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Clinical Psychology Anxiety Summary
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Full-book summary: bullet points, simple language, nicely structured! ISBN: 978-0-415-69708-8, Anxiety by Rachmann.
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RL CP SUMMARY 2018 1CP SPECIALIZATION - ANXIETY SUMMARY
Renée Lipka 2018
Chapter 1: The nature of anxiety
- Research growth on anxiety is justified because its one of the most pervasive emotions
> Especially increased after DSM has created a separate category for anxiety disorders
> Total number of disorders in DSM increases with every edition
> DSM is not exclusively scientific but also used for insurance purposes
- DSM was a major advance to chaos before but it implies rear all problems with anxiety are
pathological and indeed mental disorders
- Anxiety disorders single largest mental health problem in US
> Are distressing, disabling and costly
> Can become chronic
> Affected men often unemployed
- Beck: one of the most influential contributions through his focus on cognition
> His theory was initially developed to explain depression but does so even better with
anxiety
- Anxiety is an interplay of vigilance, perception, reasoning and memory (meat of cognitive
processes); many operations take place at unconscious level
- Psychologists have good reason for being interested in anxiety — they are good at it; we have
already found good techniques to treat it
1.1 Defining anxiety
- Anxiety = tense unsettling anticipation; negative affect (feeling); persistent
- Fear = also tension and anticipation but short term, specific focus, triggered, emergency-
quality
> Phobias = intense irrational fears
- Anxiety is not a milder form of fear; is often harder to tolerate
Similarities between fear and anxiety
Elevated arousal
Negative affect
Accompanied by bodily sensations
Uneasiness
,RL CP SUMMARY 2018 2
Fear Anxiety
Specific focus of threat Source of threat is elusive (also cues)
Understandable connection between threat & fear Uncertain connection between anxiety and threat
Episodic (brief) Pervasive uneasiness
Persistent Can be objectless
Circumscribed tension Threat seldom imminent
Identifiable threat Persistent
Provoked by cues Uncertain offset
Declines with removal of threat No clear borders
Emergency quality (also in bodily sensations) Vigilance not emergency reaction
Rational quality Body sensations of vigilance
Puzzling qualities
- Distinctions between the two are easier in theory; the criteria of focus of threat can be blurred in
clinical settings
- There is no distinct transition; anxiety often follows fear, but repeated episodes of anxiety can
generate fears
- When clinicians find the cause of anxiety the definition should change from anxiety to fear —
from unknown source to focussed trigger
- Further confusions stem from the fact that fears/anxiety can be cause by both external cues or
internal threats
- Both are accompanied by shared bodily sensations (muscle tightness, pounding heart), but also
differ in others
> Fear: sweating, dry mouth, trembling
> Anxiety: dizziness, chest pain, faintness
- Other difficulties arise because fear and anxiety as terms are often used interchangeably; or
they violate the definitions (why is it public speaking anxiety when there is a specific focus)
- A common assumption is that anxiety is reducible to fear (and that that is a progressive step
because fear is more manageable) — also contradictory because per definition the two of them
have different foci
- There is no widely accepted definition of anxiety other than its association with arousal and
negative affect; which is also true for fear — but fear can have desirable qualities (roller coaster)
> Arousal is less evident in anxiety than fear
1.2 The nature of fear
- Fears are usually underreported in populations because many of them are socially undesirable
- Feelings of anxiety can be so diffuse and vague that affected people do not recognize them
until someone else draws attention to it
,RL CP SUMMARY 2018 3
- Social influences further obscure the accurate expression of fear (people say they fear
something and then display fearless behavior when encountering)
- Assessments of fear intensity are complicated because they are hard to translate into
statements such as „terrified“ „slightly anxious“
> For this reason we now not only rely on self reports but included physiological changes
and observable behavior
- It is helpful to see fear in three components: subjective dread, physiological changes, and
behavioral attempts to avoid
> They don’t always happen all together
> We often base interpretations on outward cues (e.g. facial expressions) but these are not
always accurate
- Signs of anxiety especially difficult to detect because they tend to be formless, pervasive and
puzzling (even to person themselves)
- Effective treatments to reduce fear lead people to show improvements in behavior (even though
some still deny that they benefitted)
> Physiological reactions can be diminished but people still complain about excessive fear
- Observations of this type led to the conclusion that the components of fear might work in
desynchrony (different rates of change)
> In general people first have decline in physiological reactivity, then improvements in
behavior and finally subjective improvements
> However in CBT subjective improvements can occur easy in the chain
- There is a strong tendency for people to over-predict their fears (think they will be a lot more
frightened in specific situation)
‘Fear is not a hard phenomenal lump’
- Lang: the components of fear are loosely coupled and largely independent
- Veterans in parachute training experienced minimal increases in heart rate, subjective fear and
other measures, whereas novices had extremely string reactions
- Correspondence between measures increases at very high levels of fear and the opposite
extreme (calmness); lack of correspondence between components is most evident during
moderate levels of arousal
- It is best to avoid relying on a single measure
- The main measure (self report) can lead us to overestimate the persons fear & underestimate
their courage
Fear and courage
- Courage = approaching something that elicits high degrees of subjective bodily fear
- Even Langs revised conception doesn’t escape the problem entirely because it doesn’t take
courage into account (uncoupling the components in that the persons behavior advances
beyond subjective discomfort)
, RL CP SUMMARY 2018 4
Chapter 2: Fear, anxiety, and avoidance
- Mowrer: fear is a decisive factor in avoidance behavior
> Says that fear is best explained as a conditioned reaction to pain and that the motivating
quality of anxiety is of central importance — it energizes behavior
> In any behavior leading to reduction of anxiety, exactly this reduction acts as
reinforcement
> Shifted the emphasis from cause of fear to its motivating qualities
> Later incorporated into two-stage theory (fear is acquired through conditioning; cues
evoke fear; and followed by response that reduces fear)
- Panic disorder: causal connection between episodes of intense fear (panic) and emergence of
excessive avoidance behavior
- In animals there is also a direct connection between fear and avoidance
- But there is also exceptions where panics are not followed by avoidance or fears giving rise to
approach
2.1 The persistence of avoidance
- Problem 1: avoidance is remarkably persistent even though it should decrease in absence of
repeated unpleasant experiences (according to two-stage theory)
> Due to the elusiveness of the unconditioned stimuli (difficult to specify which stimulus
exactly the person should be avoiding)
- Problem 2: two-stage theory assumes all fears to have started with conditioning and that all
stimuli are equally likely to turn into fear-signals but thats untrue
- Problem 3: Harlow criticizes two-stage theory for exaggerating the motivating role of fear in
conditioning behavior
- Seligman: Mowrers construction of fear is driven by the past; actions are not only determined
by past events but also a lot by positive aims and thoughts about the future
- Mowrers claim that fear is an essential causal stage in the development of avoidance behavior
is not correct
- Panic frequency or length of panic history are not the major determinants of avoidance
behavior but anticipation of panic is the strongest predictor
2.2 The golden rule
- Doctors acted in accordance to two-stage theory and advised patients not to avoid because
they would risk increasing fear and avoidance
- Golden rule: try to not leave the situation until the fear is going down
- Rachmann: half of the participants used golden rule, others were told to escape asap
> Both groups made slight progress
> People in the escape group did not show increased fear or avoidance afterwards
(contrary to two-stage predictions)
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