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1Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4Slides & Handouts by Karen Clay Rhines, Ph.D.
Chapter 4Chapter 4
Anxiety DisordersAnxiety Disorders
2Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
AnxietyAnxiety
What distinguishes fear from anxiety? Fear is a state of immediate alarm in
response to a serious, known threat to one’s well-being
Anxiety is a state of alarm in response to a vague sense of threat or danger
Both have the same physiological features: increase in respiration, perspiration, muscle tension, etc.
3Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
AnxietyAnxiety
Is the fear/anxiety response useful/adaptive? Yes, when the “fight or flight” response is
protective
However, when it is triggered by “inappropriate” situations, or when it is too severe or long-lasting, this response can be disabling
Can lead to the development of anxiety disorders
4Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Anxiety DisordersAnxiety Disorders
Most common mental disorders in the U.S. In any given year, 18% of the adult population in
the U.S. experiences one of the six DSM-IV-TR anxiety disorders
Only ~20% of these individuals seek treatment
Most individuals with one anxiety disorder suffer from a second disorder, as well
Anxiety disorders cost $42 billion each year in health care, lost wages, and lost productivity
5Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Anxiety DisordersAnxiety Disorders
Six disorders: Generalized anxiety disorder (GAD)
Phobias
Panic disorder
Obsessive-compulsive disorder (OCD)
Acute stress disorder
Posttraumatic stress disorder (PTSD)
6Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Generalized Anxiety Generalized Anxiety Disorder (GAD)Disorder (GAD)
Characterized by excessive anxiety under most circumstances and worry about practically anything Vague, intense concerns and fearfulness
Often called “free-floating” anxiety
“Danger” not a factor
Symptoms include restlessness, easy fatigue, irritability, muscle tension, and/or sleep disturbance Symptoms last at least six months
7Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
8Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Generalized Anxiety Generalized Anxiety Disorder (GAD)Disorder (GAD)
The disorder is common in Western society Affects ~3% of the population in any given year
and ~6% at sometime during their lives
Usually first appears in childhood or adolescence
Women are diagnosed more often than men by 2:1 ratio
Various theories have been offered to explain the development of the disorder…
9Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Sociocultural GAD: The Sociocultural PerspectivePerspective
According to this theory, GAD is most likely to develop in people faced with social conditions that truly are dangerous Research supports this theory (example: Three Mile
Island in 1979)
One of the most powerful forms of societal stress is poverty Why? Run-down communities, higher crime rates, fewer
educational and job opportunities, and greater risk for health problems
As would be predicted by the model, there are higher rates of GAD in lower SES groups
10Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Sociocultural GAD: The Sociocultural PerspectivePerspective
Since race is closely tied to income and job opportunities in the U.S., it is also tied to the prevalence of GAD In any given year, ~6% of African
Americans and 3% of Caucasians suffer from GAD
African American women have highest rates (6.6%)
11Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Sociocultural GAD: The Sociocultural PerspectivePerspective
Although poverty and other social pressures may create a climate for GAD, other factors are clearly at work How do we know this?
Most people living in dangerous environments do not develop GAD
Other models attempt to explain why some people develop the disorder and others do not…
12Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Psychodynamic GAD: The Psychodynamic PerspectivePerspective
Freud believed that all children experience anxiety Realistic anxiety when faced with actual danger
Neurotic anxiety when prevented from expressing id impulses
Moral anxiety when punished for expressing id impulses
One can use ego defense mechanisms to control these forms of anxiety, but when they don’t work or when anxiety is too high…GAD develops
13Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Psychodynamic GAD: The Psychodynamic PerspectivePerspective
Today’s psychodynamic theorists often disagree with specific aspects of Freud’s explanation
Researchers have found some support for the psychodynamic perspective: People with GAD are particularly likely to use
defense mechanisms (especially repression)
Children who were severely punished for expressing id impulses have higher levels of anxiety later in life
14Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Psychodynamic GAD: The Psychodynamic PerspectivePerspective
Some scientists question the validity of these findings: There are alternative explanations of the
data: Discomfort with painful memories or
“forgetting” in therapy is not necessarily defensive
Some data actually contradict the model Many (if not most) GAD clients report normal
childhood upbringings
15Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Psychodynamic GAD: The Psychodynamic PerspectivePerspective
Psychodynamic therapies Use same general techniques for treating
all dysfunction Free association Therapist interpretation
Specific treatments for GAD Freudians: focus less on fear and more on
control of id Object-relations therapists: help patients
identify and settle early relationship conflicts
16Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Psychodynamic GAD: The Psychodynamic PerspectivePerspective
Psychodynamic therapies Overall, controlled research has found
psychodynamic approaches to be of only modest help in treating cases of GAD
Short-term dynamic therapy may be beneficial in some cases
17Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Humanistic GAD: The Humanistic PerspectivePerspective
Theorists propose that GAD, like other psychological disorders, arises when people stop looking at themselves honestly and acceptingly
This view is best illustrated by Carl Rogers’s explanation: Lack of “unconditional positive regard” in childhood
leads to “conditions of worth” (harsh self-standards)
These threatening self-judgments break through and cause anxiety, setting the stage for GAD to develop
18Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Humanistic GAD: The Humanistic PerspectivePerspective
Therapy based on this model is “client-centered” and focuses on creating an accepting environment where clients can “experience” themselves Although case reports have been positive,
controlled studies have only sometimes found client-centered therapy to be more effective than placebo or no therapy
Only limited support has been found for Rogers’s explanation of causal factors
19Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Cognitive GAD: The Cognitive PerspectivePerspective
Theorists believe that psychological problems are caused by maladaptive and dysfunctional thinking
Since GAD is characterized by excessive worry (cognition), this model is a good start…
20Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Cognitive GAD: The Cognitive PerspectivePerspective
Theory: GAD is caused by maladaptive assumptions Albert Ellis identified basic irrational assumptions:
It is necessary for humans to be loved by everyone
It is catastrophic when things are not as one wants them to be
If something is dangerous, a person should be terribly concerned and dwell on the possibility that it will occur
One should be competent in all domains to be a worthwhile person
When these assumptions are applied to everyday life, GAD may develop
21Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Cognitive GAD: The Cognitive PerspectivePerspective
Aaron Beck is another cognitive theorist Those with GAD hold unrealistic silent
assumptions that imply imminent danger: Any strange situation is dangerous
A situation/person is unsafe until proven safe
Research supports the presence of these types of assumptions in GAD, particularly about dangerousness
22Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Cognitive GAD: The Cognitive PerspectivePerspective
What kinds of people are likely to have exaggerated expectations of danger? Those whose lives have been filled with
unpredictable negative events To avoid being “blindsided,” they try to
predict events; they look everywhere for danger (and therefore see danger everywhere)
Theory still under investigation
23Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Cognitive GAD: The Cognitive PerspectivePerspective
Second-Generation Cognitive Explanations In recent years, two new promising explanations
have emerged: Metacognitive theory
Developed by Wells; holds that the most problematic assumptions in GAD are the individual’s beliefs about worrying itself
Avoidance theory Developed by Borkovec; holds that worrying serves a “positive”
function for those with GAD by reducing unusually high levels of bodily arousal
Both theories have received considerable research support
24Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Cognitive GAD: The Cognitive PerspectivePerspective
Two kinds of cognitive therapy: Changing maladaptive assumptions
Based on the work of Ellis and Beck
Helping clients understand the special role that worrying plays, and changing their views about it
25Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Cognitive GAD: The Cognitive PerspectivePerspective
Cognitive therapies Changing maladaptive assumptions
Ellis’s rational-emotive therapy (RET) Point out irrational assumptions
Suggest more appropriate assumptions
26Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Cognitive GAD: The Cognitive Perspective Perspective
Cognitive therapies Focusing on worrying
Therapists begin with psychoeducation about worrying and GAD
Assign self-monitoring of somatic arousal and cognitive responses
As therapy progresses, clients become increasingly skilled at identifying their worrying and its counterproductivity
27Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Cognitive GAD: The Cognitive Perspective Perspective
Cognitive therapies Focusing on worrying
With continued practice, clients are expected to see the world as less threatening; to adopt more constructive ways of coping; and to worry less
Research has begun to indicate that a concentrated focus on worrying is a helpful addition to traditional cognitive therapy
28Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Biological GAD: The Biological PerspectivePerspective
Theory holds that GAD is caused by biological factors Supported by family pedigree studies
Blood relatives more likely to have GAD (~15%) than general population (~6%)
The closer the relative, the greater the likelihood
Issue of shared environment
29Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The GAD: The Biological Biological PerspectivePerspective
GABA inactivity 1950s – Benzodiazepines (Valium, Xanax)
found to reduce anxiety
Why? Neurons have specific receptors (lock and key)
Benzodiazepine receptors ordinarily receive gamma-aminobutyric acid (GABA, a common NT in the brain)
GABA is an inhibitory messenger; when received, it causes a neuron to stop firing
30Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The GAD: The Biological Biological PerspectivePerspective
In the normal fear reaction: Key neurons fire more rapidly, creating a
general state of excitability experienced as fear or anxiety
A feedback system is triggered; brain and body activities work to reduce excitability
Some neurons release GABA to inhibit neuron firing, thereby reducing experience of fear or anxiety
Problems with the feedback system are believed to cause GAD
Possible reasons: GABA too low, too few receptors, ineffective receptors
31Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The GAD: The Biological Biological PerspectivePerspective
Promising (but problematic) explanation Other NTs also bind to GABA receptors
Research conducted on lab animals raises question: Is “fear” really fear?
Issue of causal relationships Do physiological events CAUSE anxiety? How
can we know? What are alternative explanations?
32Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Biological GAD: The Biological PerspectivePerspective
Biological treatments Antianxiety drugs
Pre-1950s: barbiturates (sedative-hypnotics)
Post-1950s: benzodiazepines
Provide temporary, modest relief
Rebound anxiety with withdrawal and cessation of use
Physical dependence is possible
Undesirable effects (drowsiness, etc.)
Multiply effects of other drugs (especially alcohol)
1980s: buspirone (BuSpar)
Different receptors, same effectiveness, fewer problems
33Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Biological GAD: The Biological Perspective Perspective
Biological treatments Relaxation training
Theory: Physical relaxation leads to psychological relaxation
Research indicates that relaxation training is more effective than placebo or no treatment
Best when used in combination with cognitive therapy or biofeedback
34Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
GAD: The Biological GAD: The Biological Perspective Perspective
Biological treatments Biofeedback
Therapist uses electrical signals from the body to train people to control physiological processes
Electromyograph (EMG) is the most widely used; provides feedback about muscle tension
Found to be most effective when used as an adjunct to other methods for the treatment of certain medical problems (headache, back pain, etc.)
35Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
PhobiasPhobias
From the Greek word for “fear” Formal names are also often from the
Greek (see “A Closer Look, p. 106)
Persistent and unreasonable fears of particular objects, activities, or situations
Phobic people often avoid the object or thoughts about it
36Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
PhobiasPhobias
We all have some fears at some points in our lives; this is a normal and common experience How do phobias differ from these
“normal” experiences? More intense fear
Greater desire to avoid the feared object or situation
Distress that interferes with functioning
37Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
PhobiasPhobias
Most phobias are categorized as “specific” Also two broader kinds:
Social phobia
Agoraphobia
38Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Specific PhobiasSpecific Phobias
Persistent fears of specific objects or situations
When exposed to the object or situation, sufferers experience immediate fear
Most common: phobias of specific animals or insects, heights, enclosed spaces, thunderstorms, and blood
39Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
40Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Specific PhobiasSpecific Phobias
~9% of the U.S. population have symptoms in any given year ~12% develop a specific phobia at some
point in their lives Many suffer from more than one phobia
at a time Women outnumber men 2:1 Prevalence differs across racial and
ethnic minority groups Vast majority do NOT seek treatment
41Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Social PhobiasSocial Phobias
Severe, persistent, and unreasonable fears of social or performance situations in which embarrassment may occur May be narrow – talking, performing,
eating, or writing in public May be broad – general fear of functioning
inadequately in front of others In both cases, people rate themselves as
performing less adequately than is objectively true
42Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
43Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Social PhobiasSocial Phobias
Can greatly interfere with functioning Often kept a secret
Affect ~7% of U.S. population in any given year ~12% develop a social phobia at some point
in their lives
Women outnumber men 3:2
Often begin in childhood and may persist for many years
44Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
What Causes Phobias?What Causes Phobias?
Each model offers explanations, but evidence tends to support the behavioral explanations:
Phobias develop through conditioningOnce fears are acquired, they are
continued because feared objects are avoided
Behaviorists propose a classical conditioning model…
45Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Classical Conditioning of Classical Conditioning of PhobiaPhobia
UCR
Fear
UCR
Fear
UCS
Entrapment
Running
water
CS
Running water
CR
Fear
+UCS
Entrapment
46Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
What Causes Phobias?What Causes Phobias?
Other behavioral explanations Phobias develop through modeling
Observation and imitation
Phobias are maintained through avoidance
Phobias may develop into GAD when a person acquires a large number of phobias
Process of stimulus generalization: responses to one stimulus are also elicited by similar stimuli
47Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
What Causes Phobias?What Causes Phobias?
Behavioral explanations have received some empirical support: Classical conditioning study involving Little
Albert
Modeling studies
Bandura, confederates, buzz, and shock
Research conclusion is that phobias CAN be acquired in these ways, but there is no evidence that this is how the disorder is ordinarily acquired
48Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
What Causes Phobias?What Causes Phobias?
A behavioral-evolutionary explanation Some phobias are much more common
than others; for example: animals, blood, and heights vs meat, grass, and houses
49Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
What Causes Phobias?What Causes Phobias?
A behavioral-evolutionary explanation Theorists argue that there is a species-
specific biological predisposition to develop certain fears
Called “preparedness”: humans are more “prepared” to develop phobias around certain objects or situations
Unknown if these predispositions are due to evolutionary or environmental factors
50Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
How Are Phobias How Are Phobias Treated?Treated?
Surveys reveal that ~19% of those with specific phobia and 25% of those with social phobia currently are in treatment
Each model offers treatment approaches Behavioral techniques (exposure treatments) are
most widely used, especially for specific phobias Shown to be highly effective
Fare better in head-to-head comparisons than other approaches
Include desensitization, flooding, and modeling
51Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Treatments for Specific Treatments for Specific PhobiasPhobias
Systematic desensitization Technique developed by Joseph Wolpe
Teach relaxation skills Create fear hierarchy Sufferers learn to relax while facing feared objects
Since relaxation is incompatible with fear, the relaxation response is thought to substitute for the fear response
Several types: In vivo desensitization (live) Covert desensitization (imaginal)
52Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Treatments for Specific Treatments for Specific PhobiasPhobias
Other behavioral treatments: Flooding
Forced nongradual exposure
Modeling Therapist confronts the feared object while the fearful
person observes
Clinical research supports each of these treatments The key to success is ACTUAL contact with the
feared object or situation
53Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Treatments for Social Treatments for Social PhobiasPhobias
Treatments only recently successful Two components must be addressed:
Overwhelming social fear Address fears behaviorally with exposure
Lack of social skills Social skills and assertiveness trainings have
proved helpful
54Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Treatments for Social Treatments for Social PhobiasPhobias
Unlike specific phobias, social phobias respond well to medication (particularly antidepression drugs)
Several types of psychotherapy have proved at least as effective as medication People treated with psychotherapy are less likely
to relapse than people treated with drugs alone
One psychological approach is exposure therapy, either in an individual or group setting
Cognitive therapies also have been widely used
55Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Treatments for Social Treatments for Social PhobiasPhobias
Another treatment option is social skills training, a combination of several behavioral techniques to help people improve their social functioning Therapist provides feedback and
reinforcement
56Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic DisorderPanic Disorder
Panic, an extreme anxiety reaction, can result when a real threat suddenly emerges
The experience of “panic attacks,” however, is different Panic attacks are periodic, short bouts of panic
that occur suddenly, reach a peak, and pass
Sufferers often fear they will die, go crazy, or lose control
Attacks happen in the absence of a real threat
57Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic DisorderPanic Disorder
Anyone can experience a panic attack, but some people have panic attacks repeatedly, unexpectedly, and without apparent reason Diagnosis: Panic disorder
Sufferers also experience dysfunctional changes in thinking and behavior as a result of the attacks
Example: sufferer worries persistently about having an attack; plans behavior around possibility of future attack
58Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
59Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic DisorderPanic Disorder
Often (but not always) accompanied by agoraphobia From the Greek “fear of the marketplace”
Afraid to leave home and travel to locations from which escape might be difficult or help unavailable
Intensity may fluctuate
There has only recently been a recognition of the link between agoraphobia and panic attacks (or panic-like symptoms)
60Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic DisorderPanic Disorder
Two diagnoses: panic disorder with agoraphobia; panic disorder without agoraphobia ~3% of U.S. population affected in a given year ~5% of U.S. population affected at some point in their
lives
Likely to develop in late adolescence and early adulthood
Women are twice as likely as men to be affected Approximately 35% of those with panic disorder
are in treatment
61Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic Disorder: Panic Disorder: The Biological PerspectiveThe Biological Perspective
In the 1960s, it was recognized that people with panic disorder were not helped by benzodiazepines, but were helped by antidepressants Researchers worked backward from
their understanding of antidepressant drugs
62Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic Disorder: Panic Disorder: The Biological PerspectiveThe Biological Perspective
What biological factors contribute to panic disorder? NT at work is norepinephrine
Irregular in people with panic attacks
Research suggests that panic reactions are related to changes in norepinephrine activity in the locus ceruleus
Although norepinephrine is clearly linked to panic disorder, what goes wrong isn’t exactly understood
May be excessive activity, deficient activity, or some other defect
Other NTs and brain circuits seem to be involved
63Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic Disorder: Panic Disorder: The Biological PerspectiveThe Biological Perspective
It is also unclear why some people have such abnormalities in norepinephrine activity Inherited biological predisposition is one
possible reason If so, prevalence should be (and is) greater
among close relatives Among monozygotic (MZ, or identical) twins = 24%
Among dizygotic (DZ, or fraternal) twins = 11%
Issue is still open to debate
64Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic Disorder:Panic Disorder:The Biological PerspectiveThe Biological Perspective
Drug therapies Antidepressants are effective at preventing or
reducing panic attacks Function at norepinephrine receptors in the panic
brain circuit Bring at least some improvement to 80% of patients
with panic disorder ~50% recover markedly or fully
Require maintenance of drug therapy; otherwise relapse rates are high
Some benzodiazepines (especially Xanax [alprazolam]) also have proved helpful
65Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic Disorder: Panic Disorder: The Biological The Biological
PerspectivePerspective Drug therapies
Both antidepressants and benzodiazepines are also helpful in treating panic disorder with agoraphobia
Break the cycle of attack, anticipation, and fear
Combination treatment (medications + behavioral exposure therapy) may be more effective than either treatment alone
66Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic Disorder: Panic Disorder: The Cognitive PerspectiveThe Cognitive Perspective
Cognitive theorists and practitioners recognize that biological factors are only part of the cause of panic attacks In their view, full panic reactions are
experienced only by people who misinterpret bodily events
Cognitive treatment is aimed at correcting such misinterpretations
67Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic Disorder: Panic Disorder: The Cognitive PerspectiveThe Cognitive Perspective
Misinterpreting bodily sensations Panic-prone people may be overly
sensitive to certain bodily sensations and may misinterpret them as signs of a medical catastrophe; this leads to panic
Why might some people be prone to such misinterpretations?
One possibility: Experience more frequent or intense bodily sensations
68Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic Disorder: Panic Disorder: The Cognitive PerspectiveThe Cognitive Perspective
Misinterpreting bodily sensations Panic-prone people also have a high degree of
“anxiety sensitivity” They focus on bodily sensations much of the time,
are unable to assess the sensations logically, and interpret them as potentially harmful
69Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic Disorder: Panic Disorder: The Cognitive PerspectiveThe Cognitive Perspective
Cognitive therapy Attempts to correct people’s misinterpretations
of their bodily sensations Step 1: Educate clients
About panic in general About the causes of bodily sensations About their tendency to misinterpret the sensations
Step 2: Teach clients to apply more accurate interpretations (especially when stressed)
Step 3: Teach clients skills for coping with anxiety Examples: relaxation, breathing
70Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic Disorder: Panic Disorder: The Cognitive PerspectiveThe Cognitive Perspective
Cognitive therapy May also use “biological challenge”
procedures to induce panic sensations Induce physical sensations which cause
feelings of panic: Jump up and down
Run up a flight of steps
Practice coping strategies and making more accurate interpretations
71Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Panic Disorder: Panic Disorder: The Cognitive The Cognitive PerspectivePerspective
Cognitive therapy is often helpful in panic disorder 85% of treated patients are panic-free for two
years compared with 13% of control subjects
Only sometimes helpful for panic disorder with agoraphobia
At least as helpful as antidepressants
Combination therapy may be most effective Still under investigation
72Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder
Made up of two components: Obsessions
Persistent thoughts, ideas, impulses, or images that seem to invade a person’s consciousness
Compulsions Repeated and rigid behaviors or mental acts
that people feel they must perform to prevent or reduce anxiety
73Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder
Diagnosis may be called for when symptoms: Feel excessive or unreasonable
Cause great distress
Consume considerable time
Interfere with daily functions
74Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
75Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder
Classified as an anxiety disorder because obsessions cause anxiety, while compulsions are aimed at preventing or reducing anxiety Anxiety rises if obsessions or compulsions are
avoided
Between 1% and 2% of U.S. population has OCD in a given year; around 3% over a lifetime
Ratio of women to men is 1:1 It is estimated that more than 40% of those
with OCD seek treatment
76Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
What Are the Features of What Are the Features of Obsessions and Obsessions and Compulsions?Compulsions?
Obsessions Thoughts that feel intrusive and foreign
Attempts to ignore or avoid them trigger anxiety Take various
forms: Wishes
Impulses
Images
Ideas
Doubts
Have common themes: Dirt/contamination
Violence and aggression
Orderliness
Religion
Sexuality
77Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
What Are the Features of What Are the Features of Obsessions and Obsessions and Compulsions?Compulsions?
Compulsions “Voluntary” behaviors or mental acts
Feel mandatory/unstoppable
Person may recognize that behaviors are irrational
Believe, though, that catastrophe will occur if they don’t perform the compulsive acts
Performing behaviors reduces anxiety ONLY FOR A SHORT TIME!
Behaviors often develop into rituals
78Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
What Are the Features of What Are the Features of Obsessions and Obsessions and Compulsions?Compulsions?
Compulsions Common forms/themes:
Cleaning
Checking
Order or balance
Touching, verbal, and/or counting
79Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
What Are the Features of What Are the Features of Obsessions and Obsessions and Compulsions?Compulsions?
Are obsessions and compulsions related? Most (not all) people with OCD experience
both
Compulsive acts often occur in response to obsessive thoughts
Compulsions seem to represent a yielding to obsessions
Compulsions also sometimes serve to help control obsessions
80Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
What Are the Features of What Are the Features of Obsessions and Obsessions and Compulsions?Compulsions?
Are obsessions and compulsions related? Many with OCD are concerned that they
will act on their obsessions Most of these concerns are unfounded
Compulsions usually do not lead to violence or “immoral acts”
81Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder
OCD was once among the least understood of the psychological disorders
In recent years, however, researchers have begun to learn more about it
The most influential explanations are from the psychodynamic, behavioral, cognitive, and biological models…
82Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
OCD: OCD: The Psychodynamic The Psychodynamic
PerspectivePerspective Anxiety disorders develop when children
come to fear their id impulses and use ego defense mechanisms to lessen their anxiety
OCD differs from anxiety disorders in that the “battle” is not unconscious; it is played out in explicit thoughts and action Id impulses = obsessive thoughts Ego defenses = counter-thoughts or compulsive
actions At its core, OCD is related to aggressive
impulses and the competing need to control them
83Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
OCD: OCD: The Psychodynamic The Psychodynamic
PerspectivePerspective The battle between the id and the ego
Three ego defenses mechanisms are common: Isolation: disown disturbing thoughts Undoing: perform acts to “cancel out” thoughts Reaction formation: take on lifestyle in contrast to
unacceptable impulses
Freud believed that OCD was related to the anal stage of development
Period of intense conflict between id and ego
Research has not supported this explanation
84Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
OCD: OCD: The Psychodynamic The Psychodynamic
PerspectivePerspective Psychodynamic therapies
Goals are to uncover and overcome underlying conflicts and defenses
Main techniques are free association and interpretation
Research evidence is poor Some therapists now prefer to treat these
patients with short-term psychodynamic therapies
85Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
OCD: The Behavioral OCD: The Behavioral PerspectivePerspective
Behaviorists concentrate on explaining and treating compulsions rather than obsessions
Although the behavioral explanation of OCD has received little support, behavioral treatments for compulsive behaviors have been very successful
86Comer, Fundamentals of Abnormal Psychology, 5e – Chapter 4
OCD: The Behavioral OCD: The Behavioral PerspectivePerspective
Learning by chance People happen upon compulsions randomly:
In a fearful situation, they happen to perform a particular act (washing hands)
When the threat lifts, they associate the improvement with the random act
After repeated associations, they believe the compulsion is changing the situation
Bringing luck, warding away evil, etc.
The act becomes a key method to avoiding or reducing anxiety
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Key investigator: Stanley Rachman Compulsions do appear to be rewarded
by an eventual decrease in anxiety Studies provide no evidence of the learning
of compulsions
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Behavioral therapy Exposure and response prevention (ERP)
Clients are repeatedly exposed to anxiety-provoking stimuli and prevented from responding with compulsions
Therapists often model the behavior while the client watches
Homework is an important component Treatment is offered in individual and group settings Treatment provides significant, long-lasting
improvements for most patients However, as many as 25% fail to improve at all and the
approach is of limited help to those with obsessions but no compulsions
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OCD: The Cognitive OCD: The Cognitive PerspectivePerspective
Cognitive theory begins by pointing out that everyone has repetitive, unwanted, and intrusive thoughts People with OCD blame themselves for
normal (although repetitive and intrusive) thoughts and expect that terrible things will happen as a result
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Overreacting to unwanted thoughts To avoid such negative outcomes, they attempt
to neutralize their thoughts with actions (or other thoughts)
Neutralizing thoughts/actions may include:
Seeking reassurance
Thinking “good” thoughts
Washing
Checking
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When a neutralizing action reduces anxiety, it is reinforced Client becomes more convinced that the
thoughts are dangerous
As fear of thoughts increases, the number of thoughts increases
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OCD: The Cognitive OCD: The Cognitive PerspectivePerspective
If everyone has intrusive thoughts, why do only some people develop OCD? People with OCD tend:
To be more depressed than others To have higher standards of morality and
conduct To believe thoughts are equal to actions and
are capable of bringing harm To believe that they can and should have
perfect control over their thoughts and behaviors
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Cognitive therapies Focus on the cognitive processes that
help to produce and maintain obsessive thoughts and compulsive acts
May include: Psychoeducation
Habituation training
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Cognitive-Behavioral Therapy (CBT) Research suggests that a combination
of the cognitive and behavioral models often is more effective than either intervention alone
These treatments typically include psychoeducation and exposure and response prevention exercises
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OCD: The Biological OCD: The Biological PerspectivePerspective
Two recent lines of research indicate that biological factors play a key role in OCD: NT serotonin
Evidence that serotonin-based antidepressants reduce OCD symptoms
Brain abnormalities OCD linked to orbital region of frontal cortex and caudate
nuclei Frontal cortex and caudate nuclei compose brain
circuit that converts sensory information into thoughts and actions
Either area may be too active, letting through troublesome thoughts and actions
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Some research provides evidence that these two lines may be connected Serotonin plays a very active role in the
operation of the orbital region and the caudate nuclei
Low serotonin activity might interfere with the proper functioning of these brain parts
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Biological therapies Serotonin-based antidepressants
Examples: clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox)
Bring improvement to 50%–80% of those with OCD
Relapse occurs if medication is stopped
Research suggests that combination therapy (medication + cognitive behavioral therapy approaches) may be most effective
May have same effect on the brain