comerfund8e

Chapter 4 Introduction

CHAPTER 4

104

TOPIC OVERVIEW

Generalized Anxiety Disorder

The Sociocultural Perspective: Societal and Multicultural Factors

The Psychodynamic Perspective

The Humanistic Perspective

The Cognitive Perspective

The Biological Perspective

Phobias

Specific Phobias

Agoraphobia

What Causes Phobias?

How Are Phobias Treated?

Social Anxiety Disorder

What Causes Social Anxiety Disorder?

Treatments for Social Anxiety Disorder

Panic Disorder

The Biological Perspective

The Cognitive Perspective

Obsessive-Compulsive Disorder

What Are the Features of Obsessions and Compulsions?

The Psychodynamic Perspective

The Behavioral Perspective

The Cognitive Perspective

The Biological Perspective

Obsessive-Compulsive-Related Disorders

Putting It Together: Diathesis-Stress in Action

Anxiety, Obsessive-Compulsive, and Related Disorders

105

Tomas, a 25-year-old Web designer, was afraid that he was “losing his mind.” He had always been a worrier. He worried about his health, his girlfriend, his work, his social life, his future, his finances, and so on. Would his best friend get angry at him? Was his girlfriend tiring of him? Was he investing his money wisely? Were his clients pleased with his work? But, lately, those worries had increased to an unbearable level. He was becoming consumed with the notion that something terrible was about to happen to him. Within an hour’s time, he might have intense concerns about going broke, developing cancer, losing one of his parents, offending his friends, and more. He was certain that disaster awaited him at every turn. No amount of reassurance, from himself or from others, brought relief for very long.

He started therapy with Dr. Adena Morven, a clinical psychologist. Dr. Morven immediately noticed how disturbed Tomas appeared. He looked tense and frightened and could not sit comfortably in his chair; he kept tapping his feet and jumped when he heard traffic noise from outside the office building. He kept sighing throughout the visit, fidgeting and shifting his position, and he appeared breathless while telling Dr. Morven about his difficulties.

Tomas described his frequent inability to concentrate to the therapist. When designing client Web sites, he would lose his train of thought. Less than 5 minutes into a project, he’d forget much of his overall strategy. During conversations, he would begin a sentence and then forget the point he was about to make. TV watching had become impossible. He found it almost impossible to concentrate on anything for more than 5 minutes; his mind kept drifting away from the task at hand.

To say the least, he was worried about all of this. “I’m worried about being so worried,” he told Dr. Morven, almost laughing at his own remark. At this point, Tomas expected the worst whenever he began a conversation, task, plan, or outing. If an event or interaction did in fact start to go awry, he would find himself overwhelmed with uncomfortable feelings—his heart would beat faster, his breathing would increase, and he’d sweat profusely. On some occasions, he thought he was actually having a heart attack—at the ripe old age of 25.

Typically, such physical reactions lasted but a matter of seconds. However, those few seconds felt like an eternity to Tomas. He acknowledged coming back down to earth after those feelings subsided—but, for him, “back down to earth” meant back to worrying and then worrying some more.

Dr. Morven empathized with Tomas about how upsetting this all must be. She asked him why he had decided to come into therapy now—as opposed to last year, last month, or last week. Tomas was able to pinpoint several things. First, all the worrying and anxiety seemed to be on the increase. Second, he was finding it hard to sleep. His nights were filled by tossing and turning—and, of course, more worrying. Third, he suspected that all of his worrying, physical symptoms, and lack of sleep were bad for his health. Wouldn’t they eventually lead to a major medical problem of some kind? And finally, his constant anxiety had begun to interfere with his life. Although his girlfriend and other acquaintances did not seem to realize how much he was suffering, he was growing weary of covering it all up. He found himself turning down social invitations and work opportunities more and more. He had even quit his once-beloved weekly poker game. Not that staying home helped in any real way. He wondered how much longer he could go on this way.

fear The central nervous system’s physiological and emotional response to a serious threat to one’s well-being.

anxiety The central nervous system’s physiological and emotional response to a vague sense of threat or danger.

106

You don’t need to be as troubled as Tomas to experience fear and anxiety. Think about a time when your breathing quickened, your muscles tensed, and your heart pounded with a sudden sense of dread. Was it when your car almost skidded off the road in the rain? When your professor announced a pop quiz? What about when the person you were in love with went out with someone else or your boss suggested that your job performance ought to improve? Any time you face what seems to be a serious threat to your well-being, you may react with the state of immediate alarm known as fear. Sometimes you cannot pinpoint a specific cause for your alarm, but still you feel tense and edgy, as if you expect something unpleasant to happen. The vague sense of being in danger is usually called anxiety, and it has the same features—the same increases in breathing, muscular tension, perspiration, and so forth—as fear.

If fear is so unpleasant, why do many people seek out the feelings of fear brought about by amusement park rides, scary movies, bungee jumping, and the like?

Figure 4.1: figure 4.1 Does anxiety beget anxiety? People with one anxiety disorder usually experience another as well, either simultaneously or at another point in their lives. (Information from: Merikangas & Swanson, 2010; Ruscio et al., 2007; Rodriguez et al., 2004; Hunt & Andrews, 1995.)

Although everyday experiences of fear and anxiety are not pleasant, they often are useful. They prepare us for action—for “fight or flight”—when danger threatens. They may lead us to drive more cautiously in a storm, keep up with our reading assignments, treat our friends more sensitively, and work harder at our jobs. Unfortunately, some people suffer such disabling fear and anxiety that they cannot lead normal lives. Their discomfort is too severe or too frequent, lasts too long, or is triggered too easily. These people are said to have an anxiety disorder or a related kind of disorder.

Anxiety disorders are the most common mental disorders in the United States. In any given year around 18 percent of the adult population suffer from one or another of the anxiety disorders identified by DSM-5, while close to 29 percent of all people develop one of the disorders at some point in their lives (Kessler et al., 2012, 2010, 2009; Daitch, 2011). Only around one-fifth of these individuals seek treatment (Wang et al., 2005).

People with generalized anxiety disorder experience general and persistent feelings of worry and anxiety. People with specific phobias have a persistent and irrational fear of a particular object, activity, or situation. People with agoraphobia fear traveling to public places such as stores or movie theaters. Those with social anxiety disorder are intensely afraid of social or performance situations in which they may become embarrassed. And people with panic disorder have recurrent attacks of terror. Most individuals with one anxiety disorder suffer from a second one as well (Leyfer et al., 2013; Merikangas & Swanson, 2010) (see Figure 4.1). Tomas, for example, has the excessive worry found in generalized anxiety disorder and the repeated attacks of terror that mark panic disorder. In addition, many of those with an anxiety disorder also experience depression (Starr et al., 2014).

Anxiety also plays a major role in a different group of problems, called obsessive-compulsive and related disorders. People with these disorders feel overrun by recurrent thoughts that cause anxiety or by the need to perform certain repetitive actions to reduce anxiety. Because anxiety is so prominent in these disorders, they will be examined in this chapter along with the anxiety disorders.