Flashcards in Anxiety Disorders Deck (166):
Where does the word phobia come from?
The Greek god Phobos who was fearless in battle.
What is a phobia?
A persistent, disproportionate and irrational fear of a specific object or situation which is often maladaptive. The individual will recognise that the fear is groundless.
What sort of reaction occurs when an individual comes into contact with a phobic object?
Panic attacks and the fight or flight response.
What are the three categories of phobias according to what book?
Specific phobia, social phobia and agoraphobia. According to the DSM-IV.
What is a specific phobia?
An intense irrational fear of a particular item or situation.
What are the three requirements to be diagnosed with a specific phobia?
1. be excessive or unreasonable to the actual danger posed
2. triggered immediately on exposure to the phobic object
3. interfere with everyday functions (maladaptive)
When does a fear become a phobia?
When it begins to be maladaptive.
What percentage of the population have specific phobias?
Are specific phobias more common in men or women?
What five subtypes of specific phobia are there?
2. Natural environment (heights, water)
4. Situational (aeroplanes, lifts, enclosed spaces)
5. Atypical (vomiting, choking)
Which subtype of phobia has a different type of reaction and what?
Tend to faint instead of panic when exposed to blood/injections/injury.
What is the fight or flight response?
An automatic physiological response of the sympathetic nervous system in fearful situations that prepares the body to fight or flee. Physiological changes include increased heart rate, sweating, diversion of blood flow to skeletal muscles.
What is a social phobia?
An extreme fear of embarrassment or humiliation in social situations.
What two types of social phobia are there?
Specific situations and generalised social phobia.
What is a social phobia of a specific situation?
Examples include fear of using public toilets, public speaking, or eating in public. Panic attacks often occur.
What is generalised social phobia?
The phobia is less specific and involves many different types of social interactions. Such as fear of initiating conversations. speaking to authority figures, or attending parties.
When do social phobias tend to develop?
In late childhood or early adolescence.
What percentages of men and women are affected by social phobias?
11% of men and 15% of women.
What is agoraphobia?
A fear of crowded public transport and public places such as shopping centres.
How much of the population suffers from agoraphobia? Mainly men or women?
2-3%, the majority are women.
What two types of agoraphobia are there?
As a complication of a panic attack, and without panic attacks.
What is agoraphobia as a complication of a panic attack?
They are anxious about having a panic attack in a public place and being unable to escape or find help. In severe cases they will refuse to leave their home.
What is agoraphobia without panic attacks?
Less common than the other type, it is a spreading fear of the environment outside the safety of the persons home. The fear gradually increases in severity until eventually the patient can become housebound.
What are the three biological explanations of a phobia?
Genetic, vulnerability, preparedness theory.
What are the to studies to support the genetic expansion of phobias?
1. Fyer found those with first degree relatives with a specific phobia were more likely to have one themselves.
2. Torgesen investigated identical twins (100% same) and fraternal twins (50% same) where at least one pair was agoraphobic. There was a higher likelihood of the other twin having agoraphobia in the identical twins.
What is the vulnerability explanation of phobias?
Eysenck proposed some people are more easily frightened by fear provoking stimuli. The autonomic nervous system controls autonomic response, and some people are born with a high autonomic reactivity making them more likely to develop a phobia.
What is the preparedness explanation of phobias?
Seligman propose we develop phobias to to items and situations that were potential sources of danger to us thousands of years ago. Therefore we have an evolutionary and physiological predisposition to be sensitive to certain stimuli. There is an innate tendency to rapidly acquire phobias to potentially harmful items.
What does innate mean?
In-born; present at birth.
What is an alternative explanation for the genetic studies of phobias?
Social learning theory would explain that relatives would observe and imitate the behaviour displayed by their family members. This means it is difficult to untangle environmental and genetic factors in family studies.
Where does support for preparedness theory come from?
Conditioning studies on humans and animals in laboratory conditions. Ohman found humans are more likely to be condition to fear snakes (fear-relevant) than flowers (fear-irrelevant).
What is the study by Cook and Mineka on preparedness theory?
Monkeys readily acquire fears of toy snakes and crocodiles (with no previous exposure) but couldn't be conditioned to fear a toy rabbit. This couldn't be accounted for by prior learning, making preparedness theory a plausible explanation.
What is the issue with fears acquired under laboratory conditions?
They are easily removed by simple verbal instruction, meaning these fears are unlike phobias acquired in the real world.
How do behaviourists think phobias are learnt?
Classical conditioning. A person learns to fear a previously neutral stimulus by pairing it with a frightening event.
What is the two-process theory?
A phobia is learned through classical conditioning and maintained by operant conditioning. It is also known as avoidance conditioning.
How are phobias maintained by operant conditioning?
The person learns that their anxiety is reduced by avoiding the stimulus that causes their phobic reaction. This is an example of negative reinforcement.
What is the famous study for the behavioural explanation of phobias?
Little Albert (Watson and Rayner) was conditioned to fear white rats.
What is the issue with the Little Albert study?
It has been difficult to reproduce, especially with adults.
Is there empirical evidence to support the behaviourist explanation?
Yes - Little Albert.
Can all fears by induced in a laboratory?
No. Not all fears can be conditioned into someone.
What was Di Nardo's behaviourist study?
60% of people with a fear of dogs could relate their fear to a frightening incident with a dog which offers some support for conditioning theory. However a number of people in a control group could recall an incident, but had not developed a fear.
What types of fears can't behaviourists explain?
Fears that develop gradually (such as social phobias) cannot be traced back to a specific incident. Fears also occur when there has been no direct contact with the stimulus.
How would social learning theory explain fears of stimuli that the individual hasn't come into contact with?
Phobias can be learned vicariously.
What is cognitive vulnerability?
Perceiving normal bodily functions (raised heartbeat) as threatening.
What causes cognitive vulnerability?
People who suffer from phobias tend to think in a distorted and catastrophic way. They think the worst.
What would cognitive psychologists say causes a fearful response?
The interpretation and appraisal of events. It is the interpretation that triggers the fear, not the event itself.
What two types of distorted appraisal are there?
1. automatic negative thoughts
2. over-generalising; assuming that one bad experience means that it will be repeated in the future
What three factors do cognitive psychologists say develops a phobia and persists it?
1. sensitisation - anxiety become associated with a stimulus so the presence of or thinking about it is enough to trigger anxiety
2. avoidance - avoiding a stimulus become rewarding because anxiety diminishes
3. negative self-talk/images - these include three distortions; over estimating a negative outcome, catastrophising, under-estimating ability to cope
What do cognitive psychologists say agoraphobics are hypersensitive to?
They are hypersensitive to spatial layouts and to being taken away from their caretaker. If access to the home or caretaker is blocked them fear is induced and the agoraphobic has an urgent need to return home.
What is hypersensitivity?
What is a schema?
A mental representation of the world, used to interpret information. If distorted, information will be perceived in negative and inaccurate ways.
What did Beck propose?
Agoraphobics poses latent fears of situations that might have been dangerous to a child but not to an adult, such as crowded shops and open places.
How do cognitive psychologists explain the onset and maintenance of social phobias?
Social phobias have developed schemas that include expectations that others will be negative and rejecting. They have become hypersensitive to picking up cues from others that they interpret negatively. They also expect their own behaviour will be unacceptable and will be rejected because of this. This makes them less able to socially interact creating a viscous cycle.
Does the cognitive approach have applications to the treatment of phobias?
Yes. It is a coherent theory with therapeutic applications. treatments have proved highly effective.
What is the link between the cognitive and behaviourist explanations for phobias?
Cognitive psychologists accept the acquisition of a fear through learning (conditioning) but still emphasise the persons own interpretations of events.
Behaviour is not always driven by cognition. Explain.
Evidence shows that cognitions can be driven/maintained by inappropriate behaviour such as avoidance.
How does psychodynamism explain phobias?
They occur when id impulses are repressed and anxiety is displaced onto another object or situation.
An unconscious part of the personality that is present at birth and demands instant gratification.
What is the psychodynamic experiment for phobias?
Little Hans case study. Hans had a fear of horses, which was his displaced fear of his father.
How does Freud explain the Hans case study?
It is due to an unresolved childhood conflict. The ego had to displace his fear of his father with the use of defence mechanisms. Hans' fear of his father came from the Oedipal complex.
What is the fear of spiders according to psychodynamism?
It is a defence of more threatening impulses of a sexual nature. Abraham proposed that spiders were a fear of sexual genitalia.
How would behaviourists explain Hans' fear of horses?
When Hans was younger, age four, he witnessed an accident where a horse collapsed in the street. This greatly upset Hans, so he could have been classically conditioned after the incident to fear horses.
How does Freud's theory of anxiety lack methodological rigour?
His theory's are drawn from clinical case studies which are limited in number and subjectively interpreted.
What is obsessive compulsive disorder (OCD)?
Obsession - anxiety provoking thought.
Compulsion - also referred to as rituals, an action performed to remove or reduce anxiety.
What does the DSM-IV say you have to be to be diagnosed with OCD?
It has to be causing considerable distress and interfering with normal everyday functioning.
How much of the population does OCD affect? Mainly men or women?
2%, equal numbers of men and women.
What age does OCD tend to occur?
Adolescence or early adulthood, but it can begin in childhood.
What is an obsession?
Persistent and recurring thoughts, ideas, images or impulses that seem senseless but intrude into someone's mind. They can be images of violence or fear of leaving the door unlocked. They occur automatically and are unwanted and disturbing to the individual and are often unrelated to real life problems.
What is a common obsession?
Contamination, by things like germs.
What is a compulsion?
A repetitive behaviour or ritual that the individual feels compelled to perform to reduce the anxiety caused by the obsessive thought. The conflict caused by needing to complete the ritual is a source of anxiety and shame, and sometimes despair.
What is the contamination compulsion?
Washing their hands up to 100 times a day, scrubbing with abrasive cleaners.
What are common compulsions?
Washing, checking and counting.
What percentage of the population suffer from OCD, but only experience the obsession? What are these thoughts often?
20%, about harming a loved one.
What is the difference between an obsession and a compulsion?
An obsession is a thought, a compulsion is an act.
What are the three biological explanations of OCD?
Genetic, biochemical, neurophysiological.
Explain the genetic explanation of OCD.
Some people are predisposed to the illness. Evidence comes from family studies, where people with OCD are likely to ha e first degree relatives with an anxiety disorder (McKeon & Murray). 10.3% of sufferers had relatives with OCD, and the control group without OCD only had 1.9% (Pauls).
Explain the biochemical explanation of OCD.
Most anxiety disorders respond to a range of drugs, but OCD only responds to serotonin. This suggests OCD is related to low levels of that neurotransmitter. Drugs such as SSRI anti depressants, which increase serotonin, decreases the OCD symptoms.
What is serotonin?
A neurotransmitter in the brain.
What does SSRI stand for?
Selective serotonin reuptake inhibitors.
Explain the neurophysiological explanation.
Neuroimaging has led to the implication of the basal ganglia. Rapoport & Wise proposed that hypersensitivity of the basal ganglia gives rise to repetitive motor behaviours as seen in OCD patients.
What is the basal ganglia?
A part of the brain that is responsible for innate psychomotor functions.
How could the family studies in the genetic explanation of OCD be alternatively explained?
By environmental influences. Relatives of OCD sufferers may observe and imitate the behaviour displayed.
What is the issue with the use of SSRIs in the treatment of OCD?
Administering SSRIs doesn't mean that a lack of serotonin is the cause of OCD. A lack of paracetamol isn't the cause of a headache. There is also a time delay of 4-12 weeks to see an effect, even though it increases serotonin in the brain in hours.
Why are SSRIs not a complete explanation?
They provide a partial remission for OCD, but most studies only report a 50% improvement suggesting there are other explanations.
What is the issue with the findings of the basal ganglia in OCD?
The findings are inconsistent and a meta-analysis by Aylward found no difference between patients and controls. Even if the basal ganglia is implicated in OCD, it only explains the compulsions and not he obsessions.
How does behaviourism explain OCD?
Operant conditioning explains compulsions as behaviour reinforced by anxiety reduction. As with phobias, Mowrer's two-process theory of avoidance learning can be applied to OCD.
How do you apply the two-process theory to OCD?
Two things become associated, such as germs and door handles. This is classical conditioning. They cause anxiety, which is reduced by washing, which is reinforced and maintained by operant conditioning. Once learned, these avoidance responses are difficult to extinguish.
What do behaviourists claim would happen if you stopped someone from carrying out their compulsion?
Anxiety levels would rise steeply, and then once they were allowed to carry out the compulsion they would drop very quickly. Support for this was carried out by Rachman and Hodgson. If they were never allowed to carry out the compulsion, it was found that heir anxiety remained high for longer, but eventually subsided.
Has the avoidance conditioning theory led to anything?
Yes, a successful behavioural treatment for OCD.
What is an issue with the behavioural explanation of OCD?
It doesn't explain how the obsessions arise in the first place.
What is cognitive bias in an OCD patient?
They may have a hypervigilant attention system.
What did Sher find for the cognitive explanation of OCD?
That sufferers often have an impaired memory, and OCD sufferers had poor memories for their actions and so could genuinely not remember if they had, for example, locked the front door.
What did Trivedi find about memory in OCD sufferers?
That they have a low confidence in their memory ability and their non-verbal memory was impaired. However there was no issue with their verbal memory.
What does hypervigilant mean?
Excessively careful and watchful.
How is cognitive vulnerability manifested?
Through hypervigilance when entering a new environment such as;
1. using rapid eye movements to scan the environment
2. attending selectively to threat-related stimuli
What is Rachman's case study on hypervigilance?
A female patient had a severe fear of diseases, especially encountering other people's blood. She had catastrophic thoughts about the probability of harm coming from even a small plaster worn by someone else. She over-estimated the seriousness of contact with anyone. When she went to a public place she would constantly be on the lookout, and misperceive a wide range of dark coloured spots as blood. She could recall in great detail the blood related items she had encountered over the years.
Has a treatment developed as a result of cognitive research?
Yes. Treatment involves reducing hypervigilance and it has shown success suggesting that hypervigilance is a contributing factor in OCD.
What is an issue with the cognitive explanation of OCD?
It concentrates too much on internal functions and ignore any social factors. It also ignores biological factors involved in cognitive bias and that the vulnerability may have underlying genetic or physiological basis.
What is a strength for the cognitive explanation of OCD?
It gives a good account of individual differences in susceptibility to OCD.
When did Freud say adult phobias occur?
Only when they have sexual problems. However many people with anxiety and specific phobias have a normal sexual life, making Freud's assertion incorrect.
What psychosexual stage does OCD occur in?
The anal phase, aged 2-3 years.
How do problems in the anal phase cause OCD?
If children are not appropriately toilet trained (for example they become fixated in the anal stage.
Where do both obsessions and compulsions stem from according to Freud?
Unconscious conflict between the impulse of the id to let go and the ego to keep hold (of faeces).
What happens when the id is dominant in the development of OCD?
Aggressive instincts will lead to intrusive noughts such as killing a loved one or decorating the wall with faeces.
What accounts for compulsions according to Freud? Give an example.
Defence mechanism are employed by the mind to try and cope with the instincts of the id. For example, fixation in the anal stage could result in reaction formation - instead of spreading faeces, you act in an extremely cleanly manner.
How did Salzman say OCD occurred?
As the result of a trauma (possibly in childhood) which has been repressed. The anxiety is manifested via intrusive thoughts.
What did Salzman say caused obsessions and compulsions?
Obsessions - the repressed memories breaking through into consciousness.
Compulsions - conscious attempts to reduce anxiety caused by the thoughts.
Where does Salzman's evidence for OCD come from?
Case studies that show OCD does follow a traumatic event.
What is the Freud case study for OCD? Explain briefly.
Rat Man. He had anxiety causing thoughts about rats eating into people he loved (specifically father and fiancée) via their anal cavity, which was brought on by a form of torture he had heard about.
What is reaction formation?
Acting and thinking in a way that is opposite to the actual impulse.
What is the problem with the evidence for the psychodynamic explanation of OCD?
It relies on a limited number of case studies, so cannot be generalised.
Is the empirical research to support the psychodynamic theory of OCD?
How did Freud contribute to out understanding of anxiety disorders?
He proposed that our present behaviour is moulded by childhood experiences and that we have a number of defence mechanisms that we employ to defend ourselves against anxiety.
Does psychodynamic treatment for OCD work?
It has not proved effective.
What is an SSRI?
Selective serotonin re-uptake inhibitor. It is a group of antidepressants such as Prozac
What is an MAOI?
Monoamine oxidase inhibitor. It is an older class of antidepressant that is used when people gain no benefit from the use of SSRIs.
How do SSRIs work?
Increases the levels of the neurotransmitter serotonin in the brain by preventing the reabsorption of it at the synapses.
What are SSRIs effective at treating?
Agoraphobia and generalised social phobia. Depression often accompanies OCD, making it effect with that as well.
Give 3 benefits of SSRIs.
1. Easily tolerated and safe, even for older patients.
2. Non-addictive, can be used long-term.
3. Quicker and cheaper that psychological treatments.
Give a benefit of MAOIs.
They have a strong panic-blocking effect and are commonly used to treat agoraphobia (panic attacks). They can be effective with generalised social phobia.
Give 3 disadvantages of SSRIs
1. Can cause side effects such as; headaches, nausea and sexual dysfunction.
2. There is a risk of relapse when coming off them.
3. They take 4-12 weeks before any therapeutic benefit is noticed. This can lead to abandonment of use.
Give 2 disadvantages of MAOIs.
1. Side effects include; hypotension, weight gain, sexual dysfunction.
2. Requires dietary restrictions. Can be fatal when combined with food that contain the amino acid tyramine (found in wine, cheese, bananas), and certain medications.
What drug is ineffective in the treatment of OCD?
Tranquilizers eg. valium.
What are the three behavioural therapies?
1. Systematic desensitisation
2. Virtual reality exposure therapy (VRET)
Who developed systematic desensitisation?
What is the premise that systematic desensitisation is based on?
Two competing emotions cannot occur at the same time. The fear response is replaced with relaxation.
What are the 3 steps involved in treatment?
1. Trained in relaxation techniques so they can relax quickly.
2. The patient and therapist construct an 'anxiety hierarchy' where the patients fear situations are ranked from least to worst.
3. Patient relaxes and imagines the lease frightening case. When the can do this without feeling anxiety, they move up the hierarchy. This is repeated until they reach the top.
What are the two ways that systematic desensitisation can be carried out?
In vivo (real-life exposure) and in vitro (imagined exposure).
What patients is systematic desensitisation effective with?
Those with OCD who have observable compulsions.
What is VRET based on?
The basic principles of systematic desensitisation, but the therapy takes place in a virtual world.
What patients is VRET mainly used with?
Phobic patients, but is being trialled with other anxiety disorders.
How are patients placed in the virtual reality in VRET treatment?
They wear a head-mounted display which lets the patient pick up sensory cues.
What are the 3 steps in VRET treatment for a fear of flying?
1. The patient is placed in a passenger cabin of a virtual aeroplane.
2. The patient is gradually exposed to a hierarchy of situations.
3. Patients rate their anxiety periodically using an anxiety scale.
What is flooding?
It involved overwhelming the patients senses with the item or situation that causes anxiety so the person can realise no harm will occur and there is no basis for the fear.
What are the 3 steps involved in flooding?
1. The patient is exposed to the anxiety causing object or situation.
2. The patient is initially overwhelmed and very fearful, but this eventually subsides.
3. They recognise that anxiety levels have dropped, and that there is no reason to avoid these situations.
What are two variations of flooding?
1. Implosion therapy, where the patient is asked to imagine the situation.
2. Exposure and response prevention (ERP), is the type of flooding used with OCD patients.
They are placed in a situation where obsessive thoughts occur, but are prevented from carrying out the compulsion. Eventually anxiety subsides and nothing has happened, showing there is no need for the compulsion. It involves a cognitive element, when the therapist normally engages in discussion with the client.
What is the only time that systematic desensitisation can be used?
When a particular phobic object or situation can be identified. Therefore is cannot be used for generalised social phobia. It is also of no value to patients with no observable compulsions.
What is the positive of systematic desensitisation?
It is quick and cost effective, and works well in the therapeutic situation.
What is a problem with systematic desensitisation?
It does not always generalise to the patients everyday life.
Why is flooding highly problematic?
It produces high levels of fear and can be traumatic, raising ethical issues.
Is in vivo or in vitro more effective, and with which techniques?
In vivo (real-life), with flooding and systematic desensitisation.
Why is VRET better than systematic desensitisation?
It is easier, cheaper and more convenient, but has similar levels of success.
What is the problem with VRET?
It is expensive and might not be suitable for all phobias. Some patients also report side effects such as nausea.
What is ERP more effective than?
Medication (Foa et al.)
What is the aim of cognitive therapy?
To replace unrealistic and fearful thinking about phobias with more realistic mental habits.
What does cognitive therapy teach patients to do?
To identify, challenge and replace counterproductive thoughts with more constructive thinking patterns.
Give examples of counterstatements for;
2. catastrophic thoughts
3. under-estimating ability to cope
1. How likely is it to happen?
2. Is it true you couldn't handle the worst?
3. You can run from a snake, and there are medicines available for bites.
What type of therapy is cognitive therapy used alongside? What is this called?
Behavioural therapy, forming cognitive-behaviour therapy (CBT).
What is the cognitive study of phobias?
Graziano and Mooney, treating a fear of the dark in young children.
Explain the Graziano and Mooney experiment.
Seventeen children were taught to relax their muscles in bed, self-reinforce efforts with praise, imagine a pleasant scene and recite brave statements. This was compared to a control group with no treatment. The children were rated by their parents on a behavioural scale.
What were the results of Graziano and Mooney's experiment?
The treatment condition improved, and maintained this at a three year check up. The untreated condition showed no improvement.
What is an issue with Graziano and Mooney's experiment?
It isn't clear what caused the improvement, as behavioural techniques were used.
What was Marks study on cognitive therapy?
He reviewed 33 studies comparing behavioural and cognitive techniques for OCD and phobias. Very little difference was found in effectiveness.
What is the issue with cognitive therapy?
It isn't clear what causes the change in behaviour. Any cognitive change could be a result of outside factors such as medication, or lifestyle change - not the intervention of the therapist.
What is the aim of psychodynamic treatment?
To provide insight into what is unconsciously causing the symptoms of OCD, or the true phobia. It requires clients to confront their fears.
How does psychodynamic treatment work?
Ego defence mechanisms have to be lifted to expose the unconscious fear.
What four techniques does psychodynamic treatment include?
Free association, dream analysis, hypnosis, Rorschach tests.
Explain free association.
The patient is encouraged to relax and say anything and everything that comes to mind, no matter how absurd. the ego will be unable to carry out its normal role of keeping check to threatening unconscious impulses and the conflict can be brought to consciousness and verbalised. Once verbalised, the therapist can interpret and explain the cause of the anxiety.
Explain dream analysis.
According to Freud, the main purpose of dreams is wish fulfilment and they are the road to the unconscious. Repressed ideas are more likely to appear in dreams than when we are awake. You analyse the dreams to reveal the latent content and make sense of the anxieties.
What is latent content?
What the dream really represents.
Give an example of a dream analysis.
A person who dreams about horses is really anxious about sex. The horse is the manifest content which disguised the latent content.
What is manifest content?
The dream as it appears to the dreamer.
How effective is psychodynamic treatment?
Highly ineffective, and it is now rarely used.
What is an issue with psychoanalysis?
It is expensive and time-consuming - sometimes taking years to complete.
How can psychoanalysis cause trauma in patients?
As the ego defences are broken down, the anxiety that has been repressed comes into consciousness and the guilt/fear associated with the repressed incident is released. This is known as catharsis.