Chapter8 Anxiety Disorders
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Abnormal and Clinical Psychology THIRD EDITION University of Dundee 97800335237463_A01.indd i 2/9/11 3:05:53 PM University of Dundee 97800335237463_A01.indd ii 2/9/11 3:05:54 PM Abnormal and Clinical Psychology AN INTRODUCTORY TEXTBOOK THIRD EDITION University of Dundee Paul Bennett Open University Press Open University Press 97800335237463_A01.indd iii 2/9/11 3:05:54 PM Open University Press McGraw-Hill Education McGraw-Hill House Shoppenhangers Road Maidenhead Berkshire England SL6 2QL email: [email protected] world wide web: www.openup.co.uk and Two Penn Plaza, New York, NY 10121-2289, USA First published 2011 Copyright © Bennett 2011 All rights reserved. Except for the quotation of short passages for the purposes of criticism and review, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher or a licence from the Copyright Licensing Agency Limited. Details of such licences (for reprographic reproduction) may be obtained from the Copyright Licensing Agency Ltd of Saffron House, 6-10 Kirby Street, London, EC1N 8TS. A catalogue record of this book is available from the British Library ISBN-13: 978-0-33-523746-3 ISBN-10: 0-33-523746-0 Library of Congress Cataloging-in-Publication Data CIP data applied for Typeset by Graphicraft Limited, Hong Kong Printed in Italy by Rotolito Lombarda, Italy Fictitious names of companies, products, people, University characters and/or of Dundee data that may be used herein (in case studies or in examples) are not intended to represent any real individual, company, product or event. 97800335237463_A01.indd iv 2/9/11 3:05:55 PM Brief Table of Contents PART 1: BACKGROUND AND METHODS 1 1 Introduction 3 2 The psychological perspective 29 3 New directions in cognitive therapy 58 4 Biological explanations and treatments 79 5 Beyond the individual 105 PART 2: SPECIFIC ISSUES 127 6 Somatoform disorders 129 7 Schizophrenia 157 8 Anxiety disorders 186 9 Mood disorders 218 10 Trauma-related conditions 246 11 Sexual disorders 276 12 Personality disorders 304 13 Eating disorders 334 14 Developmental disorders 359 15 Neurological disorders 390 16 Addictions 414 Glossary 445 Bibliography 448 Index 512 University of Dundee v 97800335237463_A01.indd v 2/9/11 3:05:55 PM Detailed Table of Contents PART 1: BACKGROUND AND Humanistic approaches 50 METHODS 1Models of the individual and 1 Introduction 3 neurosis 50 Concepts of abnormality 4Humanistic therapy 52 Historical overview 5 How effective are the therapies? 54 Somatogenic and psychogenic Meta-analyses 54 perspectives 6 Chapter summary 55 Care in the community 7 For discussion 56 Issues of diagnosis 8 Key terms 56 The medical model 8 Further reading 57 Classifi cation systems 8 Alternatives to the medical model 12 3 New directions in cognitive therapy 58 The aetiology of mental health Is it necessary to change cognitions? 59 problems 18 The third generation of CBT 59 Genetic models 19 The transtheoretical model 60 Biological models 20 The Self-Regulatory Executive Function Psychological models 21 (S-REF) model 62 Socio-cultural models 22 Metacognitive therapy 65 Systemic models 24 Mindfulness and attentional Biopsychosocial models 25 control skills 66 Chapter summary 26 Attention control skills 68 For discussion 27 Metacognitive formulation and Key terms 27 treatment approaches 68 Further reading 28 Relational frames theory 72 Acceptance and commitment 2 The psychological perspective 29 therapy (ACT) 73 The psychoanalytic approach 30 The process of therapy 75 Freud University30 of ChapterDundee summary 77 Freud’s contemporaries and For discussion 78 descendants 34 Further reading 78 The practice of psychoanalysis 35 Behavioural approaches 37 4 Biological explanations and Classical conditioning 37 treatments 79 Operant conditioning 38 The behavioural anatomy of the brain 80 Combining classical and operant Hindbrain, midbrain and forebrain 80 conditioning 38 Cerebrum 81 Behaviour therapy 39 The synapse 83 Classical conditioning-based The neurotransmitters 84 interventions 39 The autonomic nervous system 85 Cognitive approaches 41 Drug therapies 87 Social learning theory 42 Treating depression 87 Emerging clinical models 42 Treating anxiety 90 Cognitive behavioural therapy 43 Treating schizophrenia 91 Experiencing cognitive behavioural Adherence to drug treatments 93 therapy 47 Electroconvulsive therapy (ECT) 97 vi 97800335237463_A01.indd vi 2/9/11 3:05:56 PM DETAILED TABLE OF CONTENTS vii The ECT controversy 98 For discussion 155 Alternatives to ECT 99 Key terms 155 Psychosurgery 100 Further reading 156 Availability of psychosurgery 100 Post-operative effects 101 7 Schizophrenia 157 Chapter summary 102 The nature of schizophrenia 158 For discussion 103 Personal experiences 158 Key terms 103 DSM diagnostic criteria for Further reading 104 schizophrenia 159 Alternative view of the symptoms 160 5 Beyond the individual 105 Deconstructing schizophrenia 161 A systems approach 106 Aetiology of schizophrenia 162 Structural family therapy 107 Genetic factors 162 Strategic family therapy 109 Biological mechanisms 164 How effective is systemic therapy? 111 Substance abuse 167 Psychosocial explanations of mental Psychosocial factors 168 health problems 112 A psychobiological model 169 Socio-economic status 112 Psychological models 170 Gender differences 114 Treatment of schizophrenia 176 Minority status 114 Antipsychotic medication 176 Mental health promotion 115 Electroconvulsive therapy 178 Individual interventions 117 Psychological approaches 179 Using the media 117 Chapter summary 183 Economic interventions 118 For discussion 184 Systemic interventions 118 Key terms 184 Cross-cultural issues 119 Further reading 185 Presentation of problems 119 Seeking help 123 8 Anxiety disorders 186 Chapter summary 124 Simple phobias 186 For discussion 124 Aetiology of phobias 188 Key term 125 Treatment of phobias 191 Further reading 125 Generalized anxiety disorder 192 Aetiology of GAD 193 PART 2: SPECIFIC ISSUES 127 Treatment of generalized anxiety 6 Somatoform disorders University129 of Dundeedisorder 196 Somatization disorder 130 Panic disorder 198 Prevalence of somatization disorder 130 Aetiology of panic disorder 199 Aetiology of somatization disorder 131 Treatment of panic disorder 203 Treatment of somatization disorder 133 Obsessive-compulsive disorder (OCD) 206 Hypochondriasis 134 Aetiology of obsessive-compulsive Prevalence of hypochondriasis 135 disorder 208 Aetiology of hypochondriasis 135 Treatment of obsessive-compulsive Treatment of hypochondriasis 138 disorder 211 Body dysmorphic disorder 142 Chapter summary 215 Aetiology of body dysmorphic For discussion 217 disorder 146 Key term 217 Treatment of body dysmorphic Further reading 217 disorder 147 Conversion disorder 148 9 Mood disorders 218 Aetiology of conversion disorder 149 Major depression 219 Treatment of conversion disorder 153 Aetiology of major depression 219 Chapter summary 154 Treatment of major depression 224 97800335237463_A01.indd vii 2/9/11 3:05:57 PM viii DETAILED TABLE OF CONTENTS Suicide 232 Aetiology of transvestic Aetiology of suicide 232 fetishism 293 Treatment of attempted suicide 234 Treatment of transvestic Seasonal affective disorder (SAD) 235 fetishism 295 Aetiology of seasonal affective Gender identity disorder 295 disorder 236 Aetiology of gender identity Treatment of seasonal affective disorder 296 disorder 237 Treatment of gender identity Bipolar disorder 238 disorder 298 Aetiology of bipolar disorder 239 Chapter summary 301 Treatment of bipolar disorder 241 For discussion 302 Chapter summary 243 Key term 302 For discussion 244 Further reading 303 Key terms 244 Further reading 245 12 Personality disorders 304 Introduction 305 A dimensional approach 306 10 Trauma-related conditions 246 A cognitive model of personality Post-traumatic stress disorder (PTSD) 247 disorders 307 9/11 and PTSD 249 Cluster A diagnoses 308 Aetiology of PTSD 249 Cluster B diagnoses 310 Treatment of post-traumatic stress Borderline personality disorder 310 disorder 256 Aetiology of borderline personality Recovered memory 261 disorder 311 Explanations of recovered memory 262 Treatment of borderline personality Evidence of recovered memory 262 disorder 313 Overview of the evidence 266 Antisocial personality and Dissociative identity disorder (DID) 267 psychopathy 320 Aetiology of DID 268 Aetiology of antisocial personality The battleground of DID 269 and psychopathy 321 Treatment of DID 273 Treatment of antisocial personality 324 Chapter summary 274 Treatment of psychopathy 325 For discussion 275 Cluster C diagnoses 329 Key term 275 Chapter summary 331 Further reading 275 University of ForDundee discussion 332 Further reading 333 11 Sexual disorders 276 Sexual dysfunctions 277 13 Eating disorders 334 Erectile dysfunction 277 Anorexia nervosa 335 Aetiology of erectile dysfunction 277 Bulimia nervosa 336 Treatment of erectile Aetiology of anorexia and bulimia 337 dysfunction 278 Interventions in anorexia 345 Vaginismus 279 Interventions in bulimia 353 Aetiology of vaginismus 280 Chapter summary 357 Treatment of vaginismus 280 For discussion 358 The paraphilias 281 Further reading 358 Paedophilia 281 Modern diagnostic criteria 282 14 Developmental disorders 359 Aetiology of paedophilia 283 Learning diffi culties 360 Treatment of paedophilia 287 Aetiology of learning diffi culties 361 Treatment programmes 288 Social interventions in learning