psyc 316 final study guide

fight or flight response

ethological theory proposes this mechanism to respond to immediate danger developed because nature selected out those without such a mechanism

what does the triggering of fight or flight response do?

directs blood flow with increased oxygen toward the major muscle groups and brain stem, away from extremities, outer cortex, digestive system, and other that are not needed during immediate danger

systems of panic attacks can be understood as what?

due to the increase in breathing, heart rate, blood pressure, adrenalin, and other physiological changes that would help with survival

panic attacks

discrete period of intense fear or discomfort in which 4 or more symptoms devloped abruptly and reached a peak within 10 minutes

what are SOME symptoms of panic attacks

palpitations, sweating, shaking, shortness of breath, nausea, feeling dizzy, fear of losing control/ dying, chills, hot flashes, etc

fear, anxiety, and panic

normal natural responses following perceptions of threat, activation of the HPA axis

sedatives, benzos, and SSRIs and other medications interfere with what?

the biology underlying the fight or flight response

specific phobias

unreasonable or irrational fears of specific objects or situations; leads to aviodnance or intense distress when confronted with object/situation

specific phobia categories according to DSM-5

animal type, natural enviornment type, siutational type, and blood injection injury type

anxiety disorder heritability

h2 = 0.20 - 0.25

most heritibility is in common with what for anxiety disorders?

other anxiety disorders; children of parents with claustrophobia are at risk for developing it too but also other specifc phobias and anxiety disorders

stress reactivity

heritable component

what does Pavlovian conditioning model suggest?

fear is learned

what does Wolpe’s model suggest?

fear is natural and the inhibition of fear is learned

wolpe’s reciprocal inhibition model

inhibition can be learned gradually and is faciliated by engaging a body system that is incompatible with fear

wolpe’s reciprocal inhibition model perscription

systematic desensitization

systematic desensitization

aims to teach inhibition of fear, requires exposure to different stimuli using a graded hierarchy, starting with the least fear-provoking and progressing to the most; requires engaging a competing system through relaxation training

what are the steps for systematic desensitization?

establish a hierarchy, relaxation training to a level of proficiency, conduct relaxation in the presence of the first item on the hierarchy until mastery, conduct relaxation in the presence of successive items on the hierarchy until mastery

exposure therapy: systematic desensitization

most commonly used, relaxation may make the treatment more acceptable

exposure therapy: flooding

parsimonious, drop out problem

exposure based treatments appear to be equivalent

prolonged exposure, not intermittnent exposure, functional exposure, about 80% recover

improvements over exposure alone

Ost’s one day program, cognitive restructuring

what does current research for exposure therapy focus on?

indentifying the mechanisms by which exposure therapy works

history of information processing theory

Lang’s 1977 work on general info processing, rachman’s 1980 emotional processing ideas, and Foa and Kozak 1986 state of the emotional processing of fear model

information processing theory

has been used to explain selective attention, recall, and cognitive distortions; offers an explanation for how and why pathological fear changes during exposure

what does the information processing theory propose?

The memory network underlying the fear must be activated, and information that is incompatible with the fear network must be incorporated

blood injection injury phobia

blood and fainting reactions appear to be more hertiable than fear reactions and phobias

what happens when some people see blood?

experience a drop in blood pressure and feel nausea or disgust; fear reactions involve an increase in blood pressure and feelings of fear

panic disorder criterion A

recurrent and unexpected panic attacks; at least one of the attacks has been followed by 1 month or more of one or more of the following:

• persistent concern about additional attacks

• worry about implications of attacks or consequences

• significant change in behavior related to attacks

panic disorder criterion B

the presence or absence of agoraphobia

panic disorder criterion C

the panic attacks are not due to the direct physiological effects of the substance or general medication

panic disorder criterion D

panic attacks are not better accounted for by another mental disorder such as social phobia, specific phobia, OCD, PTSD or SAD

Agoraphobia criterion A

anxiety about being in places or situations from which escape might be difficult or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms.

agoraphobia fears typically involve what characteristics?

clusters of situations that included being outside the home alone, being in a crowd or standing in a line, being on a bridge, traveling on a bus train car etc

agoraphobia criterion B

the situations are avoided or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion

agoraphobia criterion C

The anxiety or phobia avoidance is not better accounted for by another mental disorder, such as social phobia, specific phobia, OCD, PTSD or SAD

biological treatments for panic disorder

medication affecting serotonin and norepinephrine systems (SSRI, SNRI, tricyclic antidepressants), most people experience a relapse of symptoms when drugs therapies are discontinued

cognitive behavioral therapy for panic disorder

relaxation and breathing exercises, challenging catastrophizing thoughts, systematic desensitization therapy

interoceptive exposure treatment: psychoeducation

accurate information on the nature and consequences of panic

interoceptive exposure treatment: cognitive restructuring

specific cognitive techniques for correcting panic producing thought patterns

interoceptive exposure treatment: behavioral experiments

Specific exercises designed to unlearn the fear of bodily sensations

interoceptive exposure treatment: risk reduction

special breathing techniques to correct faulty breathing patterns that contribute to panic

interoceptive exposure treatment: relapse prevention

information and techniques to prepare for life after treatment

anxiety sensitivity

tendency to experience the somatic sensations that are associated with anxiety as having a strong negative valence; distinguishes individuals that meet criteria for panic disorder from other groups

what does anxiety sensitivity predict?

response to laboratory challenges including anxiety, panic attacks, panic symptoms, physiological reactivity, escape and avoidance behavior; the development of panic attacks, disorder, and other anxiety disorders

what is the purpose of behavioral experiments

to collect additional evidence to weaken or eliminate faulty perceptions of threat

what is the general approach to behavioral experiements

perform an activity or put yourself in a situation that would help weaken faulty perceptions of threat

social anxiety disorder

people become anxious in social situations and are afraid of being rejected, judged, or humiliated in public; leads to aviodance of social siutations

when does social anxiety disorder usually devleop?

early preschool or adolescence; more common in women

what are the different treatments for social anxiety disorder?

SSRIs, SNRIs, cognitive behavioral therapy, and mindefullness based interventions

social anxiety disorder cognitive behavioral therapy

indentifying negative cognitions people have and learning how to dispute those

social anxiety disorder mindfulness based interventions

accept anxiety and observe it rather than judging oneself and avoiding people or situations

self focused attention

involved focusing attention forward; paying attention to sensations, one’s thoughts, behaviors or characteristics of the self

what is self focus the opposite of?

other focus which involved focusing attention outward such s scanning the environment, looking at other people, noticing changes in environment, attending to senses (colors shapes sounds smells)

safety behaviors

behaviors that we use to feel safe when anxious; help us feel less exposed

what can safety behaviors involve?

lowering eyes or looking away, hiding your face, specific posture, standing away from the center of activity, avoiding negative things being said about us

generalized anxiety disorder DSM 5 criteria

persistent, uncontrollable worry about most things including minor everyday events

GAD worry is accompanied symptoms including what?

restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

biological factors of GAD

People with GAD have. deficiency in gammaaminobutryic acid, which leads to excessive firing of neurons in many areas of the brain resulting in chronic diffuse symptoms of anxiety, modest heritability

biological treatments of GAD

benzodiazepine drugs, tricyclic antidepressant imipramine and the selective serotonin reuptake inhibitor paroxetine

cognitive behavioral therapy for GAD

confront most common worries, challenge catastrophizing thoughts, develop coping strategies

emotional and cognitive factors of GAD

tendency to experience intense negative emotions, show heightened reactivity to emotional stimuli in the amygdala, make a number of maladaptive assumptions, continuously scan the environment for possible threats

new approches to GAD: conceptualizes worry as avoidance

stress triggers worry, increases in verbal cognitive processes, reduced imagery and attention to physiological arousal, worry attenuates arousal, worry interferes with extinction, experiential avoidance

treatments to GAD

worry exposure and mindfulness and present moment focus

what is OCD associated with?

suicide, alcohol and drug use, lower quality of life, mental disorders, poor work and relationship functioning

obessions

recurrent and persistent thoughts, impulses, or images that cause marked anxiety; attempts to ignore, supress, or neutralize them; recognizes that they are a product of their own mind

common obsessions

contamination of self and others, accidental fire or harm to family members, harming others, doubts on if something was done correctly, sexual imagery

OCD obsessions differentiate from what?

delusions vs overideation, anticipation and worry about life problems, non intrusive thoughts, rumination about past events

compulsions

Repetitive behaviors or mental acts that the person feels driven to perform, aimed at preventing or reducing distress or preventing some dreaded event

common compulsions

washing, ordering, checking, hoarding, cognitive rituals, avoiding

what do OCD compulsions differentiate from?

Repetitive behavior associated with pervsive devlopmental disorders (autism)

OCD age of onset

early onset indicates greater severity; males have earlier onset than females

what is the OCD prevalence

1.0-1.5; equally in males and females

possible subtypes of OCD

cleaners, checkers, arrangers/orderers, hoarders, scrupulosity

h2 of OCD

0.35-0.40

PANDAS

pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections

what percent of children with OCD or tic disorders have PANDAS

25%

when are symptoms onset for PANDAS

between age 3 and puberty

when do symptoms onset or worsen in PANDAS

during or after an upper respiratory infection

treatment for PANDAS

antibiotics or strep, ERP and or SSRIs for the OCD as needed

biological factors and OCD

metabolism differences and changes in the caudate nucleus, cingulot on the frontal lobes

three first tier treatments for OCD

pharmacological treatments (SSRIs), exposure and response prevention, and combined pharmacological + exposure and response prevention

Abramowitz 1997

Synthesizes results from 32 high-quality studies; examines the effects of exposure and response prevention (ERP), SSRI medications

empirical evidence for ERP

initially validated on an intensive schedule ( 2 hours/ day for 3 weeks) validated on more graduate schedules ( 1 session per week, 2 sessions per week) also validated in group format

Mowrer’s two factor model

not a good model for fear acquisition, useful as a model of avoidance behavior and its maintenance

Mowrer’s first factor

The fear functions in the same way as fears acquired through Pavolvian (respondent) conditioning processes

Mowrer’s second factor

The escape and avoidance behavior is maintained through instrumental conditioning processes; escape and avoidance are operant behaviors that are reinforced by the reduction of acute anxiety

OCD treatment component: exposure definition

being in the presence of the environmental cues and/or intrusive thoughts or images that elicit anxiety, sufficiently prolonged so that habituation occurs

OCD treatment components: response prevention definition

refraining from the neutralizing behaviors (including cognitive behaviors) during the exposure and at other times

examples of OCD treatment components

in session and out session exposures, response prevention instructions, self monitoring, cognitive restructuring, relapse prevention

OCD treatment components exposures

in vivo and imaginal, refrain from compulsions, assess anxiety and compulsive urges, initially plan for up to two hour sessions, persist until habituation occurs

what are the different stages of change for OCD

precontemplation, contemplation, action, and maintenance

OCD stages of change: precontemplation

no intention to change, may be unaware of the problem

OCD stages of change: contemplation

may acknowledge problem, not yet committed to change

OCD stages of change: action

actively engaged in addressing the problem

OCD stages of change: action

working to prevent slipping back

what are the three common response from family and friends regaurding OCD

accomdating, disengaging, and percribing

OCD accommodating

helping with rituals, giving assurance that everything is okay, serving as a safe person

OCD disengaging

leaving the person when the ritualize, pulling back, withdrawal from the relationship