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Abnormal Psychology

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Abnormal Psychology ­ PSY404
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LESSON 24
ANXIETY DISORDERS
Anxiety disorder is the most complex and mysterious disorder.
Have you ever experienced anxiety?
Do you feel anxious when you have an exam or a test?
I feel anxious going to a hospital for a check up?
My friend experiences anxiety visiting his dentist?
My student reports anxiety related to attending his sick mother at an intensive care unit.
So what is anxiety?
Anxiety is a mood- state, characterized by marked negative affect, bodily symptoms of tension, restlessness
and apprehension about future.
 Anxiety is very hard to study. In humans a sense of uneasiness, looking worried and anxious.
 The physiological response of anxiety is reflected in increased heart beat and muscle tension.
 Anxiety is not pleasant, it is some unpleasant thing, usually students say they can do well on test if
they have no examination anxiety.
 But moderate amount of anxiety is needed for optimal performance of people
 Moderate anxiety creates a feeling of preparation in people
 So anxiety is future oriented mood state
 So when a student says that I better study hard for my examination, so as to respond adequately to
difficult questions of the exam as well.
 What is anxiety?
 Is it that anxiety, fear and panic are the same phenomena? So let us explore
 Anxiety , fear and panic
 Anxiety is mood state characterized negative affect, tension, apprehension of future.
 Fear is an immediate alarm reaction to danger. It protects us by activating a massive response
 In fear there is an increased heart beat, blood pressure and subjective feeling of escape of an
individual from danger or terror, so either flight from or to fight the enemy.
 In fear an individual has fight- flight response or reaction situation.
 Panic is an abrupt experience of intense fear or acute discomfort accompanied by physical
symptoms of heart palpitations, chest pains, shortness of breath and dizziness.
 Three basic types of panic attacks
 1-Situationally bound: when you know you are afraid of high places or afraid of driving over long
bridges you have situation bound panic disorder (cued).
 2- Unexpected: you may experience an unexpected panic attack disorder (uncued).
 3-Situationally predisposed: you are more likely to have a panic attack where you had before. Both
1 and 2 are included.
 Panic and anxiety combine to form different anxiety disorders
 1- Generalized Anxiety Disorder (GAD)
 2- panic with agoraphobia
 3-Specific phobia
 4- Social phobia
 5-Post Traumatic Stress Disorder (PTSD)
 6-Obessive Compulsive Disorder (OCD)
 Generalized Anxiety Disorder is unfocused, prolonged anxiety and worry.
 Anxiety is about minor every day events
 Genetics and psychological factors responsible for GAD.
 Panic with and without agoraphobia
 It is fear and avoidance of situations considered to be safe Anxiety is focused on next panic attack.
 Agoraphobia is marketplace or public place phobia.
 In Specific phobia a person avoids specific situations that produce severe anxiety or panic.
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Social phobias is fear of being around others, particularly to be in situations that call for some kind
of performance in front of other people e.g. meeting strangers in part
Post Traumatic Stress Disorder (PTSD) it focuses on avoiding thoughts or images of some past
traumatic experiences
The PTSD is a traumatic experience and the intensity of the experience seems to be a factor in
development.
Example the 8th October 2005, earthquake affected of our country show symptoms of PTSD.
Obsessive Compulsive Disorder (OCD) it focuses on avoiding frightening or intrusive thoughts
(obsessive)
Leading to ritualistic behaviors (compulsions)
Washing and checking of locks, doors.
Influences in anxiety disorders
Biological influences
Behavioral influences
Social influences
Emotional and cognitive influences
Treatments for anxiety disorders
1- drug therapy
2-Cognitive ­ behavioral therapy
3-Other treatments
Taken together, the various forms of anxiety disorders--including phobias, obsessions,
compulsions, and extreme worry--represent the most common type of abnormal behavior.
Anxiety disorders share several important similarities with mood disorders.
From a descriptive point of view, both categories are defined in terms of negative emotional
responses.
Stressful life events seem to play a role in the onset of both depression and anxiety.
Cognitive factors are also important in both types of problems.
From a biological point of view, certain brain regions and a number of neurotransmitters are
involved in the etiology of anxiety disorders as well as mood disorders.
People with anxiety disorders share a preoccupation with, or persistent avoidance of, thoughts or
situations that provoke fear or anxiety.
Anxiety disorders frequently have a negative impact on various aspects of a person's life.
Anxious mood is often defined in contrast to the specific emotion of fear, which is more easily
understood.
Fear is experienced in the face of real, immediate danger.
In contrast to fear, anxiety involves a more general or diffuses emotional reaction--beyond simple
fear--that is out of proportion to threats from the environment.
Rather than being directed toward the person's present circumstances, anxiety is associated with the
anticipation of future problems.
Anxiety can be adaptive at low levels, because it serves as a signal that the person must prepare for
an upcoming event.
An anxious mood is often associated with pessimistic thoughts and feelings.
The person's attention turns inward, focusing on negative emotions and self-evaluation rather than
on the organization or rehearsal of adaptive responses that might be useful in coping with negative
events.
Excessive Worry
Worrying is a cognitive activity that is associated with anxiety.
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Worry can be defined as a relatively uncontrollable sequence of negative, emotional thoughts that
are concerned with possible future threats or danger.
Worriers are preoccupied with "self-talk" rather than unpleasant visual images.
The distinction between pathological and normal worry hinges on quantity--how often the person
worries and about how many different topics the person worries.
It also depends on the quality of worrisome thought.
Excessive worriers are more likely than other people to report that the content of their thoughts is
negative, that they have less control over the content and direction of their thoughts, and that in
comparison to other adults, their worries are less realistic.
Anxiety Disorders
Anxiety Disorder
Description and Symptoms
Generalized anxiety disorder Excessive anxiety and worry that occur on most days for a period of six months
(GAD)
about events ad activities such as work or school; symptoms include restlessness,
fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance.
Specific phobia (sometimes Persistent, excessive, and unrealistic fear triggered by the presence of a particular
called simple phobia)
situation or object.
Social phobia
Persistent and marked fear of one or more social or performance situations.
Agoraphobia
The fear of experiencing the symptoms of fear and the fear of being in places from
which escape might be difficult. (It is also possible to experience agoraphobia
without panic.)
Panic attack
A discrete period of intense fear or discomfort that appears abruptly and
unexpectedly and peaks within ten minutes; symptoms include pounding heart,
shaking,  trembling,  shortness  of  breath,  sweating,  abdominal  distress,
lightheadedness, and fear of losing control. Panic attacks can occur with or without
agoraphobia.
Obsessive-
compulsive May be defined by either obsessive or. compulsive symptoms; obsessions are recurrent
disorder (OCD)
and persistent thoughts or images that cause distress and are experienced as intrusive
and inappropriate, and compulsions are repetitive behaviors that the person feels driven
to perform.
Posttraumatic stress disorder The persistent experiencing of a traumatic event (e.g., in images or dreams) and the
(PTSD)
avoidance of stimuli associated with the trauma; symptoms include sleep
disturbances, difficulty concentrating, angry outbursts, or an exaggerated startle
response
Acute stress disorder
Resembles PTSD, but symptoms persist for at least two days but less than four
weeks
Source: DSM-IV. Reprinted with permission from The Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright 1994 American Psychiatric Association
Is it normal to be anxious?
Almost everyone can recall at least one episode of anxious arousal and fear -- an experience of
worry tension, a racing heart, sweaty palms, or an upset stomach. Indeed, anxiety and fear can serve
an adaptive function: Anxious arousal tells us to take special action, to fight what is threatening us
or to flee. The fact that most of us experience some degree of anxiety suggests that is a part of
normal functioning.
Is being entirely anxiety-free normal or even desirable?
If we are anxiety free are we better off?
The answer is no.
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Very low levels of anxiety, like high levels, can be detrimental to performance:
With few exceptions, we perform best when we experience mild levels of anxiety.
Example when you have anxiety for your examination you will be pushed to study otherwise you
will not prepare for examination.
THE INTERACTION OF PERSON AND SITUATION ANXIETY
Does anxiety come entirely from within the person?
Is it the result of a chemical imbalance or of maladaptive thinking?
Or is it caused by environmental conditions?
1-Biological causes
The areas of the brain are affected by different neurotransmitter systems, some of which, in turn,
play an important role in the experience of fear and anxiety, and the way these events are
interpreted by the person is important in the shaping of anxiety disorders. A model of anxiety
disorders must include biological vulnerabilities that affect arousal and activation in interaction with
personal, psychological, and environmental characteristics.
2-The diathesis-stress model, is one offshoot of this interactional perspective, which holds that
individual dispositions (diathesis) and situational influences (such as stress) interact to create and
maintain psychological disorders (Magnusson & Ohman, 1987).
THEORIES ABOUT ANXIETY DISORDERS
Each of the following theoretical perspectives -- biological, cognitive, behavioral, and
psychodynamic -- has generated extensive literature on anxiety and the development of anxiety
disorders. In addition to the interactional (diathesis-stress) perspective just described, we consider
how these four major perspectives explain anxiety and anxiety disorders.
Biological Theories
 Anxiety and the anxiety disorders are often linked to the body's physical systems of arousal. In
times of heightened distress, our bodies react. When we turn a corner in our neighborhood and see
the smoke of a burning home, when we receive a phone call from a hospital late in the evening, or
when we see but can't stop a toddler who is wandering in a busy parking lot, our bodies do indeed
react.
 The autonomic nervous system carries messages between the brain and major organs of the body
-- the heart, stomach, and adrenal glands. In turn, the adrenal glands release a hormone, adrenaline
that activates this system. When signals of distress are legitimate, adrenaline galvanizes the
individual to action. In the absence of crisis, however excessive adrenaline can cause anxious
distress.
The biological perspective considers the roles of genetic and constitutional factors, biological
reactivity, endocrinological and neurotransmitter factors, and brain anatomy and functioning in the
development of anxiety and anxiety disorders.
The term selective association accounts for the finding that humans are apparently more easily
conditioned to some stimuli than to others.
Based on this, one hypothesis holds that humans and many animals learn fears. Phobias may be
learned.
Medications for Anxiety Disorders. Because anxiety symptoms often co-occur with depression, it should
not be surprising that some of the antidepressants also reduce anxiety.
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Panic disorders, in particular, respond relatively well to antidepressants. According to one published
report, 60 to 90 percent of such patients display significant improvements when treated with
antidepressants (see also Ballenger, Burrows & Dupont, 1988).
In some cases of posttraumatic stress disorder, researchers have claimed that antidepressants are
effective as well (Davidson et al., 1990).
Cognitive Theories
 The basic idea underlying cognitive approaches is that anxiety results when we try to understand
the events and experiences that we are a part of in distorted irrational ways.
 Ellis posited that people with unhealthy emotional lives are also victims of cognitive irrationality --
they view the world based on self- defeating assumptions.
Examples
1-To become afraid on a camping trip when you are familiar with the territory of your camping trip,
is an irrational fear.
2-To be unwilling to participate in a new game for fear that you won't be the absolute best player is
irrational.
**Dog lovers, when approached by a dog, might perceive the dog in any of several ways -- in
terms of attractiveness, breed, grooming, or posture. But people with a dog phobia (an excessive
fear of dogs) have a narrow and negative view of dogs, seeing them in terms of their size and
ferocity. They never see the dog's tail wagging; they see only teeth (Landau, 1980)
**Consider the following example of cognitive influences in the experience of deleterious anxiety.
Sam is waiting for his mother to pick him up after school. Most of the other children have already
gone home. Sam thinks to himself, "Why is she late?" In itself, this thought is not detrimental;
many children in the same situation might ask themselves the same question and he continues to
worry. Rather than using the time to complete a homework assignment or talk with friends or
teachers, the anxious youngster engages in task-irrelevant thought. He may question why she is late
and respond by himself due to the fact she does not love me while the fact is she is late due to
traffic block or car trouble.
Anxiety disorders have multiple causes and multiple expressions. As we discussed, several forces
interact in the development of disorders of anxiety, and not all expressions of these disorders are
the same. Indeed, several different types of anxiety disorder appear in contemporary classification
schemes.
Behavioral Theories
Behavioral explanations of anxiety emphasize the processes involved in the acquisition of anxiety
responses. Behaviorists hold that persons who suffer distressing levels of anxiety have learned to
behave in an anxious manner through classical conditioning, operant conditioning, or modeling.
 Modeling, also called observational learning, is another behavioral explanation for anxiety responses.
Unlike conditioning, modeling produces learning without personal experience with a situation or
object. Thus, an individual can develop an emotional response after watching someone else
experience an aversive emotional condition.
Example
**An adolescent boy observed the adolescent girl receive the ridicule from peers might stay away from
those same peers hoping to avoid similar teasing and rejection. He didn't experience the rejection
directly, but he observed it and learned to avoid it from the vicarious experience.
Behavioral Therapies
1- Systematic Desensitization and exposure treatments are the treatment of specific anxiety disorders
these behavioral techniques typically emphasize and focus on the client's cognitive and behavioral
functioning.
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2- Rational Emotive Behavior Therapy the focus is on modifying the irrational, illogical belief system.
3- A paradoxical intervention encourages the client to intend or wish for exactly what is feared.
 Example I think I will faint in the examination hall, you try hard to faint in the examination hall.
 The person does not faint.
The paradoxical therapists believe that people's attempts to solve their problems often cause them
to maintain the very problems they are trying to solve. The paradoxical therapist thus provides
directives that are designed to help clients give up their "problem- maintaining solutions".
 Note fully discussed in lecture no 26.
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Table of Contents:
  1. ABNORMAL PSYCHOLOGY:PSYCHOSIS, Team approach in psychology
  2. WHAT IS ABNORMAL BEHAVIOR:Dysfunction, Distress, Danger
  3. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Supernatural Model, Biological Model
  4. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Free association, Dream analysis
  5. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Humanistic Model, Classical Conditioning
  6. RESEARCH METHODS:To Read Research, To Evaluate Research, To increase marketability
  7. RESEARCH DESIGNS:Types of Variables, Confounding variables or extraneous
  8. EXPERIMENTAL REASEARCH DESIGNS:Control Groups, Placebo Control Groups
  9. GENETICS:Adoption Studies, Twin Studies, Sequential Design, Follow back studies
  10. RESEARCH ETHICS:Approval for the research project, Risk, Consent
  11. CAUSES OF ABNORMAL BEHAVIOR:Biological Dimensions
  12. THE STRUCTURE OF BRAIN:Peripheral Nervous System, Psychoanalytic Model
  13. CAUSES OF PSYCHOPATHOLOGY:Biomedical Model, Humanistic model
  14. CAUSES OF ABNORMAL BEHAVIOR ETIOLOGICAL FACTORS OF ABNORMALITY
  15. CLASSIFICATION AND ASSESSMENT:Reliability, Test retest, Split Half
  16. DIAGNOSING PSYCHOLOGICAL DISORDERS:The categorical approach, Prototypical approach
  17. EVALUATING SYSTEMS:Basic Issues in Assessment, Interviews
  18. ASSESSMENT of PERSONALITY:Advantages of MMPI-2, Intelligence Tests
  19. ASSESSMENT of PERSONALITY (2):Neuropsychological Tests, Biofeedback
  20. PSYCHOTHERAPY:Global Therapies, Individual therapy, Brief Historical Perspective
  21. PSYCHOTHERAPY:Problem based therapies, Gestalt therapy, Behavioral therapies
  22. PSYCHOTHERAPY:Ego Analysis, Psychodynamic Psychotherapy, Aversion Therapy
  23. PSYCHOTHERAPY:Humanistic Psychotherapy, Client-Centered Therapy, Gestalt therapy
  24. ANXIETY DISORDERS:THEORIES ABOUT ANXIETY DISORDERS
  25. ANXIETY DISORDERS:Social Phobias, Agoraphobia, Treating Phobias
  26. MOOD DISORDERS:Emotional Symptoms, Cognitive Symptoms, Bipolar Disorders
  27. MOOD DISORDERS:DIAGNOSIS, Further Descriptions and Subtypes, Social Factors
  28. SUICIDE:PRECIPITATING FACTORS IN SUICIDE, VIEWS ON SUICIDE
  29. STRESS:Stress as a Life Event, Coping, Optimism, Health Behavior
  30. STRESS:Psychophysiological Responses to Stress, Health Behavior
  31. ACUTE AND POSTTRAUMATIC STRESS DISORDERS
  32. DISSOCIATIVE AND SOMATOFORM DISORDERS:DISSOCIATIVE DISORDERS
  33. DISSOCIATIVE and SOMATOFORM DISORDERS:SOMATOFORM DISORDERS
  34. PERSONALITY DISORDERS:Causes of Personality Disorders, Motive
  35. PERSONALITY DISORDERS:Paranoid Personality, Schizoid Personality, The Diagnosis
  36. ALCOHOLISM AND SUBSTANCE RELATED DISORDERS:Poly Drug Use
  37. ALCOHOLISM AND SUBSTANCE RELATED DISORDERS:Integrated Systems
  38. SCHIZOPHRENIA:Prodromal Phase, Residual Phase, Negative symptoms
  39. SCHIZOPHRENIA:Related Psychotic Disorders, Causes of Schizophrenia
  40. DEMENTIA DELIRIUM AND AMNESTIC DISORDERS:DELIRIUM, Causes of Delirium
  41. DEMENTIA DELIRIUM AND AMNESTIC DISORDERS:Amnesia
  42. MENTAL RETARDATION AND DEVELOPMENTAL DISORDERS
  43. MENTAL RETARDATION AND DEVELOPMENTAL DISORDERS
  44. PSYCHOLOGICAL PROBLEMS OF CHILDHOOD:Kinds of Internalizing Disorders
  45. LIFE CYCLE TRANSITIONS AND ADULT DEVELOPMENT:Aging