PSYC 168 CH4: Anxiety Disorders and Obsessive-Compulsive Disorder - PDF

PSYC 168 CH4: Anxiety Disorders and Obsessive-Compulsive Disorder Week 3 2/6/25 Fear vs. Anxiety Fear Central nervous system’s physiological and emotional response to a serious threat to one’s well-being Anxiety Central nervous system’s physiolog...

PSYC 168 CH4: Anxiety Disorders and Obsessive-Compulsive Disorder Week 3 2/6/25 Fear vs. Anxiety Fear Central nervous system’s physiological and emotional response to a serious threat to one’s well-being Anxiety Central nervous system’s physiological and emotional response to a vague sense of threat or danger  Anxiety Disorders Anxiety Disorders are a set of -Disorders covered in this chapter: disorders in DSM, with their core Generalized anxiety disorder features as anxiety Specific Phobia Most common mental disorders in the United States. Social Anxiety disorder Any given year, 19% adult Panic disorder population; 31% of population -In addition, Obsessive-Compulsive develop one of the anxiety disorder is also discussed disorders at some point in their In DSM-IV, OCD was a part of Anxiety lives. Disorders; starting from DSM-5, OCD has its own category, but anxiety still is the key feature of OCD. Generalized anxiety disorder (GAD) Disorder marked by persistent and Dx Checklist excessive feelings of anxiety and worry about numerous events and activities 1. For 6 months or more, person experiences disproportionate, Excessive anxiety experienced under uncontrollable, and ongoing most circumstances, worry about anxiety and worry about practically anything; free-floating multiple matters. anxiety I2. The symptoms include at least Reduced quality of life three of the following: edginess, fatigue, poor Affects 3% of U.S. population; 2:1 concentration, irritability, ratio of women to men muscle tension, sleep More prevalent in LGBTQ+ problems. population; rates higher in White 3. Significant distress or Americans than in other racial and impairment. ethnic groups tianya.fi  y GAD is the least researchedbutmost common Watch the following video through Sac State Library, “Films on Demand” database. Generalized anxiety disorder: Anxiety disorders-symptoms, diagnosis, and treatment. (2002). In Films On Demand. Films Media Group. Let’s watch the start part in class, please finish watching it on your own time.  Sociocultural Perspective Societal factors GAD is most likely to develop in people faced with dangerous social conditions or highly threatened environments (e.g., crime, violence). Societal stress Poverty is one of the strongest stress factor; GAD rates increase as wage decrease Widespread contagious diseases (Covid-19) Psychodynamic Perspective Freud All children experience some degree of anxiety due to id impulse, and use ego mechanisms to control this. high anxiety occurs due to inadequate defense mechanisms. Today’s psychodynamic theorists Disagree with some Freudian explanations, but agree that GAD can be traced to early parent-child relationships (e.g., harsh punishment; overprotectiveness) 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 cause anxiety, setting the stage for GAD to develop. Cognitive-Behavioral Perspective GAD is resulted from dysfunctional thoughts, especially maladaptive assumptions. Basic irrational assumptions (Ellis) Beck: silent assumptions, “It is always best to assume the worst”. Researchers found people with GAD hold maladaptive assumptions, particularly about dangerousness, overattentive to threatening stimuli.  Metacognitive theory People hold positive and negative beliefs about worrying; they recognize the use of worry, but then worry about worrying (meta-worry). Meta-worry leads to GAD. Intolerance of uncertainty theory People cannot tolerate that negative events may occur, even if possibility of occurrence is very small. Intolerance and worrying leave them highly vulnerable to the development of GAD. Avoidance theory People with GAD have greater bodily arousal (higher heart rate, sweating, respiration) than other people; Worrying actually serves to reduce this arousal, perhaps by distracting the individuals from their unpleasant physical feelings.  Cognitive-behavioral approaches Ellis's rational-emotive therapy (RET) Challenge old assumptions, generate new ones Breaking down worrying Educate the role of worrying Accept worrying, worry less about worrying Mindfulness-based cognitive-behavioral therapy Acceptance and commitment therapy  Mindfulness Mindfulness: being in the present moment, intentionally and nonjudgmentally. Mindfulness meditation is the main approach. Common techniques: Attention to body sensation, breathing, wandering and busy thoughts Yoga, journaling, assignments… (Read p.117 to learn more about mindfulness!) Biological Perspective Supported by family pedigree studies, family history The role of GABA neurotransmitter gamma-aminobutyric acid (GABA). GABA carries inhibitory message that ends firing of neuron receptor. Low GABA could produce excessive brain circuit communication and contribute to GAD development. High GABA lessen the activity of brain circuit. Brain circuits Circuits are networks of brain structures that work together, triggering each other into action. Fear circuit is responsible for fear and anxiety emotions Fear circuit hyperactivity may be responsible for the development of the disorder memorizetheblue.fm Drug Therapies Generic Name Trade Name Early 1950s: Barbiturates Alprazolam Xanax (sedative-hypnotic drugs) Chlordiazepoxide Librium Late 1950s: Clonazepam Klonopin Benzodiazepines Ln Clorazepate Tranxene Increase GABA’s ability to bind Diazepam Valium to neuro receptors Estazolam ProSom Effect is short-lived Lorazepam Ativan Potential for dependence Midazolam Versed Side effects, dangerous when mixed with alcohol Oxazepam Serax  Benzodiazepine cannot be used for a long term due to its risk of dependency. GAD is now usually treated with antidepressants that increase serotonin and norepinephrine neurotransmitter activity (will discuss more in the Depression chapter) Antipsychotics are sometimes used for severe and difficult GAD cases. Attendance check Complete attendance check on Canvas Class activity See case handout Discuss in a group of 3-4 people  Finish Chapter 3  PSYC 168 CH4: Anxiety Disorders and Obsessive-Compulsive Disorder Week 4 2/11/25  Exam study guide Case analysis 1, due date postponed to 2/23, case will be available on Canvas soon Updated syllabus for some due dates change Reminder: this Friday 2/14 is the last day to drop class without leaving a record on the transcript; after this date, while you may still petition to drop class, the criteria will be stricter, and there will be a “W” (withdrawal) on the transcript. Phobias How do phobias differ from fear? (DSM-5-TR) More intense and persistent fear of object, activity, or situation Greater desire to avoid the feared object or situation Create distress that interferes with functioning In DSM-5-TR, most phobias are categorized under the diagnosis “Specific Phobia”, with many specifiers; the exception is “Agoraphobia”, which is a separate diagnosis. Social Anxiety Disorder (used to call Social phobia) is also a separate diagnosis. Specific Phobia Persistent fear of specific object Dx Checklist or situations 1. Marked, persistent, and Typical: animal, insect, height, disproportionate fear of a blood, thunderstorm, etc.… particular object or situation; usually lasting at least 6 months. Symptoms exist in 9% of population in U.S. in each year 2. Exposure to the object (annual prevalence), 13% of produces immediate fear. people experience symptoms during their lifetime (lifetime 3. Avoidance of the feared situation. prevalence). 4. Significant distress or 2:1 ratio of women to men impairment. About 32% seek treatment, others just avoid.  Dx Checklist Agoraphobia 1. Pronounced, disproportionate, or repeated fear about being in at least two of the following situations: Afraid of being in public spaces, Public transportation (e.g., auto or plane travel) because worry that no where to Parking lots, bridges, or other open spaces escape or get help if panic Shops, theaters, or other confined places Usually avoid going outside, or Lines or crowds very limited places they can go Away from home unaccompanied Many have panic attacks 2. Fear of such agoraphobic situations derives from a concern that it would be hard to escape Annual prevalence: 1% or get help if panic, embarrassment, or disabling Lifetime prevalence: 1.3% symptoms were to occur. Around 46% seek treatment. 3. Avoidance of the agoraphobic situations. 4. Symptoms usually continue for at least 6 months. 5. Significant distress or impairment. Phobias: What Causes Phobias? Cognitive-behavioral theories receive most research support. Focus primarily on behavioral dimension First fear of certain objects, situations, or events is learned through classical conditioning or modeling. Once fears are acquired, individuals avoid dreaded object or situation and permit fears to become entrenched. Phobias: Behavioral-Evolutionary Explanation Some specific phobias are more common than others. Species-specific biological predisposition to develop certain fears: preparedness Explains why some phobias (animals, heights, darkness) are more common than others (meat, houses) Phobias: Treatments 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 Relaxation training Fear hierarchy in vivo desensitization covert desensitization Virtual reality Flooding Modeling Phobias: Treatments for Agoraphobia Older approaches are less successful. Newer, more successful treatments: Include variety of exposure therapy (cognitive-behavioral) approaches Support groups (go out together, coax move away) Home-based self-help programs Successful for about 70 percent of agoraphobic clients; relapse in as many as half, especially when panic disorder also coexists. Attendance check Complete on Canvas Update preference for printed materials Panic Disorder: 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 attack is one of the most uncomfortable experience, many people literally feel that they are going to die or lose control, often call ambulance or rush to emergency room. See a video here About one-third of population have a panic attack at some point in their life, most of panic attack is a one-time thing, doesn’t necessarily constitute a mental disorder However, some people will develop repeated panic attacks, we call this Panic Disorder Panic Disorder After the first panic attack, Dx Checklist continuously worry about having 1. Unforeseen panic attacks occur additional panic attacks, and repeatedly additional panic attacks actually 2. One or more of the attacks happened precede either of the following Annual prevalence: 3% symptoms: Lifetime prevalence: 5% (a) At least a month of continual Associated with low income concern about having additional attacks About 59% seek treatment. (b) At least a month of May be accompanied by dysfunctional behavior changes agoraphobia associated with the attacks (e.g., avoiding new experiences) The Biology of Panic Panic circuit: amygdala, hippocampus, ventromedial nucleus of the hypothalamus, central gray matter, and locus coeruleus.  Hyperactive panic circuit in people who have panic disorder. Predisposition to develop such irregularities is inherited. Drug therapies Antidepressants are the main medication for Panic Disorder. Mainly work on serotonin and norepinephrine receptors in the panic brain circuit, especially in the locus coeruleus. Benzodiazepines are helpful in reducing immediate panic, though due to its risk of dependency, hydroxyzine (an antihistamine) is also commonly used nowadays. Cognitive-Behavioral Perspective Cognitive-behavioral perspective Experience more frequent or intense bodily sensations, misinterpreted as signs of medical catastrophe Often over breathe, or hyperventilate, a key feature in panic attack, often exacerbate the physical symptoms. Anxiety sensitivity: focus on bodily sensations much of the time, are unable to assess the sensations logically, and interpret them as potentially harmful. Patients often develop avoidance and safety behaviors. Cognitive-Behavioral Therapy Seeks to correct people's misinterpretations of their bodily sensations Educate about nature of panic attacks Teach applications of more accurate interpretations Teach skills for coping with anxiety Use biological challenge procedures (by having them exercise vigorously or do some panic-inducing tasks) to induce panic sensations so clients can apply new interpretations and skills under watchful supervision Two third of patients benefit from CBT treatment, at least as helpful as antidepressants or benzodiazepines; often combine CBT with medication  PSYC 168 CH4: Anxiety Disorders and Obsessive-Compulsive Disorder Week 4 2/13/25  Reminder of doing practice questions Case analysis Social Anxiety Disorder Dx Checklist Severe, persistent, irrational anxiety 1. Pronounced, disproportionate, and in social or performance situations; repeated anxiety about social can be either narrow or broad; situation(s) in which the individual could be exposed to scrutiny by others; greatly interfere with one’s life typically lasting 6 months or more. Annual prevalence: 7% 2. Fear of being negatively evaluated Lifetime prevalence: 12% by or offensive to others Women to men ratio is 3:2 3. Exposure to the social situation almost always produces anxiety. More prevalent in White Americans, 4. Avoidance of feared situations and in people with low incomes. 5. Significant distress or impairment Around 40 percent seek treatment.  Social Anxiety Disorder: Causes Cognitive-behavioral perspective Interplay of cognitive and behavioral factors Dysfunctional beliefs and expectations about social realm; anticipation of social disasters and dread of social situations. Avoidance and safety behaviors performed to reduce or prevent these disasters. Tied to genetic predispositions, trait tendencies, biological irregularities, traumatic childhood experiences, overprotective parent-child interactions Social Anxiety Disorder: Treatments Treatments for social anxiety disorder address two distinct features. Overwhelming social fears Medications: Benzodiazepine or antidepressant drugs Cognitive-behavioral therapy: Exposure therapy, change maladaptive beliefs and expectations Lack of social skills Model appropriate social behavior, role-play, rehearsing Social skills and assertiveness training group Obsessive-Compulsive Disorder (OCD) Most people have rituals or routines, or thoughts they think they need to follow Daily routines (e.g., check stove, lock door) Superstitious beliefs (e.g., avoid stepping on cracks, turn away from black cats, number 13) Personal ritual (e.g., wear lucky sock, arrange clothes in a certain way) Most of these rituals, routines, beliefs are fine, not pathological Watch a video  Obsessive-Compulsive Disorder (OCD) Obsessions (thoughts) Dx Checklist (APA, 2022, P. 266) Persistent thoughts, ideas, Obsessions are defined by (1) and (2): impulses, or images that seem 1. Recurrent and persistent thoughts, urges, or to invade a person's images that are experienced, at some time consciousness during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. 2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion). Reference: American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.)  Obsessive-Compulsive Disorder (OCD) Dx Checklist (APA, 2022, P. 266) Compulsions (behavior) Compulsions are defined by (1) and (2): Repetitive and rigid behaviors 1. Repetitive behaviors (e.g., hand washing, or mental acts that people feel ordering, checking) or mental acts (e.g., they must perform to prevent praying, counting, repeating words silently) that or reduce anxiety, in response the individual feels driven to perform in to obsession. response to an obsession or according to rules that must be applied rigidly. 2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they Reference: American Psychiatric Association. are designed to neutralize or prevent or are (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.) clearly excessive.  OCD Obsessions or compulsions are Dx Checklist excessive or unreasonable, cause great distress, take up 1. Occurrence of repeated much time, interfere daily life obsessions, compulsions, or Obsession cased significant both anxiety, while compulsion aimed to neutralize or reduce anxiety 2. The obsessions or compulsions take up considerable time Resisting obsession or compulsion causes more anxiety. Annual prevalence: 1.2% 3. Significant distress or impairment Lifetime prevalence: 2.3% Equally common among genders, races, and ethnicities. OCD was considered a part of Anxiety Begins in childhood or young Disorder in DSM-IV; however, since adulthood; fluctuating severity, 40% DSM-5, OCD has its own category, due seek treatment to its unique feature Features of Obsessions Features Thoughts that feel both intrusive and foreign Attempts to ignore or resist them trigger anxiety Awareness that thoughts are excessive Basic themes Dirt/contamination Violence and aggression Orderliness Religion Sexuality Features of Compulsions Features Various forms of voluntary behaviors Feel mandatory/unstoppable Recognition that behaviors are unreasonable Performing behaviors reduces anxiety for a short time Behaviors often develop into rituals Themes Cleaning compulsions Checking compulsions Order or balance seeking Touching, verbalizing, and/or counting compulsions  Most OCD patients have both obsessions and compulsions, but some only has one form, especially with only obsession. In most cases, compulsions serve as a yielding to obsessions; in some other cases, compulsions help control obsessions. Cognitive-Behavioral Perspective Many people may have unwanted, intrusive, unpleasant thoughts from time to time, most just ignore or dismiss them People who have OCD blame themselves having such thoughts, and expect something terrible may happen To avoid negative outcomes, individuals attempt to neutralize their thoughts with actions (or other thoughts). Neutralizing indeed reduce anxiety, but frequent use of neutralizing eventually turns into obsession or compulsion Cognitive-Behavioral Therapy Educate on how misinterpretations of unwanted thoughts, excessive sense of responsibility, and neutralizing acts have helped to produce and maintain symptoms Guide the clients to identify and challenge their distorted cognitions Use Exposure and Response Prevention (ERP) Expose clients to anxiety-arousing thoughts or situations, then prevent the client from performing their compulsive acts Use videoconferencing in recent years Between 50 and 70 percent improvement with therapy Biological Perspective Genetic studies identified gene anomalies. CSTC circuit: Cortico-Striato-Thalamo-Cortical brain circuit. Orbitofrontal cortex, cingulate cortex, striatum (including the caudate nucleus and putamen), thalamus, and amygdala CSTC circuit is associated with impulse, reward, movement, and habit. OCD patient’s CSTC circuit is hyperactive, difficult to turn off impulse Biological Treatment Serotonin is the main neurotransmitter related to OCD Antidepressants are the main medication used to treat OCD, usually much higher dosage is used compared with treating depression or anxiety. Improvement in 50 to 60 percent of those with OCD; obsessions and compulsion on average almost cut in half Research suggests that combination of medication + cognitive- behavioral therapy approaches may be most effective.  Obsessive-Compulsive-Related Disorders Obsessive-compulsive-related disorders Obsessive-like concerns drive people to repeatedly and excessively perform certain psychopathological patterns of behavior Hoarding disorder: feel compelled to save items and become very distressed if they try to discard them, resulting in an excessive accumulation of items Trichotillomania (hair-pulling disorder): repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other parts of the body Excoriation (skin-picking) disorder: repeatedly pick at their skin, fingernail, cuticles, resulting in significant sores or wounds Body dysmorphic disorder: preoccupied with the belief that they have certain defects or flaws in their physical appearance. Such defects or flaws are imagined or greatly exaggerated. Equifinality: Multiple Negative Variables Multifinality: Power of Protective Factors