PSY350 CH 6: Anxiety Disorders and Obsessive Compulsive Disorder

Panic Disorder

Experience of recurrent, unexpected panic attacks, followed by a month or more of concern about having another panic attack, or a significant maladaptive change in behavior related to the attacks.

Fear

Experienced in the face of real, immediate danger; builds quickly in intensity and helps organize behavioral responses to the environment.

Frequency of OCD and Related Disorders

-2% of US population meets criteria at one point in their lives -12 month prevalence is 1.2% -Men and women are equally likely to be affected. -Hoarding and excoriation are most common.

Biological Interventions

-Anti-Anxiety Medications: benzodiazepines, including diazepam (Valium) and alprazolam (Xanax). Bind to receptor sites associated with GABA, to increase its activity; side effects: sedation and mild psychomotor and cognitive impairments, can also be addictive. -Anti-Depressant Medications: SSRIS used for almost all forms of anxiety disorders; include Prozac, Luvox, Zoloft, and Paxil.

Course and Outcome

-Anxiety disorders are often chronic conditions -Frequency and intensity of panic attacks decrease nearer to middle age -GAD worries may be replaced with complaints of physical symptoms.

Across Life Span

-Anxiety is high in youth and old age (70s-80s) -Elderly: loneliness, increased dependency, declining physical and cognitive capacities, and changes in social and economic conditions.

Adaptive and Maladaptive Fears

-Evolutionary significance of anxiety and fear-adaptive in many situations. -When anxiety becomes excessive or when intense fear is triggered at an inappropriate time/place, response system is more harmful than helpful. -All different types of anxiety disorders are NOT caused by the same factors. -Each type of anxiety disorder can be viewed as the dysregulation of a mechanism that evolved to deal with a particular kind of danger.

Treatment of OCD

-Exposure and Response Prevention: prolonged exposure to what triggers anxiety with prevention of typical compulsive response; up to 20% do not respond to this treatment. -Biological Treatments: SSRIs are used most frequently, tricyclics also used; 50% of patients improved over 10 weeks.

Biological Factors

-Genetic Factors: Twin concordance rates were significantly higher for MZ than DZ, but MZ rates were low compared to those for bipolar disorder; appear to be modestly heritable, with genetic factors accounting for between 20-30% of the variance in transmission of GAD. 1. Genetic Risk Factors for these disorders are neither highly specific (a different set of genes being associated with each disorder) nor highly nonspecific (one common set of genes causing vulnerability for all disorder) 2. Two genetic factors have been identified: one associated with GAD, panic disorder, and agoraphobia, and the other with specific phobias. 3. Environmental risk factors would be unique to individuals also play an important role in the etiology of all anxiety disorders. Environmental factors that would be shared by all members of a family do not seem to play an important role for many people. -Neurobiology: specific pathways in the brain are responsible for detecting and organizing a response to danger- amygdala plays a central role in circuits; explains where in brain emotional responses are located, how they are produced, and help understand why people experience irrational fear; sensory information projected to thalamus then processed in other areas; emotional stimuli lead to amygdala- "fight or flight" response.

Psychological Factors

-Learning Processes: specific fears could be learned through classic Pavlovian conditioning; views suggest stimulus-response process is guided by a "module," or specialized circuit in the brain that has been shaped by evolutionary processes.

Frequency and Prevalence

-Only 25% of people diagnosed with an anxiety disorder seek treatment. -Anxiety disorders are the most common form of mental disorder. -Specific phobias are most common anxiety disorder, with a one year prevalence of 9% of the adult population. -Social Anxiety Disorders have one year prevalence of 7%. -Panic Disorder and GAD affect 3% of population each. -1% of people have Agoraphobia.

Comorbidity

-Over 50% of people who meet criteria for one anxiety disorder also meet criteria for at least one other form of anxiety/mood disorder. -60% of people with major depression qualify for some anxiety disorder. -People with anxiety disorders are three times more likely to become alcohol-dependent.

Cross-Cultural Comparisons

-People in nonwestern cultures are more likely to communicate their anxiety in the form of somatic complaints. -People in Western society experience anxiety in relation to their work performance, whereas other societies are more concerned with family issues or religious experiences. -Panic disorders appeared in every country studied, but the most prominent symptoms varied from one region to the next.

Cognitive Factors

-Perception, memory, and attention all contribute to reactions to events. -Perception of Control: People who believe that they are in control of events in their environment are less likely to develop symptoms of anxiety than those who believe they are helpless; linked to submissive behavior and chronic worry. -Catastrophic Misinterpretation: of bodily senses or perceived threat; panic attacks are most often triggered by internal stimuli: automatic negative response reinforces feedback loop. -Attention to Threat and Biased Information Processing: people prone to excessive worrying and panic are unusually sensitive to cues that signal the existence of future threats; generate a lot of "what-if" scenarios. 1. Worry is an experience that is made up of "self talk"- things that people say to themselves rather than visual images. 2. Worry serves the function of avoiding unpleasant somatic activation through the suppression of imagery.

Psychological Intervention

-Psychoanalytic Psychotherapy: finding insight regarding unconscious motives that presumably lie at the heart of the patient's symptoms (Freudian). -Systematic Desensitization and Interoceptive Exposure: progressive muscle relaxation and constructed hierarchy of frightening stimuli; systematic exposure to feared stimulus; direct exposure may be better than imagined -Treating Panic Disorder: 1. Situational Exposure: used to treat Agoraphobic Avoidance; repeatedly confronting situations previously avoided. 2. Interoceptive Exposure: Aimed at reducing person's fear of internal, bodily sensations that are frequently associated with the onset of a panic attack; by engaging in exercise that is known to produce these sensations-very important in treatment. -Relaxation and Breathing Retraining: teaching client alternately to tense and relax specific muscle groups while breathing slowly and deeply; procedure that involves education about the physiological effects of hyperventilation and practice in slow breathing techniques; use diaphragm rather than chest. -Cognitive Therapy: therapists help clients identify cognitions that are relevant to their problem; recognize the relation between these thoughts and maladaptive emotional responses; examine the evidence that supports OR contradicts these beliefs; and teach clients more useful ways of interpreting events in their environment; decatastrophizing: imagining the worst-case scenario and examining faulty logic and exaggeration.

Gender Differences

-Relapse rates are higher for women than men. -Women are three times more likely to develop specific phobias than men. -Women are two times more likely than men to experience panic disorder, agoraphobia, and GAD.

Social Factors

-Stressful Life Events: high-stress lifestyles develop negative emotional reactions that may lead to anxiety diagnoses; most likely experienced an event involving danger, insecurity, or family discord. -Childhood Adversity: past experiences can set the stage for anxiety; ex. maternal prenatal stress, multiple maternal partner changes, neglect, abuse. -Attachment Relationships and Separation Anxiety: attachment theory integrates psychodynamic perspective with field observations of primate behavior and laboratory research with infants.

Causes of OCD

-Thought suppression: active attempt to stop thinking about something; trying to stop worrying can make it worse; maladaptive consequences of attempts to suppress unwanted or threatening thoughts. -Resistance plays important role. -Several brain regions are overactive in people with OCD.

Specific Phobia

A marked fear or anxiety about a specific object or situation that almost always provokes immediate fear or anxiety. -Avoidance/stress must interfere significantly with normal activities and relationships, and it must be persistent (6 months or more).

Worry

A relatively uncontrollable sequence of negative, emotional thoughts that are concerned with possible future threats or danger.

The following are symptoms of Generalized Anxiety Disorder EXCEPT:

A. Difficulty sleeping. B. Worries about having a panic attack. C. Difficulties controlling worries. D. Restlessness/feeling on edge. Answer: B.

Twin studies have led to several conclusions of the genetic factors of anxiety disorders. Which of the following conclusions is true?

A. Genetic factors appear to account for a large majority of the variance in transmission of GAD. B. Genetic factors don't seem to be highly specific or highly non-specific. C. Environmental factors that are shared by all members of a family appear to also play an important role. D. All of the above. Answer: B.

The following are examples of an obsession in OCD EXCEPT:

A. Harming B. Illness C. Checking D. Contamination Answer: C.

Other Obsessive-Compulsive Related Disorders include all the following EXCEPT:

A. Hoarding Disorder. B. Pica. C. Trichotillomania. D. Body-Dysmorphic Disorder Answer: B.

Which of the following is true of anxiety?

A. It is maladaptive, even at low levels. B. It is often associated with current or past problems. C. Whereas fear is experienced in the face of real, immediate danger, anxiety tends to be an emotional reaction out of proportion to the threats in the environment. D. All of the above. Answer: C.

Which of the following is true of anxiety disorders?

A. The emotional response of anxiety and fear are never adaptive in any situation. B. There are unique causal pathways for each type of anxiety disorder listed in the DSM-5. C. Each type of anxiety disorder can be viewed as the dysregulation of a mechanism that evolved to deal with a particular kind of damage. D. All types of anxiety disorders are produced by the same causes. Answer: C.

When conceptualizing anxiety disorders, which of the following is true?

A. There has been debate on classification of disorders between "splitters" and "lumpers." B. The various editions of the DSM classify and conceptualize anxiety, obsessive-compulsive, and trauma-and-stress related disorders differently. C. A large focus in DSM-5 has been on two broad dimensions: internalizing and externalizing. D. All of the above. Answer: D.

Which of the following is NOT true regarding anxiety cross-culturally?

A. Western society is more likely to have anxiety related to work performance. B. Western cultures tend to focus more on somatic complaints C. Panic Disorders' prevalence rates have been found to be similar in countries in North America, Latin America, and Europe. D. Nonwestern society is more likely to have anxiety related to family and religion. Answer: B.

Anxious Apprehension

Consists of: 1. High levels of diffuse negative emotion 2. A sense of uncontrollability 3. A shift in attention to a primary self-focus or a state of self-preoccupation.

Agoraphobia

Exaggerated fear of being in situations from which escape might be difficult, such as being caught in a traffic jam on a bridge or in a tunnel.

Social Anxiety Disorder (Social Phobia)

Focused on social situations in which the person may be closely observed or evaluated by other people. 1. Doing something in front of unfamiliar people (performance anxiety) 2. Interpersonal interaction (ex. dating or parties)

Excoriation

Persistent picking at one's own skin, most often on the person's face, arms, and hands. This picking leads to skin lesions and is not the result of another medical condition, and it is resistant to the person's frequent attempts to decrease or stop the action.

Anxiety

Involves a more general or diffuse emotional reaction that is out of proportion to threats from the environment.

Hoarding Disorder

Persistent difficulties in getting rid of possessions, regardless of their real value. The reluctance to discard property is due to perceived need to save the items, and it results in accumulation of possessions that obstruct active areas of the person's home.

Phobia

Persistent, irrational, narrowly defined fears that are associated with a specific object or situation. -Fear is not considered phobic unless the person avoids contact with the source of the fear or experiences intense anxiety in the presence of the stimulus.

Body Dysmorphic Disorder

Preoccupation with perceived defects in personal appearance. The person believes that these flaws are unsightly or abnormal. The perceived defects are not noticeable, or appear to be completely insignificant to other people.

The most effective form of psychological treatment for OCD includes:

Prolonged exposure to the situation that increases the individual's anxiety while preventing the individual's typical compulsive response.

Trichotillomania

Recurrent pulling out one's hair, in spite of many attempts to decrease or stop this behavior. The hair may be pulled from any area of the body, with the most common sites being scalp, eyebrows, and eyelids.

Compulsions

Repetitive behaviors or mental acts that are used to reduce anxiety. The person attempts to resist performing the compulsion but cannot.

Obsessions

Repetitive, unwanted, intrusive cognitive events that may take the form of thoughts or images or urges. -Distinct from worry in two ways: 1. Obsessions are usually experienced by the person as being nonsensical, whereas worries are often triggered by problems in everyday living. 2. The content of obsessions most often involves themes that are perceived as being socially unacceptable or horrific, such as sex, violence, and disease/contamination, whereas the content of worries tends to center around more acceptable, commonplace concerns, such as money or work.

Panic Attack

Sudden, overwhelming experiences of terror or fright. -Panic is more intense than anxiety, and has a sudden onset. -Somatic/physical symptoms: heart palpitations, sweating, trembling, nausea, dizziness, chills -Attacks are said to be "cued" if in presence of a particular stimulus.

Cognitive therapy for anxiety focuses on:

Teaching clients more useful ways of interpreting events in the environment.

Generalized Anxiety Disorder (GAD)

Trouble controlling excessive anxiety and worry, and worries must lead to significant distress or impairment in occupational or social functioning. -Must occur at least 6 months, and worries must be about different events or activities rather than one specific thing. -Worries must NOT be focused on having a panic attack, being embarrassed in public, or being contaminated. -Need 3 of the following symptoms: 1. Restlessness or feeling keyed up/on edge 2. Being easily fatigued 3. Difficulty concentrating or mind going blank 4. Irritability 5. Muscle tension 6. Sleep disturbance

Preparedness Model

View that brain has a very large number of prepared modules that serve particular adaptive functions; automatic and rapid and highly selective in response to stimuli.