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Anxiety chapter

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York University
PSYC 3140
Gerry Goldberg

CHAPTER 6 – ANXIETY, OBSESSIVE-COMPULSIVE, AND POST-TRAUMATIC STRESS DISORDERS ANXIETY • Anxiety – unpleasant feeling of fear and apprehension accompanied by increased physiological arousal. It is considered a drive that mediates between a threatening situation and avoidance behaviour. Anxiety can be assessed by self-report, by measuring physiological arousal, and by observing overt behavior • PTSD is now recognized as a stress disorder in DSM-5 • Anxiety has 2 distinguishable components: o physiological - heightened level of arousal and physiological activation; heightened arousal and tension as reflected by symptoms such as a higher heart rate o cognitive – subjective perception of the anxious arousal and the associated cognitive processes: worry and rumination • anxiety is “future-focused” – emphasis on what could happen • main component: persistence uncontrollable worry about many themes • test anxiety – feeling of tension, apprehension, and worry in actual or anticipated testing situations; usually involves physiological symptoms and cognitive symptoms • test-irrelevant thinking – tendency for the mind to wander when it is too difficult to concentrate • anxiety is often overwhelming and is associated with a deficient sense of self • anxiety becomes a problem when: it is chronic, relatively intense, associated with role impairment, and causes significant distress for self or others • Craske’s study in 2012 – placed people in different situations and measured their reactions to reveal their level of anxiety • Anxiety Disorders – disorders in which fear or tension is overriding and the primary disturbance; Diagnosed when subjectively experienced feelings of anxiety are clearly present • Summary of Anxiety Disorders: o Phobia – fear and 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, such as dizziness, rapid heart rate, and trembling, accompanied by terror and feelings of impending doom; sometimes accompanied by agoraphobia, a fear of being in public places o Generalized Anxiety Disorder – Persistent, uncontrollable worry, often about minor things o Separation Anxiety – the anxious arousal and worry about losing contact with and proximity to other people, typically significant others • About 1 in 5 have an anxiety disorder(2009) 16% of women & 9% of men over one year ; highest prevalent was found in women age 15 to 24 • Separation Anxiety – results from not having contact or the possibility of losing contact with attachment figures (relevant in younger people, but is also being developed in older figures) PHOBIAS • Phobia – anxiety disorder where there is an intense fear and avoidance of specific objects and situations, recognized as irrational by the individual; disrupting, fear-mediated avoidance that is out of proportion to the danger actually posed and is recognized by the sufferer as groundless • Term usually implies that the person suffers intense distress and social or occupational impairment because of the anxiety • Calgary study by Costello 1982, found that 5% of women were “incapacitated” by their phobias • Taken from Greek God “Phobos” who frightened his enemies • Types of Phobias: claustrophobia (closed spaces), agoraphobia (public places), acrophobia (heights), ergasiophobia (working), pnigophobia (choking), taphephobia (being buried alive), mysophobia (contamination and dirt that plagues people) – Howie Mandel, paleng (fear of the cold) • Nomophobia – reflection of our increasing reliance on technology; pathological fear of remaining out of touch with technology that is experienced by people who are overly dependent on their mobile phones or computers (ie: mobile phone phobia) • Freud’s Case Little Hans who was afraid of horses – black things around their mouths and eyes resembled his father’s moustache and eye glasses (who he also feared) SPECIFIC PHOBIAS • Specific Phobias – unwarranted fear and avoidance of a specific object or circumstance; caused by the presence or anticipation of a specific object or situation • Fears can be grouped into 1 of 5 factors: 1. Agoraphobia, 2. Fears of heights, or water, 3. Threat fears (blood/needles, storms/thunders), 4. Fears of being observed, 5. Speaking fears • Phobias have a duration of an average of 20 years, and only 8% of people with phobias receive treatment • Most common phobias in order: animals, heights, being in closed spaces, flying, being in or on water, going to the dentist, seeing blood or getting an injections, and storms/thunder/lightning SOCIAL PHOBIAS • Social Phobias – a collection of fears linked to the presence of other people and a sense of not being able to do the expected to right thing in public; persistent, irrational fears linked generally to the presence of other people • Social phobias can be generalised or specific • Cox, Clara, Sareen, and Stein (2008) found three-factor model composed of 1. Social interaction fears, 2. Observation fears, and 3. Public speaking fears • Social phobias have a high conjunction rate with generalized anxiety disorder, specific phobias, panic disorder, avoidant personality disorder, and mood disorders. Also with heavy drinking and alcohol dependence, and are especially vulnerable to marijuana-related problems • Prevalence of social phobia was higher among people who had never married or were divorced, had not completed secondary education, had lower income or were unemployed, reported lacking adequate social support, reported low quality of life, or had a chronic physical condition ETIOLOGY OF PHOBIAS • Behavioral theories: focus on learning as the way in which phobias are acquired • Avoidance Conditioning: learned avoidance responses; 1. Via classical conditioning, a person can learn to fear the neutral stimulus (CS) if it is paired with an intrinsically painful or frightening event (UCS). 2. Person can learn to reduce this conditioned fear by escaping from or avoiding the CS (aka operant conditioning-the response is maintained by enforcing consequences of reducing fear) • Little Albert – fear of white rats by Watson & Rayner (1920) – classically conditioned to develop a fear of white rats • Modeling – a person can learn fears through imitating the reactions of others • Vicarious Learning – learning of fear by observing others • Bandura & Rosenthal study (1966): people reacted emotionally to a harmless stimulant event (model would be electrocuted every time the buzzer sounded) • Prepared Learning – neutral stimuli = prepared stimuli (ie: rats readily learn to associate taste with nausea but now with shock when the two are paired – McGowan & Green, 1972) • Cook & Mineka (1989) – four groups of monkeys watching videos; not every stimulus is capable of becoming a source of acquired fear • Possibly important reasons to develop phobias: Cognitive diathesis (predisposition) – a tendency to believe that similar traumatic experiences will occur in the future [Dinardo with the dog fear], and not being able to control the environment (Mineka & Zinbarg, 1996), OR aversive conditioning experiences, such as severe teasing, may help to develop a social phobia SOCIAL SKILLS DEFICITS IN SOCIAL PHOBIAS • Inappropriate behavior or lack of social skills may cause social anxiety • Cognitive Theories: focus on how thought processes can serve as a diathesis and on how thoughts can maintain a phobia or anxiety, which is related to being more likely to attend to negative stimuli, interpret ambiguous information as threatening, and to believe that negative events are more likely to occur than positive ones in the future. • Socially anxious people are concerned about evaluation, highly aware of the image the present to others, and fear that they may have a negative impact on other people/worry about causing discomfort in other people • Clark (2001) advises against exposure as usual • “widening the bandwidth” – a technique that instructs patients to act in ways that they feel are totally unacceptable and then objectively watch for the lack of a negative reaction from other people o An external focus is further facilitated by techniques such as role playing • Related research has shown that social phobia is linked with excessive self-criticism • Post-event process (PEP) – a type of cognitive processing engaged in by anxiety-prone individuals who think about things they should have or could have done after an event to make it run out in a more favorable way • Pre-disposing Biological Factors: examined responses across three conditions: negative emotion, positive emotion, and neutral conditions • People with these disorders have greater activity in two areas assosciated with negative emotional responses: the amygdala and the insula (it is the right amygdala that is implicated in PTSD) • Autonomic Liability – tendency for the autonomic nervous system to be easily aroused • Psychoanalytical theories: Freud was the first to attempt to account systematically for the development of phobic behavior; he states that phobias are a defence against the anxiety produced by repressed id impulses • Arieti proposed that the repression stems from a particular interpersonal problem of childhood rather than from an id impulse PANIC DISORDER • Panic Disorder – anxiety disorder in which a person suffers a sudden and often inexplicable attack of a host of jarring symptoms (ie: difficulty breathing, heart palpitations, dizziness, trembling, terror, and feelings of impending doom • Depersonalization – an alteration in perception of the self in which the individual loses a sense of reality and feels estranged from the self and perhaps separated from the body; feeling of being outside one’s body • Derealization – loss of the sense that the surroundings are real; a feeling of the world’s not being real, as well as fears of losing control, of going crazy, or even dying • Panic attacks may occur frequently, perhaps once a week or more, and usually last for minutes, and rarely for hours • Panic attacks are sometimes linked to specific situations (referred to as cued panic attacks when they are associated strongly with situational triggers, and uncued attacks happen in unexpected situations) • The exclusive presence of cued attacks most likely reflects the presence of a phobia • Agoraphobia – a cluster of fears centring on being in public places, open spaces, and leaving home. Also a fear of being unable to escape or find help should one become incapacitated • Biological Theories: pan
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