Abnormal Psychology: Chapter 6 - Anxiety

Characteristics of Anxiety

• Definition: Anxiety involves negative feelings and apprehensions about possible dangers. It is a complex blend of unpleasant emotions and thoughts.
• Orientation: Future-oriented and more diffused than fear.
• Aspects: Cognitive, physical, emotional, and behavioral.
• Adaptive Behavior: Can be evolutionarily adaptive by keeping us alert to danger, but excessive anxiety can be problematic.

Fear vs. Panic

• Fear: Response to immediate danger; active fight or flight.
  • Too much fear causes decreased concentration and unpleasant symptoms.
• Panic Attack: Abrupt, intense fear without real danger; similar physiological reactions to thrill-seeking activities.

Anxiety Disorders Overview

• Characteristics: Unrealistic, irrational fears of debilitating intensity.
  • Pervasive, persistent, with excessive avoidance, distress, and impairment.
• DSM Recognized Disorders:
  • Specific phobia
  • Social phobia (social anxiety disorder)
  • Panic disorder
  • Agoraphobia (with/without panic disorder)
  • Generalized anxiety disorder

Prevalence and Comorbidity

• Commonality: Anxiety disorders are common, especially among women.
• Comorbidity: High overlap with depression (55-75% of cases).
• Phobias: Most common type of anxiety disorder.

Biological Factors

• Genetic Vulnerability: Abnormally sensitive limbic system.
• Neurotransmitters: Low GABA, certain levels of norepinephrine, and serotonin.
• Inherited Behavior: Evolutionary psychology influences anxiety through prepared learning.

Psychological Factors

• Learned Behaviors: Classical and operant conditioning.
• Parenting Influences: Overprotective or intrusive parenting linked to childhood anxiety.
• Social Learning: Vicarious learning through others.
• Cognitive Factors:
  • Locus of control perceptions heavily influence anxiety.
  • Hyper-vigilance and catastrophizing.

Social and Cultural Influences

• Stressful Life Events: Peer pressure, environmental cues, culture shock.
• Cultural Syndromes: Examples include Yoruba culture (Nigeria), Koro (China), and "attack of the nerves" (Caribbean).

Integrated Model

• Theory posits that more types of vulnerabilities increase the likelihood of developing anxiety disorders.
• Symptoms can escalate existing feelings, creating a snowball effect.

Treatments for Anxiety

• Exposure Therapy: Graduated control exposure with systematic desensitization is most effective.
• Cognitive Restructuring: Identifying and disputing irrational thoughts.
• Modeling & Rehearsal: Effective for social phobia.
• Virtual Reality Treatments: Effective for phobias without placing individuals in real danger.
• Relaxation Techniques: Breathing exercises, progressive muscle relaxation.
• Psychotropic Medications: Benzodiazepines, antidepressants, MAOI inhibitors, SSRIs (e.g., Xanax, Klonopin).

Abnormal Psychology - Chapter Six: Anxiety Part Two

Phobias

Specific Phobias

• Definition: Irrational or unreasonable persistent fear of a specific object or situation, interfering with functioning.
• Development: Common in children who fear large or loud things but often outgrow it.
• Chronic Nature: Can become a long-term issue if not outgrown, though decreases with age.
• Prevalence: 12% of general population, with females outnumbering males 4:1.
• Males and Phobias: Males typically fear death, dependence, or injury, while fear of heights is equal among genders.

Subtypes of Specific Phobias

• Animal Type: Fears of animals such as dogs, cats, spiders, snakes. Snakes, mice, and dogs are the most feared.
• Natural Environment Type: Includes fear of water, heights, lightning, thunderstorms.
• Situational Type: Fear of confined spaces, the dark, crowds, dentists, flying, public speaking.
• Blood-Injection-Injury Type: Fear of needles, injections, or blood, causing nausea, dizziness, fainting.
• Other: Includes children's fear of loud sounds, mechanics, or specific characters.

Diagnostic Criteria for Specific Phobias (DSM-IV/DSM-5)

• Features:
  • Persistent, excessive, or unreasonable fear triggered by specific object/situation.
  • Immediate anxiety response to phobic stimulus, possibly a panic attack.
  • Recognition of excessive/unreasonable fear.
  • Avoidance or extreme endurance of the phobic situation.
• DSM-5 Update:
  • Must last more than six months.
  • Causes significant distress in social/occupational areas.
  • Not attributable to another disorder.

Types of Phobias

Separation Anxiety

• Affects: Mainly children, fear of being away from parents.
• Nature: Common in childhood, not a disorder unless extreme or leads to avoidance.

Social Phobias / Social Anxiety Disorder

• Definition: Extreme, irrational fear, and avoidance of social/performance situations.
• Prevalence: 12% of population, 60% female.
• Onset: Early/middle adolescence, affecting socioeconomic status.

Social Phobia Diagnostic Criteria

• Criteria:
  • Persistent fear of social/performance situations, fear of embarrassment.
  • Anxiety in feared situations, recognition of unreasonable fear.
  • Avoidance and extreme distress when enduring situations.
  • Interference with normal routine or occupational functioning.
  • Duration of at least six months.
  • Not due to another disorder, substance, or medical condition.

Abnormal Psychology: Panic Disorders, Agoraphobia, and Panic Attacks

Agoraphobia

• Definition: An anxiety disorder characterized by anxiety in perceived unsafe environments.
  • Situations: Open spaces, public transit, shopping malls, being outside the house.
  • Not just fear of leaving the house, but anxiety about social situations.
• Diagnostic Criteria:
  • Marked fear in two of the following situations: open spaces, public transport, crowded areas.
  • Immediate anxiety response, such as a panic attack.
  • Recognition of fear as disproportionate.
  • Avoidance behaviors disrupt normal routines, relationships, or occupational abilities.
  • Symptoms must persist for at least six months.
  • No other condition should explain symptoms better.

Panic Attacks

• Characteristics: False alarm of the body, often following distress or stressful situations.
  • Common: 23% of the population experiences panic attacks, more common than panic disorder.
  • Symptoms:
    • Physical manifestations: Flushed feeling, heart attack-like symptoms, nausea, hot/sweaty.
    • Often described as drowning on dry land.
  • Many seek emergency medical help during an attack.
• Diagnostic Criteria:
  • Four or more of the following: palpitations, sweating, trembling, shortness of breath, choking, chest pain, nausea, dizziness, derealization, fear of losing control, dying, numbness, chills.
  • Less than four symptoms may be a limited symptom panic attack.

Panic Disorder

• Characteristics: Recurrent unexpected panic attacks.
  • At least one attack followed by one month of concern over additional attacks or consequences.
  • Maladaptive behavior changes to avoid attacks (e.g., avoiding exercise or unfamiliar situations).
  • Not due to substance effects or other mental disorders.
• Prevalence and Demographics:
  • Increasing prevalence, about 5% of the population.
  • Common onset between ages 23-24, possible single digits to 40s.
  • 80-90% female sufferers, possibly due to sociocultural factors.
  • Higher in elderly after traumatic events.
• Comorbidity:
  • Common with other anxiety disorders like generalized anxiety disorder, PTSD, and substance abuse.
  • 30-50% experience serious depression.
  • 83% have at least one comorbid disorder.
  • 60% experience panic attacks during sleep (between 1-3:30 AM).

Treatment

• Pharmacological:
  • Anti-anxiety medications (e.g., Xanax, Valium).
  • SSRIs (e.g., Prozac, Paxil).
  • High relapse rates if medications are discontinued.
• Psychological:
  • Cognitive Behavioral Therapy (CBT): Best long-term outcomes.
  • Panic Control Treatment (PCT): Exposure to sensations to create mini-panic attacks and teaching control through breathing and relaxation.
  • Can be conducted in virtual reality or real-world settings.