anxiety disorders Flashcards
phobias OCD treatments
What is an obsession?
obsessions are persistent, reoccurring thoughts/ideas/images/impulses > unwanted thoughts and are excessive worries generally unrelated to real life problems
What is a compulsion?
compulsions are repetitive behaviours and rituals that they feel they are compelled to perform to reduce anxiety caused by obsessions
rituals are known to be unreasonable but they need to do it to reduce anxiety levels
Difference between obsession and compulsion?
obsessions are an unwanted thought
compulsion is a repetitive act performed to reduce anxiety caused by obsession
What is the biological explanation of OCD?
genetic component that predisposes individuals to the illness.
family studies > person with first degree relatives that have an OCD/anxiety disorder tend to have OCD
Studies supporting biological approach to OCD?
mckeon and murray - first degree relatives
paula - higher % to people with relatives that have ocd than not 10.3% to 1.9%
Biochemical explanation to OCD?
OCD responds well to seretonin
OCD seems to be related to low levels of seretonin (neurotransmitter) > SSRI anti depressants reduce OCD symptoms
Neurophysiological explanation?
basal ganglia in OCD responsible for innate psychomotor functions
rapport and wise - hypersensitivity of the basal ganglia gives rise to repetitive motor behaviours e.g. ocd (compulsion)
Evaluation/problems of biological?
genetic findings can be explained by environmental studies too
e.g. ocd sufferers with relatives > SLT observation and imitation
SSRI > only 50% improvement suggesting there is more than one explanation for OCD
therapeutic effect of SSRI doesn’t explain OCD
improvement in treatment won’t be noticed straight away
basal ganglia findings are inconsistent
aylward = no significant difference between OCD and control patients’ basal ganglia
> explains compulsion but not obsessions
What’s the behavioural explanation of OCD?
mower's two process theory of avoidance learning classical condition (learnt) > operant conditioning (maintained)
prediction- anxiety levels increase if compulsion is blocked which is proved by rachman and hodgson
evidence of avoidance learning? (study) ocd rachman and hodgson
rachman and hodgson > distressed participants when compulsions were blocked had high anxiety levels
when allowed to do compulsion > anxiety levels decreased
what did rachman and hodgson’s experiment support aswell as the theory?
development of a successful behavioural treatment
patient can be shown how anxiety would eventually reduce naturally over time
evaluation of OCD (behavioural)
two process theory can easily explain obsession and compulsion
short term > reduces anxiety
longterm > avoidance behaviour is learnt
avoidance conditioning theory > successful behavioural treatment
doesn’t explain how obsessions arise in first place
what is the cognitive explanation of ocd?
- cognitive bias for environmental stimuli such their attention system might be hyper vigilant.
- evidence of impaired memory
Sher & Trivedi cognitive study for ocd?
- people with OCD had poor memories for their actions
- people suffering from OCD had low confidence in memory ability and also their non verbal memory
how is cognitive vulnerability to anxiety manifested?
hyper vigilance when entering new environment:
- rapid eye movements to scan environment
- attending selectively to threat related stimuli rather than neutral stimuli
rachman case study on hyper vigilance?
catastrophic thoughts of harm > overestimated seriousness > rapid eye scans ? lookout for stimuli > misperceiving similar things to stumuli threat
evaluation of cognitive explanation for ocdv
- cognitive bias (hyper vigilance) gives good account of individual differences
- treatment of hyper vigilance > successful
- concentrates on internal thoughts and -ignores socials factors that might contribute
- ignores biological factors such as genetic or physiological basis
psychodynamic explanation of ocd
psychosexual theory of development:
obsessions and compulsions come from unconscious conflict > id and ego > defense mechanism employed (compulsions): reaction formation (thinking and acting in opposite way to actual impulse)
dominant id - aggressive instincts (obsessions)
salzman: psychodynamic approach of ocd?
salzman - ocd is a result of trauma > repressed into the unconscious > anxiety manifests via intrusive thoughts
obsessional thoughts > repressed memories surfacing into consciousness > compulsions are attempts to reduce anxiety by the consciousness
evaluation of psychodynamic explanation of ocd
ocd relies on limited number of case studies > low validity as cannot generalise
no empirical evidence
moulded by childhood > defence mechanisms to defend ourselves from anxiety
not effective in treatment
define phobia
persistent, disproportionate and irrational fear of a specific object or situation that is maladaptive and interferes with everyday life
Categories of phobias?
specific - specific objectsocial - social situationsagoraphobia - panic attack in public
symptoms of a specific phobia?
experiences great anxiety/panic response (triggered immediately)be excessive to the actual dangerinterferes with everyday life
when does a fear become a phobia?
when it becomes maladaptive and interferes with everyday life
subtypes of specific phobias
animalenvironmentblood/injurysituationalatypical (weird)
what is a social phobia?
extreme fear of embarrassment or humiliation in social situations that are much more debilitating than normal nerves
types of social phobias?
social phobias of specific situations e.g. public speakinggeneralised social phobia e.g. involves fear of many different types of social situations
when do social phobias develop?
late childhood/early adolescence - affecting 11% men 15% women (kessler)
types of agoraphobia?
as a complication of a panic attack - anxious about having a panic attack in public places where they will not be able to escape/find carerwithout panic attacks - spreading fear of the environment outside of the safety of their own home (housebound)
types of explanations!! -
biologicalbehaviouralcognitivepsychodynamic
Fyer’s study?
Fyer - first degree relative with phobias tend to be more likely to have one too. high concordance with specific phobiasno concordance with social
problem with Fyer’s study?
social learning theory suggests that relative may be ablest observe and imitate behaviour therefore it is hard to separate biology from environment
torgesen study?
investigated identical twins and fraternal twins - one of the pair was agoraphobic.higher likelihood the other twin had the same phobia in identical than fraternal suggesting genetic basis
problem with torgesen study?
social learning theory - can’t separate environment from biologyobservation and imitation
discuss vulnerability
eysenck - some people are more easily frightened by certain hints than others - high autonomic reactivity making them more likely to develop a phobia
prepardness theory
seligman - phobias are from dangers/threats to us from 1000’s of years ago.preparedness to be sensitive to certain stimuliinnate tendency to develop phobias to harmful thingsbiologically prepared from birth
problem with preparedness theory?
some people have phobias of something that poses no danger whatsoevercomes from conditioning animals to fear things in labs - low eco validity
strength of preparedness theory
cook and mineka - monkeys acquired phobia of toy snakes easily compared to chairs suggesting there’s a genetic reason behind this
problems with vulnerability theory?
different anxiety disorders have different reactions suggesting reactions in the autonomic system are more complicated than the theory suggests
what’s the behavioural explanation to phobias
phobias are learnt by classical conditioning
what’s the biological explanation to phobias
some people seem more susceptible to developing phobias than others suggesting there is a genetic basis to it
what is the two process theory by mower?
learned phobia through classical conditioning which is maintained by operant conditioning - fear is reduced by avoiding the stimulus.two factory theory as it is incorporating classical and operantknown as avoidance conditioning
study supporting behavioural explanation?
Watson’s study - albertrat and loud noise
problems with little albert study?
-difficult to reproduce results mores with adults-findings have been inconsistent and small
problems with behavioural explanation?
-doesn’t show how all fears are acquired-fear of dogs study di nardo-some phobias cannot be traced to bad experiences-sometimes occurs with no direct contact (hard to explain using conditioning theory)-just because no recollection of experience doesn’t mean there’s no environment involved = SLT suggests it can be learned vicariously through models
what is the Di Nardo study?
dogs. 60% dog phobias are a result of a bad experience but the rest had no recollection of this.some people had a bad experience but did not acquire a phobia lol
what is the cognitive approach on phobias?
fearful emotional response due to interpretation or appraisal of events-interpretation is distorted-automatic negative thoughts (ott)-over-generalising - one bad experience means all experiences will be bad
three factors of cognitive explanation of phobias?
sensitisation = anxiety becomes associated with object/situation and triggers responseavoidance = sensitisation > avoidance of object > rewarding for imagenegative self talk/images = three distortions–overestimating –castastrophising–underestimating ability to cope
cognitive approach to agoraphobia
-hypersensitivity to spacial layout-hypersensitive to being far away from a caretakerif access to home/carer is blocked > fear is induced > go home straight away
how are social phobias maintained in the cognitive approach?
develop schemas > mental representationserving as a guide> includes mental thoughts of people being negative towards it> hypersensitivity to picking up cues from others they interpret negatively> behaviour is unacceptable and others will reject them> less able to socially interact and cycle occurs
evaluation of cognitive explanation for phobias
practical therapeutic applicationstreatments are highly effectiveaccepts conditioning but also emphasises on persons thoughtsnot only driven by cognitions - maintained by inappropriate behaviour/avoidance
psychodynamic explanation of phobias?
when ID impulses are repressed ad anxiety if displaced onto object. (oedipal and electra complex can be involved)
examples of psychodynamic explanation on phobias?
Hans - freud.unresolved childhood issue > horses linked to fear of father and castrationSperling > fear of spiders is fear of sexual natureAbraham > fear of spiders symbolises fear os sexual genitalia
evaluation of psychodynamic explanation of phobias
hans phobia is complicated? it’s not - there’s a simpler explanation > classical conditioninglacks methodical rigour > low validity as it is subjective and a case study (one person that cannot be used to generalise everything)freud suggested phobias were linked to sexual problems > WRONG
drug therapy?
SSRI (selective sertonin reuptake inhibitors - anti depressant medications eg prozac.
what does the SSRI do?
increases levels of seretonin in the brain by preventing reabsorption from happening at synapses so fast
is SSRI effective? what if it isn’t?
good with panic and agoraphobia and generalised social phobia ( depressed accompanies OCD a lot)MAO - older anti depressants used when SSRI doesn’t work
evaluation of drug therapy?
safe for patientsnot additivequick and cheapside effects - headaches nausea4-12 weeks for results > people may abandon themMAOI’s are panic blocking!!side effects for MAOI are :( weight gain etc
behaviour therapies?
systematic desensitisationVRET (virtual reality exposure therapy)flooding
what is systematic desensitisation?
Wolpe - fear is replaced with relaxation - anxiety heir achy ? relaxing at each stagein vivo - exposure in realityOCD is effective - if compulsions follow
VRET?
virtual world version based on systematic desensitisation
flooding
overwhelming patient with fear/ocd so they realise no harm comes to themimplosion therapy - imaginationexposure and response prevention - ocd version > not given chance to carry out compulsion
evaluation of behaviour therapy?
systematic can be used when phobia is identified > cost effective > no good for OCD >doesn’t generalise to everyday lifeflooding > ethical implications > stress/anxiety levels > in vivo is more effective than exposure and responseexposure > more effective for ocd than medicationfret - like systematic desensitisation > expensive equipment > nausea
cognitive therapy
replace unrealistic thoughts with realistic mental habits > identify, challenge and place counterproductive thoughts with more constructive ones
what is the CBT study by graziano and mooney?
fear of dark with no treatment condition > taught to relax and praised for efforts > behavioural and cognitive approaches were used so….
evaluation of cognitive therapy?
empirical evidence for cog therapy for anxiety when combined with behavioural techniquesmarks > ocd isn’t effected by cog muchany cognitive change could be helping so therapist man not be the reason??
psychodynamic therapy
cause insight on why they have this phobia /ocdego defence mechanisms are taken away
what are the ways of lifting ego defence mechanisms?
free association > conflict can be brought to surface if ego isn’t restraining thoughtshypnotisingdream analysis > ‘royal road to unconscious’ > repressed ideas are likely to come up in dreams to be interpreted > manifest content and stuff
evaluation of psychodynamic therapy?
often ineffective making worseanxiety can be reduced without finding causeexpensive and time consumingtraumatic for patients > catharsis
