Psychology
Anxiety…
Consider how these factors might work together to contribute to an anxiety disorder:
• Genetics
• Sensitive fear pathways
• Attention to threat cues
• Classical conditioning
• Societal/cultural expectations
• Family modeling of anxiety
• Stressful life events
• Sense of lack of control
you can use your creativity and apply these to specific examples. You also can consider the case of Agnes posted on the course website; the case of Bob presented in lecture (who had a fear of flying; see “Causes of Abnormal Behavior” topic); or the case of Anne (mentioned in lecture from the book Dying of Embarrassment: a 7th grader with writer’s block and test-taking anxiety; Anne knows the material when her mother quizzes her at home, but when she gets to school and goes to take the test, she freezes and her mind goes blank. One specific outcome of her anxiety is that she ends up with ‘C’ grades rather than ‘A’ grades.) Again, how might some of the above factors work together to cause and perpetuate Agnes’s, Bob’s, and/or Anne’s anxiety?
The Case of Agnes
Agnes is a thin, reasonably attractive 43-yearold white female who was brought to the community mental health center in the eastern seaboard city in which she lived. Her 22-yearold daughter brought her in, stating that Agnes was driving her crazy with requests that she accompany her everywhere. Agnes reports that she has always been a “tense” person, has experienced agoraphobic ‘symptoms off and on during the last seven years, but the intensity has increased substantially in the last six months. For the past four years, Agnes has also suffered with what she refers to as “heart disease.” She has often taken herself to a cardiologist, complaining of rapid or irregular heartbeats. The physician always reassured her that he saw no pathology and believed that it was probably a result of anxiety and tension. He advised her to exercise regularly and prescribed tranquilizers for any severe episodes of anxiety. Agnes occasionally uses the tranquilizers, but not to any significant extent. It is interesting that she has never experienced any of the symptoms at home, even though she does rather heavy housework without any assistance. The agoraphobic pattern took a severe turn for the worse six months ago during the middle of winter, while Agnes was visiting her daughter. Her daughter had taken her own child to a movie, leaving Agnes alone in their home. There had been a severe snowstorm the day before. It was difficult for cars to get about, and Agnes became fearful that she was isolated. She tried to call her sister, who lives in a nearby city, only to find that the phone was dead. At this point, Agnes began to panic, noticed her heart beating rapidly, and thought she was going to have a heart attack. When Agnes’s daughter eventually came home after the movie and some shopping, Agnes was extremely distraught. She was lying on the couch, crying and moaning, and had started to drink to try to lose consciousness. After her daughter returned, Agnes continued to drink, and with the added reassurance of her daughter, she managed to fall asleep. When she awakened, she felt better and refused to seek help for her fears. In the last six months, she has had other similar experiences of near panic at the thought of being alone. Agnes’s husband, who is a sales representative for a national manufacturing company, spends a lot of time on the road. When he is home, he is no longer willing to listen to Agnes’s complaints. But the problem is not as apparent then, since Agnes relaxes considerably when her husband accompanies her on outings. Even though she can acknowledge that her behaviors are absurd and not warranted by demands in her environment, Agnes is still compelled to perform within this pattern. As is often the case with agoraphobia, Agnes shows an accompanying level of depression, since she has a sense of helplessness about controlling the events of her world. In that sense, she reflects the phenomenon referred to as “learned helplessness.” Agnes did not have a difficult or 37 unhappy childhood. Her father was very authoritarian and discouraged rebellion in his children, although he was otherwise warm and affectionate with them. He had a moderate drinking problem and was particularly prone to whip Agnes’s older brother when he was intoxicated. This older brother was the one family member who was overtly rebellious and independent. Her mother was passive and submissive and manifested mild agoraphobia herself, although she would never have been allowed to seek professional help for her condition. Throughout her school years, Agnes was described as a “good student” and “teacher’s pet.” She had one or two girlfriends with whom she could talk about her worries, but she was not active socially. She did not participate in school activities and was not very outgoing with other students. Because Agnes was somewhat plain in appearance, she was not “pulled out” of her withdrawal by any males who might have shown some interest. When free of school and schoolwork, she assisted her mother in domestic duties. Following high school graduation, Agnes took a job as a secretary with hopes of saving money for college. She did not make enough at first and had to remain at home. When she was 20 years old, she met her future husband at a church gathering, and they were married within the year. She continued her work as a secretary in order to help him finish his last year of college. Her husband was stable and undemonstrative and, like her father, a bit authoritarian. Agnes thus found it easy to become passive and dependent in response to him. She continued to long for a college degree but never made any real efforts to pursue it. After the birth of her daughter, she had another pregnancy, which ended in a miscarriage. This upset her so much that she refused to think of becoming pregnant again. Throughout the early years of her marriage, Agnes was stable in her functioning and only occasionally showed nervousness or anxiety. Yet, as noted, she has shown increased problems in recent years.