Chapter 4 - Anxiety, Trauma-Related Disorders and OCD

Figure 05.
01 The Relationships among

Anxiety, Fear, and Panic Attack
Psychopathology: An
Integrative Approach,
9th Edition
Chapter 5: Anxiety, Trauma- and
Stressor-Related, and
Obsessive-Compulsive and
Related Disorders
Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part. 1 or duplicated, or posted to a publicly accessible website, in whole or in part. 2
Figure 05.03 Three Vulnerabilities that Comorbidities of Anxiety and Related

Contribute to Anxiety Disorders Disorders
• High rates of comorbidity
• 55% to 76%
• Commonalities
• Features
• Vulnerabilities
• Links with physical disorders
• Suicide attempt rates
• Similar to major depression
• 20% of people with panic disorder attempt suicide
Generalized Anxiety Disorder (GAD) (1 of 2) Generalized Anxiety Disorder (GAD), (2 of 2)
• Clinical description of generalized anxiety disorder* (terms with an asterisk are key • Statistics
terms)
• 3.1% annual prevalence
• Shift from possible crisis to crisis
• Worry about minor, everyday concerns like job, family, chores, appointments • 5.7% lifetime prevalence
• Accompanied by symptoms such as sleep disturbance and irritability • Similar rates worldwide
• Leads to behaviors like procrastination, overpreparation
• Insidious onset
• GAD in children
• Need only one physical symptom • Early adulthood
• Worry about academic, social, athletic performance • Chronic course
©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 1
Figure 05.04 An Integrative Model of Treatments of GAD
Generalized Anxiety Disorder
• Pharmacological
• Benzodiazepines
• Risks versus benefits
• Antidepressants
• Psychological
• Similar benefits to drugs and better long-term results
• Cognitive-behavioral treatments
• Meditation
Panic Disorder and Agoraphobia (1 of 2) Poll Activity
• Clinical description of panic disorder* and agoraphobia* This survey asks you about how you have felt in the past two weeks. Indicate whether you have been
bothered by each item “not at all,” “several days,” “more than half the days,” or “nearly every day.”
• Unexpected panic attacks
1. Feeling nervous, anxious, or on edge
• Anxiety, worry, or fear of another attack 2. Not being able to stop or control worrying
• Persists for 1 month or more 3. Worrying too much about different things
4. Trouble relaxing
• Agoraphobia 5. Being so restless that it is hard to sit still
• Fear or avoidance of situations/events; can be persistent 6. Being easily annoyed or irritable
7. Feeling afraid as if something awful might happen
• Concern about being unable to escape or get help
Give yourself 0 points for every “not at all,” 1 point for every “several days,” 2 points for every “more than half
• Use and misuse of drugs and alcohol the days,” and 3 points for every “nearly every day.”
• Interoceptive avoidance Source: https://pubmed.ncbi.nlm.nih.gov/16717171/
Panic Disorder and Agoraphobia (2 of 2) Figure 05.05 A Model of the Causes of Panic
Disorder
• Statistics
• 2.7% annual prevalence)
• 4.7% lifetime prevalence
• Female: male = 2:1
• Acute onset, most common in young adulthood (e.g. ages 20-24)
Panic Disorder Treatment Specific Phobias (1 of 2)
• Medications • Clinical description of specific phobia*

• Benzodiazepines or SSRIs • Extreme and irrational fear of a specific object or situation
• High relapse rates after discontinuation of medication • Feared situation almost always provokes anxiety
• Psychological intervention • Significant impairment or distress
• Cognitive behavioral therapy (CBT) • Types of specific phobias:

• Panic control treatment* • Blood–injection–injury phobia*
• Combined psychological and drug treatments • Situational phobia*
• Combined treatment is no better than CBT or drugs alone • Natural environment phobia*
• CBT = better long-term results • Animal phobia*
Specific Phobias (2 of 2) Figure 05.08 A Model of Specific Phobia

Development
• Statistics
• 8.7% annual prevalence; 12.5% lifetime prevalence
• Female : Male = 4:1
• Chronic course
• Onset = Most often childhood
Treatment of Phobias Separation Anxiety Disorder
• Cognitive-behavior therapies • Clinical description of separation anxiety disorder*

• Exposure • Characterized by unrealistic and persistent worry that something will happen
to self or loved ones when apart (e.g., kidnapping, accident) as well as
• Graduated
anxiety about leaving loved ones
• Structured
• 4.1% of children meet criteria, 6.6% of adults
• Relaxation – used to be practiced more, now often not a part of empirically
supported treatment
Social Anxiety Disorder (1 of 2) Social Anxiety Disorder (2 of 2)
• Clinical description of social anxiety disorder* • Statistics

• Extreme/irrational concern about being negatively evaluated by other people • 6.8% annual prevalence; 12.1% lifetime prevalence)
• Sometimes (not always) manifests as shyness • Female : Male = 1:1
• Leads to significant impairment and/or distress • Onset = usually adolescence
• Avoidance of feared situations, or endurance with extreme distress • Peak age of onset = 13
• Subtype • More common in people who are young (18 to 29 years), undereducated,
single, and of low socioeconomic class
• Performance only: Anxiety only in performance situations (e.g., public
speaking) • 13.6% prevalence in ages 18 to 29
• 6.6% prevalence in ages 60+
Figure 05.09 A Model of Social Anxiety Treatment of Social Anxiety Disorder

Disorder Development
• Medications
• Beta blockers, benzodiazepines, SSRIs, D-cycloserine
• Psychological
• Cognitive-behavioral treatment
• Challenging of anxious thoughts about the consequences of social judgment
• Exposure to anxiety-provoking situations
• Rehearsal
• Role-play
• Highly effective
Knowledge Check Activity 1 Knowledge Check 1: Answers
Match the disorders and symptoms. The correct answers are as follows:
DISORDER SYMPTOM DISORDER SYMPTOM
Generalized anxiety disorder Marked fear or anxiety about one or more situations in which the Generalized anxiety disorder Characterized by 6 months of excessive apprehensive expectation
person is exposed to possible scrutiny by others that must be ongoing more days than not
Panic disorder Characterized by 6 months of excessive apprehensive expectation Panic disorder Recurrent episodes of fear occurring at inappropriate times
that must be ongoing more days than not accompanied by concern about additional episodes or by
maladaptive behavior related to the episodes
Agoraphobia Recurrent episodes of fear occurring at inappropriate times
accompanied by concern about additional episodes or by Agoraphobia Marked fear or anxiety about situations like public transportation,
maladaptive behavior related to the episodes open spaces, enclosed places, standing in line or being in a crowd,
and/or being outside the home alone
Social anxiety disorder Marked fear or anxiety about situations like public transportation,
open spaces, enclosed places, standing in line or being in a crowd, Social anxiety disorder Marked fear or anxiety about one or more situations in which the
and/or being outside the home alone person is exposed to possible scrutiny by others
Posttraumatic Stress Disorder (PTSD) (1 Posttraumatic Stress Disorder (PTSD) (2
of 2) of 2)
• Clinical description of posttraumatic stress disorder* • Statistics
• Trauma exposure • 3.5% annual prevalence; 6.8% lifetime prevalence
• Continued re-experiencing
• Most people who experience traumatic events do not develop PTSD
• Avoidance
• Emotional numbing • Type of trauma
• Reckless or self-destructive behavior • Proximity to trauma
• Interpersonal problems
• Refers to problems that persist for more than one month after the trauma
• Acute stress disorder* may be diagnosed in first month after trauma
Figure 05.11 A Model of the Causes of Post Treatment of PTSD

Traumatic Stress Disorder
• Cognitive-behavioral treatment
• Imaginal exposure to memories of traumatic event
• Graduated or massed
• Increase positive coping skills
• Increase social support
• Medications
• SSRIs
Other Diagnoses Related to Stressors Discussion Activity 3
• Prolonged grief disorder*: prolonged adaptation to the loss of a loved one; Consider what you know about the causes and correlates of trauma- and stressor-related
grief may even intensify with time disorders in answering the following:
• Adjustment disorders*: anxious or depressive reactions to life stress that are People sometimes treat stress and trauma as though they were some sort of strange competition.
generally milder than would be seen in acute stress disorder or PTSD but still If one person mentions they are stressed about something, another may chime in with how they
impairing have it worse or how when they had that experience, they just took in in their stride. Similarly,
people coping with a trauma may be reminded that others have it worse or they may themselves
• Attachment disorders*: disturbed and developmentally inappropriate feel they should not be as upset as they are because “others have it worse.”
behaviors in children
• Why are these responses not only not helpful, they are potentially harmful?
• Reactive attachment disorder*: child does not bond to or seek out
caregiver • How can you respond to people who, through a response that may be well-meaning, may
• Disinhibited social engagement disorder*: child shows no inhibitions minimize or dismiss the experiences of others?
around adults
Obsessive-Compulsive Disorder (OCD) Obsessive-Compulsive Disorder (OCD)
(1 of 2) (2 of 2)
• Clinical description of obsessive-compulsive disorder* • Statistics
• Obsessions* • 1% annual prevalence; 1.6% to 2.3% lifetime prevalence
• Intrusive and nonsensical • Female = Male
• Thoughts, images, or urges • Chronic
• Attempts to resist or eliminate • Onset = childhood to 30s
• Compulsions*
• Thoughts or actions
• Provide relief from obsessive thoughts
Figure 05.12 A Model of the Causes of Treatment of OCD

Obsessive-Compulsive Disorder
• Medications
• SSRIs
• High relapse when discontinued
• Psychosurgery (cingulotomy) in intractable cases
• Cognitive-behavioral therapy
• Exposure and ritual prevention (ERP)
• No added benefit from combined treatment with drugs
Disorders Related to OCD Knowledge Check Activity 2
• Body dysmorphic disorder*: preoccupation with some imagined defect in Match the disorders and symptoms.
appearance
DISORDER SYMPTOM
• Hoarding disorder: excessively collecting and keeping items with minimal value, Posttraumatic stress disorder Characterized by unwanted thoughts, images, and /or impulses that the
leading to cluttering and disruption of living space individual tries to completely avoid through the use of rituals like
checking or counting
• Trichotillomania*: the urge to pull out one’s own hair from anywhere on the Body dysmorphic disorder Disturbed and developmentally inappropriate behaviors in children
characterized by a lack of restraint around adults
body
Trichotillomania Characterized by intrusion symptoms, avoidance, negative alterations in
cognition and mood, and/or alterations in arousal and reactivity
• Excoriation*: repetitive and compulsive picking of the skin, leading to tissue Disinhibited social engagement disorder Preoccupation with some imagined defect in appearance
damage Obsessive-compulsive disorder The urge to pull out one’s own hair from anywhere on the body
Knowledge Check Activity 2: Answers Summary
Now that the lesson has ended, you should have learned how to:
The correct answers are as follows:
• 05.01 - Explain how anxiety is related to fear and panic.
DISORDER SYMPTOM • 05.02 - Discuss the biological, psychological, and social contributors that produce anxiety and related
disorders.
Posttraumatic stress disorder Characterized by intrusion symptoms, avoidance, negative alterations in
cognition and mood, and/or alterations in arousal and reactivity
• 05.03 - Explain the different types of anxiety disorders according to their symptoms as listed in the DSM-5.
• 05.04 - Identify the causal similarities in the development of specific phobias and social anxiety disorder.
Body dysmorphic disorder Preoccupation with some imagined defect in appearance
• 05.05 - Describe the factors involved in the development of posttraumatic stress disorder among trauma
Trichotillomania The urge to pull out one’s own hair from anywhere on the body
victims.
Disinhibited social engagement disorder Disturbed and developmentally inappropriate behaviors in children • 05.06 - Compare the different forms of treatment for obsessive compulsive disorder according to their
characterized by a lack of restraint around adults overall effectiveness.
Obsessive-compulsive disorder Characterized by unwanted thoughts, images, and /or impulses that the • 05.07 - Draw connections between obsessive-compulsive disorder and the different types of obsessive-
individual tries to completely avoid through the use of rituals like
compulsive and related disorders according to their symptoms and causes.
checking or counting

Chapter 4 - Anxiety, Trauma-Related Disorders and OCD

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chapter 4 - Anxiety, Trauma-Related Disorders and OCD

Uploaded by

Copyright:

Available Formats

Figure 05.

01 The Relationships among

Figure 05.03 Three Vulnerabilities that Comorbidities of Anxiety and Related

Generalized Anxiety Disorder (GAD) (1 of 2) Generalized Anxiety Disorder (GAD), (2 of 2)

Panic Disorder and Agoraphobia (1 of 2) Poll Activity

• Medications • Clinical description of specific phobia*

• Psychological intervention • Significant impairment or distress

• Cognitive behavioral therapy (CBT) • Types of specific phobias:

• Combined psychological and drug treatments • Situational phobia*

• CBT = better long-term results • Animal phobia*

Specific Phobias (2 of 2) Figure 05.08 A Model of Specific Phobia

Treatment of Phobias Separation Anxiety Disorder

• Cognitive-behavior therapies • Clinical description of separation anxiety disorder*

• Clinical description of social anxiety disorder* • Statistics

Figure 05.09 A Model of Social Anxiety Treatment of Social Anxiety Disorder

Knowledge Check Activity 1 Knowledge Check 1: Answers

Figure 05.11 A Model of the Causes of Post Treatment of PTSD

Other Diagnoses Related to Stressors Discussion Activity 3

Figure 05.12 A Model of the Causes of Treatment of OCD

Disorders Related to OCD Knowledge Check Activity 2

You might also like