Lecture 3: Anxiety, OCD, and Related Orders

Question 1

fear

Answer 1

emotional and physiological response to a perceived threat to your well-being

Question 2

anxiety

Answer 2

emotional and physiological response to a vague sense of threat or danger

Question 3

generalized anxiety disorder (GAD)

Answer 3

excessive feelings of anxeity and worry about numerous events and activities

Question 4

checklist for generalized anxiety disorder

Answer 4

• 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

Question 5

sociocultural perspective on GAD

Answer 5

disorder occurs because of dangerous ongoing social conditions (e.g. poverty, race, ethnicity)

Question 6

psychodynamic perspective on GAD

Answer 6

• 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

Question 7

humanistic perspective on GAD

Answer 7

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

Question 8

cognitive-behavioral perspective on GAD

Answer 8

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

Question 9

basic irrational assumptions (Ellis)

Answer 9

irrational beliefs that make people act in unsuitable ways

Question 10

silent assumptions (Beck)

Answer 10

e.g. “it is always best to assume the worst”

Question 11

metacognitive theory

Answer 11

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

Question 12

intolerance of uncertainty theory

Answer 12

people with GAD are unable to tolerate the possibility (however small) that negative things may occur

Question 13

avoidance theory

Answer 13

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

Question 14

cognitive-behavioral therapies for GAD

Answer 14

• 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

Question 15

biological perspective on GAD

Answer 15

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)

Question 16

biologogical perspective treatment for GAD

Answer 16

• drug therapy
• relaxation training
• biofeedback

Question 17

drug therapy

Answer 17

• barbiturates (sedative-hypnotic drugs): drugs that calm people down and help them fall asleep
• benozodiazepines
• antidepressants and antipsychotics

Question 18

relaxation training

Answer 18

teaches people to relax when they want to, so that they can calm themselves in times of stress

Question 19

biofeedback

Answer 19

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

Question 20

phobia

Answer 20

more intense and persistent fear, desire to avoid feared object/situation and create distress that interferes with functioning

Question 21

agoraphobia

Answer 21

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

Question 22

specific phobias

Answer 22

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

Question 23

cognitive-behavioral perspective on phobias

Answer 23

phobia is a result of conditioning (learned behavior)
- phobia can also develop through modeling (observing and imitating others that have a phobia)

Question 24

behavioral-evolutionary perspective on phobias

Answer 24

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)

Question 25

treatment for specific phobias

Answer 25

exposure treatment

Question 26

exposure treatment

Answer 26

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

Question 27

treatment for agoraphobia

Answer 27

focuses on gradual repeated exposure to outside places paired with additional help

Question 28

social anxiety disorder

Answer 28

severe, persistent, and irrational fear of social or performance situations in which they may face scrutiny by others and possibly feel embarrassment

Question 29

social anxiety disorder checklist

Answer 29

- 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

Question 30

cognitive-behavioral perspective on social anxiety disorder

Answer 30

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

Question 31

treatments for social anxiety disorder

Answer 31

- 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

Question 32

panic disorder

Answer 32

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)

Question 33

panic disorder checklist

Answer 33

- 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

Question 34

biological perspective on panic disorder

Answer 34

- 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

Question 35

cognitive-behavioral perspective on panic disorder

Answer 35

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

Question 36

biological challenge test

Answer 36

procedure used to produce panic and assess panic disorder

Question 37

obsession

Answer 37

persistent thoughts, ideas, or impulses that invade someone's consciousness - these thoughts feel both intrusive and foreign and attempting to ignore them causes anxiety

Question 38

compulsion

Answer 38

behavior or mental act that someone thinks they must perform repetitively to prevent or reduce anxiety - most people recognize that their behaviors are unreasonable

Question 39

obsessive-compulsive disorder (OCD)

Answer 39

unreasonable or excessive obsessions or compulsions that interfere with daily functioning - obsessions cause anxiety, the compulsions aim to prevent or reduce it

Question 40

OCD checklist

Answer 40

- occurence of repeated obsessions, compulsions, or both - take up considerable time and cause significant distress or impairment

Question 41

psychodynamic perspective on OCD

Answer 41

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

Question 42

cognitive-behavioral perspective on OCD

Answer 42

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

Question 43

biological perspective on OCD

Answer 43

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

Question 44

OCD related disorders

Answer 44

- 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