Table Of ContentMastering Anxiety
The Nature and Treatment
of Anxious Conditions
Mastering Anxiety
The Nature and Treatment
of Anxious Conditions
Ronald A. Kleinknecht, Ph.D.
Western Washington University
Bellingham, Washington
Springer Science+ Business Media, LLC
Library of Congress Catalog1ng-1n-Pub11cat1on Data
Kleinknecht, Ronald A. <Ronald Arthur>
Mastering anxiety : the nature and treatment cf anxious conditions
Ronald A. Kleinknecht.
p. em.
''Insight book."
Includes bibliographical references ana index.
ISBN 978-0-306-43769-4
1. Anxiety. 2. Pan1c disorders. I. Title.
[ONLM: 1. Anxiety. 2. Ani ety 01 sorders. 3. Anxiety Disorders
-therapy. WM 172 K64ml
RC531.K544 1991
616.85'223--dc20
DNLM/DLC
for Ltbrary of Congress 91-2218
CIP
ISBN 978-0-306-43769-4 ISBN 978-1-4899-7319-1 (eBook)
DOI 10.1007/978-1-4899-7319-1
© 1991 Springer Science+B usiness Media New York
Originally published by Plenum Press, New York in 1991
Softcover reprint of the hardcover 1st edition 1991
An Insight Book
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Preface
Anxiety, fears, phobias, and panics are the most prevalent psy
chological disturbances in our society today. Greater than 12
percent of the adult population in the United States is so ad
versely affected by these emotions as to qualify for a psychiatric
diagnosis of anxiety disorders. An additional 10 percent experi
ence distressingly high levels of anxiety that interfere with their
daily lives, although not severe enough to qualify for diagnosis.
The vast majority of the remaining population, adults and chil
dren alike, frequently experience some form of fear or anxiety, if
only on a milder or more transient basis. Clearly, anxiety and its
disorders have personal meaning for everybody.
Although the conditions of anxiety and phobias have been
observed and described for thousands of years, detailed analysis
and scientific understanding of these conditions are of relatively
recent origin. To a large extent, Sigmund Freud's writings and
theories, at the turn of the century, stimulated the current in
terest in the causes and treatments of anxiety. Although new
theories have replaced Freud's, it was from these early begin
nings, and particularly over the past 30 years, that our under
standing of fears, phobias, and anxiety has increased dramat
ically. Although we have made significant advances in
understanding and treating anxiety-related disorders, much re
mains to be learned.
v
vi PREFACE
The purpose of this book is to provide a broad overview of
this vast and important area of human emotion. In my survey, I
describe the nature of anxiety as an emotion that sometimes
serves us well whereas at other times, it imprisons us. My inten
tion in this book is to facilitate an understanding of the nature of
anxiety, the forms it takes when it becomes a problem, and the
methods found effective in treating the problem. Although this
book does not provide a prescription for self-treatment, it may
help some people to understand the sources and forms that
their anxiety has taken. If you find while reading that the il
lustrative case histories seem to match closely your own experi
ences, rest assured that you are in good company, as greater
than 20 million others in the United States alone also fit these
descriptions. Notable celebrities who have had anxiety disorders
include Carly Simon (agoraphobia), John Madden (fear of fly
ing), and Howard Hughes (obsessive-compulsive disorder).
In the first chapter, I review historical accounts and the
linguistic roots of terms pertaining to anxiety, describe the core
elements of anxiety, and briefly define the various conditions
referred to as anxiety disorders. In the second chapter, I examine
the biological and psychological roots of anxiety and then de
scribe evolutionary and genetic contributions to anxiety in
human beings and in animals, followed by a discussion of the
psychological processes that build on the biological foundations.
The psychological processes include classical conditioning and
learning. Also described are the rudiments of Freud's theory and
some current variants of existential theory pertaining to anxiety.
Chapter 3 begins with a presentation of the population
prevalence of anxiety and anxiety disorders and how they vary
by age and gender. The diagnostic process is discussed next and
a variety of methods are presented that are used in measuring
and assessing fears and anxiety states.
In Chapters 4, 5, and 6, I present detailed illustrations of the
specific anxiety disorders. Chapter 4 contains my description of
the simple or specific phobias-those intense fears of specific
objects or situations-and the social phobias-those involving
fear and anxiety associated with other individuals. In Chapter 5,
PREFACE vii
I deal with panic disorder and its frequent result, agoraphobia,
the fear of going or being out alone. Chapter 6 begins with a
description of posttraumatic stress disorder, in which I survey
the anxiety condition that affects individuals who have been
exposed to extraordinary traumas. Generalized anxiety disorder,
the condition in which a person is constantly keyed up, always
on edge, and chronically nervous, is also discussed in Chapter
6. The final condition to be illustrated in Chapter 6 is obsessive
compulsive disorder, in which uncontrollable thoughts and re
petitive behavioral rituals seem to take charge of a person's
mind and body.
Anxiety disorders of childhood are described in Chapter 7
and include over-anxious disorders, avoidant disorder, and sep
aration anxiety disorder. Since the other anxiety disorders de
scribed in the preceding chapters can also occur in children,
several childhood cases of these conditions are illustrated as
well.
In the final three chapters, I describe treatments for the
anxiety disorders. Chapter 8 focuses on several psychological
treatment procedures that have proven highly effective in treat
ing these anxiety conditions. In some instances, as with the
simple phobias, these procedures can approach 100 percent ef
fectiveness. Chapter 9 has several case studies in which the
treatment procedures previously outlined are used to overcome
the anxiety disorders. The final chapter I devote to a description
of how psychiatric drugs work and list those drugs most com
monly used in treating the anxiety disorders, along with their
potential side effects.
All names and other identifying information concerning the
illustrative cases have been fictionalized. Some examples are
drawn from case studies that are published in professional jour
nals, whereas others are composites of cases taken from my own
research and treatment of anxiety disorders over the past 25
years.
R.A.K.
Contents
1. AN INTRODUCTION TO ANXIETY 1
Origins of the Terms Anxiety, Fear, and Panic 4
Anxiety in Ancient Myths 5
Fear or Anxiety? 6
Freud's Concept of Anxiety 7
What Are Fear and Anxiety? 8
The Components of Fear and Anxiety 9
Cognitive Component 10
Physiological Component 11
Overt Behavioral Component 14
Interactions of the Three Components 14
What Determines if Anxiety Is Normal
or Abnormal? 15
Frequency of Occurrence 16
Chronicity 16
Rationality 17
Control over Reaction 17
Life Disruption and Avoidance 18
The Anxiety Disorders: A Brief Sketch 20
Summary and Conclusions 22
References 22
2. THE RoOTs OF ANXIETY 25
Biological Origins: Animal Data 26
"Wired-In" Fear Behavior Patterns 26
Genetic Transmission of Fear 29
ix
X CONTENTS
Biological Origins: Human Data 30
Learning and Conditioning Origins 36
Classical Conditioning 37
Vicarious and Informational Sources 41
Biology and Conditioning: Prepared Fears 43
Psychodynamic and Existential/ Analytic Views 45
Freud and Anxiety 46
An Existential View 49
Summary and Conclusions 51
References 52
3. THE PREVALENCE, ASSESSMENT, AND DIAGNOSIS
OF ANXIETY DISORDERS 55
Prevalence of Fears 55
Age Distribution 57
Persistence of Fears 59
Gender Distribution 60
Assessment and Diagnosis of Anxiety Disorders 64
Anxiety Disorder Diagnosis 65
The Cognitive/Subjective Component 66
The Physiological Component 75
The Behavioral Component 78
Summary and Conclusions 81
References 82
4. SIMPLE AND SOCIAL PHOBIA 87
Simple/Specific Phobias 88
Animal Phobias 91
Blood, Injury, and lllness Phobias 94
Natural Phenomena Phobias 101
Social Phobias 103
Cross-Cultural Variations 107
Summary and Conclusions 109
References 110
5. PANIC DISORDER AND AGORAPHOBIA 113
Panic Disorder 113
Prevalence of Panic Attacks 115
Panic Disorder Diagnosis 115
Types of Panic Attacks 117
CONTENTS xi
Where Do They Occur? 118
Who Has Panic Disorder? 119
Agoraphobia 120
Progression from Panic to Agoraphobia 122
Associated Problems of Panic and Agoraphobia 123
Stress Antecedents to Onset of Panic and
Agoraphobia 125
Theories of Panic and Agoraphobia Onset 125
The Neuroanatomical Basis for Panic Disorder 126
A Biopsychosocial Theory of Panic and
Agoraphobia 130
Summary and Conclusions 136
References 137
6. POSTTRAUMATIC STRESS, GENERALIZED ANXIETY,
AND OBSESSIVE-COMPULSIVE DISORDERS 141
Posttraumatic Stress Disorder 141
Symptoms of PTSD 142
Who Gets PTSD? 144
A Cognitive Theory of PTSD 147
Generalized Anxiety Disorder 148
Defining Symptoms 148
Prevalence and Onset 149
Obsessive-Compulsive Disorder 151
Obsessions 151
Compulsions 154
Prevalence and Onset of OCD 158
Theories of Obsessive-Compulsive Disorder 159
References 163
7. CHILDHOOD AND ADOLESCENT ANXIETY
DISORDERS 167
Specific Childhood Anxiety Disorders 168
Overanxious Disorder 168
Avoidant Disorder 170
Separation Anxiety Disorder and School Phobia 171
Prevalence of Specific Childhood Anxiety
Disorders 174
Anxiety Disorders in Children 175
Simple Phobia in Children 175
