anxiety, fear, OCD & related, PTSD

fear

present-oriented, fight/flight response to actual danger or threat, strong escapist & avoidance tendencies, abrupt activation of sympathetic nervous system

amygdala

regulates emotion, informs hypothalamus when there's a threat, fear conditioning

anxiety

future-oriented, future danger or misfortune, expect negative events, body tension

prefrontal cortex

cognitions, how you think & interpret information

hippocampus

memory

adaptive function

planning, recognizing danger, not everything is in control but predicting helps, based on past experiences

In anxiety, _______ is overactive but _________ & ____________ are underactive.

salient, executive & intrinsic

general anxiety disorder (GAD)

excessive anxiety & worry, difficulty in controlling worry, restless & feeling on edge, difficulty concentrating, irritability, muscle tension & sleep disturbance, "prisoner of your mind", insidious (unaware)

psychodynamic (anxiety)

neurotic anxiety- id based, fear of yourself & feelings

realistic anxiety- ego based, factual based

moral anxiety- superego based

humanistic (anxiety)

conditions of worth, lack of authenticity, incongruence

-feelings are not reflected in your own behavior conditions of worth- make exceptions for accomplishments

existential (anxiety)

realities of human condition, you are in charge of your life

-freedom, responsibility, lonliness, certainty of death

existential angst- Victor Frankel

cognitive (anxiety)

lack of control, metacognitive "meta worry"- worrying about worrying

avoidance theory: worrying reduces bodily arousal, how you learn to avoid things

biological (anxiety)

reduced GABA activity, less inhibition of areas involved in fear response, GABA receptors dense in PFC, amygdala & hippocampus

antianxiety meds increase GABA, serotonin is involved

treatments (anxiety)

-cognitive behavioral approaches most effective

-traditional cognitive

-mindfulness

-biological

phobias

intense fear about things, events, situations, ppl are aware it's an issue, chronic bec negative reinforcement cycle (avoiding situations makes you fear them more), exposure therapy helps

animal, natural environment (disasters & weather, heights), situational-public, blood & injection- fear of needles, injection, fainting, physiological effects

agoraphobia

fear of places where help isn't available if there's an emergency

social anxiety disorder

fear of being judged & embarrassed by others

-cognitive behavioral- review thoughts & meaning; exposure therapy

causes of phobias

direct conditioning- classical (association of stimulus with an event), operant- punishment of stimuli

observational/social learning

biological/evolutionary vulnerability- physiological

information transmission- hearing or seeing fear

direct conditioning

trauma, classical cond for response, anxiety about recurrence, avoidance & escape relieve anxiety (neg reinforcement)

observational

seeing traumatic experience

monkeys & snake studies

psychodynamic

unconscious anxiety displaced on phobic object

symbolic

get insight into hidden conflicts

behavioral (phobia)

systematic desensitization: adress behaviors thru catastrophic beliefs (cognitive), learning, extinction

biological (phobia)

reduce anxiety symptoms

panic attack

abrupt intense fear & discomfort, physical symptoms: trouble breathing, shaking, nausea, agitation

panic disorder

unexpected panic attacks, worry about another one, with agoraphobia, at least 1 month

biological (panic)

fight/flight response dysregulation, no regulation of norepinephrine from locus ceruleus

limbic system & stress response affected

tricyclic antidepressants- increase norepinephrine & serotonin

cognitive (panic)

increase the sensitivity of body sensations, recognize & challenge cycle of catastrophizing, relax & breathe (mindfulness)

cognitive behavioral therapy effective long term

OCD

obsessive-compulsive disorder, separate name in DSM "OCD & Related Disorders"

- obsessions (thoughts: contamination, sexual content, somatic concerns, religious concerns, need for order & organization) & compulsions (behaviors: check, repetitive actions, handwashing, counting)- reduce anxiety, gain control, resist unwanted thoughts & feelings

associated with fears, exaggeration of normal concerns

stephanie- germ exposure, rubbing envelope on couch, letting her son sit on couch, learning nothing bad will happen

exposure & response prevention

OCD related disorders

hoarding, hair pulling (trichotillamania), skin pulling (excoriation), body dysmorphic disorder (BDD)

*behavioral therapy: stop habit & allow for different experiences

common compulsions

to reduce anxiety, gain control, resist unwanted thoughts

like checking, handwashing, counting

OCD (biological)

dysfunction in brain circuit regulating primitive impulses (aggression, sexuality, body functions)

frontal cortex- impulses, filtered in caudate nucleus, think & act if impulses reach thalamus (sensory), impulses may not turn off in OCD, amygdala (anxiety, fight/flight)

serotonin deficiencies affect glutamate, GABA, dopamine

SSRIs effective

OCD (psychodynamic)

obsessions & compulsions symbolize unconscious conflicts

conflicts show anxiety, id impulses & ego defense mechanisms are how ppl act out

insight therapy

cognitive-behavioral (OCD)

intrusive, rigid thoughts; ritualistic behavior helps when we are distressed

hyperactive supergeo- sense of morality superego (all or nothing), links to anxiety or depression

operant conditioning maintains OCD

compulsive behaviors reduce anxiety

exposure therapies: expose obsessive thoughts & prevent compulsive behavior (modeling, meds)

stress

perception that environmental demands overwhelm one's personal resources available to deal with them, change perceptions, reframe demands, increase personal resources, using personal resources more efficiently

characteristics of stressful events

uncontrollable

unpredictable

change/challenge capabilities or self-concepts

adaptation- Hans Seyle

General Adaptation Syndrome (GAS)

homeostasis, alarm, resistance, exhaustion, panic, burnout

stress reponse

body turns on & off, activate sympathetic nervous system then parasympathetic nervous system to restore homeostasis

problems if homeostatic balance not restored/stress response stays

gender: male- authoritarian, female- tend & befriend

biology: facing extreme stress, nervous & endocrine (pituitary controls endocrine system reactions), hypothalamic-pituitary-adrenal, immediate:thalamus-> amygdala & long-term response: thalamus--> sensory cortex---> amygdala

PTSD

exposed to trauma posing actual/threatened death or injury or threat to self integrity

examples: physical assault/rape, sudden/near death, natural disaster

symptoms: re-experiencing trauma, avoidance, reduced responsiveness, detached, dissociated, derealized, increased arousal, neg emotions, reactivity

onset & duration of symptoms last more than one month

PTSD symptoms in children

generalized fears, sleep disturbances, posttraumatic play & reenactment, lose an acquired developmental skill, omen formation

biological (PTSD)

abnormal levels of cortisol & norepinephrine

unstable--> triggering symptoms, brain damage?

genetic factor- vulnerability

treatment of PTSD

end lingering stress reaction

gain perspective on painful experience

return to constructive living

exposure therapy- expose client to fear to extinguish it

challenge distorted cognition

reduce daily life stress

improve coping capacity

recommendations- reestablish routines, find support network, avoid big decisions

-> combat veterans

- antianxiety & depression meds

-behavioral exposure: reduce symptoms, flooding & relaxation training, EMDR

-insight therapy: bring out feelings, create acceptance, lessen guilt

4 categories PTSD symptoms

re-experiencing trauma

avoidance

reduced responsiveness

increased reactivity

PTSD treatment

cognitive behavioral therapy- exposure therapy

Eye movement desensitization & reprocessing

acute stress disorder

symptoms begin quick & last less than a month

risk factors PTSD

preexisting mental disorders, poor coping, no support