CHAPTER 5
Anxiety, Obsessive-Compulsive, and Related Disorders
- Stress
o A psychological need to attend to a problem or issue
- Fear
o Central nervous system’s physiological and emotional response to a serious threat to
one’s well-being
- Anxiety
o Central nervous system’s physiological and emotional response to a vague sense of
threat or danger
- Most common mental disorders in the United States
o In any given year, 19% of the US adult population experiences one of the six DSM-5
anxiety disorders
o About 31% develop one of the disorders at some point in their lives
o About 42% of these individuals seek treatment
o Majority have a co-morbid disorder, e.g., depression
o All can have some degree of genetic predisposition
Generalized Anxiety Disorder
- Persistent and excessive anxiety about numerous events and activities experienced under most
circumstances
- Worry about practically anything; free-floating anxiety
- Reduced quality of life
- Affects 4% of US population; 2:1 ratio of women to men; 43% receive treatment; racial-ethnic
differences
1. For 6 months or more, person experiences disproportionate, uncontrollable, and ongoing
anxiety and worry about multiple matters
2. The symptoms include at least three of the following: edginess, fatigue, poor concentration,
irritability, muscle tension, sleep problems
3. Significant distress or impairment
- Sociocultural perspective
o GAD is most likely to develop in people faced with dangerous ongoing social conditions
or highly threatened environments
Supported by research findings
o Some forms of societal stress
Poverty
Race and ethnicity
Widespread illness
- Freud
o All children experience some degree of anxiety and use ego mechanisms to control this
o GAD occurs with high anxiety levels or inadequate defense mechanisms
- Today’s psychodynamic theorists
o Disagree with some Freudian GAD explanations, but agree GAD can be traced to early
parent-child relationships
, o Research testing psychodynamic explanations
GAD and defense mechanism; repressed memories; harsh punishment;
overprotectiveness
- Psychodynamic therapies
o Free association
o Therapist interpretations of transference, resistance, and dreams to reduce fear of id
impulses and control
- Specific treatments for GAD
o Freudians focus less on fear and more on control of id
o Object-relations therapists attempt to help patients identify and settle early relationship
problems
o Short-term psychodynamic therapy is more effective than longer treatments
- Humanistic perspective
o GAD arises when people stop looking at themselves honestly and acceptingly
o Carl Rogers’ explanation
Lack of unconditional positive regard in childhood leads to conditions of worth
(i.e., harsh self-standards)
Threatening self-judgements break through and cause anxiety, setting the stage
for GAD to develop
- Humanistic treatment approach
o Client-centered therapy is used to show unconditional positive regard for clients and
empathize with them
o Despite optimistic case reports, controlled studies have failed to offer strong support
o Only limited support for Rogers’ explanation of GAD and other forms of abnormal
behavior
- Cognitive-behavioral perspective
o Problematic behavior and dysfunctional thinking often cause psychological disorders
o Treatment focus involves the nature of behavior and thoughts
- Early approach
o Maladaptive or basic irrational assumptions (Ellis)
o Silent assumptions (Beck)
- Newer cognitive-behavioral explanations
o Metacognitive theory (Wells) and meta-worries
o Intolerance of uncertainty theory (Koerner and colleagues)
o Avoidance theory (Borkovec)
- Cognitive-behavioral therapies
o Changing maladaptive assumptions
Ellis’s rational-emotive therapy (RET)
o Coping and life-skills training
o Problem-solving
o Breaking down worrying
Mindfulness-based cognitive-behavioral therapy
Acceptance and commitment therapy
Mindfulness meditation
- Behavioral therapies
o Relaxation skills training
Breathing
Anxiety, Obsessive-Compulsive, and Related Disorders
- Stress
o A psychological need to attend to a problem or issue
- Fear
o Central nervous system’s physiological and emotional response to a serious threat to
one’s well-being
- Anxiety
o Central nervous system’s physiological and emotional response to a vague sense of
threat or danger
- Most common mental disorders in the United States
o In any given year, 19% of the US adult population experiences one of the six DSM-5
anxiety disorders
o About 31% develop one of the disorders at some point in their lives
o About 42% of these individuals seek treatment
o Majority have a co-morbid disorder, e.g., depression
o All can have some degree of genetic predisposition
Generalized Anxiety Disorder
- Persistent and excessive anxiety about numerous events and activities experienced under most
circumstances
- Worry about practically anything; free-floating anxiety
- Reduced quality of life
- Affects 4% of US population; 2:1 ratio of women to men; 43% receive treatment; racial-ethnic
differences
1. For 6 months or more, person experiences disproportionate, uncontrollable, and ongoing
anxiety and worry about multiple matters
2. The symptoms include at least three of the following: edginess, fatigue, poor concentration,
irritability, muscle tension, sleep problems
3. Significant distress or impairment
- Sociocultural perspective
o GAD is most likely to develop in people faced with dangerous ongoing social conditions
or highly threatened environments
Supported by research findings
o Some forms of societal stress
Poverty
Race and ethnicity
Widespread illness
- Freud
o All children experience some degree of anxiety and use ego mechanisms to control this
o GAD occurs with high anxiety levels or inadequate defense mechanisms
- Today’s psychodynamic theorists
o Disagree with some Freudian GAD explanations, but agree GAD can be traced to early
parent-child relationships
, o Research testing psychodynamic explanations
GAD and defense mechanism; repressed memories; harsh punishment;
overprotectiveness
- Psychodynamic therapies
o Free association
o Therapist interpretations of transference, resistance, and dreams to reduce fear of id
impulses and control
- Specific treatments for GAD
o Freudians focus less on fear and more on control of id
o Object-relations therapists attempt to help patients identify and settle early relationship
problems
o Short-term psychodynamic therapy is more effective than longer treatments
- Humanistic perspective
o GAD arises when people stop looking at themselves honestly and acceptingly
o Carl Rogers’ explanation
Lack of unconditional positive regard in childhood leads to conditions of worth
(i.e., harsh self-standards)
Threatening self-judgements break through and cause anxiety, setting the stage
for GAD to develop
- Humanistic treatment approach
o Client-centered therapy is used to show unconditional positive regard for clients and
empathize with them
o Despite optimistic case reports, controlled studies have failed to offer strong support
o Only limited support for Rogers’ explanation of GAD and other forms of abnormal
behavior
- Cognitive-behavioral perspective
o Problematic behavior and dysfunctional thinking often cause psychological disorders
o Treatment focus involves the nature of behavior and thoughts
- Early approach
o Maladaptive or basic irrational assumptions (Ellis)
o Silent assumptions (Beck)
- Newer cognitive-behavioral explanations
o Metacognitive theory (Wells) and meta-worries
o Intolerance of uncertainty theory (Koerner and colleagues)
o Avoidance theory (Borkovec)
- Cognitive-behavioral therapies
o Changing maladaptive assumptions
Ellis’s rational-emotive therapy (RET)
o Coping and life-skills training
o Problem-solving
o Breaking down worrying
Mindfulness-based cognitive-behavioral therapy
Acceptance and commitment therapy
Mindfulness meditation
- Behavioral therapies
o Relaxation skills training
Breathing
