Models of Understanding Anxiety Disorders

Hello, and welcome back to Module 3, anxiety disorders.

This is Lecture 3,

models of understanding anxiety disorders.

Scientists and theoreticians have applied

a variety of models to specific anxiety disorders.

For example, there's a biological model of OCD,

as well a psychodynamic model of OCD.

In this lecture, we will not be covering all of

the models used to understand

each of the anxiety disorders.

Rather, we will discuss

the major models in use to understand anxiety disorders

in general and include a few cases

specific to particular anxiety disorders.

You will probably not be surprised to learn there is

a great deal of evidence for

the biological basis of anxiety.

Genetic research has shown that many genes appear to

contribute to a tendency to experience excessive anxiety.

These genes are turned on or activated by

situational stress and other environmental factors.

Twin studies and family studies have also yielded

a great deal of evidence for

the heritability of anxiety disorders.

Research into brain involvement and

anxiety has shown that overactivity

in specific brain circuits can create anxiety disorders.

Recall from module 1,

that the term brain circuit refers to

several brain structures that work together.

When one structure in a circuit is activated,

the rest are activated as a result.

Scientists have found specific brain circuits

are linked to particular anxiety disorders.

One such circuit is known as the fear circuit,

and it consists of the amygdala,

the prefrontal cortex, the

anterior cingulate cortex, and the insula.

The fear circuit has been found to be overactive

in people diagnosed with general anxiety disorder.

The primary neurotransmitter found in the fear circuit

is Gamma aminobutyric acid or GABA.

When present, GABA inhibits

the activity of the fear circuit.

Researchers believe that people who struggle with

generalized anxiety disorder have low levels of GABA,

which leads to hyperactivity of the fear circuit.

The panic circuit is another group of structures in

the brain believed responsible for panic episodes.

The panic circuit also includes the amygdala,

highlighting the importance of

this structure and the experience of anxiety,

as well as several other structures.

Research indicates the amygdala initiates

the fear response and then

activates the rest of the structures in the circuit,

which then create the escape impulse,

which includes elevated heart rate,

blood pressure, and respirations.

An overactive panic circuit

has been linked to panic disorder.

Twin studies have demonstrated

a genetic link to overactive panic circuits.

The last brain circuit we will

consider is related to OCD.

Interestingly, this circuit is made up of

completely different structures from those

involved in either GAD or panic disorder.

This circuit appears to regulate

our impulses regarding sexual desire,

aggression, and the need to excrete.

Research indicates a high level of activity in

the circuit leads to difficulty

ignoring or managing impulses,

needs, and thoughts related to the impulses.

This overactivity is believed to be associated with OCD.

Clearly, the research into

the biological basis of anxiety disorders is complex,

particularly because the research has focused

not only on the biological basis of anxiety in general,

but also on the biological basis

of specific anxiety disorders.

We've really only scratched the surface here.

There's abundant research evidence that

the vulnerability to

anxiety disorders is genetically inherited,

and that multiple brain structures and

neurotransmitters play major roles

in various anxiety disorders.

Let us now turn to

another major model of understanding anxiety disorders,

the cognitive behavioral model.

Besides the biological model,

the cognitive behavioral model has received

a great deal of research and theoretical support.

Similar to the biological model,

research has investigated how

the cognitive behavioral model

applies to specific anxiety disorders.

In this discussion, we will consider how CBT

has been used to understand anxiety disorders in general,

and we will cite a few examples

involving specific disorders as illustration.

Recall from Module 1,

the proponents of cognitive behavioral theory

attest that psychological disorders

occur when people develop

rigid maladaptive thought patterns that have

predictable negative impacts on

their emotions and behavior.

This theory has been successfully

applied to a variety of anxiety disorders.

In all cases, CBT asserts that a person with

an anxiety disorder holds

maladaptive or irrational beliefs about self,

world, and future that cause

excessive anxiety as well as problematic behavior.

Albert Ellis, one of

the best-known cognitive-behavioral theorists,

referred to these thought patterns

as basic irrational assumptions.

Examples of basic irrational assumptions

might be the thoughts,

I must be loved and admired by

everyone I meet in order to feel accepted,

and I must achieve at

the highest possible level

all the time or else I'm a failure.

Ellis went on to assert that

when a person with an irrational assumption

experiences a stressful event such as

a social rejection or a failing grade on an exam,

they experience this event in an intense,

catastrophic way, and they feel extreme anxiety.

If these stressful situations recur,

they're likely to develop an anxiety disorder

characterized by both intense feelings of anxiety,

worry, fear in particular situations,

accompanied by efforts to avoid

the situation that is producing this response.

This avoidance is the behavioral component

of the anxiety disorder.

Let's consider how cognitive-behavioral theory may

apply to two of

the anxiety disorders we've discussed so far.

First, let's think about the person

who has the basic irrational assumption,

I must be loved and admired by everyone I know

in order to feel accepted and worthwhile as a person.

Imagine this person is having a conversation with

a few acquaintances about

a movie they've all recently seen.

The person talks about how much they enjoyed the movie,

and an acquaintance laughs and

responds they thought the movie was so terrible,

they couldn't sit through it,

so they left the theater after 30 minutes.

The other people in the group laugh and they

agree they thought the movie was terrible too.

According to CBT, how does this person respond?

This model predicts the person will respond with

acute emotional distress that's characterized

by an intense feeling of

social rejection and humiliation.

The person is now extremely sensitive

to feeling ridiculed or rejected,

and begins to experience

the same intense emotional response in

social situations when they believe

someone is negatively evaluating them in

some way even if

this negative evaluation is not evident to other people.

They now begin to worry excessively

about the recurrence of social rejection.

They feel so much anxiety in

social situations that they

stop contributing to conversations.

Eventually, they begin

avoiding social situations altogether,

turning down invitations to parties or

meals with everyone except the people closest to them.

As long as they're able to avoid social situations,

their anxiety is under control.

When they cannot avoid them,

their anxiety overwhelms them,

and it may be apparent to others through blushing,

shaking, stuttering,

or other overt indications of distress.

At this point, the person has

developed social anxiety disorder.

Let's consider another example.

In this case, a person has

the basic irrational assumption,

an unusual physical symptom

means there's something terribly wrong with me.

In this case, the irrational assumption

leads the person to become very

sensitized to what is going on in

their bodies and all the physical sensations that occur.

When they have a physical experience

that's out of ordinary,

such as increased heart rate, they immediately think,

I'm having a heart attack, or

I'm going to lose consciousness.

This catastrophic thought creates

an intense panic response

that may lead to the person avoiding

any physical activity that leads to

increased heart rate as well as avoiding

public situations or events in which they fear

people will see them lose control or lose consciousness.

Over time, they may develop

a full-blown panic disorder with agoraphobia.

As with biological models,

we've barely scratched the surface of

the cognitive-behavioral model of anxiety disorders.

I hope this brief discussion has helped to illustrate how

cognitive-behavioral theorists believe

rigid irrational thought patterns

drive the intense worry,

fear, and anxiety as well as

the behavioral aspects of various anxiety disorders.

Which is correct, the biological

model or the cognitive-behavioral model?

Most theorists today utilize

an integrative approach that blends both theories.

It's generally believed that some people possess

biological or genetic vulnerabilities to experiences of

intense anxiety manifested through hyperactivity of

certain brain circuits or

low levels of particular neurotransmitters.

This physiological vulnerability then

interacts with experiences they have as they grow up,

including what is taught to them by

their primary caregivers and other ways

in which they see other people behaving and responding.

In this way, they develop

irrational assumptions which interact with

stressful situations to activate

their physiological vulnerability for excessive anxiety.

In short, it is not either/or, it's both.

While there are other models that have been used to

explain the development of anxiety disorders,

such as the psychodynamic and humanistic models,

those are not the leading models in use today.

In the next lecture,

we will discuss treatment interventions

used for anxiety disorders.