Second Mid.doc

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22 Apr 2012
Second Mid-term notes for PSYB32
Chapter 6: Anxiety Disorders
-anxiety is characterized as an unpleasant feeling of fear and apprehension,
disorders of anxiety are when subjectively experienced feelings of anxiety are
clearly present and are under 6 categories : phobias, panic disorder,
generalized anxiety disorder ( GAD), obsessive- compulsive disorder ( OCD) ,
post-traumatic stress disorder ( PSTD) and acute stress disorder , there is a
great deal of co-morbidity among the anxiety disorder because: a) symptoms
are not disorder specific, b) etiological factors, applicable to more than one
- high rate of childhood maltreatment has been linked to greater symptom
severity and poorer quality of life
- most common psychological disorder with 1 in 5 ,one year prevalence and
life time prevalence is 10.6% and 16.6% respectively
- has an early age of onset , and there is a clear gender difference
- must interfere with their home, school, work and social life, also independent
risk factor for suicide attempts ,co-morbidity is strongest with the depressive
- specific phobias have examined responses across three conditions: negative
emotion, positive emotion and neutral condition
Definition: a disrupting, fear mediated avoidance that is out of proportion to
the danger actually posed and is recognized by the sufferer as groundless,
suffers from intense distress and social or occupational impairment because of
the anxiety.
Specific phobias:
- unwarranted fears caused by the presence or anticipation of a specific
object or situation
- DSM sub-divides it into : blood, injuries, and injections; situations,
animals, and the natural environment
- Lifetime prevalence of 1 in 10 age of onset is around 10 yrs
Social phobias :
- persistent, irrational fears linked generally to the presence of other
- fearing that they will reveal signs of anxiousness or behave in an
embarrassing way
- can be either generalized or specific
- generalized SP involve many different interpersonal situation, earlier
age of onset, more co-morbidity ( depression and alcohol abuse ) more
severe impairment
- three factor (National Co-morbidity Survey) 1. social interaction fears,
2.observation fears and 3) public speaking fears
- linked with self medication
- onset during adolescence when social interaction and social awareness
play a much more important role in life
Etiology: Behavioural
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Aviodance Conditioning:
- assumes that it is a result of learned avoidance responses which is
based on Mowrers two factor theory:
oclassical conditioning ( fear of neutral stimuls ( cs) if paried with
an intrinsic painful or frightening event ( UCS)
oa person can learn to reduce this conditioned fear by escaping
from or avoiding the CS , operant conditioning, reinforcing
consequences of avoiding fear
- learning to fear something as a result of an unpleasant experience with
it, imitation of others
- this type of learning is otherwise called vicarious learning
Prepared learning:
-people ten to fear only certain objects, events and situations ,
- the fact that certain stimuli to which an organism is physiologically
prepared to be sensitive
- why do some people who are exposed to trauma do not develop
enduring fear provides the hypothesis that there is a cognitive
- in other words a tendency to believe that similar traumatic experiences
will occur in the future
Social Skills Defecit:
- inappropriate behaviour or a lack of social skills as the cause of social
anxiety , the individuals has not learned how to behave
Cognitive theories :
- anxiety is related to being morelikelu to aattend to nehatibve stimuli to
interpret ambigious information as threatenninf are more likelt than
postie ones to occue in the dutuew
- themes of disgust that occie without consciour introspection or
- 1. attentional bias to focus on negative social information perceived
criticism and hostile reactions form others and interpeet ambigious
situations as negative 2. perfectionistics standards fo r accepted social
performances and 3. a high degree of public self consicoucness
Biological theories:
- maybe one differs from the ease by which their ANS become aroused,
laible or jumpy, individuals are those whose autonomic systems are
readily aroused by a wide range of stimuli
- a dimension known as automatic liability
- 64% of people with ( blood injection phobias) have at least one first
degree reltive with the same disorder where as prevelance in the
general population is 3-4%
- 1. genetic complexity ( disorder likely reflect the additive effects of
multiple loci, 2. phenotypic complexity is aproblem because their
complexity likely transcend DSM categories
- These ‘issues’ make it difficult to assume a casual biological factor to
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Psychoanalyctic theories:
- defense against the anxiety produced by represeed id impulses, this is
displaces from the feared id impulses and moved to an object or
situation that has some symbolic connection to it
- based on interpersonal problems form childhood
Therapies :
- Systematic desensitization developed by Wolpe , imagines a series of
increasingly frightening scenes while in a state of deep relaxation ,
effective with eliminating or at least reducing phobias
-Exposure based treatment produced large effect , in vivo exposure:
virtual realities involve exposure to stimulate hat come in the form of
computer generated graphics
-In modelling therapies fearful clients are exposed to films or live
demonstrates of other popele interacting fearlessly with the phobic
object , flooding: is a technique in which the client exposed to the source
of the phobia at full intensity, the extreme discomfort make s it a last
resort when graduates exposure has not worked.
- Exposure us an inevitable aspect of any operant shaping of approach
behaviours , CBT techniques attend to both fear and avoidance, using
exposure techniques to reduce fear and operant shaping approach
- A person with a phobia ahs often settled into an existence in which other
people cater to his or her incapacities in way reinforcing the person
phobia – this is known as secondary gain
- Ost’s one session exposure treatment for phobias, highly intensive and
last for many hours, results indicate that this one day treatment is
highly-effective and treatment gains tend to persist over time
- Cognitive approaches: central focus is that phobic fear is recognized by
the individual as excessive or unreasonable, if the person already
acknowledge that the fear is of something harmless what use can it alter
the persons thought about it
- CBT case formulation
- biological approaches : reduce anxiety like sedaives tranquilizers or
anxiolytics, barbituates ( highly addictive though), valium and xanax,
benzodiazepines are addictive and can produce a severe withdrawal
syndrome , monoamine oxidase inhibitors fared better in treat ment of
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