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Chapter 5

Chapter 5- Anxiety Disorders.docx

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Psychology 2310A/B
Rod Martin

Abnormal Psychology 2310 October 2013 Chapter 5- Anxiety Disorders The Characteristics of Anxiety Three distinctive components of emotion that interrelate: 1. Physiological: changes in the autonomic nervous system resulting in respiratory, cardiovascular, and muscular changes 2. Cognitive: alternations in consciousness (E.g. attention levels) 3. Behavioral: consequences of certain emotions Anxiety: not an immediate danger to physical safety but rather our psychological well being  future orientated Fear: immediate danger to your safety or well-being  present orientated Fight or Flight Response: prompts a person to either flee from a dangerous situation or stand and fight; physiological symptoms and the body’s preparation to respond to danger Panic: extreme fear reaction triggered even though there is nothing to be afraid of a “false alarm” Historical Perspective Freud:  Earliest theorists to focus on anxiety  Anxiety used to be covered under neurosis category  Believed there was a difference between objective fears and neurotic anxiety o Neurotic anxiety: signal to the ego that an unacceptable drive is pressing for conscious representation  Anxiety occurred when defense mechanisms failed to repress painful memories, impulses and thoughts Etiology Biological Factors Genetics  There are no firm conclusions about the genetic background of anxiety disorders o Combination of genetics, environment o Polygenetic – not just a single gene o General temperamental vulnerability – neuroticism o Vulnerability likely not to a specific disorder Neuro-anatomy and Neurotransmitters Research through animals about the neurobiology of fear, anxiety and panic o Norepinephrine  Locus ceruleus o Serotonin o GABA – inhibitory transmitter in fear circuits Abnormal Psychology 2310 October 2013 Chapter 5- Anxiety Disorders  Higher cortical areas are necessary for extinguishing conditions fears  No neurotransmitter system is solely dedicated to the expression of fear, anxiety, and panic o Affect an assortment of functions Biological Factors • Genetics • Neurobiology Psychological Factors Social/Environmental • intolerance of uncertainty Factors • conditioning • stressful life events • anxiety sensitivity/ physicalger • early life experiences sensations Hyperexcitability of fear circuits in brain o Amygdala (most important center in the brain associated w/ fear and anxiety), locus coruleus, hippocampus, thalamus, hypothalamus, periaqueductal grey o Can function rapidly, without input from cortex Psychological Factors Behavioral Factors  Two Factor Theory (Mowrer): fears develop through a process of classical conditioning and are maintained through operant conditioning. Two phases: a) Neutral stimulus is paired with an inherently negative stimulus (CS with UCS) b) Anxiety is lessened by avoiding the CS *Not an adequate job of explaining all phobias  Vicarious Learning: Fears can be developed by observing other peoples reactions  Hearing fear- relevant info can also lead to the development of fears Cognitive Factors  Aaron Beck: people are afraid because of the biased perceptions that they have of the world, the future, and themselves o Anxious people often see the world as dangerous o Feel they are helpless and vulnerable o Focus on information that is relevant to fears Abnormal Psychology 2310 October 2013 Chapter 5- Anxiety Disorders  Schemas, information processing biases, and automatic thoughts are relevant to the development and maintenance of anxiety as well Cognitive Factors in Anxiety Disorders  Pessimistic thoughts  Perceived lack of control  Interceptive awareness – awareness of bodily sensations  Anxiety sensitivity – belief that anxiety symptoms have harmful consequences  Catastrophic thinking  Attention biases – focus on threats, negative social cues, weaknesses, etc.  Automatic thoughts, hyper vigilance  Maladaptive beliefs – “I must have everyone’s approval”; “I must always be prepared for any possible danger.”  Intolerance of uncertainty Interpersonal Factors  Anxious parents interact with their children in less warm and positive ways o Foster beliefs of helplessness and uncontrollability contribute to vulnerability of anxiety  Early Attachment Relationship: early parent- child interactions can lead to development of general belief systems (internal working models) o Parents who are inconsistent in their care giving  Anxious Ambivalent: attachment; learn to fear being abandoned by loved ones (anxiety problems seen when at 17.5 years old) Anxiety Disorders Panic Disorder and Agoraphobia Description: experience recurrent and unexpected panic attacks  At least 2 attacks followed by persistent concerns about: having additional attacks or ramifications of the attack  Often associated with other mental disorders (depression, substance abuse, etc.)  Have many financial and interpersonal costs  CBT is the most well studied and empirically supported treatment Panic Attacks: sudden rush of intense fear or discomfort while experiencing a number of physiological and psychological symptoms  Must have at least 4 of the 16 symptoms present  Develops suddenly, reaches peak within 10 minutes  These attacks occur with obvious triggers though panic is a common feature of other anxiety disorders as well Abnormal Psychology 2310 October 2013 Chapter 5- Anxiety Disorders Agoraphobia: anxiety about being in places/ situations where it is difficult to escape (line ups/ crowds), or which they would be lacking help should a panic attack occur (being alone)  “Panic disorder w/ agoraphobia” persistent avoidance of situations Diagnosis and Assessment  Experience un-cued panic attacks along with the fear of recurrence  Ideal assessment strategy: o Clinical interview: semi- structured covering Axis 1 disorders o Behavioral measurement: assesses avoidance and severity  Behavioral Avoidance Test (BAT): patients enter situations that they would usually avoid and rate the degree of anticipatory anxiety and actual anxiety they experience  Symptom Induction Test: asked to mimic symptoms in order to bring on panic (hyperventilate, spin in a chair) o Psycho -physiological tests: measuring physiological symptoms which having a panic attack o Self- report methods Etiology 1. Panic disorder tends to run in families though there are inconsistent genetic markers 2. Evidence that biological challenges induce panic attacks in individuals with panic disorder more frequently than they do in non-psychiatric controls o Biological Challenge: presentation of a stimulus intended to induce physiological changes associated with anxiety Nocturnal Panic: attacks occurring during lighter stages of sleep, between 1 and 3 hours of falling asleep o Cognitive experience: a fear of letting go Catastrophic Misinterpretation: when one misinterprets normal bodily sensations as signals that something is going extremely wrong (standing up and getting dizzy for a short period of time) Anxiety Sensitivity: belief that somatic symptoms related to anxiety will have negative consequences that extend beyond the panic episode itself Barlow’s Alarm Theory of Panic: proposes that a “true alarm” occurs when there is a real threat- our bodies produce an adaptive physiological response that allows us to face the feared object or flee from the situation. In some Abnormal Psychology 2310 October 2013 Chapter 5- Anxiety Disorders instances, this alarm system can be activated by emotional cues… a “false alarm” Specific Phobia Description: extreme fears marked with distress and significantly disrupt ones daily life; excessive and unreasonable  Higher prevalence rates in females typically animal and situational  May or may not involve a traumatic experience Diagnosis and Assessment  Must be marked and persistent fear of an object or situation producing an anxiety reaction  Interferes with everyday functioning, causes considerable distress  Having a phobia from one of the subtypes increases ones probability of developing another phobia within the same category: o Animal Type: the phobic object is an animal or insect o Natural Environment Type: the phobic object is part of the natural environment (e.g. thunderstorms, water, heights) o Blood Injection Injury Type: the person fears seeing blood or and injury and fears an injection or other type of invasive medical procedure o Situational Type: the person fears specific situations such as bridges, public transportation, and enclosed spaces o Other Type: all other phobias not covered; extreme fears of choking, vomiting, and clowns  Illness phobia: an intense fear of developing a disease that the person currently does not have (different from hypochondriacs) Etiology Classical conditioning theory of fear is criticized …  Equipotentiality Premise: assumes that all neutral stimuli have an equal potential for becoming phobias but rather there is a select number of stimuli the chances of being afraid of a lamp are equal to that of a snake  Nonassociative model: proposes that the process of evolution causes humans to be fearful to a select group of stimuli; no learning experience is necessary o E.g. people fear heights when they consider that one bad experience with falling could be deadly  Babies are born w/ prewired anxiety (stranger anxiety between 4-9 months)  Those who fail to habituate to certain stimuli have phobias  Associative and nonassociative models combine… Abnormal Psychology 2310 October 2013 Chapter 5- Anxiety Disorders o Biological Preparedness (Seligman): the process of natural selection has equipped humans with the predisposition to fear objects and situations that represented threats to our species  Explains why is it easier to develop a snake fear than a fear of lamps Disgust Sensitivity: the degree in which people are susceptible to being disgusted by a variety of stimuli such as certain bugs, types of food, small animals  Develop phobia because the object is disgusting and possibly contaminated o The cause of phobias may not always involve only fear of danger but other emotions as well Social Phobia/ Social Anxiety Disorder Description: marked and persistent fear of social or performance- related situations; fear of acting in a humiliating and embarrassing way  Frequently worry about what others will think of them  Must last at least 6 months  Typically begin in mid tens  Have low self esteem and increased risk for mood disorders o Majority have one or more additional psychiatric disorders Non- Generalized Social Phobia: fear specific social situations or activities (E.g. casual speaking, eating, formal speeches) Generalized Social Phobia: fear of most social settings and interactions  Are well aware of their excessive fears  Avoid social situations; unavoidable situations are endured with intense anxiety Diagnosis and Assessment  Structured or semi structured interviews o Asses social phobias and other psychiatric problems  Self reports o Quantify thoughts, feelings, behaviors associated w/ social anxiety
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