ANXIETY Second Edition Anxiety Second Edition S. Rachman University of British Columbia, Canada Firsteditionpublished1998byPsychologyPressLtd Secondeditionpublished2004byPsychologyPressLtd 27ChurchRoad,Hove,EastSussex,BN32FA www.psypress.co.uk SimultaneouslypublishedintheUSAandCanada byTaylor&FrancisInc., 270MadisonAvenue,NewYork,NY10016 This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” PsychologyPressispartofT&FInformaplc Copyright(cid:216)2004PsychologyPressLtd CoverdesignbyJimWilkie Allrightsreserved.Nopartofthisbookmaybereprintedor reproducedorutilisedinanyformorbyanyelectronic, mechanical,orothermeans,nowknownorhereafterinvented, includingphotocopyingandrecording,orinanyinformation storageorretrievalsystem,withoutpermissioninwritingfrom thepublishers. BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressCataloging-in-PublicationData Rachman,Stanley. Anxiety/S.Rachman.– 2nded. p.cm. – (Clinicalpsychology,amodularcourse,ISSN 1368-454X) Includesbibliographicalreferencesandindex. ISBN1-84169-515-7(hardback:alk.paper) – ISBN1-84169-516-5(pbk. :alk.paper) 1.Anxiety.I.Title.II.Series. RC531.R3342004 616.85'22–dc22 2004001276 ISBN 0-203-49094-0 Master e-book ISBN ISBN 0-203-59540-8 (Adobe eReader Format) ISBN1-84169-515-7(hbk) ISBN1-84169-516-5(pbk) ISSN1368-454X(ClinicalPsychology:AModularCourse) Contents Series preface vii Preface ix 1 The nature of anxiety 1 Defining anxiety 3 The nature of fear 8 Fear, anxiety, and avoidance 12 Varieties of fear 19 The concept of anxiety disorders 24 Summary 26 2 Influences on anxiety 27 A model of anxiety 27 Anxiety, attention, perception, and memory 37 Anxiety and memory 47 Emotional processing 53 Affect and cognition 55 Summary 58 3 Theories of anxiety 61 Anxiety as the product of learning 61 Cognitive analyses of anxiety 67 Psychoanalytical explanations 69 Biological theories of anxiety 73 Summary 76 4 Specific phobias and the conditioning theory of fear 79 Evidence for the conditioning theory 79 The conditioning theory: Contrary evidence and arguments 84 Neoconditioning theory 89 Specific phobias 92 Summary 93 CONTENTS v 5 Panic and anxiety 95 The experience of panic 99 The incidence of panic 100 The debate about panic 101 Treatment 119 Summary 122 6 Agoraphobia 123 Treatment 127 Summary 128 7 Obsessions and compulsions 129 Types of compulsive behaviour 135 Persistence 136 Obsessions 140 Compulsive hoarding 143 Relationship to anxiety 143 Treatment 143 Summary 145 8 Social anxiety 147 The definition of social anxiety 147 Cognitive theory of social anxiety 150 Social anxiety within the general framework of anxiety 156 Treatment 157 Summary 159 9 Generalized anxiety disorder (GAD) 161 The search for safety 164 Treatment 166 Summary 167 10 Post-traumatic stress disorder (PTSD) 169 Explanations for PTSD 171 Acute stress disorder (ASD) 179 Summary 180 Appendix 181 Suggested reading 183 References 185 Author index 201 Subject index 207 vi ANXIETY Series preface Clinical Psychology: A Modular Course was designed to overcome the problemsfacedbythetraditionaltextbookinconveyingwhatpsycho- logicaldisordersarereallylike.Allthebooksintheseries,writtenby leading scholars and practitioners in the field, can be read as stand- alonetext,buttheywillalsointegratewiththeothermodulestoforma comprehensive resource in clinical psychology. Students of psychol- ogy,medicine,nursing,andsocialwork,aswellasbusypractitioners in many professions, often need an accessible but thorough intro- duction to how people experience anxiety, depression, addiction, or otherdisorders,howcommontheyare,andwhoismostlikelytosuffer fromthem,aswellasup-to-dateresearchevidenceonthecausesand available treatments. The series will appeal to those who want to go deeper into the subject than the traditional textbook will allow, and base their examination answers, research projects, assignments, or practicaldecisionsonaclearerandmoreroundedappreciationofthe clinicalandresearchevidence. Chris R. Brewin Other titles in this series: Depression Constance Hammen Stress and Trauma Patricia A. Resick Childhood Disorders Philip C Kendall SERIES PREFACE vii Schizophrenia Max Birchwood and Chris Jackson Addictions Maree Teesson, Louise Degenhardt and Wayne Hall viii ANXIETY Preface Surging advances in the understanding and treatment of anxiety disordershavemadeitnecessarytoreviseandexpandthisbook.Signs of impending change were evident in the research described in the first edition but the progress made in the past 6 years has exceeded expectations.Atleast 12newtheories ofpsychopathologyhavebeen publishedinthisperiod,and7ofthemdealwiththeanxietydisorders. Some of them are causal theories—unusual in clinical psychology— and all of them incorporate cognitive concepts. The theories are becoming increasingly specific and most provide platforms for the derivationofequallyspecificmethodsoftreatment.Theevaluationof theories and treatments is an unavoidably lengthy and demanding process and definitive conclusions about particular theories, and the generalpatternofthesedevelopments,issomewayoff. The basic science deals with the psychology of anxiety but the current emphasis on applied science, on the nature and treatment of disordersofanxiety,overshadowsthebasicresearch.Thepreoccupa- tion with anxiety disorders, and the pressures to master these dis- tressingproblems,areunderstandablebuttheyhavetiltedthebalance frombasictoappliedresearch.However,theinterplaybetweenbasic andappliedresearchisatwo-wayprocessthatbenefitsboth.Advances inunderstandingthephenomenaandmechanismsofanxietydisorders help to illuminate fundamental psychological processes. The expan- sionofunderstandingoftheemotionoffearwaslargelytheresultof clinicalresearch.Anexcellentexampleoftheinterplayisnowtaking placeincurrentanalysesoftheintriguingdisturbancesofmemorythat aresoconspicuousinPTSD.Intensivestudiesoftheclinicalphenom- ena have already begun to expand our conceptions of basic memory processes. S. Rachman, Vancouver, 2003 PREFACE ix