Summary Clinical psychopathology Chapter 6

6 Anxiety and Stressor-Related Problem

LEARNING GOAL 10 Recognize the symptoms of the different types of anxiety disorders, using the
available diagnostic criteria

LEARNING GOAL 11 Apply the theories that may help explain these anxiety disorders

LEARNING GOAL 12 Discuss the psychological and biological interventions available to people with
anxiety disorders
This lecture: mainly a cognitive perspective


5Anxiety Disorders in this lecture
 Simple Phobia
 Agoraphobia
 Panic disorder
 Social phobia
 Generalised Anxiety Disorder

Conditions formerly known as Anxiety Disorders
 Obsessive-Compulsive disorder
 Posttraumatic Stress Disorder

The six main anxiety and stress-related disorders are:
 1. specific phobias
 2. social anxiety disorder
 3. panic disorder
 4. generalized anxiety disorder (GAD)
 5. obsessive compulsive disorder (OCD)
 6. post-traumatic stress disorder (PTSD).

 Anxiety as a comorbid condition

Anxiety symptoms may be particularly prone to comorbidity because many of the physiological
and cognitive components of anxiety can be found across different disorders, and so these
vulnerability factors may trigger the development of multiple anxiety problems

highly comorbid with mood disorders and with substance use disorders.


6.1 SPECIFIC PHOBIAS

Fear related to exposure to specific object or situation
 e.g. Animals, Elements of the natural (heights) or man-made (flying) environment, Seeing
blood
 Presence or anticipation
 Upon exposure, immediate anxiety response
 Avoidance or endurance with intense anxiety
 Out of proportion
 Persistent, longer than 6 months
 Significant interference with daily life (occupational, social)


 Prevalence and Criteria

, Specific phobicsThe phobic trigger usually elicits extreme fear and often panic, which usually
means that the phobic individual develops avoidance strategies designed to minimize the
possibility of contact with that phobic trigger.
 are normally aware that their fear of the phobic situation or event is excessive or
unreasonable (in comparison either with the actual threat it represents or with the less
 fearful responses of other people), but they do acquire a strong set of phobic beliefs that
appear to control their fear

What maintains the phobic’s fear and avoidance of that stimulus or situation?
phobic beliefsBeliefs about phobic stimuli that maintain the phobic’s fear and avoidance of that
stimulus or situation
 treatments for specific phobias are designed to challenge these dysfunctional phobic
beliefs

What is the prevalence?
 Specific phobias are extraordinarily common, with surveys suggesting that a clear majority
of the general population (60.2 per cent) experience ‘unreasonable fears’
 There is also a clear gender difference in the prevalence of specific phobias, with women
being twice as likely as men to be diagnosed with a specific phobia

What are the criteria for specific phobics?
 Disproportionate and immediate fear relating to a specific object or situation
 Objects or situations are avoided, or are tolerated with intense fear or anxiety
 Symptoms cannot be explained by other mental disorders and persist for at least six
months
 Phobia causes significant distress and difficulty in performing social or occupational
activities


 Common phobias

Interestingly, common phobias tend to focus on a relatively small group of objects and situations,
and the main ones are animal phobias

what subgroups of specific phobias are specified in the DSM 5? how high are the chances to suffer
from multiple phobias at once?
(1) animal phobias (e.g. spiders, insects, dogs),
(2) natural environment phobias (e.g. heights, storms, water),
(3) blood–injection–injury phobias (BII) (e.g. needles, invasive medical procedures),
(4) situational phobias (e.g. airplanes, elevators, enclosed spaces), and other phobias (e.g.
situations that may lead to choking or vomiting; in children, loud sounds or costumed characters!)

If you suffer from one, chances are higher you also suffer form another one


Aetiology

- what was the original standing on the aetiology of phobias?
Originally, there was a tendency to try to explain all types of phobias with just one explanatory
theory (e.g. classical conditioning), but this approach has now given way to the view that different
types of phobias might be acquired in quite different ways (a multifaceted approach)


 Psychoanalytic accounts

, how did Freud conceptualize aetiology of phobias? what was their believed function?
For example, psychoanalytic theory as developed by Freud saw phobias as a defence against the
anxiety produced by repressed id impulses, and this fear became associated with external events
or situations that had a symbolic relevance to that repressed id impulse.

function of phobias was to avoid confrontation with the real, underlying issues


 Classical conditioning and phobias

where do theories about causes of phobias in behaviorism originate from? Following what leads to
development of specific phobia? What is the criticism?
-What is Mowrer’s two-factor model?
-What is an alternative to stimulus-response model?
The principles of classical conditioning & Mowrer’s Model
little albert
Trauma leads to phobia, according to behaviorism

-many phobics cant recall any traumatic experience at
the time of phobic onset

Operant conditioning -vicarious learning
Fear can develop without direct experience with CS-US:
vicarious learning
-not all traumas lead to phobia (not all traumatic experiences at the dentist lead to dental phobia)

Why Mowrer’s model has been abandoned
Stimulus-response model (black box)›
Not everyone with aversive experience develops a phobia
›Not everyone with a specific phobia has aversive experience
Can not accommodate observations like
 Asymmetric distribution phobic objects (electricoutlet phobia?)
o Biological preparedness= some things become more fear related than others
 UCS inflation (case: disorder developed after learning that bank robber was dangerous
criminal)

-Simple conditioning models treat all stimuli as equally likely to enter into association with aversive
consequences, yet fears and phobias are not evenly distributed across stimuli and experiences.

-A simple conditioning model does not appear to account for the common clinical phenomenon of
incubation. Incubation is where fear increases in magnitude over successive encounters with the
phobic stimulus→behaviorism would predict the opposite: extinction

S-S model