Chapter 5: Anxiety Disorders. Be able to recognize commonalities in etiology and treatment across the

Transcription

1 Chapter 5: Anxiety Disorders Learning GOALs 1. Be able to describe the clinical features of the anxiety disorders, and how they tend to co-occur with each other. 2. Be able to describe how gender and culture influence the prevalence of anxiety disorders Be able to recognize commonalities in etiology and treatment across the anxiety disorders. 4. Be able to describe etiological factors and treatment approaches that are specific to each of the anxiety disorders. Summary Clinical Descriptions of the Anxiety Disorders As a class, anxiety disorders are the most common type of mental illness. DSM-IV-TR lists seven principal diagnoses: specific phobia, social phobia, panic disorder (with and without agoraphobia), generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and acute stress disorder. Anxiety is common to all the anxiety disorders, but phobias and panic also involve fear as a clinical feature. Phobias are intense, unreasonable fears that interfere with functionality. Social phobia is fear of unknown people or social scrutiny. Specific phobias include fears of animals, heights, enclosed spaces, and blood, injury, or injections. A patient with panic disorder has recurrent, inexplicable attacks of intense fear. Panic attacks alone are not sufficient for the diagnosis; a person must be worried

2 about the potential of having another attack. Panic attacks sometimes lead to fear and avoidance of being in places where escape would be difficult if another attack were to occur, known as agoraphobia. In generalized anxiety disorder, the person is beset with virtually constant tension, apprehension, and worry which lasts for at least 6 months. People with obsessive-compulsive disorder have intrusive, unwanted thoughts and feel pressured to engage in rituals to avoid overwhelming levels of anxiety. Post-traumatic stress disorder is diagnosed in some people who have experienced a traumatic event that would evoke extreme distress in most people. It is marked by symptoms of reexperiencing the trauma, arousal, and emotional numbing. Acute stress disorder is defined by similar symptoms, but lasts less than one month. Gender and Sociocultural Factors in the Anxiety Disorders Anxiety disorders are much more common among women than men. The focus of anxiety, the prevalence of anxiety disorders, and the specific symptoms expressed may be shaped by culture. Common Risk Factors across the Anxiety Disorders The psychoanalytic view of anxiety disorders is that they are a defense against repressed conflicts. Genes increase risk for a broad range of anxiety disorders. Beyond this general risk for anxiety disorders, there may be more specific heritability for certain anxiety disorders. Beyond genetic diatheses, other factors that appear to be involved in a range of anxiety disorders include elevated activity in the fear circuit, poor regulation of several

3 neurotransmitter systems (GABA, serotonin, and norepinephrine), lack of perceived control, a tendency to pay closer attention to signs of potential danger, and negative life events. Common Aspects of Treatment for the Anxiety Disorders Behavior therapists focus on exposure to what is feared. Systematic desensitization and modeling may be used as parts of exposure therapy. For some disorders, including social phobia, GAD, OCD and panic disorder, cognitive components may also be helpful in therapy. Antidepressants and benzodiazapenes are most commonly used for anxiety disorders, but new research also has begun to focus on medications like the anticonvulsant medication gabapentin (Neurontin). The effects of medications are often not as powerful as those seen for psychotherapy. There are some concerns that benzodiazapenes are subject to abuse, and discontinuing medications usually leads to relapse. Etiology and Treatment of Specific Anxiety Disorders Behavioral models of phobias typically emphasize two stages of conditioning. The first stage involves classical conditioning, in which a formerly innocuous object is paired with a feared object. This could be accomplished through direct exposure, modeling, or cognition. Fears of objects with evolutionary significance may be more easily conditioned. The second stage involves avoidance. Because not all people with negative experiences develop phobias, diatheses must be important. Exposure treatment for specific phobia tends to work quickly and effectively. Social phobia is harder to treat and addiing cognitive components to behavioral treatments may

4 help. Neurobiological models of panic disorder have focused on the locus ceruleus, the brain center responsible for norepinephrine release. Many different drugs have been found to trigger panic attacks in laboratory studies among people with a history of panic attacks. The key trigger is probably not a shift in a given neurotransmitter, but rather, how a person interprets changes in their body. Behavioral theories of panic attacks have posited that the attacks are classically conditioned to internal bodily sensations. Cognitive theories suggest that such sensations are more frightening due to catastrophic misinterpretation of somatic cues. CBT treatment appears more effective than medication treatment of panic disorder. Cognitive behavioral theories hold that GAD results from distorted cognitive processes. One model suggests that worry actually helps people avoid more intense emotions. Neurobiological approaches focus on the neurotransmitter GABA, which may be deficient in those with the disorder. Relaxation and cognitive approaches may be helpful, as is the use of medication. OCD symptoms have been robustly linked to activity in the orbitofrontal cortex, the caudate, and the anterior cingulate. In behavioral accounts, compulsions are considered avoidance responses that are reinforced because they provide relief. Checking behaviors may be intensified by doubts about memories. Obsessions may be intensified by attempts to inhibit unwanted thoughts, in part because people with OCD seem to feel that thinking about something is as bad as doing it. ERP is a well-validated approach that involves exposure. The SRI, clomipramine, also appears helpful, as do other antidepressant medications.

5 Research and theory on the causes of post-traumatic stress disorder focus on risk factors such as hippocampal volume, the severity of the event, dissociation, and other psychological factors that may influence the ability to cope with stress, such as social support and intelligence. Psychological treatment involves exposure, but often, imaginal exposure is used. 1. The difference between anxiety and fear is that a. anxiety is a response to immediate danger, while fear is defined as apprehension over an anticipated problem. b. anxiety is immediate and fear is anticipated. c. anxiety is apprehension over an anticipated problem, while fear is defined as a response to immediate danger. d. anxiety is always adaptive, whereas fear is not. Answer: C Type: Factual Page: Dylan is walking through the jungles of Africa, and he suddenly comes across a ferocious tiger. Which of the following reactions is most adaptive in this scenario? a. anxiety b. anger c. panic d. fear Answer: D Type: Applied: Page: To improve performance on laboratory tests, it is best for participants to a. experience a great deal of anxiety. b. experience a small degree of anxiety. c. experience no anxiety. d. experience a small amount of anxiety as well as fear. Answer: B Type: Factual Page: Which of the following statements is true? a. Hannah s performance on her algebra test will improve if she experiences a small degree of anxiety.

6 b. Hannah s performance on her algebra test will worsen if she experiences any anxiety. c. Hannah s performance on her algebra test will improve if she experiences a fair amount of anxiety before and during the test. d. Anxiety is not related to performance on tests. Answer: A Type: Factual Page: As a group, anxiety disorders a. are unlikely to be cormorbid. b. are one of the least costly psychiatric disorders to society. c. cause little interpersonal problems. d. are the most common type of psychiatric diagnosis. Answer: D Type: Factual Page: Mario was diagnosed with both post-traumatic stress disorder and dysthymic disorder. This is an example of a. an inability to distinguish depressive symptoms from anxiety symptoms. b. an error by the diagnostician, since two Axis I disorders cannot be diagnosed in the same person. c. the importance of having a multiaxial diagnostic system. d. comorbidity, a common occurrence in psychiatric diagnosis. Answer: D Type: Factual Page: Margaret and Ed have different fears. Margaret is afraid of snakes, whereas Ed is afraid of dogs. Their fears are similar in that a. both serve the same adaptive purpose. b. both require aversive learning consequences for their development. c. neither respond well to treatment. d. All of the above choices are correct. Answer: A Type: Applied Page: Why are anxiety disorders often comorbid with other kinds of diseases? a. The disorders involve similar neural pathways. b. Prolonged anxiety leads to other problems. c. Clinicians misdiagnose disorders. d. Their symptoms overlap. Answer: B Type: Factual Page: 124

7 9. Ted is fearful of interactions with others and avoids eating in public. Ted most likely has a. specific phobia. b. panic disorder with agoraphobia. c. social phobia. d. paranoia. Answer: C Type: Factual Page: An individual diagnosed with a social phobia a. exhibits paranoid symptoms, believing others are plotting to hurt him or her. b. is unable to speak in the presence of other people. c. is terrified of being in public places and may become housebound. d. becomes extremely anxious when in certain situations which involve activities done in the presence of other people. Answer: D Type: Factual Page: Julie has a social phobia. Given this information, it would not be surprising if she also met DSM-IV criteria for a. schizophrenia. b. borderline personality disorder. c. avoidant personality disorder. d. obsessive compulsive personality disorder. Answer: C Type: Factual Page: Which of the following terms have been proposed as a more appropriate label for a social phobia? a. social disorder b. social anxiety disorder c. social phobia disorder d. avoidant personality disorder Answer: B Type: Factual Page: Why has the term social anxiety disorder been proposed as a more appropriate label for social phobia? a. Social phobias tend to be more pervasive and cause more interference with daily routines than other phobias. b. A social phobia was termed social anxiety disorder in the DSM-III.

8 c. Many people with social phobias also meet criteria for Avoidant Personality Disorder. d. Social phobias cause minimal impairment and tend to be of short duration. Answer: A Type: Factual Page: Ted is fearful of most social situations, whereas Andreas is only fearful of giving speeches. Given this, one could infer a. that Ted s fear began at an earlier age. b. that Ted may be more likely to abuse alcohol. c. that Andrea has less impairment. d. All of the above choices are correct. Answer: D Type: Applied Page: In the question above, Ted would be diagnosed with while Andreas would be diagnosed with. a. social phobia, specific type; social phobia, generalized type b. social phobia, generalized type; social phobia, specific type c. agoraphobia, social type; social phobia, specific type d. agoraphobia, social type; generalized anxiety disorder Answer: B Type: Applied Page: Depersonalization and derealization are common symptoms for which disorder? a. obsessive-compulsive disorder b. specific phobia c. social phobia d. panic disorder Answer: D Type: Factual Page: Which of the following is an example of a cued panic attack? a. One that occurs during sleep. b. One that occurs in the therapist's office, under control and as part of treatment. c. One that occurs in specific situations, such as when the person is driving. d. One that occurs without warning while watching T.V. Answer: C Type: Factual Page: Agoraphobia is characterized by a fear of a. being in unfamiliar places.

9 b. being embarrassed by saying or doing something foolish in front of others. c. strangers misinterpreting their symptoms as a heart attack. d. having a panic attack in places in which escape would be difficult or embarrassing. Answer: D Type: Factual Page: Edna does not currently have panic disorder. However, she cannot leave her house and required home sessions when she began therapy. It is likely a. Edna has agoraphobia, does not meet criteria for panic disorder. b. Edna does not have agoraphobia. c. Edna is faking her symptoms. d. that Edna has more severe panic but is able to cope with the symptoms. Answer: A Type: Applied Page: Why are agoraphobia and panic disorder discussed together? a. Panic disorder often leads to agoraphobia. b. Panic disorder is a primary characteristic of agoraphobia. c. The two terms are synonymous. d. Their etiology and treatment is very similar. Answer: A Type: Factual Page: Panic attacks a. occur only in people with panic disorder, by definition. b. can occur in people who do not have panic disorder. c. occur in greatest frequency among people diagnosed schizophrenic. d. occur primarily in people with agoraphobia. Answer: B Type: Factual Page: Tom has symptoms of chronic muscle tension, occasional rapid heart rate, dizziness, and difficulty falling asleep. In addition to these symptoms, if he has Generalized Anxiety Disorder, he also has a. chronic worry. b. depersonalization. c. derealization. d. interpersonal stress. Answer: A Type: Applied Page: The worries of people with GAD

10 a. are generally limited to physiological concerns. b. are similar to worries of most people. c. typically are driven by another Axis I disorder. d. All of the above are true. Answer: B Type: Factual Page: Intrusive, irrational and unwanted thoughts are called a. irrational beliefs. b. generalized anxiety. c. obsessions. d. compulsions. Answer: C Type: Factual Page: Oscar feels the urge to turn a light switch on and off 12 times before leaving a room. This would be referred to as a. an irrational belief. b. generalized anxiety. c. an obsession. d. a compulsion. Answer: D Type: Applied Page: Which of the following is a compulsion? a. A persistent fear of getting dirty. b. Having persistent doubts about whether the stove was turned off that morning. c. Persistent checking for one's keys. d. Persistent thoughts about harming one s spouse. Answer: C Type: Applied Page: Which of the following is an obsession? a. Repeatedly checking that the water is turned off. b. Humming a tune over and over. c. Having a recurring fear that one is giving others illnesses when they actually are not. d. Having excessive worry over finances. Answer: C Type: Applied Page: What diagnosis is most appropriate for Nicole? She is constantly concerned with

11 symmetry, often spending hours arranging items in her room so that the room appears even on the left and right. She also feels that when she eats, the items on the plate must be arranged symmetrically. All of this effort interferes with her work. a. obsessive-compulsive disorder b. specific phobia c. generalized anxiety disorder d. specific phobia Answer: A Type: Applied Page: Sharon, a five-year-old girl, developed the following symptoms after being sexually molested: difficulty sleeping, nightmares, a tendency to be easily startled, and bedwetting. Which of the following would be the most likely diagnosis for Sharon? a. generalized anxiety disorder b. adjustment disorder c. depressive disorder d. posttraumatic stress disorder Answer: D Type: Applied Page: Symptoms of PTSD are grouped into which of the following major categories? a. reexperiencing of traumatic event, avoidance of stimuli associated with event and anxiety b. hypervigilance, avoidance of stimuli associated with event and exaggerated startle response c. avoidance of stimuli associated with event, symptoms of increased arousal and symptoms of suicidality d. reexperiencing of traumatic event, avoidance of stimuli associated with event and symptoms of increased arousal Answer: D Type: Factual Page: Iris was in an automobile accident. She goes to a psychologist one week after the accident. If she is experiencing nightmares, flashbacks, headache, and is ruminating about the accident, she will likely receive which diagnosis? a. acute stress disorder b. generalized anxiety disorder c. posttraumatic stress disorder d. anxiety disorder not otherwise specified Answer: A Type: Applied Page: 130

12 32. Comorbidity a. is more the rule than the exception with anxiety disorders. b. occurs in less than 1/6 of people with anxiety disorders. c. is associated with less severity and better outcomes. d. All of the above are true. Answer: A Type: Factual Page: The most common disorder comorbid with anxiety disorders is a. borderline personality disorder. b. obsessive compulsive disorder. c. avoidant personality disorder. d. depression. Answer: D Type: Factual Page: Women are more likely to be diagnosed with anxiety disorders because they are more a. likely to face their fears directly. b. physiologically vulnerable. c. willing to report their symptoms. d. exposed to social discrimination. Answer: C Type: Factual Page: Research shows that compared with men, women a. are at least twice as likely to be diagnosed with an anxiety disorder. b. are less likely to develop PTSD after exposure to a trauma. c. are less likely to report their symptoms. d. are more likely to be diagnosed with OCD. Answer: A Type: Factual: Page: According to the text, which of the following is NOT a theory as to why women are more likely to develop anxiety disorders than men? a. Women may be more likely to report their symptoms. b. Women tend to be more nervous than men in general. c. Men may be raised to believe more in personal control over situations. d. Men may experience more social pressure than women to face fears. Answer: B Type: Factual Page: 131

13 37. In relation to objects of anxiety, different cultures appear to a. have the same prevalence of a given disorder. b. play little role in what people fear. c. influence what people come to fear. d. fear the same objects, but these fears manifest themselves in different ways depending on the culture. Answer C Type: Factual Page: If you lived in Taiwan or Japan, you would a. be more likely to have an anxiety disorder. b. be less likely to have an anxiety disorder. c. be more likely to have kayak-angst. d. never receive a formal psychiatric diagnosis. Answer: B Type: Factual Page: Heritability estimates tend to be the highest for a. panic disorder. b. GAD. c. PTSD. d. arachnophobia. Answer: A Type: Factual Page: Individuals with anxiety disorders a. have weak fear circuits. b. have fear circuits that do not activate correctly when they are fearful or anxious. c. have an overactive fear circuit. d. have an underactive amygdala. Answer: C Type: Factual Page: Josie has panic disorder. She is being shown pictures of sad and angry faces as part of an experiment. Herbie does not have an anxiety disorder. He is also being shown pictures of sad and angry faces. The researchers studying Josie and Herbie s brain while they look at the pictures will most likely note that a. Josie s amygdala is less active than Herbie s. b. Josie s fear circuit is less elevated than Herbie s. c. Herbie s fear circuit is more elevated than Josie s. d. Herbie s amygdala is less active than Josie s.

14 Answer: D Type: Applied Page: Dana s baby, Sophie, participated in a study that indicated that Sophie had high levels of behavioral inhibition. Compared with babies who demonstrated low levels of behavioral inhibition, Sophie is likely to develop a. panic disorder. b. social phobia. c. OCD. d. agoraphobia. Answer: B Type: Applied Page: Behavioral inhibition is defined as a. the tendency to experience neuroticism. b. the inability to inhibit one s behavioral reactions. c. the tendency to become agitated and cry when faced with novel stimuli. d. the inability to regulate symptoms of anxiety. Answer: C Type: Factual Page: Infants with become agitated and cry when faced with novel toys or people and are more likely to show anxiety as they get older. a. neuroticism b. depersonalization c. prepared learning d. behavioral inhibition Answer: D Type: Factual Page: Neuroticism is best defined as a. depression. b. anxiety. c. the tendency to react to events with negative affect. d. the tendency towards pessimism. Answer: C Type: Factual Page: Lola is low in neuroticism. Compared with people who have high levels of neuroticism, Lola a. is more likely to experience anxiety and depression.

15 b. is less likely to develop an anxiety disorder. c. is probably characterized by a tendency to react to events with negative affect. d. is more likely to have OCD. Answer: B Type: Applied Page: Which of the following puts people at greater risk for developing anxiety disorders? a. having a perception that they have no control over their environment. b. having a comorbid diagnosis of schizophrenia. c. having low levels of neuroticism. d. having low levels of activity in the fear circuit. Answer: A Type: Factual Page: Dr. Francis randomly assigned puppies to one of two conditions. One group of puppies grew up with the ability to choose when they would receive dog biscuits. The other group of puppies had no control over when they would receive the dog biscuits. In this scenario, the group of puppies who had no control over when they would receive the biscuits a. were more likely to be aggressive. b. were less prone to neuroticism. c. were more likely to show high levels of behavioral inhibition. d. were more likely to display high levels of anxiety. Answer: D Type: Factual Page: A Vietnam veteran with PTSD would be most likely to pay attention to which of the following words? a. automobile b. apples c. furniture d. weapons Answer: D Type: Applied Page: An individual with a snake phobia would be most likely to pay attention to which of the following words? a. oranges b. desert c. Antarctica d. table

16 Answer: B Type: Applied Page: Across paradigms, effective psychological treatments for anxiety disorders share this common focus: a. psychotropic drugs b. exposure c. two-factor model d. targeting obsessions Answer: B Type: Factual Page: Which of the following is NOT a problem with anxiolytics? a. They often produce negative side effects. b. They are very expensive. c. They can be addictive. d. Individuals who take them may experience severe withdrawal symptoms. Answer: B Type: Factual Page: Which of the following is NOT a common problem with medications used to treat anxiety disorders? a. slow to take effect b. side effects c. addictive d. effective only as long as they re taken Answer: A Type: Factual Page: The two-factor model explains why a. a man who develops a dog phobia does not lose his fear of dogs. b. a man develops a dog phobia. c. a man reduces his fear of dogs. d. a man who develops a dog phobia is able to expose himself to dogs. Answer: A Type: Applied Page: One problem with Mowrer s original two-factor model of phobias is that phobias tend to develop a. following traumatic experiences. b. only with respect to certain stimuli. c. equally in all age groups.

17 d. in people not otherwise anxious. Answer: B Type: Factual Page: Greta developed a phobia of snakes after one bit her as a small child. Now she avoids all snakes and feels much better as a result. Which of the following behavioral theories of specific phobias best explain this situation? a. operant conditioning b. classical conditioning c. two-factor model d. None of the above are correct. Answer: D Type: Applied Page: Which of the following has NOT been proposed as a way that conditioning could take place? a. direct experience b. repressed memories c. modeling d. verbal instruction Answer: B Type: Factual Page: What is a reason why typically people do not fear coconuts, flowers or strawberries? a. During evolution, exposure to such stimuli was not life-threatening. b. They are not poisonous. c. They are not as common as stimuli such as blood or spiders. d. People developed prepared learning in response to such stimuli. Answer: A Type: Factual Page: The evidence for a genetic component to phobias is limited by the fact that a. agoraphobics' relatives are likely to develop a different anxiety disorder rather than a phobia. b. the similarity between parents and children may be due to modeling, not genetics. c. blood and injection phobias have a stronger genetic basis than social phobia. d. several recent studies have found that relatives of people with phobias are not more likely to develop phobias. Answer: B Type: Factual Page: After viewing tapes of monkeys apparently showing fear of snakes, lambs, and

18 flowers, monkeys who viewed these tapes were only fearful of snakes. This provides only partial support for but better support for. a. modeling; classical conditioning b. vicarious learning; avoidance learning c. modeling; preparedness d. preparedness; diathesis Answer: C Type: Applied Page: Doug was frightened by a rat coming into his bedroom when he was a child, and he now has a rat phobia. However, despite having been severely shocked by putting her finger in an electric outlet, Martha has no fear of sockets. This inconsistency is explained by the theory of a. preparedness. b. systematic desensitization. c. irrational beliefs. d. avoidance conditioning. Answer: A Type: Applied Page: Ivan reported a traumatic history with dogs, resulting in his fear of dogs. However, Sven also reported a traumatic history with dogs, but does not have a fear of dogs. This provides support for a. a diathesis for phobia. b. a preparedness view of phobia. c. a psychoanalytic theory of phobia. d. the two-factor theory. Answer: A Type: Applied Page: Which of the following is an example of a safety behavior? a. seeking treatment b. avoiding snakes c. exposing oneself to a feared stimulus in a controlled environment d. avoiding eye contact Answer: D Type: Factual Page: Why is avoidance behavior so often maintained? a. People do not want to overcome their fears. b. Such behavior reduces the amount of fear a person experiences.

19 c. Friends and family members generally encourage it. d. People fail to use safety behaviors. Answer: B Type: Factual Page: Gina has social phobia. Now, in an effort to overcome her social fear, she is awkward, frequently commits faux pas by avoiding eye contact and struggles to respond effectively when given compliments. This is an illustration of a. a predisposing biological factor. b. preparedness. c. social skill deficits in social phobia. d. cognitive bias in social phobia. Answer: C Type: Applied Page: Both Lindsay and Nicole just completed a solo in a musical competition. The judges awarded them both 9 out of 10. Lindsay has social phobia and Nicole does not. Based on this information, a. Lindsay is less likely to worry about how others perceived her performance. b. Nicole is more likely to have higher standards than Lindsay. c. Lindsay is more likely to think she sang more poorly than Nicole. d. There is not enough information to make any conclusions. Answer: C Type Applied: Page: Systematic desensitization consists of a. exposing the patient to the feared stimulus at full intensity. b. teaching the patient to alter his or her irrational self-talk while confronting the feared stimulus. c. having the patient imagine a series of increasingly frightening scenes while deeply relaxed. d. gradually exposing the patient to more and more anxiety-provoking situations in the environment. Answer: C Type: Factual Page: Based on research of effective treatments for social phobias, a therapist should consider a. exposure and cognitive therapy. b. exposure only. c. systematic desensitization. d. cognitive therapy only.

20 Answer: A Type: Factual Page: While a therapist might consider adding cognitive therapy to treatment of, research suggests that outcomes are no better when cognitive therapy is added in the treatment of a. depression, social phobias. b. anxiety disorders; depression. c. specific phobia, social phobia. d. social phobia; specific phobia. Answer: D Type: Factual Page: Cognitive theories of social phobias suggest that social phobics a. attend more to negative stimuli. b. interpret ambiguous events as negative. c. believe negative events will occur again in the future. d. All of the above choices are correct. Answer: D Type: Factual Page: Social interactions and role-play situations are used in the treatment of a. specific phobias. b. social phobia. c. panic disorder. d. obsessive-compulsive disorder. Answer: B Type: Factual Page: Despite their common use, research does not indicate that is/are effective in treating social phobia. a. paroxetine b. gabapentin c. beta blockers d. SSRI s Answer: C Type: Factual Page: In regard to panic, the locus ceruleus a. is likely to be under sensitive. b. decreases panic by decreasing activity.

21 c. shows increased activity. d. exhibits lower glucose metabolism. Answer: C Type: Factual Page: When triggering panic attacks experimentally through the use of drugs, researchers have found that a. such drugs produce panic in people without a history of panic attacks as often as they produce panic in people with a history of panic attacks. b. such drugs produce panic attacks more often in people who already have a history of panic attacks. c. it is nearly impossible to actually replicate the physiological symptoms that occur during a real panic attack. d. people with a history of panic attacks are more likely to report physiological symptoms than emotional symptoms. Answer: B Type: Factual Page: Panic attacks can be triggered by which of the following? a. caffeine b. exercise c. adrenaline d. All of the above are correct. Answer: D Type: Factual Page: Classical conditioning of panic attacks in response to bodily sensations is called a. interoceptive conditioning. b. systematic desensitization. c. two-factor model. d. exposure. Answer: A Type: Factual Page: Studies of perceived control with respect to panic attacks indicate that perceived control a. is important only when the person has panic disorder. b. plays an important role in whether a person develops a panic attack. c. is influenced by the locus ceruleus. d. leads to misinterpretation of bodily sensations. Answer: B Type: Factual Page: 144

22 78. A major psychological hypothesis regarding the onset of panic involves a. a fundamental problem with breathing control. b. difficulties in relaxing. c. a concern with, and misinterpretation of, bodily sensations. d. excessive attempts to relax that fail. Answer: C Type: Factual Page: The Anxiety Sensitivity Index a. has been important in determining panic-proneness. b. measures fear of bodily sensations. c. allows for tests of the concern with control over bodily symptoms as a hypothesis of panic. d. All of the choices are correct. Answer: D Type: Factual Page: The goal of panic control therapy for panic disorder is to help clients a. re-experience the trauma that led to the panic attacks. b. relax when symptoms of a panic attack appear. c. experience attacks fully so the panic extinguishes. d. view their symptoms as harmless and controllable. Answer: D Type: Factual Page: The primary goal of having clients with panic attacks experience primary symptoms of panic in the therapy room is a. to reinterpret physical symptoms from loss of control to harmless physical variations. b. to develop a clearer understanding of the role panic symptoms play in their life. c. the development of higher fear to be adjusted by direct therapy once the panic has been initiated. d. to access underlying psychodynamic features of the client. Answer: A Type: Applied Page: When one spouse is treated for agoraphobia, 1. a. involvement of the other spouse in the therapy is important for treatment success. 2. b. spouses are encouraged to provide support to enable the person to remain at home as needed.

23 3. c. spouses are encouraged to temporarily separate so as not to interfere with treatment. 4. d. successful treatment of the disorder often inadvertently leads to marital discord. Answer: A Type: Factual Page: When people with panic disorder first seek treatment, a. they are usually first prescribed medications. b. the therapist usually starts with PCT. c. the therapist usually starts with systematic desensitization. d. they usually seek the help of a psychologist. Answer: A Type: Factual Page: What is the main symptom of GAD? a. increased heart rate b. fear of dying c. worry d. dizziness Answer: C Type: Factual Page: In the cognitive view, which anxiety disorder develops when anxiety is reinforced by distracting people from other, more powerful, negative emotions and images? a. phobias b. panic disorder c. generalized anxiety disorder d. obsessive-compulsive disorder Answer: C Type: Factual Page: According to Borkovec and colleagues cognitive model, why do people worry? a. It prevents people from having a panic attack. b. It distracts people from more powerful negative emotions and images. c. It serves as a useful problem-solving strategy. d. Some people have a genetic disposition to worry. Answer: B Type: Factual Page: According to Borkevec and colleagues, worry

24 a. serves as an avoidance mechanism. b. is adaptive. c. increases psychophysiological signs of arousal. d. helps people remember traumatic images. Answer: A Type: Factual Page: Substantial evidence shows that symptoms of OCD are a. adaptive. b. related to overactivity in the locus cereleus. c. a result of increased worry. d. related to overactivity in the orbitofrontal cortex, caudate nucleus and the anterior cingulated. Answer: D Type: Factual Page: Research shows that some brain areas are overactive in people with obsessivecompulsive disorder (OCD). However it is not clear that over activity in these areas causes OCD because a. the same areas are overactive in other anxiety disorders. b. successful psychotherapy normalizes activity in these areas. c. medications can reduce the overactivity but do not reduce OCD symptoms. d. some people with OCD do not show overactivity in these areas. Answer: B Type: Factual Page: Behavioral models consider compulsions a. to be classically conditioned responses. b. to be operantly conditioned responses. c. to be a result of suppressed obsessions. d. to be related to deficient locus cereleus activity. Answer: B Type: Factual Page: Diane has repetitive thoughts that her house will catch on fire. She repeatedly checks the stove to make sure it is turned off. Diane s compulsive behavior serves to a. provide immediate relief from the anxiety associated with her repetitive thoughts. b. reinforce her checking behaviors. c. lower her psychophysiological arousal. d. All of the above are correct. Answer: D Type: Applied Page: 149

25 92. According to the text, a cognitive explanation for checking behaviors proposes that a. such behaviors are actually quite common. b. this behavior results from underactivity in the anterior cingulated. c. this behavior results from a lack of confidence in memory. d. this behavior results from too much worrying. Answer: C Type: Factual Page: A study of compulsive checkers (people who continually check to see if they have done something such as turning off the stove) found that these individuals a. have a memory deficit for actions they have performed. b. are likely to confront sources of threat. c. are more likely to live alone. d. have a vulnerability schema. Answer: A Type: Factual Page: Most of the cognitive research on obsessions in OCD has focused on a. why obsessions persist. b. why obsessions happen initially. c. what types of people tend to have obsessions. d. what types of thoughts become intrusive. Answer: A Type: Factual Page: Efforts to inhibit obsessive thoughts a. may increase obsessional thinking and negative mood. b. may be a helpful strategy for obsessive-compulsives to use. c. result in other problems, such as stress-induced illnesses. d. are easier if a significant other is involved to encourage and reinforce the suppression of obsessive thoughts. Answer: A Type: Factual Page: A strictly behavioral therapist treating Steve for contamination fear due to OCD would use which of the following interventions? a. Have Steve meditate daily. b. Have Steve challenge the idea that it is necessary to be clean. c. Have Steve purposely get dirty. d. Have Steve say stop to himself quietly when he feels he must wash.

26 Answer: C Type: Applied Page: The first-line treatment approach for OCD is considered to be a. Anafranil. b. flooding. c. SSRI s. d. exposure and ritual prevention. Answer: D Type: Factual Page: One of the major factors influencing whether a person will develop PTSD is a. the presence of an Axis II disorder. b. the severity of the trauma. c. having low levels of neuroticism. d. being female. Answer: B Type: Factual Page: Brain imaging studies of people with PTSD indicate that a. smaller hippocampal volume probably precedes the onset of the disorder. b. severe trauma leads to smaller hippocampal volume. c. women are more likely to have smaller hippocampal volume than men. d. identical twins have larger hippocampal volume. Answer: A Type: Factual Page: Neurobiological research indicates that PTSD is associated with a. larger hippocampal volume. b. increased sensitivity of receptors to cortisol. c. memory deficits. d. increased worry. Answer: B Type: Factual Page: Mark, Bill and John are survivors of political imprisonment in Bosnia. Mark and Bill both developed PTSD, while John did not. Based on this information, what is one reason why John may not have developed PTSD? a. Mark and Bill worried more while they were imprisoned. b. John dissociated from the experience. c. John had a sense of perceived control over the experience.

27 d. Mark and Bill were younger than John. Answer: C Type: Applied Page: People who cope with a trauma by avoiding it a. are less likely than others to develop PTSD. b. have a less vivid memory of the trauma. c. are more likely to become depressed than develop PTSD. d. are more likely than others to develop PTSD. Answer: D Type: Factual Page: According to the behavioral view, the etiology of post-traumatic stress disorder is most similar to a. phobias. b. obsessive compulsive disorder. c. depression. d. generalized anxiety disorder. Answer: A Type: Applied Page: Which of the following is NOT considered to be an important factor in helping trauma victims cope adaptively? a. high intelligence b. strong social support c. dissociation d. None of the above are important. Answer: C Type: Factual Page: Which of the following has been shown useful in treating posttraumatic stress disorder? a. Training in minimizing emotional outbursts. b. Having the person confront their fears. c. Engaging in prolonged rest, peace and quiet. d. Firm encouragement to get on with one s life. Answer: B Type: Factual Page: Treatment of acute stress disorder is a. unnecessary, as most people recover anyway with time. b. dangerous, as reliving the event increases the trauma.

28 c. important, as it reduces the risk of developing PTSD. d. difficult, as it is hard to recreate the original trauma. Answer: C Type: Factual Page: Psychoanalytic theories of anxiety disorders a. are the dominant theoretical models. b. propose that anxiety results from disagreement between the superego and ego. c. propose that anxiety results from conflicts between the id and ego. d. propose that anxiety comes from underlying fixations. Answer: C Type: Factual Page: 134: Focus on Discovery Eye movement desensitization and reprocessing (EMDR) a. is the best treatment available for PTSD. b. is very controversial. c. has been empirically proven to work better than exposure or cognitive therapy. d. is supported by strong theoretical explanations. Answer: B Type: Factual Page: 154: Focus on Discovery A recent approach intended to reduce the harmful effects of trauma is a. Critical Incident Stress Debriefing. b. Critical Stress Support Counseling. c. Post-stress Social Support Therapy. d. Post-trauma Stress Debriefing. Answer: A Type: Factual Page: 155: Focus on Discovery Critical Incident Stress Debriefing (CISD) has been criticized as possiblyharmful because a. it is not clear that survivors of trauma can process treatment so soon after an event. b. if left alone, many of those traumatized do not develop PTSD. c. in such a short time frame, negative emotions are misattributed as potentially long-term traumatic reactions. d. the interventions offered may be intrusive. Answer: D Type: Factual Page: 155: Focus on Discovery 5.4 Essay Questions: 1. Compare and contrast anxiety and fear.

29 2. Describe the difference between an obsession and a compulsion. 3. How are compulsions reinforcing to a person with OCD? 4. Explain two reasons why comorbidity within anxiety disorders is so common. 5. Why are women more likely to develop anxiety disorders than men? Provide at least two possibilities. 6. How have beliefs about cultural differences in the manifestation of anxiety symptoms changed in recent years? 7. Define the two-factor model as it relates to phobic conditioning. 8. Describe two cognitive perspectives on the causes of panic disorder. 9. According to Borkevic s cognitive model why do people with GAD worry? 10. Discuss treatment options for GAD. 11. Discuss risk factors for developing PTSD. 12. Discuss neurobiological factors in PTSD. 13. Discuss treatment options for PTSD. 14. Compare the behavioral etiology of specific phobias with that of post-traumatic stress disorder. Outline how these perspectives are similar and how they differ. 15. How are panic disorder with agoraphobia and specific phobia similar? 16. Discuss the biological theories of anxiety disorders. What common features exist across the anxiety disorders? 17. Why is social phobia listed as a separate condition from specific phobia? 18. Discuss the virtues of and problems with Critical Incident Stress Debriefing. 19. Describe the types of support that alleviate traumatic symptoms. 20. Discuss the controversy surrounding eye movement desensitization and reprocessing (EMDR).