological factors implicated in panic disorders and GAD are not the same

35. Copyright © 2010 Allyn & Bacon 35 TreatmentsTreatments  Anxiolytic drugs are commonly used and misused  Buspirone seems effective and non- addictive  Cognitive-behavioral therapy has become increasingly effective  Anxiolytic drugs are commonly used and misused  Buspirone seems effective and non- addictive  Cognitive-behavioral therapy has become increasingly effective

36. Copyright © 2010 Allyn & Bacon 36 Obsessive-Compulsive Disorder  Defined by the occurrence of unwanted and intrusive obsessive thoughts or distressing images  These are usually accompanied by compulsive behaviors performed to  Neutralize the obsessive thoughts or images  Prevent some dreaded event or situation  Defined by the occurrence of unwanted and intrusive obsessive thoughts or distressing images  These are usually accompanied by compulsive behaviors performed to  Neutralize the obsessive thoughts or images  Prevent some dreaded event or situation

37. Copyright © 2010 Allyn & Bacon  Obsessions consist most often of:  Contamination fears  Fears of harming oneself or others  Lack of symmetry  Pathological doubt  Compulsions include:  Cleaning  Checking  Repeating  Ordering/arranging  Counting  Obsessions consist most often of:  Contamination fears  Fears of harming oneself or others  Lack of symmetry  Pathological doubt  Compulsions include:  Cleaning  Checking  Repeating  Ordering/arranging  Counting 37 Obsessive-Compulsive Disorder

38. Copyright © 2010 Allyn & Bacon 38 Prevalence, Age of Onset, and Gender Differences  OCD’s one-year prevalence is 1%  OCD’s lifetime prevalence is 1.6%  OCD affects both genders about equally  Typically begins in adolescence or early adulthood  OCD’s one-year prevalence is 1%  OCD’s lifetime prevalence is 1.6%  OCD affects both genders about equally  Typically begins in adolescence or early adulthood

39. Copyright © 2010 Allyn & Bacon Comorbidity with Other Disorders  Frequently co-occurs with other anxiety disorders and mood disorders  Also co-occurs with body dysmorphic disorder with some frequency  Frequently co-occurs with other anxiety disorders and mood disorders  Also co-occurs with body dysmorphic disorder with some frequency 39

40. Copyright © 2010 Allyn & Bacon 40 Psychological Causal Factors  Mowrer developed the two-process theory of avoidance learning  Neutral stimuli become associated with fearful thoughts via classical conditioning  Obsessions with contamination and dirt appear to have evolutionary roots  Attempting to suppress unwanted thoughts may increase those thoughts  Cognitive biases toward material relevant to one’s obsessive concerns  Mowrer developed the two-process theory of avoidance learning  Neutral stimuli become associated with fearful thoughts via classical conditioning  Obsessions with contamination and dirt appear to have evolutionary roots  Attempting to suppress unwanted thoughts may increase those thoughts  Cognitive biases toward material relevant to one’s obsessive concerns

41. Copyright © 2010 Allyn & Bacon 41 Biological Causal Factors  OCD appears moderately heritable  Abnormalities in brain function may include:  Slight structural abnormalities in the caudate nucleus  high metabolic levels in other parts of the brain  Serotonin is strongly implicated in OCD  OCD appears moderately heritable  Abnormalities in brain function may include:  Slight structural abnormalities in the caudate nucleus  high metabolic levels in other parts of the brain  Serotonin is strongly implicated in OCD

42. Copyright © 2010 Allyn & Bacon 42 TreatmentsTreatments  Exposure and response prevention may be the most effective approach to obsessive-compulsive disorder  Exposure to anxiety-producing obsession, prevention of compulsion typically used  Gradually move through hierarchy of stimuli  Medications that affect the neurotransmitter serotonin have also been found helpful  Exposure and response prevention may be the most effective approach to obsessive-compulsive disorder  Exposure to anxiety-producing obsession, prevention of compulsion typically used  Gradually move through hierarchy of stimuli  Medications that affect the neurotransmitter serotonin have also been found helpful

43. Copyright © 2010 Allyn & Bacon 43 Sociocultural Causal Factors For All Anxiety Disorders  Anxiety is a universal emotion, but anxiety disorders are expressed differently across cultures  Ataque de nervios is common in the Caribbean  Different countries have very different rates of anxiety disorders  Anxiety is a universal emotion, but anxiety disorders are expressed differently across cultures  Ataque de nervios is common in the Caribbean  Different countries have very different rates of anxiety disorders

44. Copyright © 2010 Allyn & Bacon Cultural Differences in Sources of Worry  In the Yoruba culture of Nigeria, sources of anxiety are different than in the U.S.  Creating and maintaining a large family  Fertility  Dreams that may indicate bewitchment  Somatic complaints that are atypical in Western society  In China, Koro is an anxiety that a body part is retracting into the body or shrinking  In the Yoruba culture of Nigeria, sources of anxiety are different than in the U.S.  Creating and maintaining a large family  Fertility  Dreams that may indicate bewitchment  Somatic complaints that are atypical in Western society  In China, Koro is an anxiety that a body part is retracting into the body or shrinking 44

45. Copyright © 2010 Allyn & Bacon Taijin Kyofusho  Certain anxiety disorders may have evolved to fit certain cultural patterns  The Japanese disorder taijin kyofusho is somewhat like social phobia in Western culture, but fear is about offending or embarrassing others, not self  Certain anxiety disorders may have evolved to fit certain cultural patterns  The Japanese disorder taijin kyofusho is somewhat like social phobia in Western culture, but fear is about offending or embarrassing others, not self 45

46. Copyright © 2010 Allyn & Bacon 46 Unresolved Issues  Is compulsive hoarding a subtype of OCD or a distinct disorder?  Occurs in 10-30% of people diagnosed with OCD  Hoarders acquire and fail to discard many possessions that seem useless to others, often interfering with living spaces  Is compulsive hoarding a subtype of OCD or a distinct disorder?  Occurs in 10-30% of people diagnosed with OCD  Hoarders acquire and fail to discard many possessions that seem useless to others, often interfering with living spaces

47. Copyright © 2010 Allyn & Bacon End of Chapter 6