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PSYB32H3 Lecture Notes - Psychoanalysis, Generalized Anxiety Disorder, Panic Disorder

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Konstantine Zakzanis

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Chapter 6: Anxiety
Anxiety is the unpleasant feeling of fear & apprehension
Anxiety also plays an important role in the study of the psychology of normal
people, for very few of us go through even a week of our lives without
experiencing some measure of anxiety or fear
Anxiety disorders are diagnosed when subjectively experienced feelings of
anxiety are clearly present. DSM-IV-TR proposed six categories: phobias, panic
disorder, generalized anxiety disorder (GAD), OCD, post-traumatic stress
disorder (PTSD), & acute stress disorder
Often someone with one anxiety disorder meets the diagnostic criteria for another
disorder, as well. This comorbidity among anxiety disorders arises for two
reasons: 1) symptoms of the various anxiety disorders are not entirely disorder
specific. 2) the etiological factors that give rise to various anxiety disorders may
be applicable to more than one disorder
Physical or sexual abuse during childhood may increase a person’s risk for
developing several disorders
The anxiety disorders are the most common psychological disorders
According to the Ontario Mental Health Supplement study, 16% of women and
9% of men suffered from anxiety disorders in the preceding year. The highest
one-year prevalence rates (almost 1 in 5) were found in women 15-24 years of age
Although for both men & women the rates of anxiety disorders decrease with age
A majority of Canadians who met criteria for an anxiety disorder reported that it
interfered with their home, school, work, & social work
Young Canadians from the CCHS revealed that those with an anxiety disorder
were less likely to seek help from any mental health service, relative to those with
a mood disorder
Work stress was independently associated with these disorders
It should be noted at the outset that a growing body of evidence suggests that
PTSD & GAD have more in common with major depression than with other
anxiety disorders
Psychopathologies define a phobia as a disturbing, fear-mediated avoidance that
is out of proportion to the dangers actually posed & is recognized by the sufferer
as groundless
The term phobia usually implies that the person suffers intense distress & social
or occupational impairment b/c of the anxiety
Claustrophobia is the fear of closed spaces; agoraphobia, fear of public places; &
acrophobia, fear of heights; ergasiophobia, fear of writing; pnigophobia, fear of
chocking; taphephobia, fear of being buried alive; Anglophobia, fear of Englan;
mysophobia, fear of contamination & dirt
Psychoanalysts focus on the content of the phobia & see the phobic object as a
symbol of an important unconscious fear
Psychoanalysts believe that the content of phobias has important symbolic value
Behaviourists tend to ignore the content of the phobia & focus instead of its
Specific Phobias

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Specific phobia are unwarranted fears caused by the presence or anticipation of a
specific object or situation
DSM-IV-TR subdivides these phobias according to the source of the fear: blood,
injuries, & injections; situations; animals; & the natural environment
Recent empirical research involving a nationally representative sample suggests
that fears can be grouped into one of five factors: 1) agoraphobia, 2) fears of
height or water, 3) threat fears, 4) fears of being observed, & 5) speaking fears
Lifetime prevalence of specific phobias that involve specific objects was
estimated at 7% for men & 16% for women in the NCS
Lifetime prevalence in the NCS-R was 8.9% for men & 15.8% for women
The specific fear focused on in a phobia can vary cross-culturally
Social Phobias
Social phobias are persistent, irrational fears linked generally to the presence of
other people
Individuals with a social phobias try to avoid particular situations in which they
might be evaluated, fearing that they will reveal signs of anxiousness or behave in
an embarrassing way
Generalized social phobias involve many different interpersonal situations,
specific social phobias involve intense fear of one particular situation
People with the generalized type have an earlier age of onset, more comorbidity
with other disorders, such as depression & alcohol abuse, & more severe
Social phobias are fairly common, with a lifetime prevalence in the NCR of 11%
in men & 15% in women
The NCR-R obtained rates of 11.1% & 13% for men & women
A telephone survey of 499 residents from Winnipeg illustrates the different
findings can occur as a result of the stringency of criteria used
Social phobias have a high comorbidity rate with other disorders & often occur in
conjunction with generalized anxiety disorder, specific phobias, panic disorder,
avoidant personality disorder, & mood disorder
Onset generally takes place during adolescence, when social awareness &
interaction with others become much more important in a person’s life
Analyses of data from Ontario’s Mental Health Supplement found that diagnosed
social phobia was associated with marked dissatisfaction & low functioning in
terms of quality, & it was actually linked with dropping out of school
Vriends attempted to determine the rate of natural recovery from social phobia in
the community in 1.5-year longitudinal study of young German women &
reported that 64% were at least partially recovered & 36% showed full recovery
Predictors of recovery included being employed, no lifetime depression, fewer
than three lifetime psychiatric disorders, less psychopathology, less anxiety
sensitivity, fewer daily hassles, & better mental health
Etiology of Phobias
Psychoanalytic Theories
According to Freud, phobias are a defence against the anxiety produced by
repressed id impulses. This anxiety is displaced from the feared id impulse &
moved to an object or situation that has some symbolic connection to it

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The phobia is the ego’s way of warding off a confrontation with the real problem,
a repressed childhood conflict
Arieti proposed that the repression stems from a particular interpersonal problem
of childhood rather than from an id impulse
Behavioural Theories
Behavioural theories focus on learning as the way in which phobias are acquired
The main behavioural account of phobias is that such reactions are learned
avoidance responses
Two-factor theory originally proposed by Morwrer, holds that phobias develop
from two related sets of learning: 1) via classical conditioning, a person can learn
to fear a neutral stimulus (the CS) if it is paired with an intrinsically painful or
frightening event (the UCS). 2) the person can learn to reduce this conditioned
fear by escaping from or avoiding the CS. This 2nd kind of learning is assumed to
be operant conditioning; the response is maintained by its reinforcing
consequence of reducing fear
The evidence demonstrates only the possibility that some fears may be acquired in
this particular way
Recent research by Olsson & Phelps has demonstrated that Pavlovian
conditioning & observational learning via imitation can both play a role
Considerable evidence indicates that fear is extinguished rather quickly when the
CS is presented a few times without the reinforcement of moderate levels of
A phobia of a specific object or situation has sometimes been reported after a
particularly painful experience with that object
Clinical reports suggest that phobias may develop without prior frightening
A person can also learn fears through imitating the reactions of others
The learning of fears by observing other is generally referred to as vicarious
Bandura & Rosenthal reacted emotionally to a harmless stimulus even though
they had no direct contact with a noxious event
Vicarious learning may also be accomplished through verbal instructions. Thus,
phobic reactions can be learned through another’s description of what could
The anxious-rearing model is based on the premise that anxiety disorders in
children are due to constant parental warning that increase anxiety in the child
People tend to fear only certain objects & events, such as spiders, snakes, &
heights, but not other, such as lambs
The fact that certain neutral stimuli, called prepared stimuli, are more likely than
others to become classically conditioned stimuli may account for this tendency
Conditioning experiments that show quick extinction of fear may have used CSs
that the organism was not prepared to associate with UCSs
Prepared learning is also relevant to learning fear by modelling
Cook & Mineka demonstrating that not every stimulus is capable of becoming a
source of acquired fear
A cognitive diathesis (predisposition)- a tendency to believe that similar traumatic
experiences will occur in the future- may be important in developing a phobia
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