Abnormal Psych Midterm

Fear vs. Anxiety

fear is a common reaction after/near dangerous event, event is iminent/has happened, almost always after an event.

Anxiety is a reaction to a perceived threat/stressful situation, possibility of danger but nothing has happened yet, thoughts that event may happen

* both have same physiological features

Generalized Anxiety Disorder (GAD) DSM-5-TR Checklist

1) experience uncontrollable anxiety abt multiple matters for 6 months

2) symptoms include at least 3: edginess, fatigue, poor concentration, irritability, muscle tension, sleep problems

3) significant distress & impairment

Sociocultural Perspective on GAD

GAD is most likely to develop in people who are faced with ongoing societal conditions that are dangerous

Psychodynamic Perspective on GAD (Freud)

- all children experience some degree of anxiety

- occurs from punishment for expressing the "id" - leads to belief that "id" impulses are dangerous, results in overwhelming anxiety

Psychodynamic Perspective on GAD (newer theories)

GAD & defense mechanisms occur from repressed memories, harsh punishment, and overprotectiveness

*evidence is questionable

Humanistic Perspective on GAD

- GAD arises when ppl stop looking at themselves honestly and acceptingly

- Carl Rodgers: lack of Unconditional Postitive Regard in childhood leads to conditions of worth

Humanistic Therapies for GAD

client-centered therapy used to show UPR

- empathy, active listening, geunineness, and non-directive

Cog-Behavioral Early Theories on GAD

- Albert Ellis: maladaptive assumptions, ppl guided by irrational assumptions

- Aaron Beck: silent assumptions, ppl with GAD hold internal assumptions that imply they are in danger

* strong evidence

Cog-Behavioral Newer Theories on GAD

- Adrian Wells: metacognition theories, ppl hold +/- beliefs abt worrying, socieety teaches that worrying is bad, leads to worrying abt worrying (metaworries)

- intolerance of uncertainty theory: ppl cannot tolerate knowledge that negative events may occur

- Thomas Borkovec: avoidance theory, worrying serves a purpose to distract ppl from unpleasant physical feelings

Cog-Behavioral Therapies

- Ellis's rational-emotive therapy (RET) change maladaptive assumptions

- modern CBT change thoughts to be more adaptive

- mindfulness based CBT: let thoughts come and go

- Acceptance and Commitment therapy (ACT) mindfulness meditation

Biological Perspective on GAD

caused chiefly by biological factors (brain circuitry)

Biological Therapies for GAD

drug therapies:

- benzodiazepines: provide anxiety relief (increase affects of GABA)

- antidepressants that increase serotonin/norepinephrine

Phobias DSM-5-TR checklist

- marked persistent & disproportionate fear of particular object/situation

- lasts at least 6 months

- exposure produces immediate fear

- significant distress/impairment

Agoraphobia DSM-5-TR Checklist

- pronounced disproportionate, repeated fear abt being in at least two specific situations

- fear derives from concern

- avoidance of agoraphobic situations

- symptoms at least 6 months

- significant distress or impairment

Phobia Classical Conditioning/Modeling Examples

Classical: Little Albert Experiment

Modeling: parents may have fears that the child learns

Behavioral-Evolutionary Phobia explanation

- some species phobias are more common than others

- species-specific biological predisposition to develop certain fears: preparedness

Phobia Treatments: fear hierarchy

- relaxation training

- fear hierarchy: (ladder of fear) working up "ladder"

- ex: fear of roaches, starting with fake roaches, ending with real roach

Phobia Treatments: in vivo desensitization & covert desensitization

In Vivo: live, happening now

Covert: thinking of fear, pictures/videos

Phobia Treatments: Flooding

start with most feared

ex: fear of public speaking, start with speaking in front of class with clown shoes/funny outfit on

* buy in can be difficult

Agoraphobia Treatments

Exposure therapy

Support group

Home-based self-help

*successful for about 70%, relapse in as many as half

Social Anxiety Disorder (SAD) DSM-5-TR Checklist

severe, persistant, & irrational fears/ social performance situations

- 6 months or more

- fear of being negatively evaluated

- exposure to social situation almost always produces anxiety

- avoidance & significant distress/impairment

SAD Causes

- dysfunctional, negative beliefs abt them in social situations

- unrealistic social standards for themselves

- anticipation of social disasters, dread of social situations

- avoidance & safety behaviors performed to reduce/prevent these disasters

SAD Treatments

overwhelming social fears:

- medications: benzodiazipines (not recommended) or antidepressants

- cog-behavioral therapy: exposure therapy, challenge maladaptive assumptions

lack of social skills:

- therapy: social skills & assertiveness training

Panic Disorder DSM-5-TR Checklist

- unforeseen panic attacks occur repeatedly

one or more of the attacks precede either:

- at least a month of continual concern abt having additional attacks

- at least a month of dysfunctional behavior changes associated with the attacks (ex: avoiding new experiences)

Panic Disorder Biological Perspective

Panic circuit tends to be hyperactive

- fear and/or anxiety -> amygdala -> alarm and escape response

Panic Disorder Biological Treatments

Drug Therapies:

- various antidepressants used

- antianxiety drugs (benzodiazepines) have helped but NOT recommended because of physical dependence and ongoing use required

Cog-Behavioral Perspective on Panic Disorders

-bodily sensations are misinterpereted as signs of medical catastrophe

- high levels of anxiety sensitivity

Cog-Behavioral Treatments for Panic Disorder

correct people's misinterpretations of their bodily sensations

- educate abt nature of panic attacks

- teach skills for coping with anxiety

- introceptive exposure: induce panic sensations so clients can apply new interpretations and skills to issue under watchful supervision

ex: increase heart rate by running in place and let heart rate come down

DSM-5-TR Checklist: OCD

- occurence of repeated obsessions, compulsions, or both

- the obsessions/compulsiosn take up considerable time

- sig. distress or impairment

Define Obsessions

recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted

Define Compulsions

repetitive behaviors & rigid behaviors or mental acts that people feel they must perform to prevent or reduce anxiety

Psychodynamic Perspective on OCD

refers to the id being the obsessive thoughts and the ego as counter-thoughts or compulsive actions

* Frued traced OCD to anal stage of development, some children may experience intense rage, shame as a result of negative toilet training

Psychodynamic Treatment Approach for OCD

- help patients uncover & overcome their underlying conflicts and defenses

- uses free association and therapist interpretations

Cog-Behavioral Perspective on OCD

disorder grows from human tendencies to have unwanted, intrusive, and unpleasent thoughts

- to avoid negative outcomes, people attemot to neutralize their thoughts with actions

Cog-Behavioral Therapy for OCD

- educate clients on how misinterpretations of unwanted thoughts, excessive sense of responsibility, & neutralizing acts have helped them produce and maintain symptoms

- guide clients to identify and change their distorted cognitions

- use exposure and response prevention exercises

Biological Perspective on OCD

- brain scan procedured reveal hyperactive cortico-straito-thalamo-cortical brain circuit

(difficulty in turning off or dismissuing various impulses)

- symptoms often arise or subside after structures in the brain circuit are damaged

Biological Treatment on OCD

- Serotonin-enhancing antidepressants

Post Traumatic Stress Disorder (PTSD) DSM-5-TR Checklist

1) person exposed to a traumatic event- death/threatened death, severe injury, sexual violation

2) person experiences at least one of intrusive symptoms

3) avoids trauma linked stimuli

4) negative changes in trauma linked cognitions/moods (unable to remember) experiencing negative emotions

5) excessive alertness, extreme startle responses, sleep disturbance

6) significant distress/impairment

Potentially Traumatic Events

exposed to death, threatened death, actual/threatened serious injury, actual/threatened sexual violence

- direct exposure: witnessing in person

- indirectly learning close relative/close friend was exposed to trauma, actual/threatened death must have been violent/accidental/unexpected

multifinality

people with similar beginnings may end up at different points

equifinality

people with different developmental pathways may lead to the same point

Psychological First Aid (PFA)

A disaster response intervention that seeks to reduce the initial distress of survivors and foster their adaptive coping

*administered days/weeks after disaster

Skills for Psychological Recovery (SPR)

Disaster response intervention focus on building resilience and coping strategies

* administered weeks/months after disaster

Cog-Behavioral Therapy for Trauma

for adults:

- addressing unhelpful cognitions (Cognitive Processing Theory)

- reducing physiological response to trauma reminders (Prolonged Exposure Therapy)

For Children:

- learning abt emotions, adaptive coping, unhelpful cognitions, & avoidance (Trauma-focused Cognitive Behavior Therapy)

Posttraumatic Growth

positive adaptations adaptations after experiencing a traumatic event

- adaptive coping

- perceived control over recovery

- social support

Dissociative Amnesia DSM-5-TR Checklist

- inability to recall important life-related information

- significant distress or impairment

- symptoms are not caused by a substance or medical condition

Dissociative Amnesia Characteristics

- interferes with ability to recall personal information

Localized Dissociative Amnesia

most common, loss of all memory events

Selective Dissociative Amnesia

loss of memory for some, but not all, events occuring within a period

Generalized Dissociative Amnesia

loss of memory beginning with an event, extending back in time

- may lose sense of identity

- may fail to recognize family and friends

Continuous Dissociative Amnesia

- rare

- forgetting continues into the future

Dissociative Fugue

extreme version of Dissociative Amnesia

- forget personal identities and move to entirely different location

may be brief or long standing

- might show new personality characteristics, often more outgoing

- most regain most or all memories and never have another episode

Dissociative Identity Disorder (DID) DSM-5-TR Checklist

1) Disruption to Identity (at least 2 seperate personality states or experiences of possession)

2) person repeatedly experiences memory gaps regrading daily events, key personal info/traumatic events, beyond ordinary forgetting

3) sig. distress/impairment

4) symptoms are not caused by a substance or medical condition

Characteristics of Subpersonalities in DID

- each has unique set of memories, behaviors, thoughts, emotions

- sudden movement from one to another (switching) usually triggered by stress

- mutually amnesic, mutually cognizant, one-way amnesic (most common

Depersonalization-Derealization Disorder DSM-5-TR Checklist

- experience either or both depersonalization & derealization

- reality testing remains intact

- symptoms cause distress

- not due to substance use or explained by other disorders

Depersonalization

- feeling separation from own body

- seeing self from inside out (doubling)

- Having mechanical, dreamlike, dizzy feelings

- awareness that perceptionsa re distorted

Derealization

- feeling external world is unreal and strange

- changing object shape/size

- May see other people as robots

Psychodynamic Perspective on Dissociative Disorders

believed that dissociative disorders are caused by extreme repression

- motivated by traumatic childhood events, particularly abusive parenting

Cog-Behavioral Perspective on Dissociative Disorders

state-dependent-memory:

- thoughts, memories, and skills can be tied to a state of arousal

- different arousal levels may produce entirely different groups of memories, thoughts and abilites (subpersonalities)

Hypnotherapy Used in Dissociative Disorders

therapists hypnotize patients and then guide them to recall their forgotten events

Major Depressive Disorder DSM-5-TR Checklist

- presence of a major depressive episode

- no mania or hypomania

types:

- seasonal

- catatonic: irregular motor movements

- dysthimic: lack of social rewards/motivation (ex: food)

Major Depressive Episode DSM-5-TR Checklist

for 2 week period person must show:

- depressed mood for most of day and/or decreased enjoyment/interest across most activites for most of the day

For same two weeks must experience 3 or 4 of symptoms

* if have both of first symptoms only 3 of second symptoms needed, if only 1 then 4 is needed

Depression symptoms

- emotional symptoms

- motivational

- behavioral

- cognitive

- physical

Cognitive triad of depression

negative views of the world, oneself, and the future

Bipolar I Disorder (BPD) DSM-5-TR Checklist

- occurence of a manic episode

- hypomanic or major depressive episodes may precede or follow manic episode

BPD II DSM-5-TR Checklist

- presence or history of major depressive episode(s)

- presence or history of hypomanic episode(s)

- no history of a manic episode

Manic episode definition

- 1 week or more, person shows an irregular, inflated, unrestrained, or irritable mood & heightened energy/activity for most of every day

- also experiences at least 3 of symptoms

- significant distress or impairment

BPD Treatments

- Mood stabilizing drugs

- individual, group, or family therapy

* drugs MUST be used with therapy, therapy alone will not work

Schneidman's 4 suicide types (examples of each)

- death seeker: clearly intend to end ones life when attempting

- death initiator: intend to end life because they believe they are already dying

- death ignorer: don't believe death is the end of their existence

- death darer: ambivalent feelings about death

Nonsuicidal Self-Injury (NSSI)

direct, deliberate destruction of body tissue in the absence of any intent to die

How is suicide studied?

#1: retrospective analysis: "psychological autopsy", looking into past for note, diary, talk to loved ones & try to find out why

#2: suicide attempt survivors (issue with generalizability)

Suicide Triggers

stressful events, mood and thought changes, alcohol and other drug use, mental disorders, and modeling

Causes of Suicide: Durkheim 3 types

- egoistic: isolated, alienated, non-religious people

- altruistic: socially, well-intergrated people

- anomic: inhabitants of personally unstrable social environments & structure

Causes of Suicide: Interpersonal View (Joiner)

occur when people experience combination of:

- perceived burdensomeness

- thwarted belongingness

- psychological ability to carry out suicide

*risk is higher when people exhibit all three