Chapter 5 - Anxiety Disorders
PANIC DISORDER
• Description - with &without Agoraphobia
• PD w/o Agora - panic attacks
- feeling of imminent death
- numerous symptoms
(racing heart, sweating, dizziness)
- “out of blue”
- fear another attack
• PD w/Agora - avoid certain situations
- embarrassment, lack of help
- Rare
- More in women
Tx implications?
involve spouse, decrease aid
Possible Causes
• Psychodynamic:
- anxiety from sexual/aggressive impulses leaking
• Cognitive:
- Hypersensitive to internal states
- Misinterpret symptoms
- Perceive danger
Behavioral: Classical conditioning
• Panic attack (US) -> fear (UR)
• Associate place (CS) with panic attack
• Public place (CS) -> fear (CR)
(embarrassment, lack of assistance)
Agoraphobia = stimulus generalization (all
places like 1st place)
Biological
• genetic sensitivity – overactive BAS
• hyperventilation causes symptoms
Panic Treatment
Psychodynamic
• Uncover conflict
Cognitive
• Breathing retraining & relaxation
• Self-statements & reappraisal of fears
Biological
• Mild tranquilizers (Xanax)
Behavioral
• Systematic desensitization
• Barlow: gradual exposure to panic
symptoms until fear decreases
Phobias
Description
• Fear specific object or situation
• No threat or threat is exaggerated
• Common fears, but heightened
• Phobia = impairs your life
Specific Phobias
• fear of specific situation/object
• animal, nature (childhood)
• blood-injection-injury
• ~11%
Social Phobia
• fear of being judged/embarrassed in social
situations
• 3-13%
Agoraphobia
• fear situations/public places
• something bad might happen
• fear panic but no actual attacks
• avoid situation
Possible Causes
Psychodynamic
• Projection of own impulses onto object
• Avoid object to reduce anxiety
& keep impulse out of awareness
Cognitive
• Catastrophize
Behavioral: Mowrer’s 2-Factor Theory
• 1st = fear is classically conditioned
• 2nd = fear maintained by operant
conditioning
- avoid situation = avoid punishment
(negative reinforcement)
• Preparedness
- biologically prepared to fear certain
stimuli harmful to ancestors
- harder to unlearn these phobias
Treatment
• Best is behavioral (esp. specific phobia)
- Exposure to feared situation/object
- Learn that it is not so frightening
- Extinguish link of CS -> CR
- Imaginal vs. in vivo exposure
- Gradual (systematic) or flooding
- Relax vs. not during exposure
Obsessive-Compulsive Disorder
(OCD)
Description
• Anxiety if do not perform certain actions
Anxiety from certain thoughts
• Actions are pointless, often embarrassing
• Obsessions
- meaningless, troublesome thoughts that
cannot stop
• Compulsions
- meaningless acts person feels forced to
repeat
Possible Causes
Psychodynamic
• Obsessions = unconscious impulses
• Compulsions = behaviors that keep
impulses unconscious
Cognitive
• Irrational beliefs: perfectionism & seeking
approval of others
Behavioral
• Obsessions -> anxiety
compulsions reduce anxiety
• Modeling
Treatment
• Systematic desensitization + response
prevention
- Expose to thoughts and prevent behavior
- Tolerate thoughts until anxiety decreases
• Medication — SSRIs
Post-Traumatic Stress Disorder
(PTSD)
Description
• Extreme anxiety related to specific trauma
• Trauma is “outside the normal range of
human experience”
Symptoms
• Intrusive thoughts: reliving event
• Avoid reminders
• Emotional numbness
• Hypervigilance
• Dissociation - detachment from self &
surroundings
1.Acute Stress Disorder
- lasts a few weeks
2.Post-Traumatic Stress Disorder
>1 month
Possible Causes
Cognitive
• Appraising threat as extremely traumatic
Biological
• Sympathetic NS
Behavioral
• Classical conditioning - environment
becomes conditioned stimuli for PTSD
response
• Stimulus generalization - cues that resemble
original situation trigger PTSD
Treatment
• Systematic Desensitization
- progressive exposure, imaginal or in vivo
• Flooding
- imagine worst-case scene
- multiple times until anxiety decreases
• Disagreement about flooding for trauma
Generalized Anxiety Disorder
(GAD)
Description
• continual anxiety over everything
• “catch-all” vs. true disorder
Possible Causes
Cognitive
• General tendency to catastrophize, perceive
threat
Behavioral
• Worrying modeled/reinforced
Biological
Genetic predisposition + decreased GABA
• GABA = inhibits firing
• Less GABA=more firing
Treatment
Behavioral
• Relaxation exercises (deep breathing,
progressive muscle)
Cognitive
• Discover & retrain automatic thoughts
Biological
• Medications to stimulate GABA