Chapter 4

• Fear

  = Central nervous system’s physiological and emotional response to a serious threat to one’s well-being

  -> about sth
• Anxiety


  = Central nervous system’s physiological and emotional response to a vague sense of threat or danger
• Generalized anxiety disorder

  = disorder marked by persistent and excessive feelings of anxiety and worry about numerous events and activities
• Most common mental disorders in the United States

  • In any given year, 18 percent of the U.S. adult population experiences one of the six DSM-5 anxiety disorders

  • About 29 percent develop one of the disorders at some point in their lives

  • About one-third of these individuals seek treatment
• Separation Anxiety

  • Most common disorder among young children

  • DSM-5 determined separation anxiety can develop in adults

  • New categorization as an anxiety disorder is controversial
• Generalized Anxiety Disorder (GAD) -checklist

  • For 6 months or more -> person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about multiple matters

  • The symptoms include at least three of the following: edginess, fatigue, poor concentration, irritability, muscle tension, sleep problems

  • Significant distress or impairment
• Generalized Anxiety Disorder-Sociocultural perspective

  • GAD is most likely to develop in people faced with dangerous ongoing social conditions

  • Supported by research findings
• Forms of societal stress

  • Poverty

  • Race and ethnicity
• Psychodynamic perspective(GAD)

  -> not so important for anxiety

  Freud posited that all children experience anxiety:

  • Realistic anxiety when they face actual danger

  • Neurotic anxiety when they are prevented from expressing id impulses

  • Moral anxiety when they are punished for expressing id impulses

  • Some children experience particularly high levels of anxiety or their defense mechanisms are particularly inadequate
• Psychodynamic therapies - GAD

  • Free association

  • Therapist interpretations of transference, resistance, and dreams

  Specific treatments for GAD

  • Freudians focus less on fear and more on control of id

  • Short-term psychodynamic therapy is more effective
• GAD- Humanistic perspective

  • GAD arises when people stop looking at themselves honestly and acceptingly

  • Carl Rogers' explanation

  • Lack of unconditional positive regard in childhood leads to conditions of worth (i.e., harsh self-standards)

  • Threatening self-judgments break through and cause anxiety, setting the stage for GAD to develop
• Humanistic perspective- GAD


  Client-centered approach used to show unconditional positive regard for clients and to empathize with them

  • Despite optimistic case reports, controlled studies have failed to offer strong support

  • Only limited support for Rogers' explanation of GAD and other forms of abnormal behavior
• Cognitive-behavioral perspective -GAD

  • Problematic behaviors and dysfunctional thinking often cause psychological disorders

  • Treatment focus involves the nature of behavior and thoughts (focus on changing thinking patterns & behaviors)

  • Early approach

  • Maladaptive or basic irrational assumptions (Ellis)

  • Silent assumptions (Beck)
• GAD- Cognitive-behavioral perspective

  Newer explanations:

  • Metacognitive theory (Wells) and meta-worries

  • Intolerance of uncertainty theory (Koerner and colleagues)

  • Avoidance theory (Borkovec)
• Cognitive-behavioral therapies

  • Changing maladaptive assumptions

  • Ellis's rational-emotive therapy (RET)

  • Breaking down worrying

  • Mindfulness-based cognitive-behavioral therapy

  • Acceptance and commitment therapy
• Biological perspective- GAD

  • GAD is caused chiefly by biological factors

  • Supported by family pedigree studies and brain researchers

  • Challenged by competing explanation of shared environment

  • Fear reactions are tied to brain circuits
• GAD- Biological perspective

  • GAD results from a hyperactive fear circuit

  • GABA: Important neurotransmitter in this circuit

  • Involves several brain structures (‘fear network’)
• What brain stuctures are involved in biological perspective of GAD?

  • Prefrontal cortex

  • Anterior cingulate cortex

  • Insula

  • Amygdala
• Generalized Anxiety Disorder • Biological perspective: Drug therapy

  • Early 1950s: Barbiturates (sedative-hypnotics)

  • Late 1950s: Benzodiazepines

  • More recently: Antidepressant and antipsychotic medications
• Phobias- Fear

  = a normal & common experience
• How do phobias differ from fear?

  • More intense and persistent fear

  • Greater desire to avoid the feared object or situation

  • Create distress that interferes with functioning
• Categories of phobias

  • Specific phobias

  • Agoraphobia
• Specific Phobias- Checklist

  • Marked, persistent, and disproportionate fear of a particular object or situation; usually lasting at least 6 months

  • Exposure to the object produces immediate fear

  • Avoidance of the feared situation

  • Significant distress or impairment
• Specific Phobias

  • Yearly symptoms exist in 10 percent of all U.S. people

  • 14 percent of people experience symptoms during lifetime

  • Women outnumber men 2:1

  • 32 percent seek treatment
• Agoraphobia • Checklist

  • Pronounced, disproportionate, or repeated fear about being in at least two delineated situations

  • Avoidance of the agoraphobic situations

  • Symptoms usually continue for at least 6 months

  • Significant distress or impairment; often fluctuates
• Agoraphobia

  • Yearly symptoms exist in 1.7 percent of U.S. population

  • 2.6 percent of people experience symptoms during lifetime; gender differences

  • 46 percent seek treatment
• What causes specific phobias?

  Evidence supports the behavioral explanations:

  • Cognitive-behavioral theory

  • Behavioral-evolutionary explanation
• Cognitive-behavioral perspective of Phobia

  How are fears learned?

  • Classical conditioning

  – US: Entrapment → UR: Fear

  – CS: Running water → CR: Fear

  • Modeling

  – Observation

  – Imitation
• Cognitive-behavioral perspective of Phobia

  What does research indicate?

  • Early laboratory studies of classical conditioning of fear: Watson and Rayner (Little Albert)

  • Modeling: Bandura and Rosenthal

  • Fear reactions not always conditioned

  • McGabe and Gamble and colleagues

  • Phobias can be caused by conditioning/modeling; but not ordinarily so
• Behavioral-evolutionary perspective of Phobia

  • Some specific phobias are much more common than others

  • Species-specific biological predisposition to develop certain fears: preparedness

  • Explains why some phobias (snakes, spiders) are more common than others (cars, guns, bicycles)
• Behavioral-evolutionary perspective • Treatments for specific phobias

  • Actual contact with the feared object or situation is key to greater success in all forms of exposure treatment

  – Systematic desensitization (Wolpe)

  » Covert (imaginal) and in vivo desensitization; recently: virtual reality

  – Flooding = exposure exercise

  – Modeling
• Treatments for agoraphobia

  • Older approaches are less successful

  • Newer, more successful treatments

  • Variety of exposure therapy approaches

  – Support groups

  – Home-based self-help programs

  • Are successful for about 70 percent of agoraphobic clients

  • Relapses may occur, especially when panic disorder also exists
• Social Anxiety Disorder

  • Yearly symptoms exist in 8 percent of U.S. population

  • 13 percent of people experience symptoms during lifetime

  • Often begins in late childhood or adolescence and into adulthood

  • 40 percent seek treatment
• Social Anxiety Disorder- Checklist

  • Pronounced, disproportionate, and repeated anxiety about social situation(s) in which the individual could be exposed to scrutiny by others; typically lasting 6 months or more

  • Fear of being negatively evaluated by or offensive to others

  • Exposure to the social situation almost always produces anxiety

  • Avoidance of feared situations

  • Significant distress or impairment
• Social Anxiety Disorder- Cognitive-behavioral perspective

  • Leading explanation for this disorder features cognitive and behavioral factors

  • Group of social-realm dysfunctional beliefs and expectations held

  • Anticipation of social disasters and dread of social situations

  • Avoidance and safety behaviors performed to reduce or prevent these disasters
• Treatments for social anxiety disorder

  • Overwhelming social fears: Addressed behaviorally with exposure

  • Cognitive-behavioral therapy: Exposure therapy and systematic therapy discussions

  • Medications: Benzodiazepine or antidepressant drugs

  • Lack of social skills

  • Social skills and assertiveness training
• Panic attacks

  = Periodic, short bouts of panic that occur suddenly, reach a peak within minutes, and gradually pass

  Feature at least four of the following symptoms of panic:

  • Heart palpitations

  • Tingling in the hands or feet

  • Shortness of breath

  • Sweating

  • Hot and cold flashes

  • Trembling

  • Chest pains

  • Choking sensations

  • Faintness

  • Dizziness

  • Feeling of unreality
• Panic Disorder

  • 3.1 percent of U.S. population experience this disorder yearly

  • More than 5 percent of people experience symptoms during lifetime

  • Often begins in late adolescence or early adulthood

  • 59 percent seek treatment

  • May be accompanied by agoraphobia
• Panic Disorder- Checklist

  • Unforeseen panic attacks occur repeatedly

  • One or more of the attacks precede either of the following symptoms:

  • At least a month of continual concern about having additional attacks

  • At least a month of dysfunctional behavior changes associated with the attacks (e.g., avoiding new experiences)
• Panic Disorder-Biological perspective

  Initial theory:

  • Panic attacks caused by abnormal norepinephrine activity in locus coeruleus

  More recent theory:

  • Brain circuits and amygdala are the more complex root of the problem

  • May be an inherited predisposition to abnormalities in these areas