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depression and insulin resistance
What conditions are associated with loss of negative feedback in the HPA axis
The hippocampus
-in encoding contextual info→ feeds it to the amygdala
-high in glucocortoid receptors and CRH levels in some parts
-in associative memory
-in memory involving fear (extinction and consolidation)
Fear v anxiety
-anxiety involves uncontrollability of future events
-Anxiety responds to a future threat
-Fear involves noncognitive processes
-anxiety involves cognitive processes
integrated model of anxiety
-biological vulnerability (heritibal contributions to negative effects)
-specific psychological vulnerability (physical sensations are potentially dangerous)
-generalized psychological vulnerability (sensing events are uncontrollable/ unpredictable)
-all three enhance the chance of somone having an anxiety disorder
Biological vulnerability
-multiple genes add to risk
-difference in brain circuits
HPA
limbic systems
fight or flight
-different reactivity to stressfull events
Psychological vulnerability
-pay select attention to the threat
-misinterpreting something neutral as threatening
-overestimation of future bad events
-personalization of neg events
-thinking world is uncontrollable
Panick attack
intense fear eithout reason to be afraid
-peaks within 10 minutes
-four or more autonomic symptoms
-can be unexptected or expected
panic disorder
-reacurring panick attacks
-1 attack followed by a month of…
continual concern of panic attack and its consequences
maladaptive change as a result of panic attacks (agoraphobia)
-no better explained by another disorder
Agoraphobia
-dread/avoidance of 2+ situations where environments are unfamiliar or theres a perceived lack of control
-fear of public panic attacks
-situations provoke fear/anxiety
-avoidance is persistent
conditioning and panic
US: uncued panick attacks (by coincidence at grocery store)→UR: anxiety
CS: grocery store →CR: anxiety
interoceptive conditioning
-small changes in physical sensation induce a panick attack
-low levels of physical sensations of arousal or anxiety become conditional stimuli→early somatic components of an anxious responce elicits panic
-for example: CO2 make make somone with panic disorder have a panic attack
Introceptive avoidance
-avoiding activities that may produce physiological arousal reminiscent of panic
Cognitive contributions to panic disorder
-seeing bodily functions as dangerous (eg: feeling faint or about to have a heart attack)
Causes for panick disorder
-anxiety and sensitivity
percieve anxiety as harmful
-biological vulnerability: more sensitivity to stress
-general psychological vulnerability
anxiety on future events
hypervigilience
more introspectively aware
Panic disorder treatment
-psychoeducation
-exposure
-cognitive restructuring
-relaxation
GAD
-worrying about # of activities or events
-difficulties controlling worry
restless or on edge
easily fatigue/ sleep disturbance
mind going blank/cant concentrate
irritable
muscle tention
GAD biases
-inderited tendency for anxiousness
-cognitive
overstimation of bad outcomes
catastrophic thinking
-attentional/judgmental
allocate more attention to ‘threat’ sources
-stressful life events
GAD medical treatments
-Benzodiazepines (short term)
-antidepressants (side effects)
GAD psychological treatments
-cognitive behavioral treatments
exposure to worry process
confronting anxiety provoking images
coping stratagies
relaxation techniques
attentional bias modification
-acceptance
-meditation
Specific phobia
extreme fear of an object or situation
Blood injection phobia
-early onset (9 years old)
-less heart rate and blood pressure
-fainting
-more of a genetic component
situational phobia
fear of specific situations
-onset at 20
-no uncued panic attacks
Animal phobia
-onset at 7
-may associate with real danger
Natural enviorment phobia
-onset at 7
-assoc with real danger
-must last 6 months minimum
causes of specific phobia
-inherited vulnerability to anxiety
-some objects are more readily associated with danger/aversion (preparedness)
-trauma
conditioning
-observational learning
-info transmission (being told of danger)
Extinction of classical conditioning
CR is gradually diminished over time since CS is shown without US
Treatment for specific phobia
-systemic desensitization (gradually giving exposure in a relaxed enviorment)
-cognitive behavior therapy
exposure
hieractchy of exposure
structured
consistant
within a therapy setting
Social anxiety disorder
-fear social situations will result in scrutiny by others or some loss of status
Cognitive factors in social anxeity disorder
-social situations are dangerous (so perfect performance is needed)
-predict
some social situations are bound to lead to humiliation/status loss
-problematic comparisons
rate self lowly
believe others have high expectations of them
Social anxiety psychological treatment
-group therapy
-cognitive behavioral therapy
exposure
rehearsal
roleplay
group settings
Social anxiety medical treatment
-norepinephrine (beta blockers)
dampens physiological cues (heart medication)
Seratonin reuptake inhibitors
PTSD
-NOT an anxiety disorder but a trauma/stress disorder
-needs trauma exposure and its continual experience
-avoidance (emotional numbing)
-neg cognition/mood (low opinion on self and others)
-1 month post trauma
-intrapersonal problems/dysfunction
PTSD statistics
-affects women on a greater scale
-prevalance varies
-comorbidy with MDD, GAD, and alchohol use disorder
PTSD causes
-intense/severe trauma with little social support and additional life stress
Why may people with the same trauma not all get PTSD?
generalized biological vulnerability
-family hostory of anxirrty
-gene enviorment interactions: kids acting out→ more likely to encounter trauma
-high norepinephrine activity
PTSD and hippocampus
reduced hippocampal volume (but may not be due to the disorder itseld acc to studies)
PTSD treatment
-meds (SSRI’s) seratonin reuptake inhibitors
-cognitive behavioral treatment
exposure
more positive coping skills
more social support
very effective
OCD
-obsessive, compulsive or both
OCD obsession
reacurent and persistent thoughts +impulses that are intrusive + innapropriate → causes distress
-attempts to supress thoughts, impulses, images with other thoughts and actions
OCD compulsion
-repetitive behaviors or mental acts that a person feels driven to perform due to rules or obsession
-usually aimed at reducing/ impairing distress (but are not realistically connected)
OCD treatment
-SSRI’s (60% benifit)
-psychosurgery (cingulate bundle lesion, 30% benefit)
-cognitive behavioral treatment
exposure
response prevention
reality testing (most effective)
-NO BENIFIT for combined treatment