PSY254 Behavior Problems and Personality Disorders: Chapter 6 Anxiety Disorders
Alice Cheng, Ph.D.
University of Hartford
Anxiety Disorders
Anxiety - An emotional state characterized by physiological arousal, unpleasant feelings of tension, and a sense of apprehension or foreboding.
Anxiety disorder - A class of psychological disorders characterized by excessive or maladaptive anxiety reactions.
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Fear or panic is a basic emotion that involves activation of the “fight-or-flight” response in the sympathetic nervous system
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The Fear and Anxiety Response Patterns
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Anxiety is a general feeling of apprehension about possible dange
Anxiety is more oriented to the future and more diffuse than fea
It has cognitive/subjective, physiological, and behavioral components
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The Fear and Anxiety Response Patterns
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Anxiety disorders have unrealistic, i
ational fears or anxieties of disabling intensity
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The Anxiety Disorders and Their Commonalities
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The DSM-IV-TR recognizes seven primary types of anxiety disorders
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The Anxiety Disorders and Their Commonalities
Phobic disorders of the “specific” type
Phobic disorders of the “social” type
Panic disorder with agoraphobia
Panic disorder without agoraphobia
Generalized anxiety disorde
Obsessive-compulsive disorde
Post-traumatic stress disorde
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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
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The Anxiety Disorders and Their Commonalities
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Panic disorde
Panic disorder - A type of anxiety disorder characterized by repeated episodes of intense anxiety or panic.
There is a stronger bodily component to panic attacks than to other forms of anxiety.
The attacks are accompanied by feelings of sheer te
or and a sense of imminent danger or impending doom and by an urge to escape the situation.
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Panic disorder is characterized by the occu
ence of “unexpected” panic attacks that often seem to come “out of the blue”
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Panic Disorder with and without Agoraphobia
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The two features of panic attacks that distinguish them from other types of anxiety are
Their characteristic
evity
Their intensity
Many people with panic disorder also develop an agoraphobic fear of situations in which they might have an attack
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Panic Disorder with and without Agoraphobia
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Agoraphobia
The word agoraphobia is derived from Greek words meaning “fear of the marketplace,” which suggests a fear of being out in open, busy areas.
People with agoraphobia develop a fear of places and situations from which it might be difficult or emba
assing to escape in the event of panicky symptoms or a full-fledged panic attack or of situations in which help may be unavailable if such problems should occur.
People with agoraphobia may fear shopping in crowded stores; walking through crowded streets; crossing a
idge; traveling on a bus, train, or car; eating in restaurants; or even leaving the house.
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3.5 percent of the adult population have had panic disorder at some time in their lives
It’s twice as prevalent in women as men
50 percent of people with panic disorder have additional diagnoses
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Panic Disorde
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Panic disorde
Agoraphobia - Excessive, i
ational fear of open or public places.
For a diagnosis of panic disorder to be made, the person must have experienced repeated, unexpected panic attacks, and at least one of the attacks must be followed by one of the following :
a) At least a month of persistent fear of subsequent attacks.
) Wo
y about the implications or consequences of the attack.
c) Significant change in behavior.
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Prevalence of panic disorder by gende
Panic disorder affects about two times as many women as men.
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Panic disorder has a moderate heritable component
There is a
oad range of biochemical panic provocation agents
There are also several areas of the
ain implicated in panic attacks
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Biological Causal Factors
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Panic and the Brain
Panic attacks may arise from abnormal activity in the amygdala
Phobic avoidance may involve activity of the hippocampus
The anticipatory anxiety about future panic attacks is thought to arise from activity in the limbic system
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Theoretical Perspectives
The prevailing view of panic disorder reflects a combination of cognitive and biological factors, of misattributions misperceptions of underlying causes) on the one hand and physiological reactions on the other.
Perceiving these bodily sensations as dire threats induces anxiety, which is accompanied by activation of the sympathetic nervous system.
The changes in bodily sensations that trigger a panic attack may result from many factors, such as unrecognized hyperventilation (rapid
eathing), exertion, changes in temperature, or reactions to certain drugs or medications.
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Panic Disorder: The Cognitive Theory of Panic
Trigger stimulus
(internal or external)
0
Apprehension or wo
y
(e.g., about having a panic attack or about any distressing situation)
Body sensations
Interpretation of sensations as catastrophic
Perceived
threat
Trigger stimulus
(internal or external)
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Medications
Minor tranquilizers
Antidepressants
Behavioral and cognitive-behavioral treatments
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Treating Panic Disorder
and Agoraphobia
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A phobia is a persistent and disproportionate fear of some specific object or situation that presents little or no actual dange
The DSM-IV-TR lists three main categories of phobias:
specific phobia
social phobia
agoraphobia
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Phobic Disorders
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Specific Phobias
Specific phobia - A phobia that is specific to a particular object or situation.
Such as fear of heights (acrophobia), fear of enclosed spaces (claustrophobia), or fear of small animals such as mice or snakes and various other “creepy-crawlies.”
The person experiences high levels of fear and physiological arousal when encountering the phobic object, which prompts strong urges to avoid or escape the situation or avoid the feared stimulus, as in the following case.
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Phobic Disorders
The word phobia derives from the Greek phobos, meaning “fear.”
The concepts of fear and anxiety are closely related.
Fear is anxiety experienced in response to a particular threat.
A phobia is a fear of an object or situation that is disproportionate to the threat it poses.
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Common Specific Phobias
Acrophobia
Heights
Algophobia
Pain
Astraphobia
Thunderstorms
Claustrophobia
Enclosed places
Hydrophobia
Wate
Monophobia
Being alone
Mysophobia
Contamination
Nychtophobia
Darkness
Pyrophobia
Fire
Zoophobia
Animals or some particular animal
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Blood-injection-injury phobia occurs in about 3–4% of the population
16% of women and 7% of men suffer from some form of specific phobia in their life
The age of onset for different phobias varies widely
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Specific Phobias
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Specific Phobias
Specific phobia - A phobia that is specific to a particular object or situation.
Such as fear of heights (acrophobia), fear of enclosed spaces (claustrophobia), or fear of small animals such as mice or snakes and various other “creepy-crawlies.”
The person experiences high levels of fear and physiological arousal when encountering the phobic object, which prompts strong urges to avoid or escape the situation or avoid the feared stimulus, as in the following case.
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A range of factors have been implicated in the origins of specific phobias including relatively straightforward traumatic conditioning of fea
Genetic and temperamental factors are known to affect the speed and strength of conditioning of fea
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Specific Phobias
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Exposure therapy is the most commonly used treatment for specific phobias
Other therapies include
participant modeling
virtual reality therapies
combining cognitive techniques with exposure-based therapies
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Treating Specific Phobias
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Social phobia involves disabling fears of one or more discrete social situations in which a person fears that she or he may be exposed to the scrutiny and potential negative evaluation of others
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Social Phobia
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Social Phobia
It is not abnormal to experience some degree of fear in social situations such as dating, attending parties or social gatherings, or giving a talk or presentation to a class or group.
Social phobia - Excessive fear of social interactions or situations.
The underlying problem is an excessive fear of negative evaluations from others.
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Percentage of people with social phobia reporting specific difficulties associated with their fears of social situations.
More than 90% of people with social phobia feel handicapped by anxiety in their jobs.
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Treatments for social phobias include
ehavior therapy
cognitive-behavioral therapy
medications
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Social Phobia
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Psychodynamic Perspectives
From the psychodynamic perspective, anxiety is a danger signal that threatening impulses of a sexual or aggressive (murderous or suicidal) nature are nearing the level of awareness.
To fend off these threatening impulses, the ego mobilizes its defense mechanisms.
In phobias, the Freudian defense mechanism of projection comes into play.
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Learning Perspectives
The classic learning perspective on phobias was offered by psychologist O. Hobart Mowrer (1948).
Two-factor model - A theoretical model that accounts for the development of phobic reactions on the basis of classical and operant conditioning.
The fear component of phobia is believed to be acquired through classical conditioning, as previously neutral objects and situations gain the capacity to evoke fear by being paired with noxious or aversive stimuli.
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Biological Perspectives
Genetic factors can predispose individuals to develop anxiety disorders, including panic disorder and phobic disorders.
Investigators showed links between variations of a particular gene and different patterns of
ain activity when people were exposed to fearful stimuli (Hariri et al., 2002).
Individuals with a particular form of the gene showed greater neuronal activity in response to fearful stimuli in the amygdala, an almond-shaped structure in the limbic system of the
ain.
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The amygdala and limbic system.
The amygdala is part of the limbic system, a set of interconnected structures in the
ain involved in forming memories and processing emotional responses. The limbic system, which also consists of specific parts of the thalamus and hypothalamus and other nea
y structures, is located in the fore
ain below the cere
al cortex.
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The “all-clear” signal quells fear in rats.
Evidence shows that “all-clear” signals from the prefrontal cortex to the amygdala inhibit fear in rats. This discovery may lead to treatments that can help quell fear reactions in humans.
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Cognitive Perspectives
Recent research highlights the importance of cognitive factors in determining proneness to phobias, including factors such as oversensitivity to threatening cues, overpredictions of dangerousness, and self-defeating thoughts and i
ational beliefs:
Oversensitivity to threatening cues.
Overprediction of danger.
Self-defeating thoughts and i
ational beliefs.
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Snakes and Spiders
Snakes and spiders. According to the concept of prepared conditioning, we are genetically predisposed to more readily acquire fears of the types of stimuli that would have threatened the survival of ancestral humans—stimuli such as large animals, snakes, and other creepy-crawlers.
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Treatment Approaches
Traditional psychoanalysis fosters awareness of how clients’ fears symbolize their inner conflicts, so the ego can be freed from expending its energy on repression.
Modern psychodynamic therapies also foster clients’ awareness of inner sources of conflict.
They focus to a greater extent than do traditional approaches on exploring sources of anxiety that arise from cu
ent rather than past relationships, however, and they encourage clients to develop more adaptive behaviors.
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Learning-Based Approaches
Systematic desensitization - A behavior therapy technique for overcoming phobias by means of exposure to progresively more fearful stimuli (in imagination or by viewing slides) while remaining deeply relaxed.
Fear-stimulus hierarchy - An ordered series of increasingly fearful stimuli.
Gradual exposure - In behavior therapy, a method of overcoming fears through a stepwise process of exposure to increasingly fearful stimuli in imagination or in real-life situations.
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Learning-Based Approaches
Flooding - A behavior therapy technique for overcoming fears by