Abnormal Psych Midterm 2 Ch. 5
Phobic Disorder
A phobia is a fear of an object or situation that is disproportionate to the threat it poses. To experience a sense of gripping fear when your car is about to go out of control is not a phobia, because you truly are in danger. In phobic disorders, however, the fear exceeds any reasonable appraisal of danger. A curious thing about phobias is that they usually involve fears of the ordinary events in life, such as taking an elevator or driving on a highway, not the extraordinary.
Specific Phobia
A specific phobia is a persistent, excessive fear of a specific object or situation that is out of proportion to the actual danger these objects or situations pose. The phobic person experiences high levels of fear and physiological arousal when encountering the phobic object, which prompts strong urges to avoid or escape the situation or to avoid the feared stimulus, as in the following case.Specific phobias often begin in childhood. Many children develop passing fears of specific objects or situations. More common in women then men.
Cognitive Factors of a panic disorder
Anxiety sensitivity, or fear of fear itself, involves fear of one's emotions and bodily sensations getting out of control. When people with high levels of AS experience bodily signs of anxiety, such as a racing heart or shortness of breath, they perceive these symptoms as signs of dire consequences or even an impending catastrophe, such as a heart attack. Anxiety sensitivity is influenced by genetic factors. But environmental factors also play a role, including factors relating to ethnicity. A study of high school students showed that Asian and Hispanic students reported higher levels of anxiety sensitivity on the average than did Caucasian adolescents. The fact that panic attacks often seem to come out of the blue seems to support the belief that the attacks are biologically triggered.
Treatment approaches to Obsessive Compulsive Disorder and Related Disorders
Behavior therapists have achieved impressive results in treating obsessive-compulsive disorder with the technique of exposure with response prevention (ERP). The exposure component involves exposure to situations that evoke obsessive thoughts. Through exposure with response prevention, people with OCD learn to toler- ate the anxiety triggered by their obsessive thoughts while they are prevented from per- forming their compulsive rituals. With repeated exposure trials, the anxiety eventually subsides, and the person feels less compelled to perform the accompanying rituals. DRUGS: SSRI antidepresssants (selective serotonin reuptake inhibitors; discussed in Chapter 2) also have therapeutic benefits in treating OCD (Pampaloni et al., 2009; Simpson et al., 2008). This class of drugs includes fluoxetine (Prozac), paroxetine (Paxil), and clomipramine (Anafranil). These drugs increase the availability of the neurotransmitter serotonin in the brain. CBT produces at least as much benefit as drug treatment with SSRIs and may lead to more lasting results in treating OCD (Franklin & Foa, 2011). As with other forms of anxiety disorder, some people with OCD may benefit from a combination of psychological and drug treatment (Simpson et al., 2008). The Closer Look section in the following page explores an experimental treatment for OCD and other psychological disorders involving electrical stimulation of structures deep within the brain.
What is CBT and how does it help with panic disorders?
CBT helps people acquire skills they can use even after treatment ends. Although psychiatric drugs can help quell panicky symptoms, they do not assist patients in developing new skills that can be used after drugs are discontinued. However, there are some cases in which a combination of psychological treatment and drug treatment is most effective. We should also note that other forms of psychological treatments may have therapeutic benefits.
Treatment approaches to phobic disorder: Cognitive Therapy
Cognitive therapists seek to identify and correct dysfunctional or distorted beliefs. For example, people with social anxiety might think no one at a party will want to talk with them and that they will wind up lonely and isolated for the rest of their lives. Cognitive therapists help clients recognize the logical flaws in their thinking and to view situations rationally. Clients may be asked to gather evidence to test their beliefs, which may lead them to alter beliefs they find are not grounded in reality. Cognitive restructuring, a method in which therapists help clients pinpoint self-defeating thoughts and generate rational alter- natives they can use to cope with anxiety-provoking situations. For example, Kevin (see earlier case study) learned to replace self-defeating thoughts with rational alternatives and to practice speaking rationally and calmly to himself during his exposure trials.
Excoriation (Skin-Picking) Disorder
Compulsive or repeated picking of the skin, resulting in skin lesions or sores that because of repeated picking at scabs. Could be a coping method for anxiety.
Trichotillomania (Hair-Pulling Disorder)
Compulsive or repeated pulling resulting in hair loss. Self-soothing effect comes from it.
Treatment approaches to phobic disorder: Drug Therapy
Evidence also supports the use of antidepressant drugs, including ser- traline (Zoloft) and paroxetine (Paxil), in treating social anxiety. A combination of psychotherapy and drug therapy in the form of antidepressant medication may be more effective in some cases than either treatment approach alone.
Biological Factors of a panic disorder
Evidence indicates that genetic factors contribute to proneness or vulnerability to panic disorder. Genes may create a predis- position or likelihood, but not a certainty, that panic disorder or other psychological dis- orders will develop. Other factors play important roles, such as thinking patterns. People with panic disorder tend to have low levels of GABA in some parts of the brain. GABA is an inhibitory neurotransmitter, which means that it tones down excess activity in the central nervous system and helps quell the body's response to stress.
Treatment approaches to phobic disorder: flooding
Flooding is a form of exposure therapy in which subjects are exposed to high levels of fear-inducing stimuli either in imagination or in real-life situations. Why? The belief is that anxiety represents a conditioned response to a phobic stimulus and should dissipate if the individual remains in the phobic situation for a long enough period of time without harmful consequences.
Biological perspective of phobic disorder
For one thing, we've learned that people with varia- tions of particular genes are more prone to develop fear responses and to have greater difficulty overcoming them. The amygdala produces fear responses to trigger- ing stimuli without conscious thought. It works as a kind of "emotional computer" whenever we encounter a threat or danger. The prefontal cortex is responsible for many higher mental functions, such as thinking, problem solving, reasoning, and decision making. So when you see an object in the road that resembles a snake, the amygdala bolts into action, inducing a fear response that makes you stop or jump backwards and sends quivers of fear racing through your body. But a few moments later, the prefrontal cortex sizes up the threat more carefully, allowing you to breathe a sigh of relief. People with anxiety disorders, the amygdala may become overreactive to cues of threat, fear, and rejection. prepared conditioning, suggests that evolution favored the survival of human ancestors who were genetically predisposed to develop fears of potentially threatening objects, such as large animals, snakes, spiders, and other "creepy- crawlies"; of heights; of enclosed spaces; and even of strangers.
Theoretical Perspective to Generalized Anxiety Disorder (GAD)
From a psychodynamic perspective, gen- eralized anxiety represents the threatened leakage of unacceptable sexual or aggressive impulses or wishes into conscious awareness. The person is aware of the anxiety but not its underlying source. The problem with speculating about the unconscious origins of anxiety is that they lie beyond the reach of direct scientific tests. We cannot directly observe or measure unconscious impulses.
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is characterized by excessive anxiety and worry that is not limited to any one object, situation, or activity. For people with generalized anxiety disorder, anxiety becomes excessive, becomes difficult to control, and is accompanied by physical symptoms such as restlessness, jumpiness, and muscle tension. The central feature of GAD is excessive worry - even life long worries. They tend to worry about everyday, minor things, such as getting stuck in traffic, and about unlikely future events, such as going bankrupt. The emotional distress associated with GAD interferes significantly with the per- son's daily life. GAD frequently occurs together with other disorders, including depres- sion or other anxiety disorders such as agoraphobia and obsessive-compulsive disorder. Other related features include restlessness; feeling tense, keyed up, or on edge; becoming easily fatigued;
Psychodynamic Perspective of phobic disorder
In phobias, the Freudian defense mechanism of projec- tion comes into play. A phobic reaction is a projection of the person's own threatening impulses onto the phobic object. For instance, a fear of knives or other sharp instruments may represent the projection of one's own destructive impulses onto the phobic object. The phobia serves a useful function. Avoiding contact with sharp instruments prevents these destructive wishes toward the self or others from becoming consciously realized or acted on. The threatening impulses remain safely repressed.
Theoretical perspective of Obsessive Compulsive Disorder and Related Disorders: Biological
Just what genes are involved in OCD remains under study, but research evidence points to a possible role for a gene that works to tone down the actions of a particular neurotransmitter, glutamate, at least in some cases of the disorder. Chemical balances in the brain that lead to over-arousal of a network of neurons called a worry circuit, a neural network that signals danger in response to perceived threats. In OCD, the brain may be continually sending messages through this "worry circuit" or neural circuit that something is wrong and requires immediate attention, leading to obsessional, worrisome thoughts and repetitive, compulsive behaviors. Perhaps a disruption in these neural pathways explains the failure of people with compulsive behavior to inhibit repetitive, ritualistic behaviors.
Learning perspective of phobic disorder
Mowrer's two-factor model incorporated roles for both classical and operant conditioning in the development of phobias. The fear com- ponent of phobia is believed to be acquired through classical conditioning, as previously neutral objects and situations gain the capacity to evoke fear by being paired with noxious or aversive stimuli. As Mowrer pointed out, the avoidance component of phobias is acquired and maintained by operant conditioning, specifically by negative reinforcement. That is, relief from anxiety negatively reinforces the avoidance of fearful stimuli, which thus serves to strengthen the avoidance response. Phyllis learned to relieve her anxiety over riding the elevator by opting for the stairs instead. Avoidance works to relieve anxiety, but at a significant cost. By avoiding the phobic stimulus (e.g., elevators), the fear may persist for years, even a lifetime. On the other hand, fear can be weakened and even eliminated by repeated, uneventful encounters with the phobic stimulus. In classical conditioning terms, extinction is the weakening of the conditioned response (e.g., the fear component of a phobia) when the conditioned stimulus (the phobic object or stimulus) is repeatedly presented in the absence of the unconditioned stimulus (an aversive or painful stimulus). observational learning, observing parents or significant others model a fearful reaction to a stimulus can lead to the acquisition of a fearful response.
Hoarding Disorder (compulsive hoarding)
Strong need to accumulate possessions, regardless of their value, and persistent associated with discarding them. Fail to recognize hoarding as a behavior and also feel a sense of security when they hoard. Hoarding disorder bears a close relationship to obsessive-compulsive disorder (Frost, Steketee, & Tolin, 2012). The obsessional features of hoarding disorder may involve recur- ring thoughts about acquiring objects and fears over losing them. The compulsive features may involve repeatedly rearranging stacks of possessions and stubbornly refusing to avoid discarding them, even in the face of strong protests from other people.
Cognitive perspective of phobic disorder
Oversensitivity to threatening cues. People with phobias tend to perceive danger in situations most people consider safe, such as riding on elevators or driving over bridges. Similarly, people with social anxiety tend to be overly sensitive to social cues of rejection or negative evaluation from others . Overprediction of danger. Phobic individuals tend to overpredict how much fear or anxiety they will experience in the fearful situation. The person with a snake phobia, for example, may expect to tremble when he or she encounters a snake in a cage. People with dental phobia may have exaggerated expectations of the pain they will experience during dental visits. Self-defeating thoughts and irrational beliefs. Self-defeating thoughts can height- en and perpetuate anxiety and phobic disorders. When faced with fear-evoking stimuli, the person may think, "I've got to get out of here," or "My heart is going to leap out of my chest." Thoughts like these intensify autonomic arousal, dis- rupt planning, magnify the aversiveness of stimuli, prompt avoidance behavior, and decrease self-efficacy expectancies concerning a person's ability to control the situation.
Obsessive Compulsive Disorder and Related Disorders
People with obsessive-compulsive disorder (OCD) are troubled by recurrent obsessions or compulsions, or both obsessions and compulsions, that are time-consuming, such as lasting more than an hour a day, or causing significant distress or interference with a per- son's normal routines or occupational or social functioning. An obsession is a recurrent, persistent, and unwanted thought, urge, or mental image that seems beyond the person's ability to control. Obsessions can be potent and persistent enough to interfere with daily life and can engender significant distress and anxiety. A compulsion is a repetitive behavior (e.g., hand washing or checking door locks) or mental act (e.g., praying, repeating certain words, or counting) that the person feels compelled or driven to perform.
Theoretical perspective of Obsessive Compulsive Disorder and Related Disorders: Psychological
Psychological models of OCD emphasize cognitive and learning-based factors. People with OCD tend to be overly focused on their thoughts (Taylor & Jang, 2011). They can't seem to break the mental loop in which the same intrusive, negative thoughts keep reverberating in their minds. Another cognitive factor linked to the development of OCD is perfectionism, or belief that one must perform flawlessly
Panic disorder
Repeated panic attacks (episodes of sheer terror accompanied by strong physiological symptoms, thoughts of imminent danger or impending doom, and an urge to escape). physical symptoms such as a pound- ing heart; rapid respiration, shortness of breath, or difficulty breathing; heavy perspira- tion; and weakness or dizziness. The first panic attacks occur spontaneously or unexpectedly, but over time they may become associated with certain situations or cues, such as entering a crowded depart- ment store or boarding a train or airplane.
Treatment approaches to phobic disorder: Systematic desensitization
Systematic desensitization is a gradual process in which clients learn to handle progressively more disturbing stimuli while they remain relaxed. Systematic desensitization is based on the assumption that phobias are learned or conditioned responses that can be unlearned by substituting an incompatible response to anxiety in situations that usually elicit anxiety.
Biological Perspective to Generalized Anxiety Disorder (GAD)
The cognitive and biological perspectives converge in evidence showing irregularities in the functioning of the amygdala in GAD patients and in its connections to the brain's thinking center, the pre- frontal cortex (PFC). It appears that in people with GAD, the PFC may rely on worrying as a cognitive strategy for dealing with the fear generated by an overactive amygdala. irregularities of the neurotransmitter serotonin are implicated in GAD on the basis of evidence that GAD responds favorably to the antidepressant drug paroxetine, which specifically targets serotonin.
Cognitive Perspective to Generalized Anxiety Disorder (GAD)
The cognitive perspective on GAD emphasizes the role of exag- gerated or distorted thoughts and beliefs, especially beliefs that underlie worry. People with GAD tend to worry just about everything. They also tend to be overly attentive to threatening cues in the environment perceiving danger and calamitous consequences at every turn.
Treatment Approaches to Generalized Anxiety Disorder (GAD)
The major forms of treatment of generalized anxiety disorder are psychiatric drugs and cog- nitive-behavioral therapy. Antidepressant drugs, such as sertraline (Zoloft) and paroxetine (Paxil), can help relieve anxiety symptoms. Drugs do not cure the underlying problem of GAD. Cognitive-behavioral therapists use a combination of techniques in treating GAD, including training in relaxation skills; learning to substitute calming, adaptive thoughts for intrusive, worrisome thoughts; and learning skills of decatastrophizing. In one illustrative study, the great majority of GAD patients treated with either behavioral or cognitive methods, or the combination of these methods, no longer met diagnostic criteria for the disorder fol- lowing treatment
Treatment Approaches to a panic disorder
The most widely used forms of treatment for panic disorder are drug therapy and cognitive- behavioral therapy. Drugs commonly used to treat depression, called antidepressant drugs, also have antianxiety and antipanic effects. Antidepressants used for treating panic disorder include the tricyclics imipramine (Tofranil) and clomipramine (Anafranil) and the SSRIs paroxetine (Paxil) and sertraline (Zoloft) , Xanax. Cognitive-behavioral therapists use a variety of techniques in treating panic disorder, including coping skills development for handling panic attacks, breathing retraining and relaxation training to reduce states of heightened bodily arousal, and exposure to situations linked to panic attacks and bodily cues associated with panicky symptoms. The therapist may help clients think differently about changes in bodily cues, such as sensations of dizziness or heart palpitations. 3 elements for treating a panic disorder is monitoring, exposure, and development of coping skills.
Theoretical perspective of a panic disorder
The prevailing view of panic disorder is that panic attacks involve a combination of cognitive and biological factors, of misattributions on the one hand and physiological reactions on the other. Under control of the sympathetic nervous system, the adrenal glands release the stress hormones epinephrine (adrenaline) and norepinephrine (noradrenaline). These hormones intensify physical sensations by inducing accelerated heart rate, rapid breathing, and sweating. The changes in bodily sensations that trigger a panic attack may result from many factors, such as unrecognized hyperventilation (rapid breathing), exertion, changes in temperature, or reactions to certain drugs or medications.
Treatment approaches to phobic disorder: Virtual Reality Therapy
a behavior therapy technique that uses computer- generated simulated environments as therapeutic tools. By donning a specialized helmet and gloves that are connected to a computer, a person with a fear of heights, for example, can encounter frightening stimuli in this virtual world, such as riding a glass-enclosed elevator to the top floor of an imaginary hotel, peering over a railing on a balcony on the 20th floor, or crossing a virtual Golden Gate Bridge.
agoraphobia
an excessive fear of being in public places in which escape may be difficult or help unavailable. They, too, tend to become dependent on others for support.
Learning Perspective to Generalized Anxiety Disorder (GAD)
generalized anxiety is precisely that: generalization of anxiety across many situations. People concerned about broad life themes, such as finances, health, and family matters, are likely to experience apprehension or worry in a variety of settings. Anxiety would thus become connected with almost any environ- ment or situation.
Theoretical perspective of Obsessive Compulsive Disorder and Related Disorders: Psychodynamic
obsessions rep- resent leakage of unconscious urges or impulses into consciousness, and compulsions are acts that help keep these impulses repressed. Obsessive thoughts about contamination by dirt or germs may represent the threatened emergence of unconscious infantile wishes to soil oneself and play with feces.
Social anxiety disorder (social phobia)
social anxiety disorder have such an intense fear of social situations that they may avoid them altogether or endure them only with great distress. The underlying problem is an excessive fear of negative evaluations from others—fear of being rejected, humiliated, or embarrassed.People with social anxiety often turn to tranquilizers or try to "medicate" them- selves with alcohol when preparing for social interactions (see Figure 5.3). In extreme cases, they may become so fearful of interacting with others that they become essentially housebound. 5% of U.S. adults are affected by social anxiety disorder at some point in their lives. Consistent with the diathesis-stress model, shyness may represent a diathesis or predisposition that makes a person more vulnerable to developing social anxiety in the face of stressful experiences, such as traumatic social encounters.
Ethnic Differences in Anxiety Disorders
the National Comorbidity Survey Replication (NCS-R), showed that African Americans (or non-Hispanic Blacks) and Latinos have lower rates of social anxiety disorder and general- ized anxiety disorder than do European Americans (non-Hispanic Whites). We have evidence from yet another large national survey showing higher lifetime rates of panic disorder in European Americans than in Latinos, African Americans, or Asian Americans.
Treatment approaches to phobic disorder: gradual exposure
uses a stepwise approach in which phobic individuals gradu- ally confront the objects or situations they fear. Repeated exposure to a phobic stimulus in the absence of any aversive event
Theoretical perspective of Obsessive Compulsive Disorder and Related Disorders: Learning Perspective
we can view compulsive behaviors as operant responses that are negatively reinforced by relief from anxiety triggered by obsessional thoughts. Put simply, "obsessions give rise to anxiety/distress and compulsions reduce it". If a person obsesses that dirt or foreign bodies contaminate other people's hands, shaking hands or turning a doorknob may evoke powerful anxiety.