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Chapter 8 Anxiety, Obsessive Compulsive Disorder and Trauma
Abnormal Psychology (PSYCH-55 )
Chaffey College
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Anxiety Disorders ● Anxiety disorders are conditions in which fear/anxiety are experienced as the core of the disturbance ● Fear: A set of responses to perceived danger (biologically primitive alarm system) ○ Fear is present oriented ■ It prepares the organisms for immediate action (fight/flight ~ sympathetic division of the autonomic nervous system) ● Anxiety: Diffuse sense of apprehension about impending real/imagined threat ○ Anxiety is future oriented ■ The course of action is not clear ~ Person doesn’t know how to stop it Symptoms of Anxiety ● Somatic (Bodily) ○ Goosebumps emerge ○ Muscles tense ○ Heart rate increases ○ Respiration deepens ○ Pupils dilate ○ Perspiration increases ○ Adrenaline is secreted ○ Salivation increases ● Emotional ○ Sense of dread ○ Terror ○ Restlessness ○ Irritability
Cognitive Behavioral
● Anticipation of harm ● Exaggeration of danger ● Problems in concentrating ● Fear of dying
● Avoidance ● Aggression ● Decreased appetitive responding ● Increased aversive responding
Common Phobias ● Acrophobia - fear of heights ● Aerophobia - fear of flying ● Agoraphobia - fear of open/crowded places, leaving one’s own home, or of being in places from which escape is difficult ● Arachnophobia - fear of spiders ● Cynophobia - fear of dogs ● Trypanophobia - fear of needles/blood draws/injections
Phobias ● Irrational, excessive fear that causes intense distress and interferes with everyday life ● Most common form of anxiety disorder ○ Specific Phobias ■ Intense, persistent fear of specific objects/situations that pose little or no actual threat ○ Social Phobias ■ Fear of being judged/embarrassed by others ■ May be situation - specific (e., public speaking) /general (all social interactions) ○ Agoraphobia with or without panic disorder ■ Fear of places where they might have trouble escaping, getting help, and avoiding embarrassment Specific Phobias ● Animal ○ Fears of animals, such as dogs, cats, spiders, bugs, mice, rats, birds, fish, and snakes ● Natural Environment ○ Fears of heights, fires, storms, or being near water ● Blood-Injection Injury ○ Fears of seeing blood, receiving an injection, watching/talking about medical procedures ● Situational ○ Fears of situations, such as driving, flying, elevators, enclosed places ● Other ○ Fears of choking/vomiting, balloons popping, clowns, fear of contagion/illness Social Phobia ● Intense fear of humiliation/scrutiny in social settings, which can be specific/general/global ● Panic-like symptoms, but only in social situations ● Commonly feared situations ○ Participating in small groups ○ Eating/drinking in public ○ Talking to people of authority ○ Giving a talk to an audience ○ Going to a party Phobias: Epidemiology ● Specific phobia: ~10% lifetime prevalence ○ Top fears: heights and snakes ● Social Phobia: ~7% lifetime prevalence
■ Therapist participates with client and models calm reactions to items in anxiety hierarchy ● Cognitive behavioral: ○ Confront phobic cognitions in a supportive, setting (e., group therapy for social phobics) Panic Disorder ● Periods of intense physical discomfort known as panic disorders ● Increasing anxiety about: ○ Having a future attack ○ The implications of the attack and its consequences ● Situational avoidance: ○ Avoidance of specific activities associated with attacks ○ May generalize to fear of outdoors (i., agoraphobia) Panic Attack: Clinical Description ● Approx. 40% of young adults experience occasional panic attacks ○ A discrete period of intense fear/discomfort ○ Occurs in the absence of real danger ○ Sudden onset and peaks within 10 minutes ● Includes 4 or more symptoms of fear ○ Heart palpitations, chest pain ○ Sweating ○ Trembling ○ Shortness of breath, choking ○ Nausea ○ Unreality ○ Fear of loss of control/dying Panic Disorder With or Without Agoraphobia ● About ⅓ of ½ of individuals diagnosed with panic disorder develop agoraphobia (however, they can occur alone) ● Agoraphobia: (<fear of the marketplace=) fear of open spaces, crowded places, unfamiliar places, or any place where one could have trouble getting help in an emergency (e., panic attack) ● Typically, people with agoraphobia fear they’ll have a panic attack Panic Disorder: Epidemiology ● Typical onset in young adulthood ● 3% lifetime prevalence ● Gender differences ○ No gender differences for panic disorder with agoraphobia ○ Females > Males have panic disorder with agoraphobia ● Occurs across cultures and ethnic groups
● 20% will attempt suicide ● Comorbidity is very common (agoraphobia, depression, substance abuse) Panic Disorder: Biological Etiology ● Biochemical (Neurotransmitters) ○ Poor regulation (high levels) of norepinephrine ○ Poor regulation of serotonin (high levels of serotonin in some areas of the brain, and low levels in other areas) ● Too little Gamma-Aminobutyric Acid (GABA) ○ Inhibitory neurotransmitter that is essential for the proper function of your brain and the central nervous system, and has the impact of reducing excessive brain exercise and prompting a state of calm ● Genetics ○ Rules in families (heritability = 30-40% Panic Disorder: Cognitive Etiology ● People who are prone to panic attacks are overly sensitive to bodily sensations ○ <Interoceptive awareness=: Heightened awareness of bodily panic cues ● Misinterpret bodily sensations in a negative way ○ Catastrophic distortions (I’m losing control. I’m having a heart attack.=) ● This manner of thinking increases one’s anxiety and physiological arousal, making it more likely to experience a panic attack Panic Disorder: Treatment ● Biological interventions: Goal is to block/prevent panic ○ Antidepressants ■ Tricyclic antidepressants (TCAS) regulates norepinephrine and SSRIs increases serotonin. 20-50% relapse ■ Benzodiazepines (e., Xanax) - GABA + Addictive impairs cognitive abilities, 90% relapse ● Psychological Interventions ○ Cognitive-behavior therapies ■ Anxiety-management skills (e., progressive muscle relaxation, breathing) ■ Identify and challenge panic-inducing thoughts (e,. Keeping a diary of panic related thoughts) ■ Systematic desensitization ● CBT is brief (e., 12 sessions) ● CBT is as effective as medications and is more effective at preventing relapses Generalized Anxiety Disorder (GAD) Pathological Worry ● Excessive (out of proportion) ● Global (worry about everything)
■ Less severe GAD: Etiology ● Biology ○ Deficient GABA transmission ● Psychological ○ Psychoanalytic: ■ We fear our impulses and can’t express them ● Humanistic/Existential ○ Contingencies of self-worth (due to lack of unconditional positive regard as children) ○ Existential anxiety: fear that one’s life has no meaning ● Cognitive ○ Threat focused cognitions from unconscious and conscious levels ■ <I can’t do this.= ○ Attentional bias towards threat and failure ○ Maladaptive assumptions and impossibly high standards for oneself. GAD: Treatment ● Biological ○ Antidepressants ○ Benzodiazepines (increase GABA release) ○ Antidepressants and benzodiazepines are equally efficacious but benzos have high chance of relapse ○ Overall efficacy is fair-good Psychological: Cognitive Behavioral Treatment (CBT) ● CBT is the treatment of choice ● Skills similar to those for panic disorder ● Education and cognitive restructuring ● Exposure to aversive internal state ● Exposure to worry triggers Obsessive Compulsive Disorder (OCD) ● Obsessions: ○ Recurrent, distressing, intrusive thoughts, urges, or images that the person cannot control ● Compulsions: ○ Repetitive behaviors that must be performed in response to an obsession. These acts follow rigid rules. ○ The compulsion is aimed and preventing or neutralizing distress/some dreaded event ● The patient knows that the thoughts and behaviors are irrational
● Patient feels anxious because of obsessive thoughts and when they can’t carry out compulsions Typical Obsessions and Compulsions ● Obsessions: ○ Repetitive thoughts about contamination (e., catching a disease from a public bathroom) ○ Repeated doubts (e., Did I turn off the stove?) ○ Intense need to have orderliness/symmetry ○ Aggressive/horrific impulses (e., swearing at your boss) ○ Repeated sexual thoughts/images ● Compulsions: ○ Cleaning ○ Hoarding ○ Washing ○ Repeating actions ○ Ordering ○ Repeating words silently ○ Checking ○ Counting OCD: Epidemiology ● Lifetime prevalence: 1-3% ● Slightly higher rates in women than men ● Course is chronic ● Most common obsessions are contamination and aggression ● Most common compulsions are checking and washing ● Males have earlier onset (6-15) and more severe course than females (20-29) ● People with OCD generally don’t seek treatment right away ● In the U., individuals in upper economic classes and caucasians have higher rates of OCD than African Americans and Hispanic Americans OCD: Biological Etiology ● Certain brian regions that are important for impulse control maybe dysregulated serotonin levels may be too low in the brain, so there isn’t enough inhibition of impulses ● Genetic influences are also present ○ OCD runs in families OCD: Treatment ● Biological ○ SSRIs (25-75% improve) ● Cognitive Behavioral Treatment (CBT) ○ Exposure: Systematic exposure to feared thoughts and situations ○ Response prevention: Rituals are actively prevented.
● Sense of foreshortened future (e., doesn’t expect to have a career, family, or normal lifespan) Acute Stress Disorder ● Intended to capture the time limited responses to trauma, rather than the more enduring pervasive PTSD ● Occurs within 4 weeks of the traumatic event and lasts less than a month ● Symptoms of reexperiencing, avoidance, and hypervigilance/arousal and dissociative symptoms ○ Sense of detachment, numbing, indifference ○ Reduced awareness of surroundings, <in a daze= ○ Sense that things aren’t real ○ Feelings like the mind and body aren’t connected ○ Memory disturbance or memory loss for part of the trauma PTSD: Epidemiology ● Men experiencing more trauma, but women are more likely to develop PTSD ○ Exposure to different types of trauma ● Lifetime prevalence is 8% ○ 20-70% of male vietnam veterans (depending on exposure) ○ 2:1 Female:male in general population ● Comorbidity ○ Substance abuse, mood disorders, dissociative and somatic disorders ● Different courses ○ Acute (symptoms last less than 3 months) ○ Chronic (symptoms last more than three months, usually for years) ○ Delayed onset (symptoms occur more than 6 months after event) PTSD: Personal Risk Factors ● Prior exposure to uncontrollable/traumatic events ● Lower SES, intelligence, and/or education ● Poor social support ● Certain personality traits (e., neuroticism, hostility) PTSD: Situational Risk Factors ● Prolonged/repeated exposure to trauma ● Sense of vulnerability/loss of control ● High magnitude stressors ○ Rape: 65% of men develop PTSD, 50% of women ○ Non-sexual assault: 27% PTSD: Biological Etiology ● Amygdala ○ Increased activation in right amygdala (fear) ● HPA axis
○ Lower cortisol over time > less regulation of fight or flight response (too much arousal) ● Hippocampus ○ Volume reduced (perhaps due to chronic cortisol feedback) ● Genes ○ Heritability levels similar to phobias (~30%) PTSD: Psychological Etiology ● Shattered assumptions ○ Personal invulnerability ○ Just-world hypothesis (bad things don’t happen to good people) ● Pre-existing distress ○ People who are already anxious/depressed before the trauma are more likely to develop PTSD than those without pre-existing distress ● Coping Styles ○ Emotion-focused coping: rumination, drinking, drugs, dissociation ○ Problem-focused coping: trying to make sense of the experience (without ruminating): examine the problem to find solutions to resolve it PTSD: Treatment ● Biological ○ Antidepressants/anxiolytics ● CBT ○ Psychological - Cognition ■ Cognition restructuring: replace dysfunctional thoughts with more realistic thoughts ■ <I’ll never be normal again.= versus <I will get better.= ○ Psychological - Behavioral ■ Systematic desensitization ■ Anxiety management: thought stopping, relaxation, breathing
Chapter 8 Anxiety, Obsessive Compulsive Disorder and Trauma
Course: Abnormal Psychology (PSYCH-55 )
University: Chaffey College
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