Abnormal Psychology

328 CHAPTER 7

conditioning of a fear response in social situ-

ations may contribute to social phobia; avoid-

ing feared social situations is then negatively

reinforced.

Social factors that give rise to social pho-

bia include parents’ modeling or encouraging

a child to avoid anxiety-inducing social inter-

actions. Moreover, people in different cultures

may express their social fears somewhat

differently.

Neurological factors are targeted by beta-

blockers for periodic performance anxiety, and

SSRIs or SNRIs for more generalized social

phobia. The treatment that targets psycholog-

ical factors is CBT, specifi cally, exposure and

cognitive restructuring. Treatments that target

social factors include group CBT and exposure

to feared social stimuli.

Thinking like a clinician

Nick loved his job—he was a programmer

and he worked from home. The thing he loved

most about his job was that he didn’t have to

deal with people all day. However, his com-

pany was recently bought by a larger firm

that wants Nick to start working in the central

office a few days a week. His new boss tells

him he’ll have to attend several weekly meet-

ings. Nick gets anxious about these changes.

What determines whether Nick has a social

phobia, or is just shy and nervous about the

work changes? Explain your answer. If Nick

gets so anxious that he can’t attend the meet-

ings, what would be an appropriate treatment

for him?

Summary of

Specifi c Phobias

Specific phobia involves excessive and ir-

rational anxiety or fear related to a specific

stimulus, and avoidance of the feared stimu-

lus. DSM-IV-TR specifi es fi ve types of specifi c

phobias: animal, natural environment, blood-

injection-injury, situational, and other.

Neurological factors, such as an over-

reactive amygdala and genetics, appear to

contribute to specifi c phobias. Neurotransmit-

ters involved in specifi c phobias include GABA,

serotonin, acetylcholine, and norepinephrine.

Psychological factors that give rise to specifi c

phobias include operant conditioning, pos-

sibly classical conditioning, and cognitive

biases related to the stimulus. Observational

learning—a social factor—can infl uence what

particular stimulus a person comes to fear.

The medication for specifi c phobia is ben-

zodiazepines. However, medication is usually

not necessary because CBT—the treatment

of choice for specifi c phobia—is extremely ef-

fective. CBT—particularly when exposure is

part of the treatment—can work in just one

session.

Thinking like a clinician

Iqbal is horribly afraid of tarantulas, refusing

to enter insect houses at zoos. Do you need

any more information before determining

whether Iqbal has a specifi c phobia of taran-

tulas? If so—what would you need to know?

If not, do you think he has a specifi c phobia?

Explain. How might Iqbal have developed his

fear of tarantulas—what factors are likely

to have been involved in its emergence and

maintenance? Suppose Iqbal decided that he

wants to “get rid of ” his fear of tarantulas.

What treatments are likely to be effective and

what are the advantages and disadvantages

of each?

Summary of Obsessive-

Conversion Disorder

Obsessive-compulsive disorder (OCD) is

marked by persistent and intrusive preoc-

cupations and—in most cases—repetitive

behaviors that usually correspond to the ob-

sessions. Although people with OCD recog-

nize that their obsessions are irrational, they

cannot turn off the preoccupying thoughts;

they feel driven to engage in the compulsive

behaviors, which provide only brief respite

from the obsessions. Common obsessions

include anxiety about contamination, order-

ing, losing control, doubts, and getting rid of

objects. Common compulsions include wash-

ing, order, counting, checking, and hoarding

or collecting.

Neurological factors associated with OCD

include disruptions in the normal activity of

a neural loop among frontal lobes, the thala-

mus, and the basal ganglia such that the fron-

tal lobes do not turn off the neural loop, which

may then lead to the persistent obsessions.

Genes appear to make some people more vul-

nerable to anxiety disorders in general—not

necessarily to OCD specifi cally.

Psychological factors that may underlie

OCD include negative reinforcement of the

compulsive behavior. In addition, normal pre-

occupying thoughts may become obsessions

when the thoughts are deemed “unaccept-

able” and hence require controlling. In turn,

the thoughts lead to anxiety, which is then

relieved by a mental or behavioral ritual. Like

people with other anxiety disorders, people

with OCD have cognitive biases related to

their feared stimuli, in this case, regarding the

theme of their obsessions.

Social factors related to OCD include so-

cially induced stress, which can infl uence the

onset and course of the disorder, and culture,

which can infl uence the particular content of

obsessions and compulsions.

Medication (such as an SSRI or clomip-

ramine) is the treatment for OCD that directly

targets neurological factors. The primary

treatment for OCD—exposure with response

prevention—directly targets psychological

factors. Cognitive restructuring to reduce the

irrationality and frequency of the patient’s in-

trusive thoughts and obsessions may also be

employed. Family education or therapy, tar-

geting social factors, may be used as an ad-

ditional treatment to help the patient’s family

function in a more normal way.

Thinking like a clinician

You visit a new friend. When you use her bath-

room, you notice that all her toiletries seem

very organized. Her kitchen is also neatly or-

dered. The next day, you notice that her class-

work is well-organized—arranged neatly in

color-coded folders and notebooks. You don’t

think twice about it until she drops her open

backpack and all her stuff falls out, spilling all

over the fl oor. She starts to cry. Based on what

you have learned, do you think she has OCD?

Why or why not? If she has OCD, is it because

she has inherited the disorder? Explain your

answer. If she does have OCD, what sorts of

treatments should she consider?

Summary of

Posttraumatic Stress

Disorder

Stress disorders are characterized by three

types of persistent symptoms: reexperienc-

ing of the traumatic event avoidance of stimuli

related to the event, and increased arousal

and anxiety. DSM-IV-TR includes two types

of stress disorder: acute stress disorder and

posttraumatic stress disorder (PTSD). These

two disorders are distinguished in part by the

timing and duration of symptoms. The diag-

nostic criteria for acute stress disorder also

include symptoms of dissociation.

An event is considered traumatic if the

individual experienced or witnessed an ac-

tual or threatened death or serious injury

and responded with intense fear, helpless-

ness, or horror. Interpersonal violence is

more likely to lead to a stress disorder, as

are traumatic events that are severe, of long

duration, and of close proximity. The DSM-

IV-TR diagnosis of PTSD has been criticized

because the defi nition of traumatic stress is

too broad, encompassing normal responses

to trauma, and because the symptoms speci-

fi ed in the criteria overlap with those of other

disorders.