Abnormal Psychology includes the study of Generalized Anxiety Disorder and Phobias. This presentation provides an introduction to GAD and outlines the diagnostic criteria from the DSM5.

1. Generalized Anxiety Disorders and
Phobias
Chapter 4/5

2. Bob Donaldson was a 22-year-old carpenter referred to the psychiatric
outpatient department of a community hospital. . . . During the initial
interview Bob was visibly distressed. He appeared tense, worried, and
frightened. He sat on the edge of his chair, tapping his foot and fidgeting
with a pencil on the psychiatrist’s desk. He sighed frequently, took deep
breaths between sentences, and periodically exhaled audibly and changed
his position as he attempted to relate his story: ...
Bob went on to say that he had stopped playing softball because of
fatigability and trouble concentrating. On several occasions during the
past two weeks he was unable to go to work because he was “too nervous.”

3. ● Think about a time when your breathing quickened, your muscles
tensed and your heart pounded with a sudden sense of dread
● Any time face what seems to be a serious threat to your well-being,
you may react with the state of immediate alarm known as fear.
● The vague sense of being in danger is usually termed anxiety
● These prepare us for action- for “fight or flight”- when danger
threatens
● Unfortunately, some people suffer such disabling fear and anxiety
that they cannot lead normal lives.

4. What are some things that
causes you to feel anxious?

5. The Differences...
People with generalized anxiety
disorder experience general and
persistent feelings of anxiety
People with phobias experience
a persistent and irrational fear of
a specific object, activity, or
situation
Individuals with panic disorder
have recurrent attacks of terror
Those with obsessive-compulsive
disorder feel overrun by recurrent
thoughts that cause anxiety or by
the need to perform repetitive
actions to reduce anxiety
Those with acute stress disorder
and posttraumatic stress disorder
are tormented by fear and related
symptoms well after a traumatic
event (military combat, rape,
torture) has ended

6. Generalized Anxiety Disorder

8. What is it?
● People with generalized anxiety disorder experience excessive anxiety
under most circumstances and worry about practically anything AKA
free-floating anxiety
● Symptoms include: restless, on edge, tire easily, difficulties concentrating,
muscle tension, sleep problems and usually last at least 6 months
● They’ve been accused of “wanting” to worry, “looking” for things to worry
about, and being “happy” only when worrying
● But, we know that is not the case
● Dsm 5 checklist on textbook

10. The Sociocultural Perspective
- According to sociocultural theorists, generalized anxiety disorder is most likely to
develop in people who are faced with societal conditions that are truly dangerous.
- Take for example cataclysmic events or 9/11
- One of the most powerful forms of societal stress is poverty. People without
financial means are likely to live in run-down communities with high crime rates,
have fewer educational and job opportunities, and run a greater risk for health
problems
- Even if sociocultural factors play a broad role, theorists still must explain why
some people develop the disorder and others do not

11. The Psychodynamic Perspective
- Sigmund Freud believed that all children experience some degree of
anxiety as part of growing up. They feel: realistic anxiety when they
face actual danger; neurotic anxiety when they are repeatedly
prevented, by parents or by circumstances, from expressing their id
impulses, and moral anxiety when they are punished or threatened for
expressing their id impulses
- We all use ego defense mechanisms to help control these forms of
anxiety; in some people, however, the anxiety is so strong and the
defense mechanisms are so inadequate that generalized anxiety
disorder develops.

12. When childhood anxiety goes unreported
● Say that a boy is spanked every time he cries for milk as an infant, messes
his pants as a 2-year-old, and explores his genitals as a toddler. He may
eventually come to believe that his various id impulses are very
dangerous, and he may experience overwhelming anxiety whenever he
has such impulses. Or perhaps the ego defense mechanisms are too weak
to cope with the resulting anxiety
● Overprotected children, shielded by their parents from all frustrations and
threats, have little opportunity to develop effective defense mechanisms.
When they face the pressures of adult life, their defense mechanisms may
be too weak to cope with the resulting anxieties

13. Psychodynamic Therapies
● Free association and the therapist’s interpretations of transference,
resistance, and dreams
● Freudian psychodynamic therapists use these methods to help clients
with generalized anxiety disorder become less afraid of their id impulses
and more able to control them successfully
● Object relations therapists, use them to help anxious patients identify and
settle the childhood relationship problems that continue to produce
anxiety in adulthood

14. Techniques defined
● Free association a therapist asks a person in therapy to freely share thoughts,
words, and anything else that comes to mind. The thoughts need not be
coherent
● Transference occurs when a person redirects some of their feelings or desires
for another person to an entirely different person For example, transference in
therapy happens when a patient attaches anger, hostility, love, adoration, or a
host of other possible feelings onto their therapist or doctor
● Resistance is a way of pushing back against suggestions, even those that could
help you solve mental or emotional health concerns

15. The Humanistic/Existential Perspectives
● Humanistic theorists propose that generalized anxiety disorder arises when
people stop looking at themselves honestly and acceptingly. Repeated denials of
their true thoughts, emotions, and behavior make these people extremely anxious
and unable to fulfill their potential as human beings
● Rogers believed that children who fail to receive unconditional positive regard
from others may become overly critical of themselves and develop harsh
self-standards, what Rogers called conditions of worth.
● Client-Centered Therapy- The humanistic therapy developed by Carl Rogers in
which clinicians try to help clients by being accepting, empathizing accurately,
and conveying genuineness.
● Client’s anxiety and other symptoms will subside when they eventually
“experience” themselves

16. Rogers explanation of a successful session
She was unusually sensitive to the process she was experiencing in herself. To use some of her
expressions, she was feeling pieces of a jigsaw puzzle, she was singing a song without words, she
was creating a poem, she was learning a new way of experiencing herself which was like learning
to read Braille. Therapy was an experiencing of herself, in all its aspects, in a safe relationship. At
first it wa her guilt and her concern over being responsible for the maladjustments of others. Then
it was her hatred and bitterness toward life for having cheated and frustrated her in so many
different areas, particularly the sexual, and then it was the experiencing of her own hurt, of the
sorrow she felt for herself for having been so wounded. But along with these went the
experiencing of self as having a capacity for wholeness, a self which was not possessively loving
toward others but was “without hate,” a self that cared about others. This last followed what was,
for her, one of the deepest experiences in therapy . . . the realization that the therapist cared, that
it really mattered to him how therapy turned out for her, that he really valued her.

17. Avoiding Choice and Responsibility
● Existential Anxiety- a universal human fear of the limits and
responsibilities of one’s existence
● We fear the death that awaits us
● Our actions and choices may hurt others
● Our personal existence may ultimately lack meaning
● Existential therapists use a variety of techniques to help anxious people
take more responsibility and live more meaningful: support or confront
them

18. Other Explanations
1. Cognitive Theory- theorists believe that GAD is caused by
maladaptive assumptions that lead persons to view most
life situations as dangerous
a. Teach how to cope with situation
2. Biological Theory- theorist argue that GAD results from
low activity of the neurotransmitter GABA
a. Anxiety drugs particularly benzodiazepines

19. PHOBIAS

20. DEFINED
● Phobia is a persistent and unreasonable fear of a particular object, activity, or
situation
● People with a phobia become fearful if they even think about the object or
situation they dread, but they usually remain comfortable as long as they
avoid the object or thoughts about it.
● Agoraphobia- a severe or persistent fear of venturing into public places,
especially when one is alone
● How do common fears differ from phobias?

21. DSM 5 Criteria/Checklist: Specific Phobia
A severe and persistent fear of a specific object or situation (other than agoraphobia
and social phobia)
1. Marked and persistent fear of a specific object or situation that is excessive or
unreasonable, lasting at least six months.
2. Immediate anxiety usually produced by exposure to the object.
3. Recognition that the fear is excessive or unreasonable
4. Avoidance of the feared situation
5. Significant distress or impairment
Common examples include specific fears of animals/insects, heights, enclosed
spaces, thunders, and blood

22. DSM 5 Criteria/Checklist: Social Phobia
A severe and persistent fear of social or performance situations in which
embarrassment may occur
1. Marked and persistent fear of social or performance situations involving exposure
to unfamiliar people or possible scrutiny by others, lasting at least six months.
Concern about humiliating or embarrassing oneself.
2. Anxiety usually produced by exposure to the social situation
3. Recognition that the fear is excessive or unreasonable.
4. Avoidance of feared situations
5. Significant distress or impairment

23. What Causes Phobias?
Each of the models offers explanations for phobias. Today evidence
tends to support the behavioral explanations. Behaviorists believe
that people with phobias first learn to fear certain objects,
situations, or events through conditioning. Once the fears are
acquired, the individuals avoid the dreaded object or situation,
permitting the fears to become all the more entrenched.

24. How are fears learned?
● Classical Conditioning- a process of learning in which two events that
repeatedly occur close together in time become tied together in a person’s
mind and so produce the same response
● In the 1920s a clinician described the case of a young woman who
apparently acquired a phobia of running water through classical
conditioning
● Entrapment (unconditioned stimulus) → Fear response (unconditioned
response): As she struggled to free her feet, the girl heard a waterfall nearby
● Running water (conditioned stimulus) → Fear response (conditioned
response): From that day forward, the girl was terrified of running water

25. ● Modeling- a process of learning in which a person observes and then imitates
others
● Consider a young boy whose mother is afraid of illnesses, doctors, and hospitals. If
she frequently expresses those fears, before long the boy himself may fear
illnesses, doctors, and hospitals.
● Why should one upsetting experience develop into a long-term phobia?
● Behaviorists believe that after acquiring a fear response, people try to avoid what
they fear.
● Stimulus Generalization- a phenomenon in which responses to one stimulus are
also produced by similar situation eg the fear of running water acquired by the girl
in the rocks could have generalized to such similar stimuli as milk being poured
into a glass or even the sound of bubbly music

26. A Behavioral-Biological Explanation
● Phobic reactions to animals, heights, and darkness are more common than phobic
reactions to meat, grass, and houses. Theorists often account for these differences by
proposing that human beings, as a species, have a predisposition to develop certain fears-
preparedness: human beings are “prepared” to acquire some phobias
A four-year-old girl was playing in the park. Thinking that she saw a snake, she ran to her
parents’ car and jumped inside, slamming the door behind her. Unfortunately, the girl’s hand
was caught by the closing car door, the results of which were severe pain and several visits to
the doctor. Before this, she may have been afraid of snakes, but not phobic. After this
experience, a phobia developed, not of cars or car doors, but of snakes. The snake phobia
persisted into adulthood, at which time she sought treatment from me
● Arne Ohman and Colleagues research pg 119

27. How are Phobias Treated?

28. Treatments for Specific Phobias
The major behavioral approaches to treating them are desensitization, flooding,
and modeling. Together, these approaches are called exposure treatments, because
in all of them individuals are exposed to the objects or situations they dread
1. Systematic Desensitization- A behavioral treatment that uses relaxation
training and a fear hierarchy to help clients with phobias react calmly to the
objects or situations they dread.
a. Fear Hierarchy- A list of objects or situations that frighten a person, starting with those that
are slightly feared and ending with those that are feared greatly
b. In Vivo Desensitization- eg someone who fears heights may stand on a chair or climb a
stepladder
c. Overt Desensitization- the person imagines the frightening event while the therapist
describes it

29. 2. Flooding- A treatment for phobias in which clients are exposed repeatedly and
intensively to a feared object and made to see that it is actually harmless
a. Can either be in vivo or overt
3. Modeling- the therapist confronts the feared object or situation while the
fearful person observes
a. The behavioral therapist acts as a model, to demonstrate that the person’s
fear is groundless

30. Treatments for Social Phobias
● Clinicians have only recently begun to have much success in treating social
phobias. This progress is due in part to the growing recognition that social
phobias have two distinct features that may feed upon each other: (1) people
with the phobias may have overwhelming social fears, and (2) they may lack
skill at initiating conversations, communicating their needs, or meeting the
needs of others.
● Armed with this insight, clinicians now treat social phobias by trying to
reduce social fears or by providing training in social skills, or both.