ZeePedia

ANXIETY DISORDERS:Social Phobias, Agoraphobia, Treating Phobias

<< ANXIETY DISORDERS:THEORIES ABOUT ANXIETY DISORDERS
MOOD DISORDERS:Emotional Symptoms, Cognitive Symptoms, Bipolar Disorders >>
img
Abnormal Psychology ­ PSY404
VU
LESSON 25
ANXIETY DISORDERS
(Symptoms of anxiety)
(Type of anxiety disorders)
Recap Lecture No. 24
·  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.
·
Before GAD can be diagnosed, several criteria must be met. According to DSM-IV, the excessive
and unrealistic anxiety and worry must be present for a minimum of six months; impulses must be
experienced as difficult to control; and they must be associated with at least three of the following
symptoms:
·
Restlessness, feeling on the edge
·
Easily fatigued
·
Difficulty in concentrating or mind going blank
·
Irritability
·
Muscle tension
·
Sleep disturbance (difficulty falling or staying asleep, or restless and unsatisfying sleep)
·
Although 98.6 percent of GAD patients meet the criterion of three out of six symptoms, a large
percentage of patients with other anxiety disorders also fulfill this criterion. Raising the criterion to
four or more symptoms increases diagnostic accuracy.
Treating GAD Borkovec and his colleagues (1983) have provided some interesting information
·
about the ability of clients to learn how to manage their worrying.
·
In one study clients reported that worry consumed approximately 50 percent of each day and
caused those major problems. During an intervention, the clients participated in a program that
included (1) establishing a specified half-hour period (same place, same time) for daily worrying, (2)
identifying negative thoughts and task- relevant thoughts, (3) postponing worrying until the allotted
time, and (4), at the time assigned for worrying, engaging in intense worry and problem solving.
After four weeks, the treated subjects showed a reduction in the percentage of time they spent
worrying.
·
Apparently, providing a time and place for worrying (stimulus control) reduces its detrimental
effects.
·
Phobic disorders are tied to specific objects or situations. Phobias are intense, recurrent, and
irrational fears that are disproportionate to the actual situation. Claustrophobia, the fear of closed
spaces, is a common example of a phobia. Small room or lift etc.
·
Most of us have some discomfort or fear associated with fire, disease, snakes, and being in small
and enclosed places. Youngsters have been known to avoid walking near an abandoned "haunted
house," and college students may avoid biology courses because they are uneasy about the blood
that is rumored to be a part of the lab work. To a degree, these fears are rational but Phobic
reactions are irrational.
·
Phobias involve specifiable fear reactions --
114
img
Abnormal Psychology ­ PSY404
VU
·
Clients with phobias recognize that their fears are excessive and unreasonable, and they work to
avoid the phobic stimulus.
·
Symptoms such as headaches, dizziness, stomach pains, and other general physical complaints are
often reported in association with phobias. Lack of self-confidence and mild depression may also
accompany phobic conditions. Fainting has been reported in phobic exposed to the feared situation
or object (such as the sight of blood), but these reports are not as prevalent as once thought.
·
Some phobias, such as those provoked by small animals, are present in early childhood, but phobic
disorders typically begin in adolescence or early adulthood.
Who Is Affected with Phobias? Phobic disorders are the most common of the anxiety disorders,
·
with a lifetime prevalence of 14.2 percent of the population (Eaton, Dryman & Weissman, 1991).
·
Using current diagnostic criteria, and sampling from more than eight thousand people from non-
institutional households, Magee and associates (1996) reported lifetime prevalence of 13.3 percent
for social phobia, 11.3 percent for specific phobia, and 6.7 percent for agoraphobia.
Specific (Simple) Phobias
·
Specific phobias are pathological (excessive and unrealistic) fears of specific animals, objects, or
situations.
·
Common examples include phobias of the needles, elevators, dogs, snakes, storms, blood, dentists,
and tightly enclosed spaces although the phobic individual may be reasonably well adjusted when
not directly faced by the phobic stimulus, he or she experiences anticipatory anxiety when aware of
an impending situation that could force a confrontation with the object of fear. When the phobic
individual is actually exposed to the phobic stimulus, there is almost invariably an intense and
immediate anxiety response.
·
For example, the person with needle phobia who comes in contact with a needle will report
sweating, difficulty breathing, and a racing heart. The phobic stimulus is viewed as powerful indeed,
as this example illustrates. In an experiment conducted in the Netherlands. Women with phobias
were shown various, slides of phobic stimuli and given very mild shock. The researchers concluded
that because phobic stimuli cause such discomfort, they are routinely avoided rather than faced
directly and endured.
Social Phobias
·
It refers to being asked to perform before an audience will produce some anxiety in almost all of us.
The thought of having nothing to say or of saying something inappropriate causes us to become
self-conscious and nervous. These are normal, rational fears. Social phobias, however, involve a
persistent fear of being in a social situation in which one is exposed to scrutiny by others and a
related fear of acting in a way that will be humiliating or embarrassing. As self-focus increases, so
does the anticipation of anxiety (Woody, 1996).
·
Phobic and non-phobic individuals have comparable concerns, but the intensity, extremeness, and
irrationality of the reactions of social phobic set them apart from their non-phobic counterparts.
·
Examples of social phobias include irrational reactions to eating in public places, using public
restrooms, or speaking in front of large groups of people. Like the specific phobic, the social
phobic experiences marked anxiety when anticipating the phobic situation and therefore usually
avoids it. This avoidance interferes with the person's daily routine and can potentially ruin his or
her career.
Agoraphobia
·
The term agoraphobia, which is derived from the Greek word agora, meaning marketplace, was
originally used to refer to a pathological fear of open or public places.
·
At present, agoraphobia is considered a fear of being alone or of being in public places where
escape is difficult or where help is not readily available in case of a panic attack that the person
fears would be overwhelming. The agoraphobic might experience intense fear in shopping malls
115
img
Abnormal Psychology ­ PSY404
VU
during the holidays, in crowds at concerts or sports events, and in tunnels, bridges, or in public
transport.
·
Agoraphobia also occurs within an interrelated and overlapping cluster of phobias, such as a
phobia of cars, buses, planes, and trains. As a result of agoraphobia, the sufferer restricts travel or
requires a companion when away from home.
Label
Fear
Agoraphobia
Open places
Aichmophobia
Pointed objects
Algophobia
Pain
Arachnophobia
Spiders
Astraphobia
Storms; thunder and lightning
Claustrophobia
Closed spaces; confinement
Hydrophobia
Water
Nyctophobia
Darkness
Ophidiophobia
Snakes
Pyrophobia
Fire
Thanatophobia
Death
Xenophobia
Strangers
Causes of Phobias
·  Phobic disorders have been explained in several ways, according to the various models of
psychopathology.
·  For example, the psychodynamic explanation of phobia is that the anxiety expressed toward the
phobic object or situation is actually displacement of an internal anxiety.
·
·  From this perspective, then, a snake phobia is more than a fear of snakes -- it represents some
other underlying anxiety. The phobia is seen as having arisen because the patient lacks
understanding about this underlying anxiety and uses displacement as a defense mechanism.
·
Some evidence of a genetic predisposition for phobic disorder exists (Torgersen, 1983). First,
regarding incidence of behaviors that are relevant to the study of social phobia (such as eating in
public, being observed at work), monozygotic twins are more alike than dizygotic twins. Second,
parents of children who are diagnosed with a childhood phobic disorder are themselves more likely
to meet the criteria for this disorder. Although these findings suggest that the pattern can be genetic
or learned.
·
**One model of the development of agoraphobia specifically includes cognitive and behavioral
processes
·  1- A case of agoraphobia.
116
img
Abnormal Psychology ­ PSY404
VU
·
2- Persons with agoraphobia hold biased emotional expectations; they expect
unwanted emotional arousal, are overly alert to cues that signal anxiety, and are
highly motivated to avoid anxiety- provoking stimuli.
·
3- In persons with agoraphobia, have an unwillingness to approach or to try to
master stressful situations is accompanied by a sense of loss of control.
Treating Phobias
·  Specific phobias have been successfully treated with systematic desensitization, where anxiety is
paired with relaxation with imagined (or real) scenes involving the client in anxiety-producing
situations.
·  Systematic desensitization is a behavior therapy procedure developed by Joseph Wolpe (1995,
1982).where old maladaptive associations are replaced by newer, more adaptive ones.
·  Behavioral exposure treatments, both flooding and desensitization, do provide evidence of clients'
newly acquired knowledge and ability to manage anxiety. As the clients come to experience and
accept the ability to cope with once-feared situations, self-efficacy increases and remains with the
clients as part of their newly acquired sense of mastery over prior phobia.
·  To paraphrase a familiar maxim: Nothing succeeds like a belief in success.
Panic Disorder
·  The term panic originated with Pan, the Greek god who was said to be a happy but an ugly man: He
had the horns, ears, and legs of a goat. When in a bad mood, he enjoyed scaring away travelers --
hence the word panic (Ley, 1987). Experiences that may well be called panic have been around for a
long but it was not until recently that consistency in research findings and clinical practice led to the
identification of panic disorder as a separate type of anxiety disorder.
·  A person suffering from panic disorder is vulnerable to frequent panic attacks -- discrete
instances of fear or discomfort. Panic attacks are unexpected in the sense that they do not occur in
a predictable context or immediately before a situation that almost always causes anxiety reactions;
they are not the result of evaluation of the person or of scrutiny by others. In these ways, panic
disorder is differentiated from specific phobia and social phobia, which do involve situational
determinants.
·  Who Is Affected with Panic Disorder? Panic attacks occur in panic disorder, but they are also
sometimes reported in patients with phobias, substance-abuse disorder, and mild depression. In
one study, researchers interviewed 1,306 residents of San Antonio, Texas, and found that 5.6
percent reported panic attacks, but only 3.8 percent met criteria for panic disorder.
·  Panic disorder in women typically occurs at more than twice the frequency of panic disorder in
men. However, research conducted in Australia determined that, in terms of symptoms, age of
onset, cognition, and duration, there are no significant differences between male and female
patients with panic attacks (Oei, Wanstall & Evans, 1990).
1. Palpitations pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath
5. Feeling of choking
6. Chest pain or discomfort,
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded,
117
img
Abnormal Psychology ­ PSY404
VU
9. Derealization (feelings of unreality) or depersonalization (feeling detached from
oneself)
10. Fear of losing control or going crazy
11. Fear of dying
12. Numbness or tingling sensations
13. Chills or hot flashes
Source: Adapted from DSM-1V Reprinted with permission from The Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition, Copyright @ 1994 American
Psychiatric Association.
Are Panic Attacks Biological?
·
**Are panic attacks specifically associated with biological factors?
·
Proponents of a biological model cite studies showing that panic patients responded distinctively
to a variety of "challenges" they faced in the laboratory. Other proponents of a biological model
have suggested that patients with panic disorder have a dysfunctional heart.
·
**panic is a fear response to unexpected and unexplained somatic events (Clark, 1989). It is as if
changes in bodily functions that can't be easily explained (such as a sudden change in breathing)
prompt the panic sufferer to anticipate the worst and to experience fear and panic (see also
McNally & Eke, 1996).
·
According to Clark (1986), misinterpretation of the arousal cues is causally linked to panic. Thus,
although persons with panic attack with a history of it and those without such a history both
experience similar arousal (as a result of, say, hyperventilation), only the subjects with panic
disorder view these physiological cues as indications that a catastrophe is forthcoming. Somatic
complaints precede the fear, and the somatic changes are frightening to the panic sufferer.
·
In general, research has supported the idea that panic attacks result from the client's fear response
to certain bodily sensations.
Obsessive-Compulsive Disorder (OCD)
·  Have you ever found yourself humming a commercial jingle -- a tune that stays in your mind
longer than you want it to? In a small way, this experience is like an obsession. Obsessions are
persistent and unwanted thoughts, ideas, or images that a person does not intentionally produce.
Rather, the unwanted thoughts are perceived as invading the person's thinking. The recurring
thoughts are troublesome, unnecessary, and distracting, and the person tries to be rid of them.
Features of OCD
The content and form of normal and abnormal obsessions are similar. Abnormal obsessions,
however, are more frequent, more intense, and of longer duration; they produce more
discomfort; and they are more associated with compulsions than are normal obsessions.
·  Is heightened emotional intensity possibly an important aspect of the intrusive quality of
obsessions? (Clark & de Silva, 1985). The studies to date, using nonclinical cases, support this
hypothesis and suggest that reducing the frequency of any negative cognition will increase the
client's ability to dismiss such thoughts.
·  Although compulsions appear to be purposeful behaviors, they are essentially nonfunctional and
ritualistic. The compulsion reported most often is checking, which results from pathologic doubt
linked to repeated attempts to "make sure".
·
An obsessive- compulsive person might fear that the front door was left unlocked and so
repeatedly return to the door to check that it is locked. Other common examples of compulsive
checking include repetitions intended to determine that gas and water taps are shut and lights and
118
img
Abnormal Psychology ­ PSY404
VU
appliances are off. Still other cases highlight a need for organization -- checking that kitchen
utensils are properly aligned, cupboard contents are correctly arranged, and closets are organized in
the "right" order. Some common rituals include repeatedly putting clothes on and taking them off;
hoarding items such as newspapers, mail, or boxes; and repeating certain actions such as going
through a doorway.
·
Compulsive hand washing is linked to a preoccupation with dirt and contamination and may be
tinged with reports of disgust regarding urine and feces. Compulsive hand washers avoid public
restrooms, doorknobs, shaking hands, and money, all of which are viewed as contaminated.
Patients may wash as many as eighty times a day, often causing damage to their skin.
Causes of OCD
·  **Researchers have speculated that the obsessions and compulsions reflect fixed-action patterns
that are "wired" into the brain. When stressful conditions stimulate the person's perception of
danger, these fixed action patterns may be inappropriately activated. Normal individuals cease
performing an action when their senses tell them that the action has been completed, whereas,
according to the theory just described, persons with OCD become helpless victims of their
repeating patterns. Example hand washing.
Treating OCD
·  The impatient friend of an obsessive person advises, "Just don't think about it." But the person's
unwanted thoughts persist nonetheless.
·
The spouse of a compulsive checker shouts, "We're going to be late. Stop that damn checking."
But the checking continues. The experience of nonprofessionals is that obsessive- compulsive
disorder is very resistant to direct instructions. Indeed, obsessive patients have thought and thought
about matters that they feel are major, and they frequently do not respond to the suggestions of
others. Compulsive persons, too, are said to be resistant to advice.
Treatment of OCD especially of chronic cases is difficult earlier the treatment begins the better it is and
when it is becomes chronic or it goes without any treatment for some time then patient takes time to
respond to any therapy.
Posttraumatic Stress Disorder (PTSD)
·  Psychologically speaking, what is similar about the experiences of rape, torture, military combat,
airplane crash, earthquake, a disastrous fire, and the collapse of a large building? Each can cause
severe trauma. Posttraumatic stress disorder (PTSD) is a cluster of psychological symptoms that
can follow a psychologically distressing event. Stressors that produce PTSD would produce marked
distress in almost anyone, and they are outside the range of normal, common stressors such as
chronic illness, marital separation, or business failure. Although not all disasters result in
psychopathology (Rubonis & Bickman, 1991) -- indeed, some people seem invulnerable to the
distress -- certain individuals do develop severe disorders related to trauma.
·  The typical symptoms of PTSD occur following a recognizable stressor (traumatic event) that has
involved intense fear and horror. They include re-experiencing of the traumatic event, persistent
avoidance of any reminders of the event, numbing of general responsiveness, and increased arousal.
To warrant a diagnosis of PTSD, a client must experience these symptoms for at least one month.
Acute stress disorder, a recent addition to DSM, refers to PTSD-like reactions that persist for at
least two days but less than four weeks.
**Who Is Affected with PTSD?
According to recent epidemiological data (Kessler et al., 1995),
the estimated lifetime prevalence of PTSD is 7.8 percent. The trauma most commonly associated with
posttraumatic stress disorder among men is combat exposure, which is rated the most upsetting trauma for
28.8 percent of men with PTSD. Among women, rape is most commonly associated with PTSD; it is rated
most upsetting by 29.9 percent of women with PTSD. Fifty-eight percent of battered women also report
high rates of PTSD (Astin, Ogland-Hand, Coleman & Foy, 1995).
119
img
Abnormal Psychology ­ PSY404
VU
·
**Military-combat-produced PTSD is not new; writers described its occurrence after the Civil War,
World Wars I and II, and the Korean War. Early reference was made to "shell shock" or "battle
fatigue" to refer to an array of symptoms seen in men whose military experience included exposure
to artillery fire, attack, and bombings. In the United States, the Centers for Disease Control
conducted a four-year epidemiological study of approximately 15,000 Vietnam veterans and
reported that 15 percent suffered from combat-related PTSD since their discharge (Roberts, 1988).
Catastrophes such as aircraft disasters, tornadoes, and fires can also produce widespread and serious
emotional problems. An aircraft crash at a major airport can cause emotional stress reactions in any of the
surviving passengers or flight crew as well as in witnesses to the crash, in members of the families or work
associates waiting for passengers to arrive, and in the airport employees who are asked to assist in the
emergency services and crash cleanup. Only some of those involved actually suffer diagnosed PTSD or
acute stress disorder, but case reports nevertheless indicate widespread distress. After mobilizing energies
and working cooperatively during the immediate time of the emergency, people soon tire. When the event
has passed and is no longer the topic of conversation, people report loss of sleep, a reliving of the
experience, and fearful dreams.
**Treating PTSD
·
The psychological treatment of clients with posttraumatic stress disorder has generated interest and
enthusiasm. The research literature is young, however, because PTSD did not appear as an
identifiable form of disorder until 1980. An early and practical first step was Operation Outreach, a
program designed specifically for Vietnam combat veterans. At Operation Outreach, any veteran
can find a needed outlet for his or her emotional distress.
·
**An approach has proved effective in the management of PTSD among rape victims. Edna Foa
and her colleagues (1991) reported that a cognitive-behavioral treatment and a prolonged exposure
treatment (at follow-up) were more effective in reducing PTSD symptoms.
·
Many of the rape victims who were offered treatment declined to participate. This may be related
to rape victims' tendency to avoid confrontation of the rape memory, a tendency that is
symptomatic of PTSD. In addition, some rape victims may not show symptoms of any disorder or
may not see themselves as patients in need of treatment. Nevertheless, cognitive-behavioral and
exposure treatments seem to be helpful to PTSD sufferers, whether veterans or rape victims.
CLASSIFYING AND TREATING ANXIETY DISORDERS
"Neuroses Are No Longer a Psychological Problem!" If such a headline had appeared in the
newspaper, it would have been technically accurate, because, the DSM IV TR system abandoned the
use of terms and categories related with neurosis. For example, phobic neurosis is now called specific
phobia or social phobia, and obsessive-compulsive neurosis became obsessive- compulsive disorder.
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- Obsessive Compulsive Disorder (OCD)
·
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 most commonly observed.
120
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