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Chapter 6

Chapter 6 - Detailed

Course Code
Konstantine Zakzanis

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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
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) because...
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
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
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Specific Phobias
Social Phobia: unwarranted fears caused by the presence or anticipation of a specific object or
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
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
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:
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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)
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
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
How people’s thought processes can serve as a diathesis and how thoughts can maintain a
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
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