© Cengage Learning 2016 Anxiety and Obsessive- Compulsive and Related Disorders 5.
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© Cengage Learning 2016 © Cengage Learning 2016
Anxiety and Obsessive-Compulsive and Related
Disorders
5
© Cengage Learning 2016
• Anxiety – Produces tension, worry, and physiological
reactivity
• Anxiety disorders – Unfounded fear– Produces clinically significant distress– Symptoms interfere with an individual’s day-
to-day functioning
Understanding Anxiety Disorders from a Multipath Perspective
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Prevalence and Lifetime Morbidity Risk of Anxiety Disorders in the U.S.
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Multipath Model of Anxiety Disorders
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• Ruling out medical or physical causes of anxiety symptoms is important– Hyperthyroidism
– Cardiac arrhythmias
– Asthma medications
– Stimulants
– Withdrawal from alcohol
Biological Dimension
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• Amygdala– Plays a central role in triggering state of fear
or anxiety
– HPA activity triggers “fight-or-flight” response
• Sensory signals travel to hippocampus and prefrontal cortex– Process sensory input and evaluate danger
• Higher-level mental processing may result in signals to stop the HPA response
Fear Circuitry in the Brain
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• Serotonin (a neurotransmitter) linked to depression and anxiety– Research focused on variation in serotonin
transporter gene, 5-HTTLPR• Result: short alleles of the 5-HTTLPR gene are
associated with a reduction in serotonin activity and increased anxiety-related behaviors
• Numerous genes affect vulnerability– Only influence an individual’s predisposition
Genetic Influences
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Neuroanatomical Basis for Panic and Other Anxiety Disorders
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• Puzzling result: only some children with short alleles of the 5-HTTLPR gene exhibit behavioral inhibition
• Subsequent study results– Behavioral inhibition occurred when certain
environmental factors interacted with a child’s genetic predisposition
Interactions Between Biological and Environmental Influences
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• Psychological characteristics can interact with biological predispositions– Can produce anxiety symptoms
• Negative appraisal– Interpreting events as threatening
• Skill of reappraisal– Looking at a situation from various
perspectives
– Minimize negative responses
Psychological Dimension
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• Daily environmental stress can produce anxiety– People with biological or psychological
vulnerabilities are most likely to be affected
• Factors– Poverty, traumatic events, adverse working
conditions, limited social support, and acculturation
– Culture can influence how anxiety is expressed
Social and Sociocultural Dimensions
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Anxiety Disorders
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• Strong, persistent, unwarranted fear of a specific object or situation– Extreme anxiety or panic is expressed when
phobic stimulus is encountered
– Most adults recognize fear is excessive, but children may not
• Most common mental disorder in United States
Phobias
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• Intense fear of being scrutinized or doing something embarrassing or humiliating in the presence of others
• Often comorbid with major depressive disorder and substance-use disorders
• Women twice as likely as men to have social anxiety disorder
• Can be chronic and disabling
Social Anxiety Disorder
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• Extreme fear of a specific object or situation– Exposure to stimulus nearly always produces
intense anxiety or panic attack
• Primary types– Living creatures (example: spiders)
– Environmental conditions (example: heights)
– Blood/injection or injury (example: needles)
– Situational factors (example: flying)
Specific Phobia
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• Intense fear of at least two of the following– Being outside of the home alone
– Traveling via public transportation
– Being in open spaces
– Being in stores or theatres
– Standing in line or being in a crowd
• Situations are feared because escape or help may not be readily available
Agoraphobia
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Phobia Onset
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• All phobia subtypes have moderate genetic contribution– 31 percent heritability
• Perspectives regarding the psychological dimension– Classical conditioning
– Observational learning or modeling
– Negative information
– Cognitive-behavioral response
Etiology of Phobias
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Multipath Model of Phobias
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• Parental behaviors influence development of social anxiety in children– Overprotection
– Lack of support for independence
– Punitive maternal parenting style
• Negative family interactions and family stress– Associated with social anxiety in middle
childhood
Social Dimension
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• Females more likely to have phobias– Some objects of phobia trigger both fear and
disgust responses• Disgust response stronger in females
• Social anxiety disorder (SAD) more common in collectivistic cultures– Individual behaviors seen to reflect on entire
family or group
• SAD expression differs among cultures
Sociocultural Dimension
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• Medications with efficacy for SAD– Benzodiazepines
• Examples: Ativan, Xanax, Valium
• Can produce dependence
– SSRIs• Often prescribed for chronic forms of anxiety
– Beta-blockers
– D-cycloserine
Treatment of Phobias
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• Exposure therapy– Gradual introduction to the feared situation
• Systematic desensitization– Exposure techniques with relaxation
• Cognitive restructuring– Identifying and changing irrational thoughts
• Modeling therapy– Viewing another person’s successful
interactions with the subject of the phobia
Cognitive-Behavioral Treatments
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• Recurrent, unexpected panic attacks– Combined with apprehension about having
another attack or behavior changes designed to avoid having another attack
– Reactions present for one month or more
• Twelve month prevalence rate in the U.S. is 2.7 percent– Twice as common in women as in men
Panic Disorder
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• Biological dimension– Heritability is 32 percent
– Individuals with panic disorders have fewer serotonin receptors
– SSRIs have been shown to be effective• Designed to increase serotonin levels
• Psychological dimension– Individuals show heightened fear responses
to bodily sensations
Etiology of a Panic Disorder
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Multipath Model of a Panic Disorder
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Role of Cognitions in Panic Attacks
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• Contributing factors– Stressful childhood
• Separation anxiety, family conflicts, school problems, or loss of a loved one
• Asian American and Latino/Hispanic adolescents– Higher anxiety sensitivity than European
American adolescents• Less likely to have panic attacks
Sociocultural Dimensions of Panic Disorder
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• Benzodiazepines
• Antidepressants
• Beta-blockers
• High relapse rates after cessation of drug therapy
Biological Treatment of Panic Disorder
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• Promotes self-efficacy
• General steps– Educating the client about panic disorder
– Identifying and correcting catastrophic thinking
– Teaching client to self-induce physiological symptoms in order to extinguish the conditioning
– Encouraging client to face the symptoms
Cognitive-Behavioral Treatmentof Panic Disorder
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• Persistent, high levels of anxiety and excessive, hard-to-control worry over life circumstances
• DSM-5 diagnostic criteria– Symptoms must be present on the majority of
days for six months
– Causes significant impairment in life activities
• Develops gradually– Often begins in childhood or adolescence
Generalized Anxiety Disorder (GAD)
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• Biological dimension– Small but significant heritability factor
– May disrupt prefrontal cortex modulation of response to threatening situations
• Psychological dimension– Cognitive theories: dysfunctional thinking and
beliefs
Etiology of Generalized Anxiety Disorder
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Multipath Model of Generalized Anxiety Disorder (GAD)
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• Negative schemas play a key role– Ambiguous or positive situations may be
viewed with apprehension
• Aspects of worrying– Cope with stressful events or situations
– Constantly generate solutions to “what if” scenarios
– Worry about worry
Psychological Dimension of GAD
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• Mothers with anxiety may be less engaged with their infants– Associated with increased likelihood of child
developing GAD
• Some stressors that influence GAD– Poverty, poor housing, prejudice, and
discrimination
– Peer relationship conflicts
Social and Sociocultural Dimensions of GAD
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• Drug therapy– Benzodiazepines
• Issues with dependence
– Antidepressants• Lower less risk of dependence
• Cognitive-behavioral therapy– Effective psychological treatment
• 60 percent showed significant symptom reduction that persisted 12 months after treatment
Treatment of Generalized Anxiety Disorder
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• Obsessive-compulsive disorder– Consistent, anxiety producing thoughts or
images
– Overwhelming need to engage in activities or mental acts to counteract anxiety or prevent occurrence of dreaded event
• Hoarding disorder– Inability to discard items regardless of their
value
Obsessive-Compulsive and Related Disorders
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Clinical Examples of Obsessions and Compulsions
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Common Obsessions and Compulsions
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• Body dysmorphic disorder– Preoccupation with a perceived physical
defect
– Symptoms cause significant distress or impairment in life activities
• Hair-pulling disorder– Recurrent and frequent hair-pulling despite
repeated attempts to stop
• Skin-picking disorder– Results in skin lesions
Other Types of OCD-Related Disorders
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• Heredity is involved
• Endophenotype characteristics for OCD– Impairment in:
• Decision-making
• Planning
• Mental flexibility
• Increased metabolic activity in frontal lobe of left hemisphere of the brain
Etiology of Obsessive-Compulsive and Related Disorders
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Multipath Model of Obsessive-Compulsive Disorder
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• Behavioral perspective– Obsessive-compulsive behaviors develop
because they reduce anxiety
• Cognitive characteristics– Exaggerated estimates of probability of harm
– Control
– Intolerance of uncertainty
– Thought-fusion
– Disconfirmatory bias
Psychological Dimension of OCD
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• Family variables– Controlling, overly critical parenting styles
– Low parental warmth
– Discouragement of autonomy
• Reactions of family members to OCD can increase symptom severity
• Culture may affect how symptoms are expressed
Social and Sociocultural Dimensions
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• Biological treatments– SSRI antidepressants
• Only about 60 percent respond to this therapy
• Outcome improved when combined with behavioral interventions
• Behavioral treatments– Flooding
– Response prevention
Treatment of Obsessive-Compulsive and Related Disorders
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• Cognitive-behavioral therapies considered most effective in treating anxiety and OCD– Many who show improvement relapse
• Novel methods and approaches– Specialized therapy programs targeting
specific disorders
– Treatment protocols that can be used across anxiety disorders
– Technology to improve CBT outcome and outreach
Contemporary Trends and Future Directions
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• According to the multipath model, how are biological, psychological, social, and sociocultural factors involved in the development of anxiety disorders?
• What are phobias, what contributes to their development, and how are they treated?
• What is panic disorder, what produces it, and how is it treated?
Review
© Cengage Learning 2016
• What is generalized anxiety disorder, what are its causes, and how is it treated?
• What are characteristics of obsessive-compulsive and related disorders, what causes these disorders, and how are they treated?
Review (cont’d.)
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