Lecture 3: Anxiety, OCD, and Related Orders Flashcards
fear
emotional and physiological response to a perceived threat to your well-being
anxiety
emotional and physiological response to a vague sense of threat or danger
generalized anxiety disorder (GAD)
excessive feelings of anxeity and worry about numerous events and activities
checklist for generalized anxiety disorder
- for 6 months or more, the person experiences disproportionate ongoing anxiety and worry about multiple matters
- the symptoms include at least three of the following: edginess, fatigue, poor concentration, irritability, muscle tension, and sleep problems
- significant distress or impairment
sociocultural perspective on GAD
disorder occurs because of dangerous ongoing social conditions (e.g. poverty, race, ethnicity)
psychodynamic perspective on GAD
- Freud: all children experience anxiety and use their ego defense mechanisms to cope with it; however, some children experience high anxiety levels or their defense mechanisms are inadequate, and they may develop a generalized anxiety disorder
- realistic anxiety when facing actual danger
- neurotic anxiety when prevented from expressing id impulses
- moral anxiety when punished for expressing id impulses
- short-term psychodynamic therapy is very effective
humanistic perspective on GAD
arises through denial of someone’s true thoughts and emotions
- Rogers: people without unconditional positive regard from caretakers develop conditions of worth (overly critical self-views), which set the stage for GAD
- client-centered therapy has little research support
cognitive-behavioral perspective on GAD
caused by problematic behaviors and dysfunctional thinking
- old explanations: basic irrational assumption (Ellis), and silent assumptions (Beck)
- new explanations: metacognitive theory, intolerance of uncertainty theory, avoidance theory
basic irrational assumptions (Ellis)
irrational beliefs that make people act in unsuitable ways
silent assumptions (Beck)
e.g. “it is always best to assume the worst”
metacognitive theory
people with GAD implicitly hold both positive and negative beliefs about worrying
- they see worrying as useful way to deal with threats
- but society tells them that worrying is a bad thing
- develop beliefs that worrying is harmful and they start worrying about worrying (meta-worrying)
- net effect is GAD
intolerance of uncertainty theory
people with GAD are unable to tolerate the possibility (however small) that negative things may occur
avoidance theory
people with GAD have a greater bodily arousal (higher heart rate, perspiration, respiration)
- worrying reduces this arousal by distracting them from their unpleasant physical feelings
cognitive-behavioral therapies for GAD
- rational-emotive therapy: changing maladaptive assumptions
- mindfulness-based, acceptance and commitment therapy: breaking down worrying, clients are helped to become aware of their streams of thoughts and to accept them rather than try to eliminate them
biological perspective on GAD
explains the disorder through biological factors
- fear reactions are tied to brain circuits
- GAD is caused by a hyperactive fear circuit, in which the neurotransmitter GABA plays an important role
- Benzodiazepines reduce anxiety by binding to receptors for GABA (GABA has an inhibiting function and benzodiazepines mimic this function)
biologogical perspective treatment for GAD
- drug therapy
- relaxation training
- biofeedback
drug therapy
- barbiturates (sedative-hypnotic drugs): drugs that calm people down and help them fall asleep
- benozodiazepines
- antidepressants and antipsychotics
relaxation training
teaches people to relax when they want to, so that they can calm themselves in times of stress
biofeedback
a technique in which a person receives feedback on physiological responses, such as the level of muscle tension, by means of an EMG (electromyograph)
- in this way, reactions are learned to be controlled voluntarily
phobia
more intense and persistent fear, desire to avoid feared object/situation and create distress that interferes with functioning
agoraphobia
fear of public places or other situations where there are few possibilities for escaping or receiving help
- symptoms last for at least 6 months
- significant distress or impairment, often fluctuates
specific phobias
severe and persistent fear of a specific object or situation, usually lasting at least 6 months
- exposure to the object produces immediate fear
- avoidance of the feared situation
- significant distress or impairment
cognitive-behavioral perspective on phobias
phobia is a result of conditioning (learned behavior)
- phobia can also develop through modeling (observing and imitating others that have a phobia)
behavioral-evolutionary perspective on phobias
helpful for ancestors to develop fears of stimuli that are dangerous because it makes them avoid those stimuli
- preparedness: predisposition to fear certain stimuli (why some phobias are more common than others)
treatment for specific phobias
exposure treatment
exposure treatment
focuses on exposing people to things they are afraid of, consisting of 3 types
- systematic desensitization
- flooding: repeated exposure to fear-inducing stimulus in order to show the person that they are afraid of something that is harmless
- modeling
treatment for agoraphobia
focuses on gradual repeated exposure to outside places paired with additional help
social anxiety disorder
severe, persistent, and irrational fear of social or performance situations in which they may face scrutiny by others and possibly feel embarrassment
social anxiety disorder checklist
- pronounced, disproportionate, and repeated anxiety about the social situation(s) in which the individual could be exposed to scrutiny by others; typically for 6 months or more
- fear of being negatively evaluated by or offensive to others
- exposure to the social situation almost always produces anxiety
- avoidance of feared situations
- significant distress or impairment
cognitive-behavioral perspective on social anxiety disorder
people hold a cluster of unrealistic beliefs and expectations regarding social interactions (e.g. they believe they are socially inadequate and anticipate terrible consequences if they don’t perform perfectly in social settings)
- thus they avoid social interactions to reduce or prevent social disasters
treatments for social anxiety disorder
- reducing social fears: medication (benzodiazepine or antidepressants), cognitive-behavioral therapies: systematic discussions in which maladaptive beliefs are reexamined, exposure therapy
- training social skills: the therapist models appropriate social behaviors and clients role-play and rehearse them
panic disorder
characterized by recurrent panic attacks (= sudden occurping episodes of panic in which certain symptoms occur, e.g. heart palpitations, shortness of breath, hot and cold flashes)
panic disorder checklist
- unforseen panic attacks occur repeatedly
- one or more of the attacks precede either of the following symptoms: at least a month of continual concern about having additional attacks, or at least a month of dysfunctional behavior changes associated with the attacks
biological perspective on panic disorder
- initial theory: caused by abnormal norepinephrine activity in locus coeruleus
- recent theory: brain circuits and the amygdala are the root of the problem, an inherited predisposition
- treatment: drug therapies
cognitive-behavioral perspective on panic disorder
bodily sensations are misinterpreted as signs of medical catastrophe and controlled by avoidance and safety behaviors
- anxiety sensitivity may exist (=tendency to focus on biological sensations and interpret them as harmful)
- treatment: cognitive therapy – correct misinterpretations of bodily sensations
biological challenge test
procedure used to produce panic and assess panic disorder
obsession
persistent thoughts, ideas, or impulses that invade someone’s consciousness
- these thoughts feel both intrusive and foreign and attempting to ignore them causes anxiety
compulsion
behavior or mental act that someone thinks they must perform repetitively to prevent or reduce anxiety
- most people recognize that their behaviors are unreasonable
obsessive-compulsive disorder (OCD)
unreasonable or excessive obsessions or compulsions that interfere with daily functioning
- obsessions cause anxiety, the compulsions aim to prevent or reduce it
OCD checklist
- occurence of repeated obsessions, compulsions, or both
- take up considerable time and cause significant distress or impairment
psychodynamic perspective on OCD
obsession is the result of impulses of the id and compulsion is the result of a defensive act from the ego
- treatment: free association and therapist interpretation techniques to overcome conflicts
cognitive-behavioral perspective on OCD
disorder grows from human tendencies to have unwanted thoughts and to avoid negative outcomes, individuals attempt to neutralize thoughts with behaviors or with other thoughts
- treatment: cognitive-behavioral therapy focused on changing cognitive processes + exposure and response prevention in which clients are repeatedly exposed to objects or situations that produce obsessions and compulsions and are instructed to resist performing the compulsive behaviors
biological perspective on OCD
links disorder to 2 main causes:
- abnormal serotonin activity – low activity
- abnormal brain structure and functioning – orbitofrontal cortex and caudate nuclei overactivation
- treatment: drug therapies to raise serotonin levels
OCD related disorders
- hoarding disorder: the need to save items and not wanting to get rid of them
- trichotillomania (hair-pulling disorder): repeatedly pulling out your own hair
- excoriation (skin-picking disorder): repeatedly picking your own skin, which results in wounds
- body dysmorphic disorder: obsessively believeing that you have a flaw in your physical appearance
