Generalized Anxiety Disorders and

Phobias
Chapter 4/5
What are some things that
causes you to feel
anxious?
Generalized Anxiety Disorder
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
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
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.
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
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
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
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
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
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
PHOBIAS
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?

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
 A severe and persistent fear of social or
performance situations in which embarrassment

DSM 5 may occur

Criteria/Checklist:
1. Marked and persistent fear of social or
performance situations involving exposure

Social Phobia
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
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.
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
● 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
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
How are Phobias Treated?
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
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
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.
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