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CHAPTER 6: Panic, Anxiety, and Their Disorders
Teaching Objectives
1. Compare and evaluate the merits of Freud’s use of the concept of anxiety in the etiology of the neuroses
versus the descriptive approach used in DSM since 1980.
2. Distinguish between fear and anxiety.
3. Describe the major features of phobias, identify and differentiate the different subtypes of phobia, explicate
the major etiological hypotheses, and discuss the most effective treatment approaches.
4. List the diagnostic criteria for panic disorder, contrast panic attacks and other types of anxiety, and explain
the association with agoraphobia. Summarize prevalence, age of onset, and comorbidity.
5. Describe recent findings on the biological, behavioral, and cognitive influences for anxiety proneness.
6. Summarize the evidence that anxiety sensitivity constitutes a diathesis for the development of panic attacks.
7. Describe how safety behaviors and cognitive biases help to maintain panic.
8. Compare and contrast the major treatment approaches for panic disorder and agoraphobia.
9. Summarize the central features of generalized anxiety disorder, and distinguish among psychoanalytic,
conditioning, and cognitive theories of etiology.
10. Identify the central nervous system processes and structures associated with generalized anxiety disorder,
and evaluate treatments for the disorder.
11. Describe the defining features of obsessive-compulsive disorder, summarize theories of etiology along with
supporting evidence (or the lack thereof), and outline the treatment of OCD.
12. Provide several examples of sociocultural effects on anxiety disorders.
Chapter Overview/Summary
Although anxiety disorders were initially considered neuroses, this term has been largely abandoned ever since
DSM-III (1980). The anxiety disorders have panic or anxiety or both at their core. Today anxiety impacts 25%–29%
of Americans. Anxiety is defined as an anticipation for possible future danger and fear is in response to immediate
danger. Panic is a basic emotion that involves activation of the fight-or-flight response of the autonomic nervous
system. Anxiety is more diffuse, including blends of high levels of negative affect, worry about possible threat or
danger, and a sense that threats are unpredictable or uncontrollable. Although everyone has identifiable, rational,
realistic sources of anxiety, people with anxiety disorders, by definition, have irrational sources of, and unrealistic
levels of, anxiety. Mood-congruent information processing, such as attentional and interpretive biases, seem to
maintain all anxiety disorders.
Specific phobias are intense and irrational fears of specific objects or situations accompanied by avoidance
of the feared object. Stimuli may acquire phobic properties through conditioning or other learning mechanisms or
through activation of constitutional predispositions. Because stimuli such as heights and menacing animals that
posed a threat to our early ancestors are better able to become the target of phobias, it is thought that we are
biologically “prepared” to associate them with trauma. Phobia subtypes include: (1) animals—the fear of snakes,
spiders, dogs, insects, and birds; (2) natural environment—fear of storms, heights, and water; (3) blood-injection-
injury—fear of seeing blood or an injury, receiving an injection, or seeing a person in a wheelchair; (4) situational—
fear of public transportation, tunnels, bridges, elevators, flying, driving, and enclosed spaces; and (5) other—phobias
associated with choking, vomiting, or “space phobias.”
Social phobia, also known as social anxiety disorder, involves disabling fears, or even panic attacks, in one
or more social situations, usually out of fear of negative evaluation by others or fear of acting in an embarrassing or
humiliating manner. Social stimuli signaling dominance and aggression from other humans, including facial
expressions of anger or contempt, appear “prepared” in the evolutionary sense to elicit phobic responses. The
preoccupation with negative self-evaluative thoughts characteristic of social phobia tends to interfere with the ability
to interact in socially skillful ways. Panic disorder involves unexpected panic attacks that often create a sense of
stark terror, which usually subsides in a matter of minutes. The fear of future panic attacks is known as “anxious
apprehension.” Many people with panic disorder also develop agoraphobic avoidance of situations in which they
Copyright © 2013 Pearson Education, Inc. All rights reserved.

111
fear they might have an attack and would find it difficult to escape or would be especially embarrassing. According
to the conditioning theory of panic disorder, interoceptive bodily symptoms associated with early stages of prior
attacks come themselves to be able to elicit panic attacks. According to the cognitive theory of panic disorder, it is
the catastrophic misinterpretation of these bodily cues that produces panic attacks, especially among those with high
levels of preexisting anxiety sensitivity. Biological theories of panic disorder emphasize biochemical abnormalities
in the brain as well as abnormal activity of the neurotransmitter norepinephrine and probably also serotonin. The
area of the brain known as the amygdala is thought to be an especially important source of panic attacks.
Another anxiety disorder is panic disorder, which involves recurrent and unexpected attacks wherein the
individual worries about having more attacks. The average panic attack lasts around ten minutes. A panic attack
usually includes feelings of heart racing, sweating, shaking, shortness of breath, and so on as just some examples.
About 85% of people who experience a panic attack think it is a heart attack and may show up at the emergency
room. Agoraphobia is the fear of public places such as crowded spaces, shopping malls, and movie theaters. Panic
disorder with agoraphobia means that someone has recurrent panic attacks and presence of agoraphobia.
Agoraphobia without a history of panic disorder has the presence of agoraphobia but the person has not met the
diagnostic criterion for panic disorder. Panic disorder without agoraphobia is when one has recurrent panic attacks,
worry about having more attacks, and the absence of agoraphobia.
Generalized anxiety disorder (GAD) involves chronic and excessive worry about a number of events or
activities and high levels of psychic and muscle tension. People with GAD may have extensive experience with
unpredictable and/or uncontrollable life events as well as having schemas through which strange and dangerous
situations promote automatic thoughts focused on possible threats. The neurobiological bases of GAD differ from
those related to panic disorder, involving the neurotransmitter GABA and the limbic system of the brain.
Obsessive-compulsive disorder (OCD) involves unwanted and intrusive distressing thoughts or images
usually accompanied by compulsive behaviors designed to neutralize those thoughts or images. Checking and
cleaning rituals are most common. Genetic, brain function imaging, and psychopharmacological studies all suggest
significant biological contributions to OCD. The anxiety-reducing qualities of the compulsive rituals may help
maintain OCD.
Medical treatments of people with anxiety disorders often include anti-anxiety and anti-depressant
medications. These medications suppress anxiety symptoms, have high addiction potential, and tend to be associated
with high relapse rates once the medications are discontinued. Behavioral and cognitive therapies are effective for
anxiety disorders. Behavior therapies involve prolonged exposure to feared situations to allow fear or anxiety to
habituate. With OCD, the rituals also must be prevented following exposure to the feared situations. Cognitive
therapies focus on getting clients to understand their underlying automatic thoughts, which often involve cognitive
distortions such as unrealistic predictions of catastrophes that in reality are very unlikely to occur, and to change
these thoughts and beliefs through cognitive restructuring.
Detailed Lecture Outline
I. The Fear and Anxiety Response Patterns
A. Fear and Panic Activate the “Fight or Flight” Response

1. Cognitive/subjective components.
2. Physiological components in the absence of any external danger.
3. Behavioral components.
4. Anxiety—involves feeling of apprehension about possible future danger.
5. Fear—a response to immediate danger.
6. Panic Attack—a response that occurs. When the fear response occurs in the absence of
any obvious external danger
Lecture Launcher 6.1: Thrills or Chills?
B. Anxiety Is a Complex Blend of Unpleasant Emotions and Cognitions that Is Both More Oriented

112
to the Future and Much More Diffuse than Fear
1. Adaptive value.
2. Has cognitive/subjective, physiological, and behavioral components.
C. Unconditional versus Learned Sources of Fear and Anxiety
1. Conditionability of fear.
2. External versus internal (interoceptive) cues.
II. Overview of the Anxiety Disorders
A. Unrealistic and Irrational Fears of Disabling Intensity

B. DSM-IV-TR Recognizes Seven Anxiety Disorders
1. Specific phobia
2. Social phobia or social anxiety disorder.
3. Panic disorder with or without agoraphobia and agoraphobia without panic.
4. Generalized anxiety disorder.
5. Obsessive-compulsive disorder.
6. Acute stress disorder .
7. Post traumatic stress disorder.
C. Anxiety Disorders are Relatively Common
1. Most common group of disorders among women.
2. Comorbidity is typical.
3. Phobias are the most common of the anxiety disorders.
4. Commonalities in causes across these disorders:
a. Common genetic vulnerability is the personality trait of neuroticism.
b. Brain structures most commonly involved are generally in the limbic system.
c. Most common neurotransmitters involved are GABA, norepinephrine, and
serotonin.
d. Classical conditioning is common.
e. People with perceptions of lack of control over their environment and their
emotions are more vulnerable.
5. Commonalities across effective treatments:
a. Graduated exposure is the single most effective treatment.
b. Cognitive restructuring.
c. Benzodiazepines and anti-depressants.
MyPsychLab Resource 6.1: Video on “Overcoming Fears and Anxieties”
III. Specific Phobias (See Table 6.1 for a brief overview)—a person is diagnosed with a specific phobia when
she or he shows a persistent fear that is excessive and unreasonable
A. Blood-Injection-Injury Phobia
1. Occurs in about 3%–4% of the population.
2. Disgust is as typical a response as fear.
3. Initial heart acceleration followed by a drop in rate and pressure.
4. Nausea, dizziness, and fainting.
B. Prevalence, Age of Onset, and Gender Differences
1. Common in women.
2. Animal phobias—about 90%–95% are women.
3. Lifetime prevalence rate is about 12%.
4. Animal, dental, and blood-injection-injury phobias begin in childhood.
5. Agoraphobia and claustrophobia begin in adolescence and early adulthood.
C. Psychological Causal Factors
1. Psychoanalytic viewpoint:
a. View of phobia as defense against anxiety via repression of id impulses; anxiety
is then displaced onto some external object or the situation is symbolically

113
linked to the real object of the anxiety.
2. Phobias as learned behavior:
a. Classical conditioning and generalization.
b. Direct traumatic conditioning.
c. Vicarious conditioning of phobic fears.
d. Prepared learning—when primates and humans acquire fears of certain objects
or situations that posed real threats.
Lecture Launcher 6.2: The Transmission of Fear Responses
e. Sources of individual differences in the learning of phobias:

(1) History of previous positive experiences reduces the likelihood of a
phobia developing.
(2) Events during conditioning such as inescapable and uncontrollable
events.
(3) Experiences after a conditioning event such as the inflation effect.
(4) Cognitive factors maintaining phobias.
f. Evolutionary preparedness for the development of fears and phobias.
D. Biological Causal Factors
1. Affect the speed and strength of conditioning of fear.
2. Behavioral inhibition and fear—high levels in early development correlate with
developing multiple specific phobias by 7–8 years of age.
3. Twin studies indicate modest heritability—but nonshared factors play a larger role.
E. Treatments
1. Exposure therapy—involves controlled exposure to the stimuli or situations that elicit
phobic fear.
2. Participant modeling.
3. Virtual reality environments.
4. Cognitive and pharmacological treatments are ineffective.
5. Some evidence that anti-anxiety medications may interfere with the positive effects of
exposure therapy.
Activity 6.1: Systematic Desensitization Exercise
Activity 6.2: Roller Coasters
IV. Social Phobias or Social Anxiety Disorder
MyPsychLab Resource 6.2: Video “Steve Social Phobia”
A. Prevalence, Age of Onset, and Gender Differences

1. Approximately 12% of the population qualifies for a social phobia. More than half of
these suffer from one or more additional anxiety disorder during their lives.
2. 60% of individuals are female.
3. Starts in early or middle adolescence—early adulthood.
4. The disorder results in lower employment rates and lower SES.
B. Psychological Causal Factors
1. Social phobias as learned behavior
a. Direct or vicarious conditioning, such as experiencing or witnessing a perceived
social defeat or humiliation, or being or witnessing someone else being the
target of anger or criticism.
b. 92% of an adult sample of those with social phobia recalled severe teasing as a
child.
c. Those with social phobia are also more likely to have grown up with parents
who were socially isolated and avoidant.

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2. Social fears and phobias in an evolutionary context
a. Proposes that social phobias are a by-product of dominance hierarchies.
b. Evolutionarily based predisposition.
3. Perceptions of uncontrollability and unpredictability
a. Lead to submissive and unassertive behavior.
b. Likelihood increases if person has experienced an actual social defeat.
c. Diminished sense of personal control that may, in part, have developed from
overprotective parents.
4. Cognitive biases
a. Danger schemas concerning others.
b. Expect they will behave in an awkward and unacceptable way resulting in
rejection.
c. Preoccupied with bodily responses and negative self-images in social situations.
d. A negative attribution bias may also come into play here.
Teaching Tip 6.1: Incorporating Social Psychology
C. Biological Causal Factors

1. Genetic and temperamental factors
a. Modest genetic contribution—about 30% due to genes.
b. Behavioral inhibition—those high on behavioral inhibition between 2–6 years of
age are three times more likely (22%) to be diagnosed with a social phobia even
in middle childhood.
D. Treatments
1. Cognitive and behavioral therapies
a. Exposure.
b. Challenge of negative, automatic thoughts.
c. Cognitive restructuring—review the faulty beliefs.
2. Medications
a. Antidepressants may also be effective.
b. Monoamine oxidase inhibitors (MAOIs).
c. Selective Serotonin Reuptake Inhibitors (SSRIs).
b. One study found that cognitive behavioral therapy was more effective than
medication and had better long-term results.
Handout 6.1: Commonalities among Social Phobias
V. Panic Disorder with and without Agoraphobia

A. Panic Disorder—defined as the occurrence of panic attacks
Lecture Launcher 6.3: “False Alarms”
1. As many as 85% seek help from an emergency room or doctor’s office.

2. Case of Mindy Markowitz.
MyPsychLab Resource 6.3: Video on “Panic Disorder”
MyPsychLab Resource 6.4: Video “Panic Disorder: Jerry”
B. Agoraphobia
1. Conceptualized as a complication of repeated panic attacks in varied situations.
2. Case of John D.
3. Most commonly avoided situation is crowded places and streets (see Table 6.2)
MyPsychLab Resource 6.5: Video on “Phobias”

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C. Agoraphobia without Panic
1. Usually a gradually spreading fearfulness.
2. Extremely rare in clinical settings.
D. Prevalence, Age of Onset, and Gender Differences
1. Prevalence increasing with younger generations.
2. Onset most common between 15–24 years.
3. Twice as common in females, probably for sociocultural reasons (see Table 6.3 for chart
of gender differences in anxiety disorders).
E. Comorbidity with Other Disorders
1. High comorbidity with other anxiety disorders.
2. 30%–50% will experience serious depression.
3. 83% of people with panic disorder also have at least one comorbid disorder.
F. Timing of a First Panic Attack
1. Frequently follows feelings of distress or a highly stressful life situation.
2. Panic attacks more common (23% of population) than panic disorder.
G. Biological Causal Factors
1. Genetic factors
a. Only moderate heritability.
b. Liability is probably for panic disorder and phobias.
2. Panic and the brain
a. Amygdala—a collection of nuclei in front of the hippocampus in the limbic
system of the brain, which is key in the interpretation of fear.
b. Abnormally sensitive fear network.
c. Hippocampus implicated in conditioned anxiety.
d. Higher cortical centers mediate cognitive symptoms.
3. Biochemical abnormalities
a. Biological challenge procedures suggest that no single neurobiological
mechanism is implicated.
b. Noradrenergic and serotonergic systems are implicated.
c. GABA recently shown to be implicated in anticipatory anxiety.
d. Panic provocation procedures—something that produces panic attacks in
panic disorder.
H. Psychological Causal Factors
1. Comprehensive learning theory of panic disorder
a. “Fear of fear” hypothesis and process of interoceptive and extereoceptive
conditioning.
b. Anxiety conditioned to internal and external cues.
c. Panic attacks themselves are likely conditioned to certain internal cues.
d. Constitutional and experiential vulnerabilities.
Teaching Tip 6.2: Fear of Fear
2. The cognitive theory of panic (see Figure 6.2)

a. Catastrophic interpretations of bodily sensations.
b. Automatic thoughts become the triggers of panic.
c. Evidence that cognitive therapy for panic works supports the prediction that
changing cognitions about bodily symptoms may reduce or prevent panic.
3. Learning and cognitive explanations of results from panic provocation studies
a. Catastrophic cognitions are not needed in conditioning theory.
b. Cues can be unconscious.
c. Learning theory is better than cognitive model at explaining nocturnal panic
attacks and panic attacks that occur without any preceding negative
(catastrophic) automatic thoughts.
4. Anxiety sensitivity and perceived control

116
a. Anxiety sensitivity is a trait—like belief that certain bodily sensations may have
harmful consequences.
b. Anxiety sensitivity predicted the development of spontaneous panic attacks
during a highly stressful period.
c. Psychological manipulations, such as having a sense of perceived control or
having a “safe” person, may block panic.
5. Safety behaviors and the persistence of panic
a. Disconfirmation does not occur because people with panic disorder engage in
“safety behaviors” such as breathing slowly.
b. Safety behaviors believed to prevent catastrophe.
c. Safety behaviors need to stop for effective treatment.
6. Cognitive biases and the maintenance of panic
a. People with panic disorder interpret ambiguous bodily sensations and situations
as threatening.
b. Attentional bias toward threat cues.
c. Memory bias favoring threatening information.
I. Treatments
1. Medications
a. Benzodiazepines/anxiolytics, e.g., xanax or klonopin
(1) Rapid effects.
(2) Addictive.
(3) Withdrawal must be gradual.
(4) Rebound panic and relapse.
(5) Interfere with cognitive therapy.
b. Antidepressants (primarily the tricyclics and the SSRIs)
(1) Non-addictive.
(2) Slow effects—may take up to 4 weeks.
(3) Side-effect problems—SSRIs better tolerated.
(4) High relapse rates.
2. Behavioral and cognitive-behavioral treatments
a. Prolonged exposure is effective in 60%–75% of patients.
b. Interoceptive exposure.
c. Integrative cognitive-behavioral techniques.
d. Combined medication and cognitive-behavior therapy seems to always lead to
greater relapse.
Lecture Launcher 6.4: Overcoming Phobias
VI. Generalized Anxiety Disorder

A. General Characteristics
1. Future-oriented mood state of chronic worry and “anxious apprehension.”
2. Restless, easily fatigued, poor concentration, irritable, tense, indecisive.
3. Worry experienced as uncontrollable.
4. The “basic” anxiety disorder.
5. Subtle avoidance such as procrastination and checking.
6. High vigilance, muscle tension, and sleep disturbance.
7. A graduate student with GAD.
1. Relatively common.
2. Twice as common in women.
3. Most continue to function despite symptoms.
4. Age of onset difficult to determine with as many as 60%–80% report being anxious all
their lives.
C. Comorbidity with Other Disorders
1. Seen with other Axis I disorders, especially other anxiety and mood disorders.

117
2. Excessive use of tranquilizing drugs, sleeping pills, and alcohol complicates the clinical
picture.
D. Psychological Causal Factors
1. The psychoanalytic viewpoint
a. Unconscious conflict between id and ego.
b. Defenses broken down or never developed.
c. No object to displace upon.
d. Theory is not testable and has basically been abandoned.
2. Perceptions of uncontrollability and unpredictability
a. Cognitive processes associated with prior aversive events.
b. Unpredictability of important past events generalizes to future ones
c. Lack of safety signals.
3. A sense of mastery: The possibility of immunizing against anxiety
a. “Master” and “yoked” infant monkeys, rhesus monkeys.
b. “Masters” coped better with stress when older.
c. Suggests that early experiences with control and mastery can immunize the
individual against the harmful effects of stressful situations.
4. The central role of worry and its positive functions
a. Five benefits of worry identified by people with GAD: superstitious avoidance
of catastrophe, actual avoidance of catastrophe, avoidance of deeper emotional
topics, coping and preparation, motivating device.
b. Suppression of emotional and aversive physiological responding may serve to
reinforce the process of worry.
c. Worry impairs the processing of the event, thereby preventing fear from being
extinguished.
5. The negative consequences of worry
a. Worrying is itself not pleasant.
b. Attempts to control thoughts and images actually increase them.
6. Cognitive biases for threatening information

a. Attention is drawn toward threat cues.
b. Interpret ambiguous stimuli as threats.
Activity 6.3: Cognitive Restructuring
E. Biological Causal Factors

1. Genetic factors
a. Small to modest heritability.
b. Inherited predisposition is to neuroticism (proneness to experience negative
mood states); shared with major depression.
2. Neurotransmitters and neurohormonal abnormalities
a. A functional deficiency of GABA.
b. The corticotrophin-releasing hormone system and anxiety.
3. Neurobiological differences between anxiety and panic
a. Biology of panic and GAD are not the same.
b. Amygdala and fight-or-flight for fear and panic, limbic system for GAD.
F. Treatments
1. Medications
a. Benzodiazepines not as effective as believed by public.
b. Busipirone is a new, non-addictive, non-sedating, but slow drug.
c. Antidepressants are useful.
2. Cognitive behavioral treatment
a. Therapy involves applied muscle relaxation and cognitive restructuring, is quite
effective.

118
Handout 6.2: Progressive Muscle Relaxation
VII. Obsessive-Compulsive Disorder
MyPsychLab Resource 6.6: Video “Dave: Obsessive Compulsive Disorder”
MyPsychLab Resource 6.7: Video “Margo: Obsessive Compulsive Disorder”
A. Characteristics of OCD
1. Types of obsessive thoughts
a. Obsessions—Contamination fears, harming self or others, lack of symmetry,
pathological doubt, sexual obsessions, and obsessions concerning religion or
aggression.
b. Obsessions rarely carried out.
2. Types of compulsions
a. Compulsions—Five primary types: cleaning, checking, repeating,
ordering/arranging, and counting.
b. Performance of act brings feeling of reduced tension and satisfaction, as well as
a sense of control.
3. Consistent characteristics
a. Anxiety is the affective symptom.
Teaching Tip 6.3: The ABCs of Psychology
b. Fear that something terrible will happen to them or to others because of them.
c. Compulsion reduces anxiety in the short term.
d. “What if” illness; this tendency to judge risks unrealistically is very common
among those with OCD.

1. Not as rare as once thought, 2.3% lifetime prevalence.
2. More than 90% of those who present for treatment experience both obsessions and
compulsions; if include mental rituals and compulsions, this jumps to 98%.
3. Divorced and unemployed people overrepresented.
4. Little or no gender difference.
5. Typically begins in late adolescence or adulthood but is not uncommon in children.
6. Early onset more common in boys and is usually associated with more severe symptoms.
7. Gradual onset and chronic once serious.
C. Comorbidity with other disorders
1. Depression is especially common, up to 80% may experience significant depressive
symptoms.
2. Body dysmorphic disorder also rather common as a comorbid disorder.
D. Psychological Causal Factors
1. OCD as learned behavior
a. Mowrer’s two-process theory of avoidance learning.
b. Several classic experiments have supported this theory.
c. Core of the most effective form of behavior therapy for OCD.
d. Does not explain development of obsessions or abnormal assessments of risk.
2. OCD and preparedness
a. Some fears have occurrence rates that seem nonrandom.
b. Obsessions also adaptive in evolutionary terms.
3. Cognitive causal factors
a. The effects of attempting to suppress obsessive thoughts
(1) Thought suppression may lead to paradoxical increase in those thoughts
later.

119
(2) Normal and abnormal obsessions differ in degree to which they are
resisted.
b. Appraisals of responsibility for intrusive thoughts
(1) Inflated sense of responsibility may lead to thought-action fusion.
c. Cognitive biases and distortions.
(1) Problems inhibiting cognitive processing.
(2) Predisposition to thought suppression.
(3) Nonverbal, but not verbal, memory deficits.
Handout 6.3: Superstitious Behavior and Compulsions
E. Biological Causal Factors

1. Genetic influences
a. Moderately high heritability.
b. Higher rates if sub-clinical obsessive-compulsive symptoms and tic-related
OCD is included.
2. OCD and the brain
a. Abnormally active metabolic levels in the orbital frontal cortex, caudate nucleus,
and cingulate cortex.
b. Brain functions normalize after behavior or pharmacotherapy.
c. Dysfunction of the cortico-basal-ganglionic-thalamic circuit leading to
inappropriate behavioral responses that are normally inhibited.
d. Orbital frontal cortex is responsible in the obsessions.
3. Neurotransmitter abnormalities
a. Anafranil (clomipramine) and prozac often effective.
b. Drugs must be taken at least 6–12 weeks before changes noted.
c. Leads to a functional decrease in availability of serotonin.
F. Treatments
1. Behavioral and cognitive-behavioral treatments
a. Behavioral treatment that combines exposure and response prevention is most
effective.
b. Success in 50%–70% of patients; this is superior to medication.
2. Exposure and response prevention—the treatment involves having OCD clients
develop a hierarchy of upsetting stimuli
3. Medications
a. Serotonin-reuptake inhibitors.
b. Relapse rates high (up to 90%) following medication discontinuance.
c. Combining medication with behavioral treatment has not been shown to be more
effective in adults; one study showed promise in children.
d. Neurosurgery being investigated once again.
e. Antipsychotic medications.
Lecture Launcher 6.5: Medications
VIII. Sociocultural Causal Factors for all Anxiety Disorders

A. Cultural Differences in Sources of Worry
1. Yoruba culture in Nigeria indicates three clusters of symptoms: worry, dreams, bodily
complaints.
2. Culturally related syndrome in China is called Koro.
3. Caribbean cultures and ataque de nervios.
B. Taijin Kyofusho
1. Anxiety disorder symptoms unique to Japanese cultural patterns.
2. Fear of blushing, making eye contact, emitting an offensive odor.
IX. Unresolved Issues

120
A. Compulsive Hoarding: Is it a Subtype of OCD?
1. When considered a subtype of OCD, hoarding accounts for 10%–40% of diagnosed
persons.
2. Generally, these individuals are for more disabled than those with OCD and are at greater
risk for fire and health risks.
3. Recent studies indicate that the brain scans of hoarders is different than those of persons
with OCD that don’t hoard.
4. Many persons with hoarding do not respond to the medications that work on those with
OCD.

121
Key Terms
agoraphobia interoceptive conditioning

amygdala obsessions
anxiety obsessive-compulsive disorder (OCD)
anxiety disorder panic attack
anxiety sensitivity panic disorder
blood-injection-injury phobia panic provocation procedures
cognitive restructuring phobia
compulsions prepared learning
exposure and response prevention social phobia
exposure therapy specific phobia
exteroceptive conditioning
fear
generalized anxiety disorder (GAD)
Lecture Launchers
Lecture Launcher 6.1: Thrills or Chills?

Bungee jumping, riding roller coasters, participating in extreme sports, scary movies, and parachuting all produce
physiological reactions extraordinarily similar to panic attacks. Of course, they are not panic attacks, and this is
likely to be related to the fact that the sensations being experienced are expected and, indeed, even sought after.
Nevertheless, they are also frequently described as very fear provoking—and that’s a big part of their appeal! A
classroom discussion of fear-seeking and fear-avoidance can help illustrate how cognitive and environmental factors
can influence the experience of fear to a remarkable degree.
Lecture Launcher 6.2: The Transmission of Fear Responses

This is a great time to again discuss conditioning theories. You may want to refer back to Handout 2.4 from Chapter
2 on classical conditioning. This demonstrates how classical conditioning accounts for at least part of the learning
aspect of fear. Ask students to discuss fear responses they have and how they could have been classically, operantly,
or socially learned. One example could be the fear of dogs; it could be classically conditioned (e.g., you’ve been
bitten by a dog and now fear all dogs) or vicariously conditioned (e.g., mom and dad always show a fear response to
dogs so now you do too).
Lecture Launcher 6.3: “False Alarms”

The comprehensive learning theory of panic emphasizes the reactions to initial panic attacks. A variety of external
circumstances can lead up to initial attacks, but if people experiencing attacks fail to attribute the attacks to external
circumstances, they might be left to imagine they are having heart attacks, dying, or going crazy instead. For
instance, one might run up the stairs to get to an important meeting but nevertheless attribute physiological
symptoms to cardiac problems, neglecting to consider the roles of upcoming meeting stress and of bounding up the
stairs. Similarly, one might attribute feelings of dizziness and disorientation to “going crazy” when it might be more
accurate to attribute these feelings to, say, a missed lunch and physical exertion. These points can be emphasized
through a discussion of why pregnant women rarely experience panic attacks. One likely explanation is that
pregnant women have a readily available attribution for any physiological symptoms they experience—the
physiological changes associated with pregnancy. If students appreciate the role of attributions, they should be able
to offer this explanation with fairly minimal prompting. It can further emphasize elements of the theory to discuss
ambiguous circumstances, where ready attributions to external circumstances are not available to anyone. That is,
even people prone to appropriately attribute panic symptoms to external circumstances might sometimes fail to
identify any. In these ambiguous circumstances, any particular attribution is arbitrary, and the preference for
catastrophizing attributions is what sets those prone to panic disorder apart from those who are not. The class might
be asked to brainstorm benign alternatives to catastrophic interpretations. This would also be a good time to

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emphasize that medical rule-outs are always necessary before pursuing such psychological aspects of panic disorder.
Lecture Launcher 6.4: Overcoming Phobias

Students are often more comfortable talking about their phobias when asked how they defeated them. Alternatively,
they can be asked how they intervened with their fears before they became full-blown phobias. For instance, they
might be asked whether they recall things that made them fearful initially but about which they later became at ease.
How did the initial apprehension come about? What did they think about it? Was there anything they did
deliberately to combat the fear? What worked and what didn’t? These informal attempts can be compared to the
more formal ones described in the book, and the characteristics of effective and ineffective self-help strategies can
be explored in the context of therapeutic principles drawn out in the text.
Lecture Launcher 6.5: Medications

A variety of issues about medications are nicely illustrated in the context of anxiety disorders. For one, students
often associate medication with “cure” and are surprised to learn that once anxiety medications are discontinued, the
underlying physiology of the disorder returns. That is, these medications control but do not cure the disorders for
which they are being taken. Another medication issue concerns the way medications can undermine the
effectiveness of behavior therapy for panic disorder. This can be used to re-examine the important features of
effective behavior therapy. When students are asked why medication might undermine behavior therapy, they
should recognize that medications can weaken exposure experiences and that medications provide complicating
additional targets to which attributions about fear can be made and to which therapeutic progress can be credited.
Classroom Activities, Demonstrations, and Assignments
Activity 6.1: Systematic Desensitization Exercise

Systematic desensitization is a popular technique to demonstrate in the classroom. To demonstrate systematic
desensitization, a volunteer must be secured from the class or else a “guest” can be brought in especially for this
purpose. The demonstration begins with a brief interview to determine what is anxiety-provoking for this person
(simulated symptoms are suitable). Prompt the person for as many details as possible about the circumstances
surrounding the fear; when it occurs, where it occurs, who else is there, coping strategies, how long it lasts, how it
feels, and so on. Write each scenario onto a separate index card. Then, you construct a fear hierarchy of about 15
specific fear situations, ordered in terms of how anxiety provoking they are. Tell the subject to signal you with a
raised finger anytime anxious feelings occur. When the subject seems and reports being very relaxed, begin by
describing the least anxiety-provoking situation from the hierarchy. Pause and let the subject imagine it for about 10
seconds. Then ask the volunteer to stop imagining this situation and to relax once again. Proceed to the next scene
from the hierarchy in the same way. If the person signals anxiety, ask him or her to stop visualizing the scene and to
relax. If this is difficult to do, it might help to pre-arrange a relaxing scene to visualize. Once the volunteer is relaxed
again, start with the image one step lower on the hierarchy than the one that prompted the anxiety and proceed as
before. If the next step again provokes anxiety, it may be necessary to construct an intermediate step to soften the
transition.
Activity 6.2: Roller Coasters

Working individually, have each student imagine him or herself waiting in line to ride a roller coaster. Each student
is to record the physical sensations they would experience while waiting to get on the ride. Warn students that you
are interested only in physical sensations and that they are not to list their emotional reactions or thoughts. Once
students have completed this task, have volunteers read their physical sensations. Make a list on the board or use an
overhead projector. Once again, eliminate any descriptors that interpret their physical sensations such as emotional
reactions or thoughts. Once a thorough listing has been created that represents the responses of all students, have
students raise their hands to indicate if they like roller coasters or dislike them. Point out that their physical
sensations are identical. Use this activity as a launching point to discuss cognitive appraisal and the importance of
past experiences in interpreting events.
Activity 6.3: Cognitive Restructuring

For this exercise, ask the class to report the automatic thoughts associated with the various anxiety disorders. It can
be helpful to select one disorder or else to structure the task by going through the disorders one-by-one. Student
responses often feed off of each other and fairly comprehensive sets of thoughts are fairly quickly produced. Once a

123
detailed set of these dysfunctional thoughts is produced, students can brainstorm therapeutic “challenges” to these
thoughts as well as more functional coping thoughts. Alternatively, once the dysfunctional thoughts are listed,
students can be asked to write them down and to generate challenges and replacement thoughts on their own as a
homework assignment.
Activity 6.4: Stressors and Worries from the letter A to Z

Defining stressors and coping strategies
The exercise is designed to allow students to use their creativity and critical thinking to analyze the impact of stress
and ways of coping. Before beginning the activity, split the class into small groups of three to four students. Then
ask the students to work together as a group and come up with a list of stressors, starting with every letter of the
alphabet from A–Z, and then come up with an additional list of ways to cope with stressors, again using every letter
of the alphabet A–Z. Ask each group to pull out two separate sheets of notebook paper and designate a group
member to be the recorder. The coping techniques can be positive or negative ways to deal with stress. You may
also get more specific, asking the students to make a list using every letter of the alphabet from A–Z of anxiety-
provoking events, situations, or objects as well. You could also designate certain letters of the alphabet like B, C, D,
R, S, T, L, A, and D. After every group has completed the activity, allow time for an in-class discussion of the
various stressors and ways to cope with stress. Was it easier to come up with a list of stressors or was it easier to
come up with the list of ways to cope? Can stress lead to anxiety disorders? Why or why not? At what point does a
worry turn into anxiety? This can also be a time to discuss the stress and anxiety that college brings, and it also
offers a chance to normalize this experience for students, as it shows a sense of universality.
MyPsychLab Resources
MyPsychLab Resource 6.1: Video “Overcoming Fears and Anxieties”

You may want to show a brief, 3-minute video discussing treatment options for anxiety disorders. To access this
video, log in to MyPsychLab, select the front cover of this textbook, then click on the “Multimedia Library” button
on the next page in the left-hand column. A new page will appear with search criteria. In the pull-down menu next to
“Chapter,” select Chapter 6, Panic, Anxiety, and Their Disorders. In the Media Type field, select “Watch,” then
click the “Find Now” button at the bottom. “Overcoming Fears and Anxieties” will appear as one of your video
offerings. You can either watch this video as an in-class demo—if your room has a computer set up—or assign as a
suggested exercise.
MyPsychLab Resource 6.2: Video “Steve Social Phobia”

You may want to show a brief, 3-minute video case study on Steve who has social anxiety disorder. To access this
video, log in to MyPsychLab, select the front cover of this textbook, then click on the “Multimedia Library” button
on the next page in the left-hand column. A new page will appear with search criteria. In the pull-down menu next to
“Chapter,” select Chapter 6, Panic, Anxiety, and Their Disorders. In the Media Type field, select “Watch,” then
click the “Find Now” button at the bottom. “Steve Social Phobia” will appear as one of your video offerings. You
can either watch this video as an in-class demo—if your room has a computer set up—or assign as a suggested
exercise.
MyPsychLab Resource 6.3: Video “Panic Disorder”

You may want to show a brief, 1-minute video on panic disorder brain imaging and the role of serotonin in panic
disorder. To access this video, log in to MyPsychLab, select the front cover of this textbook, then click on the
“Multimedia Library” button on the next page in the left-hand column. A new page will appear with search criteria.
In the pull-down menu next to “Chapter,” select Chapter 6, Panic, Anxiety, and Their Disorders. In the Media Type
field, select “Watch,” then click the “Find Now” button at the bottom. “Panic Disorder II” will appear as one of your
video offerings. You can either watch this video as an in-class demo—if your room has a computer set up—or
assign as a suggested exercise.
MyPsychLab Resource 6.4: Video “Panic Disorder: Jerry”

You may want to show a brief, 2-minute video on a case study on panic disorder. To access this video, log in to
MyPsychLab, select the front cover of this textbook, then click on the “Multimedia Library” button on the next page
in the left-hand column. A new page will appear with search criteria. In the pull-down menu next to “Chapter,”
select Chapter 6, Panic, Anxiety, and Their Disorders. In the Media Type field, select “Watch,” then click the “Find

124
Now” button at the bottom. “Panic Disorder: Jerry” will appear as one of your video offerings. You can either watch
this video as an in-class demo—if your room has a computer set up—or assign as a suggested exercise.
MyPsychLab Resource 6.5: Video “Phobias”

You may want to show a brief 2-minute video case study of an agoraphobic. To access this video, log in to
Now” button at the bottom. “Phobias” will appear as one of your video offerings. You can either watch this video as
an in-class demo—if your room has a computer set up—or assign as a suggested exercise.
MyPsychLab Resource 6.6: Video “Dave: Obsessive Compulsive Disorder”

You may want to show a brief, 3-minute case study on Dave who has OCD. To access this video, log in to
Now” button at the bottom. “Dave: Obsessive Compulsive Disorder” will appear as one of your video offerings.
You can either watch this video as an in-class demo—if your room has a computer set up—or assign as a suggested
exercise.
MyPsychLab Resource 6.7: Video “Margo: Obsessive Compulsive Disorder”

You may want to show a brief, 2-minute case study on Margo who has OCD. To access this video, log in to
Now” button at the bottom. “Margo: Obsessive Compulsive Disorder” will appear as one of your video offerings.
You can either watch this video as an in-class demo—if your room has a computer set up—or assign as a suggested
exercise.
Teaching Tips
Teaching Tip 6.1: Incorporating Social Psychology

You may want to draw the connection here between social cognition, specifically attribution and social facilitation,
and how these processes may have gone awry or be more sensitively set in some than others. For example, in social
facilitation, tasks like public speaking become easier or more difficult based on if there is an audience present. A
study by Zajonc, Heingartner and Herman (1969) found that even cockroaches show this effect, suggesting that this
is a very basic response. In the case of social phobias, some individuals may be reacting to a larger extent than the
average. It is also a good time to remind students that much of abnormal psychology are processes, like anxiety and
attribution, that all of us have but are stronger or set more sensitively in some than others. This should further
illustrate the adaptive values of many of these traits and faculties.
Teaching Tip 6.2: Fear of Fear

Many students fail to recognize how easy it could be to condition a fear to being in public spaces. You may want to
help illustrate this point with the following example. Say you were at the mall shopping when you suddenly had a
panic attack for no apparent reason. The next time you are at the mall you begin to worry that you might have
another panic attack because the first one was not in response to any specific event or stimuli. Now because you are
worried you leave the mall and start to feel better. It would not be surprising for you to not be eager to return to the
mall anytime soon. Why? Initially, you associate mall and panic attack via classical conditioning then it becomes
maintained via operant conditioning. This almost guarantees that you will avoid the mall. If your brain starts to think
the panic can occur in other social contexts, generalization will occur. Thus, it could be quite easy for someone to
become agoraphobic after even one panic attack at the mall.
Teaching Tip 6.3: The ABC’s of Psychology

This is a great time to cover how affect, behavior, and cognition are intertwined. Remind students that this

125
relationship is epigenetic and bidirectional. Affect effects both cognition and behavior. Behavior effects both affect
and behavior. And of course cognition affects both affect and cognition. Functioning or change on one level
necessarily affects the others.
Handout Descriptions
Handout 6.1: Commonalities among Social Phobias

Social phobias are characterized by a fear of being humiliated or embarrassed in a public setting. These types of
fears are quite common among college students. Using Handout 6.1, have each student find three people with
different religious, cultural, or socioeconomic backgrounds to interview. Each person interviewed should be able to
describe a social fear they have that might be similar to a social phobia. Once the information is collected, have
students share their findings with other students in a small group setting. Finally, have groups share what they found
as similar features of social fears and describe how these commonalities cut across the different individuals they
interviewed.
Handout 6.2: Progressive Muscle Relaxation

Progressive muscle relaxation (PMR) can be conducted on the entire class while they remain in their seats or else
they can lie on the classroom floor if the room is suitable. Emphasize that PMR is a skill and that once people are
skilled at relaxation they are well equipped to benefit from many anxiety-reducing therapies, such as systematic
desensitization. Students often have many comments about the experience immediately after you complete the
demonstration. An alternative approach to this exercise involves pairing students up and having them take turns
being the therapist and client.
Handout 6.3: Superstitious Behavior and Compulsions

The behaviorist B. F. Skinner compared the compulsions observed in OCD with superstitious behavior he produced
in pigeons under fixed-time schedules of reinforcement. These pigeons acted as if whatever they were doing before
reinforcement had actually produced the reinforcement, even though their behavior was in fact irrelevant. Students
will often admit to superstitious behaviors, like using their “lucky” exam pencil, wearing a special hat when their
favorite sports team is playing, or avoiding stepping on sidewalk cracks. They are also likely to know some of the
many superstitious behaviors engaged in by professional athletes and celebrities. What do superstitious behaviors
and compulsions have in common? How are they different? Why don’t they extinguish? How do “popular”
superstitions spread to many people? This might also be a good place to remind the students about negative
reinforcement, which is the name given to increases in behavior due to the removal of a stimulus. Superstitious
behaviors and compulsions both might appear to be negatively reinforced inasmuch as bad things don’t happen after
they are engaged in. The compulsive cleaner can point to a long history of not catching deadly diseases in the same
way the superstitious athlete can point to a long history of not failing.
Video / Media Sources
Anxiety Disorders—DSM-IV: New Diagnostic Issues Videotape Series. Allyn & Bacon Video Library.
Body Dysmorphic Disorder—Anxiety-Related Disorders: The Worried Well Video Series. Princeton, NJ:
Films for the Humanities and Social Sciences.
Challenge Cases for Differential Diagnosis. Differential Diagnosis in Psychiatry Series. Princeton, NJ:
Films for the Humanities and Social Sciences.
Chronic Anxiety in the Elderly. Princeton, NJ: Films for the Humanities and Social Sciences.
Cognitive Therapy for Panic Disorder. Psychotherapy Videotape Series II: Specific Treatments for Specific
Populations. Washington, DC: American Psychological Association.
Coping with Phobias. Princeton, NJ: Films for the Humanities and Social Sciences.
Getting Anxious. New York, NY: Insight Media.
Mixed Anxiety and Depression: A Cognitive-Behavioral Approach with Dr. Donald Meichenbaum.
Assessment and Treatment of Psychological Disorders Series. Princeton, NJ: Films for the Humanities and
Social Sciences.
Obsessive-Compulsive Disorder: An Alternative Treatment. Allyn & Bacon Video Library.
Obsessive-Compulsive Disorder—Anxiety-Related Disorders: The Worried Well Video Series. Princeton,
NJ: Films for the Humanities and Social Sciences.

126
Obsessive-Compulsive Disorder: Pharmacotherapy and Psychotherapy—Treatments of Psychiatric
Disorders Videotape Series. Allyn & Bacon Video Library.
Obsessive-Compulsive Disorder, Tanya—Patient Interview Video for Abnormal Psychology (12th ed.).
Allyn & Bacon Video Library.
OCD Clinic—#2 ABC News and Client Interviews. Allyn & Bacon Abnormal Psychology Video.
Panic. Sherborn, MA: Aquarius Health Care Videos.
Panic. Princeton, NJ: Films for the Humanities and Social Sciences.
Panic Attacks—Anxiety-Related Disorders: The Worried Well Video Series. Princeton, NJ: Films for the
Humanities and Social Sciences.
Panic Attacks: Causes and Treatments. Princeton, NJ: Films for the Humanities and Social Sciences.
Phobias: Overcoming the Fear. New York, NY: Filmmakers Library.
Secret Fears: Phobias. The Nature of Things Series. New York, NY: Filmmakers Library.
Sedatives. Drugs: Uses and Abuses Series. Princeton, NJ: Films for the Humanities and Social Sciences.
Self-harm. Anxiety-Related Disorders: The Worried Well. Princeton, NJ: Films for the Humanities and
Social Sciences.
Step on a Crack: Obsessive Compulsive Disorder. Boston, MA: Fanlight Productions.
The Anxiety Disorders—Vol. 3, The World of Abnormal Psychology Video Series. South Burlington, VT:
Annenberg/CPB Collection.
Web Links
Web Link 6.1: http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

National Institute of Mental Health brochure on anxiety disorders, covering symptoms and treatment of the major
anxiety disorders. Also lists organizations to contact for further information.
Web Link 6.2: www.lexington-on-line.com/naf.html

The National Anxiety Foundation homepage provides information and links about panic disorder and obsessive-
compulsive disorder.
Web Link 6.3: http://familydoctor.org/handouts/137.html

The American Academy of Family Physicians “Panic Attacks and Agoraphobia” fact sheet.
Web Link 6.4: www.mentalhelp.net/poc/center_index.php?id=1

Mental Help Net provides an enormous amount of basic information as well as many Web links for anxiety
disorders.
Web Link 6.5: www.apa.org

This is the APA website. It has many articles that students can access for free, or that you can use for assignments.
Web Link 6.6: www.apahelpcenter.org

This is the APA help center. It has many articles students that can access for free, or that you can use for
assignments.
Web Link 6.7: www.psychiatrictimes.com/resources

This is the site for Psychiatric Times. It has many articles that students can access for free, or that you can use for
assignments.
Web Link 6.8: www.ocfoundation.org

This site provides education, resources, and support for those suffering from OCD and for family and friends with
loved ones with OCD.

127
Handout 6.1
Social Fears and Phobias
Characteristics Description of 1. What problems has this How does the

of person fear fear caused the person? person attempt
2. Does the person avoid to cope with
certain activities? this fear?
3. Does the person
experience any physical
symptoms?
Interview # 1
Interview # 2
Interview # 3

128
Handout 6.2
Progressive Muscle Relaxation
The idea behind Progressive Muscle Relaxation (PMR) is that muscle relaxation is incompatible with anxiety. In addition, PMR
is a skill that can be learned. Therefore, it is important to pay very close attention to the differences between muscle tension and
relaxation. We will walk through a series of muscles. As we focus on each, you will flex each muscle for 7–10 seconds, in a
smooth, strong squeeze. Do not strain or squeeze as hard as you can. Take special care when squeezing painful or injured parts of
the body. Continue breathing throughout the lesson. After flexing each muscle group, abruptly let the muscle go completely limp,
as limp as you can possibly get it, for about 15–20 seconds, focusing especially carefully on how it feels as you go from tense to
relaxed. As you let the muscle go completely limp, think to yourself “Re-laaaax.”
• Start with three deep abdominal breaths, exhaling very slowly each time. As you exhale, imagine that tension throughout
your body is already flowing away.
• Clench your fists tightly. Hold for 7–10 seconds and then release for 15–20 seconds. Use these same time intervals for all
other muscle groups.
• Tighten your biceps by drawing your forearms up toward your shoulders and “making a muscle” with both arms. Hold . . .
and then relax.
• Tighten your triceps—the muscles on the undersides of your upper arms—by extending your arms out straight and locking
your elbows. Hold . . . and then relax.
• Tense the muscles in your forehead by raising your eyebrows as far as you can. Hold . . . and then relax. Imagine your
forehead muscles becoming smooth and limp as they relax.
• Tense the muscles around your eyes by clenching your eyelids tightly shut. Hold . . . and then relax. Imagine sensations of
deep relaxation spreading all around your eyes.
• Tighten your jaws by opening your mouth so widely that you stretch the muscles around the hinges of your jaw. Hold . . .
and then relax. Let your lips part and allow your jaw to hang loose.
• Tighten the muscles in the back of your neck by pulling your head way back, as if you were going to touch your head to
your back (be gentle with this muscle group to avoid injury). Focus only on tensing the muscles in your neck. Hold . . . and
then relax.
• Take a few deep breaths and tune in to the weight of your head sinking into whatever surface it is resting on.
• Tighten your shoulders by raising them up as if you were going to touch your ears. Hold . . . and then relax.
• Tighten the muscles around your shoulder blades by pushing your shoulder blades back as if you were going to touch them
together. Hold the tension in your shoulder blades . . . and then relax.
• Tighten the muscles of your chest by taking in a deep breath. Hold for up to 10 seconds . . . and then release slowly. Imagine
any excess tension in your chest flowing away as you exhale.
• Tighten your stomach muscles by sucking your stomach in. Hold . . . and then release. Imagine a wave of relaxation
spreading through your abdomen.
• Tighten your lower back by arching it up. (You should omit this exercise if you have lower back pain.) Hold . . . and then
relax.
• Tighten your buttocks by pulling them together. Hold . . . and then relax. Imagine the muscles in your hips going loose and
limp.
• Squeeze the muscles in your thighs all the way down to your knees. You will probably have to tighten your hips along with
your thighs, since the thigh muscles attach at the pelvis. Hold . . . and then relax. Feel your thigh muscles smoothing out and
relaxing completely.
• Tighten your calf muscles—by pulling your toes toward you. Hold . . . and then relax.
• Tighten your feet by curling your toes downward. Hold . . . and then relax.
• Mentally scan your body for any residual tension. If a particular area remains tense, repeat one or two tense-relax cycles for
that group of muscles.
• Now imagine a wave of relaxation slowly spreading throughout your body, starting at your head and gradually penetrating
every muscle group all the way down to your toes.
The entire progressive muscle relaxation sequence should take you 20–30 minutes the first time. With practice you may decrease
the time needed to 15–20 minutes. You can record the above exercises on an audio cassette to expedite your early practice
sessions. Or you may wish to obtain a professionally made tape of the progressive muscle-relaxation exercise. Some people
always prefer to use a tape, whereas others have the exercises so well learned after a few weeks of practice that they prefer doing
them from memory.
Adapted from Goldfried, M. R., & Davison, G. (1994). Clinical behavior therapy (expanded edition). New York: Wiley.

129
Handout 6.3
Superstitious Behavior
List common superstitious behaviors. Provide a possible reason for the development of the behavior.
Superstition Reasons for the superstition Prevention of behavior
1.
2.
3.
4.
5.

130

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Abnormal Psychology Core Concepts 2nd Edition Butcher

Abnormal Psychology 6th Edition Nolen-Hoeksema

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Copyright © 2013 Pearson Education, Inc. All rights reserved.

Detailed Lecture Outline

I. The Fear and Anxiety Response Patterns

A. Fear and Panic Activate the “Fight or Flight” Response

Lecture Launcher 6.1: Thrills or Chills?

Copyright © 2013 Pearson Education, Inc. All rights reserved.

II. Overview of the Anxiety Disorders

A. Unrealistic and Irrational Fears of Disabling Intensity

MyPsychLab Resource 6.1: Video on “Overcoming Fears and Anxieties”

Copyright © 2013 Pearson Education, Inc. All rights reserved.

Lecture Launcher 6.2: The Transmission of Fear Responses

e. Sources of individual differences in the learning of phobias:

Activity 6.1: Systematic Desensitization Exercise

Activity 6.2: Roller Coasters

IV. Social Phobias or Social Anxiety Disorder

MyPsychLab Resource 6.2: Video “Steve Social Phobia”

A. Prevalence, Age of Onset, and Gender Differences

Copyright © 2013 Pearson Education, Inc. All rights reserved.

Teaching Tip 6.1: Incorporating Social Psychology

C. Biological Causal Factors

Handout 6.1: Commonalities among Social Phobias

V. Panic Disorder with and without Agoraphobia

Lecture Launcher 6.3: “False Alarms”

1. As many as 85% seek help from an emergency room or doctor’s office.

MyPsychLab Resource 6.3: Video on “Panic Disorder”

MyPsychLab Resource 6.4: Video “Panic Disorder: Jerry”

MyPsychLab Resource 6.5: Video on “Phobias”

Copyright © 2013 Pearson Education, Inc. All rights reserved.

Teaching Tip 6.2: Fear of Fear

2. The cognitive theory of panic (see Figure 6.2)

Copyright © 2013 Pearson Education, Inc. All rights reserved.

Lecture Launcher 6.4: Overcoming Phobias

VI. Generalized Anxiety Disorder

Copyright © 2013 Pearson Education, Inc. All rights reserved.

6. Cognitive biases for threatening information

Activity 6.3: Cognitive Restructuring

E. Biological Causal Factors

Copyright © 2013 Pearson Education, Inc. All rights reserved.

VII. Obsessive-Compulsive Disorder

MyPsychLab Resource 6.6: Video “Dave: Obsessive Compulsive Disorder”

MyPsychLab Resource 6.7: Video “Margo: Obsessive Compulsive Disorder”

Teaching Tip 6.3: The ABCs of Psychology

B. Prevalence, Age of Onset, and Gender Differences

Copyright © 2013 Pearson Education, Inc. All rights reserved.

Handout 6.3: Superstitious Behavior and Compulsions

E. Biological Causal Factors

Lecture Launcher 6.5: Medications

VIII. Sociocultural Causal Factors for all Anxiety Disorders

IX. Unresolved Issues

Copyright © 2013 Pearson Education, Inc. All rights reserved.

Copyright © 2013 Pearson Education, Inc. All rights reserved.

agoraphobia interoceptive conditioning

Lecture Launcher 6.1: Thrills or Chills?

Lecture Launcher 6.2: The Transmission of Fear Responses