Anxiety - Disorders

Stress Response

Fight or Flight

Disorder = abnormal

Out of Order

PANIC ATTACKS

PHOBIAS

GENERALISED ANXIETY DISORDER (GAD)

OBSESSIVE COMPULSIVE DISORDER (OCD)

POST TRAUMATIC STRESS DISORDER (PTSD)

Diagnostic features of PHOBIAS

1. Intense, persistent, irrational fear a particular object, event or situation.

2.Response is disproportionate and leads to avoidance of phobic object, event or situation.

3.Fear is serve enough to interfere with everyday life.

Condition may or may not be accompanied by PANIC ATTACKS

Types of PHOBIASSPECIFIC PHOBIAS, of animals, events (flying),

bodily (blood), situations (enclosed places).

SOCIAL PHOBIAS, of social situations, public speaking, parties, meeting new people.

AGORAPHOBIA, of public crowded places (not open spaces), of leaving safety of home

All phobias are more common in women than men, in particular Agoraphobia.

Social Phobia is most prevalent in adolescence and Agoraphobia in middle age.

Biological explanations of PHOBIAS - Evolution

The Theory - Biological Preparedness Seligman (1971) Fear of harmful animals and situations would provide an evolutionary advantage and therefore be passed on by natural selection.

The Evidence – Most people rate as most fearful those animals which move unpredictably and are slimy.

Cook & Mineka (1990) found it easier to condition monkeys to fear toy snakes than cuddly teddies.

Ohman (1996) found it easier to condition humans to fear snakes rather than flowers.

Biological explanations of PHOBIAS - Genetics

Theory – Genetics could explain why some individuals inherit the condition. Specific (but not Social) phobias seem to run in families to some existent but this behaviour could be learnt by imitation.

Twin Studies could separate nature from nurture. Shields & Slater (1969) showed concordance rates of MZ (identical) twins to be higher (49%) than that of DZ (fraternal) twins (4%). Only 45 pairs of twins!

Evaluation: Concordance rate would have to be 100% if entirely genetic. Also identical twins could be emotionally closer than non-identical.

Biological explanations of PHOBIAS - Vulnerability

The Theory - Eysenck (1967) suggested that some people are born with a more reactive autonomic nervous system.

The Evidence – Eysenck designed a personality test to measure stability / instability and predicted that unstable individuals would be more likely to show an anxiety disorder. Problems with this are …

•Difficult to show if instability is caused by hypersensitive nervous system or if anxiety disorder has affected ANS.

•Personality traits are not only determined by genetics, environmental factors, upbringing, life events also relevant.

Biological explanations of PHOBIAS - Evaluation

These theories are all compatible and are supported by evidence but …

• The evidence is subject to alternate explanations and can be criticised methodologically (lack ecological validity etc)

• The theory does not explain why individual people develop a phobia of particular objects / situations.

• Does not work so well with Social Phobias and Agoraphobia – what is the evolutionary advantage?

• However it does explain why phobias persist even when unhelpful, evolution need thousands of years to work.

Behavioural explanations of PHOBIAS

The Theory – Watson (1920) claimed that most emotional responses including fear of objects are learnt by C.C.

The Evidence – He demonstrated a “rat phobia” in little Albert by pairing a loud bang (UCS) with a white rat (CS) the fear response was generalised to similar stimuli – ??

Evaluation – Does not show that “real life” phobias happen this way. DiNardo (1988) found over half of “dog phobic's” could recall being bitten (but what about the rest?) but over half of those who reported been bitten did not go onto develop a phobia of dogs.

1 – Classical Conditioning

Behavioural explanations of PHOBIAS

Mowrer (1947) the original learnt fear is maintained by operant conditioning. The relief felt by avoiding the phobic object is reinforced by “avoidance learning”.

The Evidence – DiNardo’s findings that more than half of those people bitten did not develop a phobia of dogs.

Evaluation – Could explain specific phobias but does not work so well with Agoraphobia & Social Phobia.

Also difficult to explain cases when there is no history of contact with the phobic object. (eg: DiNardo’s participants who had not been bitten.

2 – The Two Process Theory

Behavioural explanations of PHOBIAS

Bandura (1986) showed that modelling and observational learning provides a better explanation for many behaviours.

Mineka (1984) found that monkeys could develop snake phobias just by watching another monkeys fear.

Could explain children learning to fear some objects from their parents or role models but in most cases of phobias there is little evidence of this.

3 – Social Learning Theory

Despite this emphasis on behaviour to understand phobias in humans we need to what is going on their minds.

Cognitive explanations of PHOBIAS

The Emotions we feel are the result of our interpretations of our experiences according to our existing SCHEMAS.

Phobic's are likely to

i) over exaggerate the negative consequences

ii) under estimate their ability to cope.

iii) show “Catastrophic Misinterpretation”

Cognitive Bias (Beck 1985)

It’s poisonous !

I can’t escape !

I’m going to die !

Cognitive explanations of PHOBIAS

Better at explaining how phobias are maintained than how and why they appeared in the first place.

Evaluation

Can be applied to Social Phobia and Agoraphobia because of the emphasis on negative thinking about expectations.

Treatments based on this approach (eg: cognitive restructuring) have proved to be very effective.

Combined with the two process theory this provides best explanation yet but still weak on why some people develop phobias when others in similar situations do not.

They will all laugh at me!

Psychodynamic explanations of PHOBIAS

Freud explained phobias using his idea of Ego Defence mechanisms. Anxiety provoking thoughts or desires coming from the ID are REPRESSED into the unconscious where the anxiety is DISPLACED onto another neutral object which becomes the subject of the phobia.

In the case of Little Hans the ID’s desire was to kill his father (Oedipus Complex) and the fear of castration was displaced onto horses - the link was big “widdlers”!Hans phobia was only resolved when he had overcome his Oedipus complex.

Psychodynamic explanations of PHOBIAS evaluation

Freudian interpretations of snake or spider phobias suggest displacement from an unconscious fear of sexual gentitalia. However most people with these phobias seem to have a normal sex life.

Using Little Hans as evidence for this theory has many flaws-not least that other approaches can offer alternative, simpler explanations for Hans phobia. (eg: Behaviourist)

The best evidence comes from therapeutic case studies were the interpretation of the symptoms makes sense in the wider picture of the individual’s problems and their avoidance of conflicts in their lives.

O.C.D. - Obsessive Compulsive Disorder

Symptoms & DiagnosisObsessions – persistent, recurring,

unwanted cognitions, usually unrealistic or irrational. eg – contamination by germs

Compulsions – repetitive, ritualistic behaviours that reduce the anxiety associated with the obsessive thoughts. eg: repetitive hand washing / cleaning

O.C.D. – Biological Explanations

Genetics - Family of OCD patients 10 x’s more likely to have OCD. However this could be due to S.L.T. Twin studies suggest some inheritance (Shields & Slater)

Neurotransmitters - OCD associated with low levels of SEROTONIN – Anti-depressant drugs like Prozac (SSRI’s) also reduce the symptoms of OCD in about half of cases.But lack of serotonin could be an effect not a cause.

Brain Function - PET scans show basal ganglia to be involved in repetitive motor behaviours but differences between OCD patients and controls are yet to be established. Also cause / effect issue.

O.C.D. – Behavioural ExplanationsTwo Process Theory (Mowrer)

1. Classical Conditioning - A specific behaviour becomes associated with an event (eg; dirt - illness / shirt – winning).

Evidence - If compulsive behaviour is prevented then initially anxiety increases but reduces over time. This is used as a basis for behaviour therapy (eg: gradual exposure to dirt.)

2. Operant Conditioning - Repeating ritual behaviour leads to a reduction in anxiety which gives positive reinforcement.

Evaluation - Useful in explaining how OCD is maintained but not how obsessions arise in the first place. Also used to explain superstitious behaviour.

O.C.D. – Cognitive ExplanationsCognitive Bias (Beck)

Hyper-vigilance – OCD sufferers are always on the look out for the source of there obsessions. Eg: germs

Memory Problems – Often show poor memory for actions, eg: locking doors, or washing hands.

Catastrophic Misinterpretation - Irrational ideas concerning unfortunate consequences if they don’t perform their rituals.

Evaluation - Effective cognitive treatments involve correcting cognitive bias and become less hyper-vigilant. Does not really explain the emotional aspect of the irrational beliefs.

O.C.D. – Psychodynamic ExplanationsFixation at Anal Stage (Freud)

Unconscious Conflict – between the Id and the Ego lead to the obsessive thoughts and compulsive actions.

Frued belived that this occurs in the Anal stage of development, when potty training takes place.

The ego defends itself by REACTION FORMATION – ie: over- reacting in the opposite direction. A child’s desire to be messy is replaced by obsessive cleanliness and a fear of dirt.

Evaluation - No empirical evidence apart from Freud's own case studies – Rat Man.There may be a childhood link with OCD but the anal connection has little support.

Biological Treatments for Anxiety Disorders

Drug Therapy – SSRI’s (eg: Prozac, Serotzac) are often prescribed for phobias and OCD.

Effectiveness: Some reduction in symptoms is found in most cases however without any other form of treatment they do not usually provide a cure. They are not physically addictive but patients can become psychological dependant on them. Side effects can include headaches & nausea.

They work by increasing the level of the neurotransmitter Serotonin, low levels of which is associated with Anxiety.

Evaluation: Best used for management of symptoms when combined with Psychological treatments.

Behavioural Treatments for Anxiety Disorders 1

Flooding – Repeated exposure to the source of anxiety. Called Exposure & Response Prevention (ERP) for OCD, also prevented from completing compulsive behaviour.

Effective only when patient fully consents and understands theory. Ethical issues overcome by Implosion Therapy when client just imagines the source of anxiety. ERP is one of most effective treatments available for OCD.

Based on idea of Extinction in Classical Conditioning, continue CS without UCS and eventually CR will die out.

Evaluation: Because clients are encouraged to discuss and understand their conditions as part of the treatment its not clear if it is effective because of cognitive changes.

Behavioural Treatments for Anxiety Disorders 2

Systematic Desensitisation – Wolpe (1958) for phobias, fears are ranked in an anxiety hierarchy, patient learns to relax and either imagine or approach each in turn.

Effective for specific phobias, but can take many sessions. Used with ERP for OCD reduces compulsions.

Assumes can not experience two emotions at same time, CR is re-learnt so that CS is associated with relaxation not fear. Uses positive reinforcement to reverse avoidance learning.

Evaluation: Again there is a Cognitive element which could also explain why it works. Less effective with Social phobias and the obsessions in OCD.

Virtual Reality Exposure Therapy (VRET) uses VR to give more control and reality to the experience.

Cognitive Treatments for Anxiety Disorders

Cognitive Restructuring – Beck (1985) aims to change unhelpful schemas, by challenging faulty cognitions.

Research evidence shows effective for most phobias and OCD, but most effective when combined with behavioural techniques to give Cognitive Behaviour Therapy (C.B.T.).

The client is asked to look at their own thinking processes (often by keeping a “thoughts diary”), the therapist then points out examples of cognitive bias. Then try to do this themselves.

Evaluation: CBT is used by NHS for A.D.’sDifficult to tell if it is successful due to cognitive or behavioural techniques or some other factors (therapists attention?).

I will not catastrophise

Psychodynamic Treatment for A.D.sPsychoanalysis – Developed by Freud aims to strengthen the ego is its battle with the Id and the super-ego.

The therapists role is to help the adult client understand the origins their feelings in their childhood. This involves an emotional release “catharsis”.

This is done by revealing the contents of the unconscious using techniques like Free Association & Dream Analysis.

Evaluation: It is expensive and can take years. Clients may start and stop therapy and it can throw up other (deeper?) issues which makes it difficult to measure effectiveness. Criticised for “interpretation bias”.

Counselling (humanistic) is now days more likely to be recommended often alongside other therapies.

The endNow I realise that what I am really frightened of is my father who once

threatened to take away “Willy” my toy snake.