Sunday, 21 October 2007

Anxiety Disorders

Anxiety Disorders

Aims:
· Describe the genetic, biological and psychological characteristics of:
o Phobias;
o Obsessive-compulsive behaviour.
· Assess the value of various explanations of these disorders.


Phobia’s

Definition: A pathological condition which stops the individual functioning normally.

Female to Male ratio for seeking help : 2:1.
I.e. they’re twice as likely to seek help.

Four clinical sub types of phobias have been found (Can these be separated???):
Animal
Situational
Natural environment
Injury

Psychological explanations:
Behavioral model;
Classical conditioning
Operant conditioning
Social learning theory.
Cognitive behavioral;
Diathesis stress model:


1. Behavioral model:
· Classical conditioning.
Certain stimuli elicit reflexive, involuntary responses. E.G. Pavlov’s Dogs…
E.G. Watson & Rayner (1920) infants fear of furry objects

Hans Eysenck (1970) attempted to link anxiety disorders such as phobias to personality dimensions, notably neuroticism and introversion (Inward looking, passive and withdrawn from social contact.)

· Operant Conditioning:
‘All behaviour is learned by its consequences’
B.F. Skinner (1981) claimed that all behaviour including inappropriate, phobic responses was learned through experiences that had consequences.

· Social Learning theory:
Albert Bandura’s Social Learning Theory (1963) claims that direct experience of the anxiety producing stimulus such as flying in an aircraft isn’t necessary for the acquisition of phobic response. – We learn much by observing and imitating people.


· Psychodynamic explanations for phobic anxiety disorders:
Freudian. Suggests that (Hypothetical) unconscious ‘urges’ drive us to think and behave in certain ways.
Displacement and suppression (Source of anxiety becomes attached to something else and buried deep in the unconscious mind) reduce and remove the mind from potential harm. Thus the original anxiety is displaced onto something which should not have originally resulted in a fear response.

e.g. The Case of Little Hans = fear of horses – jealous of fathers relationship with mother
and castration anxiety resulting in fear of horses. :S.

John Bowlby emphasized the importance of early emotional attachments in shaping later behaviour and saw that children who are insecurely attached may show agoraphobic symptoms, reflecting their fear of being left alone.

2. Cognitive behavioral explanations for phobic anxiety disorders
Ellis (1962) and Beck (1963) point out that the behavioral model ignores the role of cognition. They see phobias as being the result of an illogical association that we have made in our minds following an unpleasant experience.
Suggest that the catastrophic thoughts and irrational beliefs contribute to the development of a phobia.

Beck states that phobic’s tend to have belief systems whereby they know at a rational level that danger is minimal yet also truly believe that their feared object or situation will cause them physical or psychological harm.

Beck et al (1985) found that danger beliefs are activated when a person is in close proximity to a stimuli yet decrease with distance to zero. People with phobias are more preoccupied with their ‘fear of fear.’

Bieling and Alden (1997) found that people with social phobia scored significantly higher on controls on perfectionism and had lowered perceptions of their social ability.

3. Diathesis stress model explanation of phobias
Refers to the (probably) genetically inherited predisposition that we each have to develop certain illnesses, diseases, or other conditions. In this case the condition is stress or anxiety.

Suggests an interaction between vulnerability factors and triggering events
Holmes & Rahe (1967) explain the cumulative effects of major life events and the work of Kobassa (1979) highlight the effects of everyday minor hassles.

Kleiner & Marshall (1987) found that in a group of agoraphobics 84% had experienced family problems prior to the onset of their first panic attack this was confirmed by a number of other studies.

However, many people who do not experience the most adverse life events do not develop an anxiety disorder.

It is suggested that each individual have their own tolerance thresholds which form their predisposition to stress this being known as our diathesis / vulnerability factor.
This may be genetic or inherited through early experience.
Explanations being psychodynamic, cognitive and behavioral.
We all have fears and anxieties this only develops into a mental disorder when they become so severe that they prevent the individual getting on with life and their life becomes dysfunctional.

Obsessive-Compulsive Disorder
· Range of intensity from fairly minor to pathological affliction.
· One of the most severe of all anxiety disorders
· One of the most difficult to deal with.

· Obsessions dominate ones thinking and are persistent and recurrent thoughts images or beliefs entering the mind uninvited and which cannot be removed.
· Compulsions are the behavioral responses intended to neutralize these obsessions.


DSM-IV defines the diagnostic features of OCD as:
Recurrent obsessions or compulsions that are severe enough to be time consuming (I.e. take more than 1 hr a day) or cause marked distress or significant impairment.
At some point during the course of the disorder the person has recognized that the obsessions or compulsions are excessive or unreasonable. The disturbance is not due to the direct physiological effects of a substance (E.G. alcohol or drug abuse, or medication) or a general medical condition.’



Clinical characteristics:
· Sufferers are generally aware of how behaviors and thoughts are irrational but are powerless to overcome them. Often they attempt to hide them from others.
· Suffer severe anxiety however:
Initial obsessions and compulsions do not relieve initial anxiety
Rather they add to form additional anxieties as a consequence.
· Often suffer from severe depression – an understandable reaction.

· Onset from late teens to early twenties.
· Affects 2% of USA population (American Psychiatric Association.)
· Occurs equally in males and females though females are more likely to have compulsions involving cleaning.

Explanations of OCD:
· Research is in its infancy – evidence for each claim tentative.
· Some evidence that there is a genetic link and that biochemical imbalances may also be involved.
· Some drugs have proved successful treatment.
· Behavioral therapies effective therefore can’t be entirely biological.

Biological explanations of OCD:
Genetics, Biochemistry and Neuroanatomy.

· Genetics:
o Carey & Gottesman (1981) – 10% prevalence in 1st degree relatives.
o Hoeker & Schnurr (1980) – concordance rate of 50-60% in twin studies.
§ N.B. people share same environment and therefore evidence can be disputed.
o Repoport (1989) most people have individual fixed action patterns in their brain that have evolutionary significance for survival. Under stress they are triggered and cease when actions have been completed.
For people with OCD the patterns are triggered by an overly active sense of danger.
· Biochemistry:
o OCD resulting from insufficient or malfunctioning serotonin metabolism.
o Support comes from certain drugs which inhibit the re-uptake of neurotransmitter serotonin – Zohar et al. (1996) found beneficial in up to 60% of patients.
o Lydiard et al (1996) shows partial alleviation of symptoms only, therefore medication only alleviates and is not a cure.
· Neuro-anatomical explanations:
o Rapoport & Wise (1988) have suggested that OCD arises from structural dysfunction in the central nervous system. – probably the basal ganglia.
o Rapoport et al. (1994) have reported that surgery which disconnects the basal -ganglia from the frontal cortex brings relief in severe cases of OCD.

Evaluation: Biological explanations.
Genetics Vs environment debate continues.
Inconsistent findings regarding serotonin:
§ Studies on role of serotonin in OC have yielded inconsistent findings.
Much of the evidence is flawed and studies have not included controls to rule out the possibility that anti-depressant drugs bring relief because they alleviate the symptoms of depression that frequently accompany OCD.
Psychological therapy can be very successful treatment and this is difficult to account for in the serotonin hypothesis.
Possible dysfunction in the basal ganglia.
Aylward et al (1996) found no difference between this and matched control patients.








Psychological explanations of OCD.
1. Psychodynamic;
2. Behavioral;
3. Cognitive-Behavioral.

1. Psychodynamic:
· Freud states that OCD occurs from a fixation at the anal stage of development

Evaluation: Psychodynamic explanation.
· Hard to test the idea of unconscious motivation experimentally.
· Importance of obsessive personality style:
· There is evidence of an obsessive personality style.
· Peterson (1992) States such people do not seem any more likely to be diagnosed with OCD than anyone else.

2. Behavioral:
· An extreme form of learned avoidance behaviour.
· Initial event is linked to anxiety / fear initially fear is alleviated and then becomes a conditioned response.
Evaluation: Behavioral Explanation:
· Flawed argument:
o Behavioral explanation falls down in that the symptoms of OCD e.g. avoidance behaviour, creates anxiety. It’s hard to argue that people learn these responses to reduce fear.
· Effectiveness of behavioral therapies:
Baxter et al. (1992) behavioral therapies not only reduce symptoms of OCD but also bring about changes in biochemical activity.
Marks (1981) Behavioral therapy helps in reducing obsession behaviour but not the obsession thoughts.

3. Cognitive-Behavioral explanations
· Disorder is a consequence of faulty or irrational ways of thinking taken to a extreme.
· Specific or environmental stimuli are paired at some time with anxiety provoking thoughts and compulsive rituals are then used to try and neutralize them.
· Rachman & Hodges (1987) some people are more susceptible to developing obsession thoughts. Vulnerability factors include genetically determined hyper-arousability depressed mood and poor socialization.
Evaluation: Cognitive-Behavioral Explanation.
· Lack of evidence that OCD reduces through increased socialization.
· Emmelkamp et al. (1988) Effectiveness of CBT has shown a reasonably effective result in OCD.
· No long term solution – remains a difficult disorder to understand and treat effectively.



References:

Watson & Rayner (1920) - Infants fear of furry objects
(Classical conditioning.)
Hans Eysenck (1970) - Attempted to link anxiety disorders such as
phobias to personality dimensions, notably neuroticism and introversion
(Inward looking, passive and withdrawn from social contact.)
B.F. Skinner (1981) - Claimed that all behaviour including
inappropriate, phobic responses was learned through experiences that had consequences.
Albert Bandura’s
Social Learning Theory (1963) - Claims that direct experience of the anxiety
producing stimulus such as flying in an aircraft isn’t necessary for the acquisition of phobic response. – We learn much by observing and imitating people.
Ellis (1962) and Beck (1963) - point out that the behavioral model ignores
the role of cognition. They see phobias as being the result of an illogical association that we have made in our minds following an unpleasant experience.
Beck et al (1985) - Found that danger beliefs are activated when
a person is in close proximity to a stimuli yet decrease with distance to zero. People with phobias are more preoccupied with their ‘fear of fear.’
Bieling and Alden (1997) - Found that people with social phobia scored
significantly higher on controls on perfectionism and had lowered perceptions of their social ability.
Holmes & Rahe (1967) - Explain the cumulative effects of major life
events
Kobassa (1979) - Highlights the effects of everyday minor
hassles.
Kleiner & Marshall (1987) - Found that in a group of agoraphobics 84%
had experienced family problems prior to the onset of their first panic attack this was confirmed by a number of other studies.
Carey & Gottesman (1981) – 10% prevalence in 1st degree relatives
as genetic link for OCD
Hoeker & Schnurr (1980) – concordance rate of 50-60% in twin
studies with OCD. N.B. people share same environment and therefore evidence can be disputed.
Repoport (1989) - Most people have individual fixed
action patterns in their brain that have evolutionary significance for survival. Under stress they are triggered and cease when actions have been completed.
For people with OCD the patterns are triggered by an overly active sense of danger.
Zohar et al. (1996) - Support comes from certain drugs which
inhibit the re-uptake of neurotransmitter serotonin have been found beneficial in up to 60% of patients.
Lydiard et al (1996) - Shows partial alleviation of symptoms only,
therefore medication only alleviates and is not a cure.
Rapoport & Wise (1988) - Have suggested that OCD arises from
structural dysfunction in the central nervous system. – probably the basal ganglia.
Rapoport et al. (1994) - Have reported that surgery which
disconnects the basal ganglia from the frontal cortex brings relief in severe cases of OCD.
Aylward et al (1996) - Found no difference between this
and matched control patients.
Rachman & Hodges (1987) - Some people are more susceptible to
developing obsession thoughts. Vulnerability factors include genetically determined hyper-arousability depressed mood and poor socialization.
Peterson (1992) - States such people do not seem any more
likely to be diagnosed with OCD than anyone else.
Baxter et al. (1992) - Behavioral therapies not only reduce
symptoms of OCD but also bring about changes in biochemical activity.
Marks (1981) - Behavioral therapy helps in reducing
obsession behaviour but not the obsession thoughts.
Emmelkamp et al. (1988) - Effectiveness of CBT has shown a
reasonably effective result in OCD.
Concepts to note:

Define these terms:
· Autonomic nervous system
· Diathesis
· Displacement
· obsessive-compulsive disorders (OCD)
· Oedipus complex
· operant conditioning
· panic disorders
· phobic disorders
· repression
· somatic nervous system

What did they do or say?

· Asso and Beech
· Bandura
· Beck
· Brenner
· Ellis
· Eysenck
· Freud
· Holmes and Rahe
· Horowitz
· Kobasa
· Lader and Mathews
· Pavlov

41 comments:

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