Abnormal Cards Part 2

Health Psychologist

A psychologist who studies the interrelationships between psychological factors and physical health

Stress

A demand made on an organism to adapt or adjust

Stressor

A source of stress

Adjustment Disorder

A maladaptive reaction to a distressing life event or stressor that develops within 3 months of the onset of the stressor, characterized by impaired functioning or emotional distress that exceeds what would normally be expected

Percentage of people receiving outpatient mental health care who have an adjustment disorder

5 to 20

Chief characteristics of Adjustment disorders with depressed mood

Sadness, crying, and feelings of hopelessness

Chief characteristics of Adjustment disorder with anxiety

Worrying, nervousness, and jitters (or in children, fear of separation from primary attachment figures)

Chief characteristics of Adjustment disorder with mixed anxiety and depressed mood

A combination of anxiety and depression

Chief characteristics of Adjustment disorder with disturbance of conduct

Violation of the rights of others or violation of social norms appropriate for one’s age; sample behaviors include vandalism, truancy, fighting, reckless driving, and defaulting on legal obligations (e.g., stopping alimony payments)

Chief characteristics of Adjustment disorder with mixed disturbance of emotion and conduct

Both emotional disturbance, such as depression or anxiety, and conduct disturbance (as described previously)

Chief characteristics of Adjustment disorder unspecified

A residual category that applies to people not classifiable in one of the other subtypes

True or false: For a diagnosis of adjustment disorder to apply, the stress-related reaction must not be sufficient to meet the diagnostic criteria for other clinical syndromes

True

Acute Stress Disorder

Acute maladaptive reaction in the days or weeks following a traumatic event, lifetime prevalence varies based on the type of trauma, Features similar to those of PTSD, but limited to a period of one month following direct exposure to the trauma, witnessing other people exposed to the trauma, or learning about a trauma experienced by a close family member or friend

Post-traumatic stress disorder

Prolonged maladaptive reaction to a traumatic event, lifetime prevalence is about 9%, Reexperiencing the traumatic event; avoidance of cues or stimuli associated with the trauma; general or emotional numbing, hyperarousal, emotional distress, and impaired functioning

True or false: Traumatic stress disorders can occur if you didn’t directly experience the trauma

True

Most common trauma linked to PTSD

Motor vehicle accidents

Acts most likely to lead to PTSD

Violent acts, particularly SA

Amount of people that experience traumatic events

Over 2/3

Amount of people that develop PTSD after a traumatic event

less than 1/10

Factors relating to the event that affect PTSD

Degree of exposure and severity

Factors relating to the person that affect PTSD

History of childhood SA, genetic predisposition or vulnerability, lack of social support, lack of active coping responses, feeling shame, feeling numb, and prior psychiatric history, gender

Who’s more likely to get PTSD, men or women?

Women

PTSD within the classical conditioning framework

Traumatic experiences are unconditioned stimuli, sights smells and sounds are conditioned stimuli, anxiety becomes the conditioned response

PTSD within the operant conditioning framework

A person will learn to avoid contact with trauma-related stimuli, avoidance behaviors are operant responses negatively reinforced with relief from anxiety

Extinction

gradual weakening or elimination of conditioned anxiety, only occurs when a person encounters the conditioned stimuli in the absence of any troubling unconditioned stimuli

Propranolol

Commonly used blood pressure medication that has shown to he helpful in reducing PTSD when paired with the patient describing the traumatic event, Propranolol blocks adrenaline receptors in the amygdala, which may weaken memories of fearful stimuli

Theories for why propranolol works

May interfere with the reconsolidation of reactivated memories, perhaps weakening or eliminating them, or may reduce acquired fear responses

Other things that help with PTDS

Morphine given at the time of the trauma, sleep deprivation, blocking memories, antidepressant drugs

Questions to reflect on for dulling traumatic memories

1. Who should decide whether memory-blocking drugs are used in the immediate aftermath of trauma?

2. What if the trauma survivor is rendered unconscious or unable to make this decision?

3. s it right to obliterate a person’s memories of a significant life event in the hopes that it may prevent later emotional suffering?

4. Would you want to blot out traumatic memories?

CBT for PTSD

The basic component of treatment is exposure to cues and emotions associated with the trauma. By repeatedly recalling the traumatic experience in a safe therapeutic setting, the person reexperiences the anxiety associated with the traumatic event, allowing extinction of anxiety to take its course.

Prolonged Exposure

The exposure continues for lengthy periods of time without the patient attempting to escape from the anxiety associated with the trauma

EMDR

A controversial form of therapy for PTSD that involves the client’s eye tracking of a visual target while holding images of the traumatic experience in mind

2 majo concerns of EDMR

Lack of a compelling theoretical model explaining why rapid eye movements would relieve symptoms of PTSD, and whether the therapeutic effects of EMDR have anything to do with eye movements themselves, might just work because it’s like exposure therapy

Occum’s Razor, AKA Parsimony

The simpler the explanation the better

Prolonged Grief Disorder

A psychological disorder characterized by a maladaptive grief reaction lasting (in adults) more than a year after death

Features/Symptoms

1. Intense yearning or longing for the departed person

2. Mental preoccupation with thoughts about the departed person

These must be present for more days than not and exceed cultural norms

Criteria for Prolonged Grief Disorder

Disruption of personal identity, a strong sense of disbelief the person is gone, avoidance of cues or reminders of the death, intense and persistent emotional pain, difficulty resuming daily life, emotional numbness, feeling that life is meaningless

Percentage of people that get prolonged grief disorder

10%

Amount of soldiers who got PTSD from Vietnam

1/5

Anxiety

An emotional state characterized by physiological arousal, unpleasant feelings of tension, and a sense of apprehension and foreboding

Anxiety disorders

Characterized by excessive or maladapative anxiety reactions

Neurosis

Derives from roots that mean “an abnormal or diseased condition of the nervous system, coined by William Cullen

True or false: Anxiety started out being classified as biological until Freud

True

Neuroses

General category of anxiety, dissociative, and somatic disorders grouped together by Freud

Physical features of anxiety disorders

Jumpiness, jitteriness, trembling or shaking, tightness in the pit of the stomach or chest, heavy perspiration, sweaty palms, light-headedness or faintness, dryness in the mouth or throat, shortness of breath, pounding or racing heart, cold fingers or limbs, and upset stomach or nausea

Behavioral features

Avoidance behavior, clinging or dependent behavior, and agitated behavior

Cognitive Features

Worry, a nagging sense of dread or apprehension about the future, preoccupation with or keen awareness of bodily sensations, fear of losing control, thinking the same disturbing thoughts over and over, jumbled or confused thoughts, difficulty concentrating or focusing one’s thoughts, and thinking that things are getting out of hand

Anxiety disorders recognized by the DSM

Panic disorders, phobic disorders, generalized anxiety disorder

Disorders no longer recognized as anxiety by the DSM

Obsessive–compulsive disorder, acute stress disorder, and posttraumatic stress disorder

How many people affected globally by anxiety disorders

1/6, it’s the most common

How many people affected in the US by anxiety disorders

1/5 adults at some point in their lives, 1/10 in any given year

Anxiety disorder lifespan

Starts in early adolescence or early adulthood and can become chronic, symptoms usually decrease with age

Panic disorder

Lifetime prevalence - 4.7%, Repeated panic attacks, fears of recurring attacks may prompt avoidance of situations associated with the attacks or in which help might not be available; attacks begin unexpectedly but may become associated with certain cues or specific situations; may be accompanied by agoraphobia or general avoidance of public situations

Generalized anxiety disorder

Lifetime prevalence - 6%-9%, Persistent anxiety that is not limited to particular situations, excessive worrying; heightened states of bodily arousal, tenseness, being on edge

Specific phobia

Lifetime prevalence 12.5%, excessive fears of particular objects or situations, avoidance of a phobic stimulus or situation; examples include acrophobia, claustrophobia, and fears of blood, small animals, or insects

Social Anxiety Disorder (Social Phobia)

Lifetime prevalence - 12.1%-13%, Excessive fear of social interactions, characterized by an underlying fear of rejection, humiliation, or embarrassment in social situations

Agoraphobia

Lifetime prevalence - 1.4-2%, Fear and avoidance of open, public places, May occur secondarily to losses of supportive others to death, separation, or divorce

Cultural differences in anxiety disorders

Hispanic and black people have lower rates in general, and lower lifetime rates

Panic attacks

Intense anxiety reactions that are accompanied by physical symptoms such as a pounding heart; rapid respiration, shortness of breath, or difficulty breathing; heavy perspiration; and weakness or dizziness, and a strong urge to escape where they are

Timeline for panic attacks

Usually peaks at 10-15 minutes, can last anywhere from minutes to hours

Percentage of people healthy that experience an isolated attack

11%

Features required for the month following a attack in order to be diagnosed with a panic disorder

1. Persistent fear of subsequent attacks or of the feared consequences of an attack, such as losing control, having a heart attack, or going crazy

2. Significant maladaptive change in behavior, such as limiting activities or refusing to leave the house or venture into public for fear of having another attack

Amount of women that get panic disorders over men

double

Cognitive-biological model of panic disorders

Panic proneness → Triggering event → perception of threat → worry or fear → changes in bodily sensation → Catastrophic misinterpretations of bodily sensations → back to perception of threat and it goes in a circle

Perception of threat

Triggers the sympathetic nervous system, releases epinephrine (adrenaline) and norepinephrine (nonadrenaline) which are stress hormones which intensify the physical sensations

Catastrophic misinterpretations

Reinforce the perception of threat

Biological factors in panic disorders

Genes can create a disposition for them, sensitivity to physical sensations, or inadequate GABA, maybe serotonin too

GABA, gamma-aminobutyric acid

Inhibitory neurotransmitter, tones down excess neural activity in the central nervous system and helps quell the body’s response to stress

Valium and Xanax

Benzos that help GABA

Cognitive factors

Anxiety sensitivity

Anxiety Sensitivity

Fear of fear itself, fear of one’s emotions and bodily sensations getting out of control

Most widely used treatments for panic disorders

drug therapy, namely antidepressants and CBT

SSRIs used for panic disorders

Sertaline (Zoloft), and escitalopram (Lexapro)

Side effects of SSRIs

Sleep problems, drowsiness, nausea, and dry mouth

Benzo used for anxiety

Alprazolam, AKA Xanax, high risk of abuse

Issue with drugs for anxiety

Long terms effects aren’t proven

Breathing retraining

Restore a normal level of CO2 to the blood stream

Self-monitoring

Keeping a log of panic attacks to help determine situational stimuli that might trigger them

Exposure

A program of gradual exposure to situations in which panic attacks have occurred

Development of coping responses

Developing coping skills to interrupt the vicious cycle in which overreactions to anxiety cues or cardiovascular sensations culminate in panic attacks, example is breathing retraining

Coping responses to a panic attack

Breathe slow and deep, breathe into a paper bag, talk yourself down, find someone to help you through the attack, don’t become housebound, seek immediate medical assistance

Phobia

Excessive, irrational fear

Average age of onset for specific phobias

11

Average age of onset for social anxiety disorder (formerly social phobia)

14

Average age of onset for agoraphobia

20

Specific phobia

A phobia that is specific to a particular object or situation

Average age of onset for claustraphobia

20

How long does the fear, anxiety and avoidance behavior associated with specific phobias last for?

6 months or longer

Gender differences in phobias

More likely for women to have one

Social anxiety disorder

Excessive fear of social interactions or situations

Percentage of people with social anxiety who developed the disorder by age 20

80%

Diathesis-stress model and social anxiety

Social anxiety is strongly associated with childhood shyness, shyness may represent a diathesis or predisposition that makes a person more vulnerable to developing social anxiety in the face of stressful experiences

How long does social anxiety usually last and when do people usually seek help?

16 years, age 27

Agoraphobia

Stems from “fear of the marketplace,” a fear of being out in open, busy areas

How much more likely are women than men to get agoraphobia?

Twice as likely

Agoraphobia and dependencies

People with agoraphobia become really dependent on people

Psychodynamic perspective on anxiety

A danger signal indicating that threatening impulses of a sexual or aggressive (murderous or suicidal) nature are nearing the level of awareness. To fend off these threatening impulses, the ego mobilizes its defense mechanisms

Psychodynamic perspective on phobias

A phobic reaction is a projection of a person’s own threatening impulses onto the phobic object

O. Hobart Mowrer

Developed the two-factor model for phobias, the classic learning perspective

Two-factor model

A theoretical model that accounts for the development of phobic reactions on the basis of classical and operant conditioning, the fear component is acquired through classical conditioning, the avoidance is acquired through operant conditioning namely negative reinforcement, which is relief from the anxiety of the fearful stimuli