Chapter 4 Powerpoint: Anxiety

ABNORMAL PSYCHOLOGY, THIRD EDITION
Deborah C. Beidel/ Cynthia M. Bulik/ Melinda A. Stanley
Chapter 4
Anxiety, ObsessiveCompulsive, and Trauma- and
Stressor-Related Disorders
2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.
Chapter Outline
What Is Anxiety?
What Are the Anxiety Disorders?
What Are the Obsessive-Compulsive and
Related Disorders?
What Are the Trauma- and Stressor-Related
Disorders?
The Etiology of Anxiety, OCD, and Trauma- and
Stressor-Related Disorders
The Treatment of Anxiety, OCD, and Traumaand Stressor-Related Disorders
What Is Anxiety?
A common emotion characterized by
physical symptoms, future-oriented
thoughts, and escape or avoidance
behaviors
-Occurs when people encounter a new situation
or anticipate a life-changing event
-Usually is time-limited and ends when the event
is over
Fight-or-Flight Response
Activation of the SNS triggered by
fear or stress
-Sympathetic nervous system (SNS):
increases heart rate and respiration allowing

body to perform at peak efficiency
-Allows you to use all available resources to
escape
-Parasympathetic nervous system (PNS):
slows down the heart rate and respiration,
thus returning the body to a resting state
Figure 4.1 The

Fight-or-Flight Response Sympathetic
and the
Parasympathetic Nervous
Systems
Adapted from
Lilienfeld, et al.,
Psychology: From
Inquiry to
Understanding
(p.121).
Pearson/Allyn and
Bacon. Copyright
2009 Pearson
Education, Inc.
Reprinted
by 2012,
2014,
permission of
2010 by Pearson Education, Inc. All rights reserved.
You are walking

on a path at a
local park and all
of a sudden you
see a snake
slither out in
front of you.
Just how it works
As soon as you see

the snake, your
heart starts racing
and your breathing
increases (bodys
response).
What if the snake strikes

me and its poisonous?
Figure 4.2: The Three

Components of Anxiety
You scream for

help or run in the
other direction.
Figure 4.3 Negative Reinforcement Increases

Avoidance Behavior and Anxiety
Normal Anxiety vs. Abnormal Anxiety

Things to consider:
Feeling anxious occasionally is normal
Functional impairment
Developmental age
Cognitive development, not actual chronological age
Sociodemographic factors
Sex, race/ethnicity, and SES)
Women and men seek treatment at equal

rates if fear is severe
Table 4.1 Common

Fears at Various
Developmental
Ages
What Are the Anxiety Disorders?

Group of disorders
characterized by
heightened physical
arousal, cognitive
distress, and behavioral
avoidance of feared
objects/situations/events
How does comorbidity relate to anxiety
disorders?
57% of people diagnosed with one
anxiety disorder also have another
anxiety disorder or depression.
-Panic Attacks
-Panic Disorder
-Agoraphobia
-Generalized Anxiety Disorder
-Social Anxiety Disorder
-Specific Phobia
-Obsessive Compulsive
Disorder
-Posttraumatic Stress Disorder
-Separation Anxiety Disorder
The Facts about Anxiety Disorders

31.2% of American adults will suffer at some
point in their lives
Most common disorder among all age groups
Onset is around age 11 years old
Equally distributed among Hispanics, nonHispanic blacks, and non-Hispanic whites
Significant economic burden: $42.3 billion
Frequent comorbidity issues
Fact Or Fiction?
Panic attacks tend to only occur in

people diagnosed with a panic disorder.
Generalized Anxiety Disorder (GAD) is

found to be more common in individuals
from lower socioeconomic status (SES).
Fact or fiction?
Fact or fiction?
No. Actually, 28.3% of adults report having had

a panic attack, but only 4.7% of adults have
panic disorder.
Yes, because populations from lower SES have more

legitimate things to worry about, such as unsafe
living conditions, lower income, poor health care,
and more medical conditions.
Panic Attacks
Discrete period of intense fear and
physical arousal, which develops abruptly
Symptoms peak in about ten minutes
-Somatic and cognitive symptoms
-Common occurrence
Two types of attacks

-Expected panic attacks
-Unexpected attacks
Remember, as many as 28.3% of

adults report having had a panic
attack, although only 4.7% of
adults have panic disorder.
Agoraphobia
Fear of the marketplace
Can sometimes enter fear situations with trusted
companions
Fear embarrassment
Usually begins in early adulthood
Women are more likely to experience agoraphobia
than men.
Generalized Anxiety Disorder (GAD)

Excessive worry about future events, past
transgressions, financial status, and the
health of oneself and loved ones
Lasts at least six months
Onset late teens early adulthood (20s)
Account for 12% of PCP visits
Common in lower SES
More likely to occur in adults than children.
Social Anxiety Disorder

The third most common
Intense fear that others
psychiatric disorder
will detect anxiety
A pervasive pattern of
Social situations that
social timidity
create distress:
characterized by fear that
speaking, eating,
the person will behave in a
drinking, or writing in
way that will be humiliating
the presence of others,
or embarrassing
engaging in social
interactions, and
initiating conversations
Table 4.2 Developmental Differences in Distressful

Social Situations
Real People, Real Disorders:

Ricky Williams
Heisman trophy
winner
1st round college draft
pick for the NFL
Conducted interviews
with his helmet on
How would life change for
you to live with a social
phobia?
Difficulty interacting
with others
At times unable to
leave the house to
run errands
Is it easier to mask social phobia or
phobias in general if you are not in the
limelight?
Specific Phobias
Severe and persistent fears of
circumscribed events, objects, or situations
that led to significant disruption in areas of
functioning
Four groups
-Animal phobias
-Natural environment phobias
-Blood/injection/injury phobias (vasovagal syncope)
-Situational phobias
Figure 4.4 Percentage of Adults with a Specific Phobia
Figure 4.5: Vasovagal Response in Blood/Injection/Injury

Phobias
Obsessive-Compulsive Disorder
A condition involving obsessions
(intrusive thoughts), often combined
with compulsions (repetitive
behaviors), that can be extensive,
time consuming, and distressful
Obsessions vs. Compulsions
Is Trichotillomania a Variant of OCD?

Facts: Defined as repetitive
hair pulling that results in
noticeable hair loss, which
individuals feel powerless to
stop the pulling.
Lets Examine the Evidence:
-Both are characterized by
repetitive behavior that is
used to decrease anxiety
-Both are associated with high
rates of anxiety and
depression
-Higher rates of OCD occur

in people with TTM
-Obsessive thoughts exist
in both OCD and TTM
-Antidepressants used to
treat both
Conclusion: TTM and
OCD share common
features, but studies
suggest differences related
to treatment, symptoms,
and features
Posttraumatic Stress Disorder

(PTSD)
After an event that involves actual or
threatened death, serious injury, or a
threat to physical integrity, emotional
distress leads to avoidance of stimuli
associated with the trauma
Persistent symptoms of increased SNS
arousal
Classic symptoms associated with PTSD

Research Hot Topic:

9/11 Trauma, Grief, PTSD, and Resilience
Experiences lived by
What are some
inner city adolescents
protective factors that
shield one from
-Stabbings
developing PTSD?
-Shootings
What does the word
-Murder
resilience mean?
90% of Americans have
been exposed to trauma, How can we
Exposure to
use this
trauma is not
but only 5 to 11%
information to
enough to
understand
develop PTSD as a
develop PTSD!
PTSD?
result
Separation Anxiety Disorder (SAD)

Severe and unreasonable fear of
separation from a parent or caregiver
3 to 5% of all children suffer
More common among girls
Children from all ethnic backgrounds

are equally likely to suffer from SAD
Think back to your childhood when you first started preschool
or kindergarten. Do you remember experiencing some
separation anxiety from your parent or guardian?
Stop and Think!

Do animals experience separation
anxiety like humans? Why or why not?
How would we define the symptoms?
Are there things pet owners do to cause
this, or how can it be prevented?
How do anxiety disorders develop?

Biology says:
Behavioral inhibition =
withdrawal from people,
objects, or situations.
-Hereditary factors
-Trait anxiety (personality traits)
-Differences in brain functioning and brain structure
-Neurotransmitters, particularly serotonin (responsible
for mood, thoughts, behavior, and appetitive) and
GABA (the bodys natural way to decrease anxiety,
natural valium)
-Corticotrophin-releasing factor (CRF)
-Adrenocorticotropic hormone (ACTH)
-Temperament
Figure 4.6: Stress May Affect Brain Functioning
Adapted from Biological Psychiatry, 46, Heim, C., & Nemeroff,

C. "The impact of early adverse experiences on brain systems
involved in the pathophysiology of anxiety and affective
disorders." pp. 1509-1522, Copyright 1999 Society of
Biological Psychiatry with permission from Elsevier Science Inc.

Freud says:
-A conflict exists between the id (childish wants)
and ego (adult ways of thinking)
-Sexual and aggressive impulses
-Defense mechanisms, especially repression and
displacement, result in phobias
-Little Hans

Behavioral theories
-Learned behavior; one becomes classically
conditioned
-Vicarious learning theory
-Information transmission
Figure 4.8: The Fear of Fear Model

Cognitive theories
-Information is processed differently, leading to
the development of anxiety
-Aaron Beck and maladaptive thoughts
-Fear of Fear model
-One is hypersensitive to bodily sensations
-Anxiety sensitivity
-Distorted cognitions or faulty beliefs
Quick Recap
1. _____ is a pervasive pattern of social
timidity characterized by fear that the
person will behave in a way that will be
humiliating or embarrassing.
(a) Generalized anxiety disorder
(b) Panic disorder
(c) Social anxiety disorder
(d) Obsessive-compulsive disorder
Quick Recap
2. _____ consists of intrusive
thoughts and repetitive behaviors
that are extensive, time consuming,
and distressful.
(a) Posttraumatic stress disorder
(b) Separation anxiety disorder
(c) Obsessive-compulsive disorder
(d) Specific phobia
Biological Treatment Options

Medication
-Use of Selective Serotonin Reuptake Inhibitors
(SSRIs) for the depletion of serotonin in the neural
synapses (Prozac, Luvox, and Zoloft)
-Use of Benzodiazepines to allow GABA to transmit
nerve signals more effectively, which reduces
anxiety (Valium and Xanax)
Figure 4.9: How SSRIs Work
Biological Treatment Options

Psychosurgery
-Only considered if a patient has failed to benefit
from medication and therapy
-Cingulotomy: more common option, involves
inserting thin probes into the portion of the brain
called the cingulate bundle where the probes burn
selective portions of the brain tissue
-Capsulotomy: gamma knife surgery (form of
radiation treatment) which makes precise lesions in
the brain tissue without opening the skull
Psychological Treatment Options

Psychodynamic
-Uses free association and dream interpretation as
a reflection of the patients experience in the
outside world
-Little knowledge of the effectiveness of treatment
-Interpersonal Psychotherapy (IPT) targets
interpersonal disputes and conflicts, interpersonal
role transitions, and complicated grief reactions for
social phobias, PTSD, and panic disorder

Behavioral
-Well-researched approach
-Exposure: a client faces fears to get over them
-Exposure therapy
-Imaginal exposure
-70% improve after this treatment, with remission
rates of 93% after two years and 62% after ten years,
excluding combat-related PTSD
-Virtual reality exposure
-Social skills training (SST)
Research HOT Topic:

Virtual Reality Therapy
Behavior therapy most
effective with some
element of exposure
Patient fitted with a
head-mounted display
that has screens for
eye, earphones, and a
device that tracks
movement
Used to treat specific

phobias
Sounds, noises, and
vibrations are added
Now being used with
veterans
What are your thoughts on the

use of this technology?

Cognitive Behavioral Therapy (CBT)
-Well-researched approach
-Exposure in combination with cognitive
restructuring to change negative cognitions
-Hypothesis testing (to see whether this worst thing
actually happens)
-Generate positive coping cognitions to counteract
the negative thoughts
-70% of patients improve
-Relaxation training and biofeedback
I Object or Accept!
What are your thoughts?
Our society rewards people who deal
with stress by working harder and faster
to produce more in a shorter time
(Davis, M., Eshelman, E. R., & McKay, M. (2000). The Relaxation & Stress Reduction
Workbook, 5th Ed. Oakland, CA: New Harbinger Publications, Inc., p. 9)
In essence, do you think as a

society we are fostering the
development of anxiety
disorders as a means to cope?
Does this relate to formulating

theories about anxiety
disorders? Why or why not?
Reviewing Learning Objectives

1. Anxiety consists of three parts: physiological,
cognitive, and the behavior.
2. Anxiety is a common occurrence. However, to be
diagnosed, the fear or anxiety must cause impairment.
3. When considering the expression of anxiety, it is
important to assess ones cognitive maturity, gender,
race/ethnicity, age, and SES, as well as sociocultural
implications.
4. Many different types of anxiety disorders exist, such
as panic disorder, GAD, OCD, phobias, PTSD, and
SAD.
Reviewing Learning Objectives

5. Anxiety disorders can develop in many different ways,
but it is becoming clear that neuroanatomical and
neurochemical alterations lead to anxiety disorders.
6. The most appropriate approach to understanding the
etiology of the disorder is to take into account a
biopsychosocial approach including biological and
psychological/environmental factors.
7. Anxiety disorders can be treated through the use of
medication or behavioral or cognitive behavioral
interventions.

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ABNORMAL PSYCHOLOGY, THIRD EDITION

Deborah C. Beidel/ Cynthia M. Bulik/ Melinda A. Stanley

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

increases heart rate and respiration allowing

Figure 4.1 The

2010 by Pearson Education, Inc. All rights reserved.

You are walking

Just how it works

As soon as you see

What if the snake strikes

Figure 4.2: The Three

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

You scream for

Figure 4.3 Negative Reinforcement Increases

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

Normal Anxiety vs. Abnormal Anxiety

Women and men seek treatment at equal

Table 4.1 Common

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

What Are the Anxiety Disorders?

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

The Facts about Anxiety Disorders

Panic attacks tend to only occur in

Generalized Anxiety Disorder (GAD) is

No. Actually, 28.3% of adults report having had

Yes, because populations from lower SES have more

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

Two types of attacks

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

Remember, as many as 28.3% of

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

Generalized Anxiety Disorder (GAD)

Social Anxiety Disorder

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

Table 4.2 Developmental Differences in Distressful

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

Real People, Real Disorders:

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

Figure 4.4 Percentage of Adults with a Specific Phobia

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

Figure 4.5: Vasovagal Response in Blood/Injection/Injury

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

Is Trichotillomania a Variant of OCD?

-Higher rates of OCD occur

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

Posttraumatic Stress Disorder

Classic symptoms associated with PTSD

Research Hot Topic:

Separation Anxiety Disorder (SAD)

Children from all ethnic backgrounds

Stop and Think!

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

How do anxiety disorders develop?

Figure 4.6: Stress May Affect Brain Functioning

Adapted from Biological Psychiatry, 46, Heim, C., & Nemeroff,

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

How do anxiety disorders develop?

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

How do anxiety disorders develop?

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

Figure 4.8: The Fear of Fear Model

2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.

How do anxiety disorders develop?