Intro to mental health - Unit 2

Anxiety (ch. 6), Mood and Suicide (ch. 7), Schizophrenia (ch. 13)

Anxiety

A general feeling of apprehension about possible future danger.

Fear

An alarm reaction that occurs in response to immediate danger.

T or F: Fear is a basic human emotion, shared by many animals.

T

What emotion involves the activation of the “fight or flight” response of the autonomic nervous system?

Fear

Panic Attack

When the fear response occurs in the absence of an obvious external danger.

What feelings often accompany a panic attack?

Subjective sense of impending doom, fears of dying, going crazy, or losing control.

Anxiety response pattern is a complex blend of what?

Unpleasant emotions and cognitions.

T or F: Anxiety has cognitive/subjective, psychological, and behavioral components.

True

Many sources of fear and anxiety are what?

Learned

T or F: Basic fear and anxiety response patterns are not conditionable.

False

Cognitive/subjective component of fear.

“I am in danger”

Cognitive/subjective component of anxiety.

“I am worried about what might happen”

Physiological component of fear.

Increased heart rate, sweating.

Physiological component of anxiety.

Tension, chronic overarousal.

Behavioral component of fear.

Desire to escape or run.

Behavioral component of anxiety.

General avoidance.

Anxiety disorders are characterized by…

Unrealistic, irrational fears or anxieties that cause significant distress and/or impairments.

What are the five anxiety disorders recognized in the DSM-5.

-Specific phobia

-Social anxiety disorder (social phobia)

-Panic disorder

-Agoraphobia

-Generalized anxiety disorder

Commonalities across anxiety disorders include…

-Genetics

-Classical conditioning

-Neuroticism

-The brain structures most commonly involved are generally in the limbic system

-The most common neurotransmitters involved are GABA, norepinephrine, and serotonin

-People who feel they are out of control over their environment and their emotions are more vulnerable

-Sociocultural environment in which people are raised

Commonalities across effective anxiety disorder treatments include…

-Graduated exposure to feared cues, objects, or situations is the single most powerful treatment

-Cognitive restructuring

-Medications can be effective in treating all disorders except phobias

Phobia

A persistent and disproportionate fear of some specific object or situation that presents little or no actual danger and yet leads to a great deal of avoidance of those feared situations.

Specific Phobia

Strong/persistent fear, triggered by the presence of a specific object or situation, leads to significant distress and/or impairment in a persons ability to function.

Specific phobia: blood-injection-injury phobia

Typically experience as much disgust as fear, show a unique physiological response when confronted with the sight of blood or injury, initial hear acceleration is followed by a dramatic drop in heart rate and blood pressure.

Specific phobia: Animal (examples)

Snakes, spiders, dogs, insects, birds.

Specific phobia: Natural Environment (examples)

Storms, heights, water.

Specific phobia: Situational (examples)

Public transport, tunnels, bridges, elevators, flying, driving, enclosed spaces.

Specific phobia: Other (examples)

Choking, vomiting, “space phobia” (fear of falling down if away from walls or other support).

Prevalence of specific phobias.

Common, occurring in about 12% during their lifetime.

Gender differences of specific phobias.

More common in women than men.

Types of phobias that usually begin in childhood.

Animal, dental, and blood-injection-injury phobias.

Types of phobias that tend to begin in early adolescence/early childhood.

Other phobias (ex. claustrophobia, driving phobias)

Psychoanalytic viewpoint of specific phobias

Phobias represent a defense against anxiety that stems from repressed impulses from the id.

Too dangerous to “know” the repressed id impulse.

Anxiety is displaced onto some external object or situation that has some symbolic relationship to the real object of anxiety.

Phobias as learned behavior.

With classical conditioning, a fear response can be conditioned to previously neutral stimuli when paired with traumatic/painful events.

Vicarious conditioning: phobias as learned behavior.

Observing a phobic person behaving fearfully with their phobic object.

Can result in fear being transmitted from one person to another.

Specific phobias: individual differences in learning.

Differences in life experiences strongly affect whether conditioned fears or phobias develop (some life experiences may serve as risk factors, other experiences may serve as protective factors)

Our thoughts help maintain our phobias once they have been acquired

Specific phobias: evolutionary preparedness for learning certain fears and phobias.

When primates and humans are evolutionarily prepared to associate certain objects with frightening events (prepared learning).

Specific phobias: biological casual factors.

Genetic and temperamental variables also affect the speed and strength of the conditioning of the fear.

Several behavior genetic studies also suggest a modest genetic contribution.

T or F: Large twin studies show that identical twins are not likely to share animal phobias than situational phobias than nonidentical twins.

False

Specific phobias: treatments

Exposure therapy

Participant modeling

Medication

Exposure therapy

A form of behavior therapy that involves controlled exposure to the stimuli that elicit phobic fear.

Participant modeling

The therapist calmly models ways of interacting with the phobic stimulus or situation.

T or F: Medication treatments for specific phobias are ineffective by themselves.

True

Social anxiety disorder (social phobia)

Characterized by disabling fears of 1 or more specific social situations. Underlying fear of exposure to scrutiny and potential negative evaluation by others.

Subtypes of social anxiety disorder

Performance (ex. public speaking), nonperformance (ex. eating in public)

Prevalence of social anxiety disorder

About 12 percent of the population meets the diagnostic criteria at some point in their lives.

Age of onset of social anxiety disorder

Typically begins in adolescence or early adulthood.

Gender differences of social anxiety disorder.

More common in women (although may be more likely to seek help and men are under reported)

T or F: Social anxiety disorder is often present along with other anxiety disorders and/or use of alcohol to cope with social situations.

True

Social Anxiety as learned behavior

Originates from direct or vicarious classical conditioning

Social anxiety as learned behavior (examples)

Being or witnessing someone else being a target of anger or criticism.

Experiencing or witnessing a perceived social defeat or humiliation.

Social fears and phobia in an evolutionary context.

Evolutionary based predisposition to acquire fears of social stimuli that signal dominance/aggression from other humans. Such as facial expressions for anger or contempt.

T or F: Social fears and phobia evolved as a by-product of dominance hierarchies among primates.

True

Perceptions of uncontrollability and unpredictability in social anxiety disorder.

Lead to submissive and unassertive behavior.

Especially likely if the person has experienced an actual social defeat.

Diminished sense of personal control may have developed in part due to somewhat overprotective parents.

Cognitive biases of social anxiety disorder

People tend to expect that other people will reject or negatively evaluate them.

T or F: individuals with social anxiety do not become occupied with bodily responses and negative self-images in social situations.

False

Biological casual factors of social anxiety disorder.

The most important temperamental variable is behavior inhibition

Children assessed as being high on behavioral inhibition between ages 2-6 were three times more likely to be diagnosed.

Modest genetic contribution.

Cognitive and behavioral therapies as treatments for social anxiety disorder.

Prolonged and graduated exposure to the feared situation has proven to be a very effective treatment.

Cognitive restructuring

Therapist attempts to help client identify their underlying negative thoughts and change them.

Medications as treatments for social anxiety disorder

Sometimes effective, antidepressants are most effective/widely used.

Panic disorder

Occurrence of panic attacks that often come “out of the blue”.

DSM-5 criteria for panic disorder

Person must have experienced recurrent, unexpected attacks and been persistently concerned about having another attack or worried about the consequences of having an attack for at least a month (anticipatory anxiety)

Agoraphobia

Fear of “open gathering places”

Anxiety about being in places that would be difficult to escape, or where immediate help would be unavailable.

At most debilitating, may involve inability to leave home.

Frequent complication of panic disorder.

T or F: All patients with agoraphobia experience panic.

False

Agoraphobia is listed in the DSM-5 as a…

distinct disorder

Age of onset of panic disorder (with or without agoraphobia)

Typically begins between 20s-40s, sometimes in teen years.

Gender differences of panic disorder and agoraphobia.

Twice as prevalent in women as in men.

What factors explain the gender disparity in agoraphobia and panic disorder.

Sociocultural factors

The majority of people with panic disorder have at least one…

Comorbid disorder

Most common comorbid disorders with panic disorder

Generalized anxiety disorder, social anxiety, specific phobia, PTSD, depressions, and substance use disorders.

Panic disorder is often associated with an increased risk for…

Suicidal ideation

Genetic factors of panic disorder

Moderate heritable component.

30-34% of the variance in liability to symptoms is due to genetic factors.

Panic and the brain - amygdala

Collection of nuclei in front of the hippocampus. Critically involved in the emotion of fear.

Biochemical abnormalities of panic disorder

Individuals are more likely to experience panic attacks when exposed to various biological challenge procedures.

Panic provocation procedures

Produce panic attacks in panic disorder clients at a much higher rate than normal subjects.

What two systems are most implicated in panic attacks?

Noradrenergic and serotonergic systems

T or F: GABA has recently been shown to be implicated in anticipatory anxiety.

True

Cognitive theory of panic

Proposes that people with panic disorder are hypersensitive to their bodily sensations.

Tendency to catastrophize about the meaning of bodily sensations.

Comprehensive learning theory of panic disorder

Panic attacks become associated with initially neutral internal and external cues through an interoceptive conditioning process.

“Anxiety conditioned to internal external cues sets the stage for anticipatory anxiety and sometimes agoraphobic fears” is part of what theory?

Comprehensive learning theory of panic disorder.

Anxiety sensitivity

A trait-like belief that certain bodily symptoms may have harmful consequences.

Anxiety sensitivity is shown to predict…

The development of panic attacks as well as the onset of other anxiety disorders

T or F: Having a sense of perceived control reduced anxiety and blocks panic.

True

Safety behaviors and the persistence of panic.

People with panic disorder frequently engage in safety behaviors (ex. slow breathing) before or during an attack.

Safety behaviors attribute…

lack of catastrophe

T or F: Safety behaviors do not need to be identified during treatment of panic disorders.

False

Behavioral and cognitive-behavioral treatments of panic disorder

Prolonged exposure treatments are effective in 60-75% of people with agoraphobia.

Panic control treatment (PCT) targets agoraphobic avoidance and panic attacks.

Interoceptive exposure

Deliberate exposure to feared internal sensations.

Magnitude of improvement of panic disorders is often greater with which treatments, as opposed to medication?

Cognitive and behavioral treatments

Medications used for panic disorder.

Anxiolytics from the benzodiazepine category (ex. xanax or klonopin)

Anxiolytics uses/effects

Act very quickly, useful in acute situations of intense panic or anxiety.

Side effects such as drowsiness and sedation.

Antidepressants as panic disorder treatment.

Take about 4 weeks to have any beneficial effects.

Can alleviate comorbid depressive symptoms and disorders.

Troublesome side effects mean that many people reuse to take the medications or discontinue their use.

Generalized Anxiety Disorder (GAD)

Future oriented mood state of anxious apprehension, chronic tension, worry, and diffuse uneasiness that they cannot control.

People with GAD frequently engage in…

Subtle avoidance activities like checking and procrastination.

Prevalence of GAD

About 3% of the population.

Tends to be chronic.

Gender differences of GAD

About twice as common in women than men.

GAD comorbidity with other disorders.

Often co-occurs with other disorders, especially other anxiety and mood disorders.

T or F: Many people with GAD experiences occasional panic attacks with qualifying for a diagnosis of panic disorder.

True

Psychoanalytic viewpoint of GAD

Generalized or free-floating anxiety results from an unconscious conflict between ego and id impulses.

Defense mechanisms do not work with GAD.

Theory is not testable and has largely been abandoned.

Perceptions of uncontrollability and unpredictability of GAD.

May have a history of experiencing important events as unpredictable or uncontrollable

May be more likely to have had a history of trauma in childhood.

Far less tolerance for uncertainty.

A sense of mastery: the possibility of immunizing against anxiety with GAD

Parents responsiveness to their children’s needs directly influences their children’s development of a sense of mastery.

A persons history of control over important aspects of their environment is another significant experiential variable.