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PSYC3460 chapter 6 notes

Course Code
PSYC 3460
Stephen Kosempel

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Chapter 6: Anxiety Disorders
Anxiety is an unpleasant feeling of fear and apprehension
It can occur in many psychopathologies
An anxiety disorder is diagnosed when feelings of anxiety are clearly present
DSM proposes 6 categories
Fear & avoidance of objects or situations that do not present any real danger
oPanic disorder
Recurrent panic attacks involving a sudden onset of physiological symptoms (dizziness, rapid heart rate
etc) accompanied by terror and feeling of impending doom; sometimes accompanied with agoraphobia, a
fear of being in public places
oGeneralized anxiety disorder
Persistent, uncontrollable worry, often about minor things
oObsessive-compulsive disorder
Experience of uncontrollable thoughts, impulses, or images (obsessions) and repetitive behaviours or
mental acts (compulsions)
oPosttraumatic stress disorder
Aftermath of traumatic experience in which the person experiences increased arousal, avoidance of stimuli
associated with the event, and anxiety in recalling the event
oAcute stress disorder
Symptoms are the same as those of posttraumatic stress disorder, but last for 4 weeks or less
Often someone with one anxiety disorder meets the diagnostic criteria for another disorder as well (co-morbidity)
oSymptoms of the various anxiety disorders are not entirely disorder specific
oThe etiological factors that give rise to various anxiety disorders may be applicable to more than one disorder
16% and 9% of men suffer from anxiety disorders (mostly women 15-24 years)
Phobia: a disrupting, fear mediated avoidance that is out of proportion to the danger actually posed and is recognized by
the sufferer as groundless
Examples: fear of heights, closed spaces, snakes or spiders
The person suffers intense distress and social or occupational impairment because of the anxiety
For other phobia disorders, the suffix phobia is preceded by a Greek word for the feared object or situation
oClaustrophobia: fear of closed spaces
oAgoraphobia: fear of public places
oAcrophobia: fear of heights
oErgasiophobia: fear of writing
oPnigophobia: fear of choking
oTaphenphobia: fear of being buried alive
oAnglophobia: fear of England
Psychoanalysts believe that the content of the phobias has important symbolic value
Behaviourist ignore the content of the phobia and focus on its function instead
There are 2 types of phobias: Specific & Social Phobias
Specific Phobias
Specific Phobia: unwarranted fears caused by the presence or anticipation of a specific object or situation
DSM-IV subdivides these phobias according to the source of the fear
oInjuries & Injections
oNatural Environment
Recent empirical research involving a national representative sample suggests that fear can be grouped into 1 of 5 factors
oFears of heights of water
oThreat fear (blood/needle, storms/thunder)
oFear or being observed
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oSpeaking fears
oBut then these were classified under the higher-order categories – specific & social fears
Specific fear focused on in a phobia can vary cross culturally
oPa-leng: fear of the cold
They worry that loss of body heat may be life threatening
oTaijinkyofu-sho: fear of other people
Fear of embarrassing others
Social Phobias
Social Phobia: persistent, irrational fears linked generally to the presence of other people
They try to avoid particular situations where they might be evaluated, fearing they will reveal signs of anxiousness or
behave in an embarrassing way
People with generalized type have an earlier age of onset, more co-morbidity with other disorders (depression, alcohol
abuse, and more severe impairments)
Social phobias are fairly common
11% in men and 15% in women
Often occur in conjunction with generalized anxiety disorder, specific phobias, panic disorder, avoidant personality
disorder, and mood disorders
Onset is usually during adolescent when social awareness and interaction with others is important
There was a link between social phobia and dropping out of school
Etiology of Phobias
Psychoanalytic Theories
oPhobias are against the anxiety produced by repressed id impulses
oAnxiety is deplaced from the feared id impulse and moved to an object or situation that has some symbolic
connection to it
oRepression stems from a particular interpersonal problem of childhood rather than from an id impulse
Behavioural Theories
Learning is the way in which phobias are acquired
Types of learning (3)
Avoidance Conditioning
oPhobias reactions are learned avoidance responses
o(Watson & Rayner) Phobias develop from 2 related sets of learning:
Via classical conditioning (a person learns to fear a neutral stimulus when it’s paired with a painful or
frightening event). The person learns to reduce the conditioned fear by avoiding/escaping it
Via operant conditioning (response is maintained by its reinforcing consequence of reducing the fear)
oThe evidence is very little in the laboratory (because you can’t apply aversive stimuli to people) and mixed outside
(some people do produce a phobia through bad experiences)
oA person can learn a fear through imitating the reaction of others
oViscarious learning: learning of fear by observing others
oViscarious learning can also be accomplished through verbal instructions
oAnxious-rearing model: anxiety disorders in children are due to constant parental warnings that increase anxiety in
the child
Prepared Learning
oPrepared stimuli: certain neutral stimuli
oCertain prepared stimuli are more likely that others to become classically conditioned stimuli
oPeople tend to fear only certain objects and events; spiders, snakes and heights
oIt is also relevant to learning fear by modelling
So why do some people have this fear and others don’t?
oCognitive diathesis (a tendency to believe that a similar situation will happen in the future) is important in
developing a phobia
In sum, some phobias are developed through avoidance conditioning other are not
Social Skills Deficits in Social Phobias
This view says that a person develops social phobias because the individual has not learned how to behave so that he/she
feels comfortable with others OR the person repeatedly commits faux pas, is awkward and socially unskilled and is often
criticized by social companions
(Behaviourists say its caused by inappropriate behaviour or lack of social skills)
Cognitive Theories
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How peoples thought processes can serve as a diathesis and how thoughts can maintain a phobia
People are more likely to attend to negative stimuli, and believe that negative events are more likely than positive ones to
occur in the future
Socially anxious people are more considered of what others think of them and are preoccupied with hiding imperfections
(Clark & Wells, Rappee & Heimberg) link social phobia with certain cognitive characteristics
oAttention on negative social information
oPerfectionistic standards for accepted social performances
oHigh degree of public self-consciousness
Research has shown social phobia is linked with high self criticism
Predisposing Biological Factors
Maybe there is a biological malfunction (diathesis) that predisposes someone to develop a phobia to a stressful event
Autonomic nervous system
oPeople differ in how easily their ANS become aroused
oAutonomic liability: extent to which the ANS is involved in fear and phobic behaviour
oAutonomic liability may be genetically determined
Genetic Factors
oBlood-injection phobia is strongly related in first-degree relatives
oSocial and specific phobias are also higher in relatives
oTwin studies have shown a heritable component as well
oIn a study inhibited children are shown to be more than 5x more likely o develop a phobia later on
Therapies for Phobias
Psychoanalytic Approaches
Attempt to uncover the repressed conflicts believed to underlie the extreme fear and avoidance characteristic of these
Free association the analyst listens carefully to what the patients mentions in connection to the phobia; also to discover
the clues to the repressed origins of the phobia in the manifest content of dreams
Orthodox analyst – will look for conflicts related to sex or aggression
Arieti’s theorists – will encourage patients to examine their generalized fear or other people
Contemporary ego analyst – focus less on gaining historical insights and more on encouraging the patient to confront the
phobia (but they do view the phobia as resulting from some earlier problem)
Behavioural Approaches
Systematic desensitization was most widely used
The individual images a series of increasingly frightening scenes while in a deep relaxation
In vivo exposure - using real life situations instead of just imaging them
Virtual reality: using exposure through a realistic computer program
Blood-and-injection phobias are distinguished from others by the DSM-IV because of the distinctive reactions that people
have (instead of using relaxation techniques, they are asked to tense because their blood pressure drops and faint instead
of increasing)
For social phobia, social skills can help people with social phobias
Role-play - interpersonal encounters in the consulting room or in small therapy groups
Modelling – uses exposure to feared situations; they are exposed to a film or live demonstration of other people fearlessly
interacting with the phobic object
Flooding – client is exposed at full intensity
Behaviour therapists who favour operant conditioning techniques ignore the fear assumed to underlie phobias and attend
instead to the overt avoidance of phobia objects.
Many behaviour therapists attend to both fear and to avoidance, using techniques such as desensitization to reduce fear
and operant shaping to encourage approach
Secondary gain: when other people cater to the persons incapacities, in a way reinforcing the persons phobia
Overt behaviour can be positively reinforced, and avoidance discouraged by family and friends
Cognitive Approaches
There is no evidence that the elimination of irrational beliefs alone, without exposure to the fearsome situation, reduces
phobic avoidance
For social phobia, cognitive method with social skill training can help
Behavioural and cognitive approach both have them face their fears
Biological Approaches
Sedatives, tranquilizers or anxiolytics help reduce anxiety
Barbiturates were used before but were banned because of its addictiveness
Valium & Xanax are still used today
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