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PSYB32 Chapter 6

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University of Toronto St. George
Konstantine Zakzanis

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 o Phobias Fear & avoidance of objects or situations that do not present any real danger o Panic 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 o Generalized anxiety disorder Persistent, uncontrollable worry, often about minor things o Obsessive-compulsive disorder Experience of uncontrollable thoughts, impulses, or images (obsessions) and repetitive behaviours or mental acts (compulsions) o Posttraumatic 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 o Acute 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) because... o Symptoms of the various anxiety disorders are not entirely disorder specific o The etiological factors that give rise to various anxiety disorders may be applicable to more than one disorder 16% of women and 9% of men suffer from anxiety disorders (mostly women 15-24 years) Phobias 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 o Claustrophobia: fear of closed spaces o Agoraphobia: fear of public places o Acrophobia: fear of heights o Ergasiophobia: fear of writing o Pnigophobia: fear of choking o Taphenphobia: fear of being buried alive o Anglophobia: fear of England o Mysophobia: fear of contamination and dirt that plagues many ppl (eg. Howie mandel) 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 C h a p t e r 6 : A n x i e t y D i s o r d e r s Page 1 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 o Blood o Injuries & Injections o Situations o Animals o Natural Environment Recent empirical research involving a national representative sample suggests that fear can be grouped into 1 of 5 factors o Agoraphobia o Fears of heights of water o Threat fear (blood/needle, storms/thunder) o Fear or being observed o Speaking fears -These fears were then classified under the 2 higher-order categories specific & social fears Specific fear focused on in a phobia can vary cross culturally o Pa-leng: fear of the cold They worry that loss of body heat may be life threatening In Chinese culture o Taijinkyofu-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 Social phobias can be either generalized or specific, depending on the range of situations that are feared and avoided Generalized social phobia: involve many different interpersonal situations Specific social phobias: involve intense fear of one particular situation (public speaking) 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 Lifetime prevalence of 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 Freud (first to attempt to account systematically for the development of phobic behaviour) o Phobias are a defence against the anxiety produced by repressed id impulses o Anxiety is displaced from the feared id impulse and moved to an object or situation that has some symbolic connection to it Arieti o He proposed that Repression 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 C h a p t e r 6 : A n x i e t y D i s o r d e r s Page 1 o Phobias 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 its 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) o The evidence is very little in the laboratory (because you cant apply aversive stimuli to peopleethical considerations) and mixed outside the laboratory (some people do produce a phobia through bad experiences) Modelling o A person can learn a fear through imitating the reaction of others o Vicarious learning: learning of fear by observing others o Vicarious learning can also be accomplished through verbal instructions o Anxious-rearing model: anxiety disorders in children are due to constant parental warnings that increase anxiety in the child Prepared Learning o Prepared stimuli: certain neutral stimuli o prepared stimuli are more likely than others to become classically conditioned stimuli o People tend to fear only certain objects and events; spiders, snakes and heights o It is also relevant to learning fear by modelling A diathesis is needed So why do some people have this fear and others dont? o Cognitive diathesispredisposition (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 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 concerned of what others think of them and are preoccupied with hiding imperfections cognitive behavioural models of social phobia link social phobia with certain cognitive characteristics o Attention on negative social information o Perfectionistic standards for accepted social performances o High 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 o People
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