PSYCH 330 Exam 2

Generalized Anxiety Disorder (GAD)

Excessive anxiety and worry, more days than not, for at least 6 months about various situations or activities.

GAD Diagnostic Criteria

Excessive worry for 6 months, difficulty controlling worry, 3 or more associated symptoms, and clinically significant distress or impairment.

GAD Six Symptoms

Restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance.

GAD Minimum Symptoms

3 or more of the 6 associated symptoms.

GAD Duration

At least 6 months.

GAD Comorbidity

Especially major depressive disorder, panic disorder, and social anxiety disorder.

GAD vs. Normal Worry

GAD worries differ in frequency, intensity, and perceived control over worry.

GABA Theory of GAD

Individuals with GAD have decreased GABA activity and less inhibition of threat-activated structures.

GABA

A neurotransmitter that aids inhibition of subcortical circuits stimulated by threat.

GABA Receptor Locations

Frontal cortex, hippocampus, and amygdala.

Benzodiazepines

Facilitate GABA binding and can be effective for GAD.

Cognitive Errors in GAD

Maladaptive assumptions, including probability overestimation and catastrophizing.

Probability Overestimation

Overestimating the likelihood that negative events will occur.

Catastrophizing

Expecting extremely negative consequences from situations.

Attentional Bias

Bias toward threat-related material.

Memory Bias

Bias toward threat-related material in memory.

Sociocultural Perspective of GAD

GAD is more likely to develop in people facing dangerous ongoing social conditions or highly threatened environments.

Societal Stress Factors

Poverty, race and ethnicity-related stressors, and widespread illness.

Avoidance Theory of GAD

Worry is often a verbal or linguistic process that may distract from emotional distress.

Negative Reinforcement of Worry

Worry continues because it temporarily reduces emotional distress.

Intolerance of Uncertainty

Difficulty tolerating uncertainty; changes in intolerance of uncertainty may precede changes in worrying.

Metacognitive Model

Focuses on beliefs about worry, including positive and negative beliefs.

Positive Beliefs About Worry

Belief that worry is helpful.

Negative Beliefs About Worry

Belief that worry is uncontrollable or dangerous.

Meta-Worry

Worry about worry.

CBT for GAD

More effective than wait-list and nonspecific alternatives, with better long-term maintenance and tolerability in comparisons with medication.

First-Line Medication for GAD

Selective serotonin reuptake inhibitors (SSRIs).

Benzodiazepine Risks

Tolerance, dependence, and withdrawal symptoms.

Benzodiazepine Treatment Recommendations

Recommended only for short-term treatment or severe, treatment-resistant GAD.

Specific Phobia

Marked fear or anxiety about a specific object or situation.

Specific Phobia DSM-5-TR Criteria

Immediate fear, avoidance or intense endurance, disproportionate fear, persistence typically at least 6 months, and clinically significant distress or impairment.

Specific Phobia Duration

Typically at least 6 months.

Agoraphobia

Marked fear or anxiety about 2 or more situations because escape or getting help might be difficult.

Five Agoraphobia Situations

Public transportation, open spaces, enclosed places, standing in line or crowds, and being outside the home alone.

Agoraphobia Minimum Situations

2 or more of the 5 specified situations.

Agoraphobia Avoidance

Situations are avoided, require a companion, or are endured with intense fear or anxiety.

Agoraphobia Duration

Typically at least 6 months.

Classical Conditioning

Learning fear through association between stimuli.

Little Albert

Watson and Rayner's 1920 example of classical conditioning of fear.

Observational Learning

Acquiring fear by watching or modeling others.

Negative Reinforcement of Phobic Avoidance

Avoidance continues because escaping a feared situation reduces anxiety.

Preparedness

A behavioral-evolutionary explanation for why certain fears are more readily acquired.

Phobia Treatments

Exposure therapies, modeling, and participant modeling.

Social Anxiety Disorder

Marked anxiety about social situations involving possible scrutiny by others.

Social Anxiety Core Fear

Fear of acting in a way or showing anxiety that will be negatively evaluated.

Social Anxiety DSM-5-TR Criteria

Fear of scrutiny, negative evaluation, avoidance or intense anxiety, disproportionate fear, persistence, and impairment.

Social Anxiety Duration

Typically at least 6 months.

Social Anxiety Treatments

Cognitive therapy, exposure therapy, group therapy, and social skills training.

Panic Disorder

Recurrent unexpected panic attacks followed by persistent concern or maladaptive behavior change.

Panic Attack

An abrupt surge of intense fear or discomfort reaching a peak within minutes.

Panic Attack Minimum Symptoms

4 or more listed symptoms.

Panic Attack Heart and Breathing Symptoms

Palpitations, pounding heart, accelerated heart rate, sweating, trembling, shortness of breath, choking, and chest discomfort.

Other Physical Panic Attack Symptoms

Nausea, dizziness, chills or heat sensations, and numbness or tingling.

Psychological Panic Attack Symptoms

Derealization, depersonalization, fear of losing control, and fear of dying.

Paresthesias

Numbness or tingling sensations.

Panic Disorder One-Month Criterion

At least one attack followed by at least 1 month of persistent worry about attacks or their consequences and/or maladaptive behavior change.

Panic Brain Circuit

Includes the amygdala, hippocampus, hypothalamus, central gray matter, and locus coeruleus.

Cognitive Explanation for Panic Disorder

Misinterpretation of bodily sensations and anxiety sensitivity.

Anxiety Sensitivity

Fear of anxiety-related bodily sensations.

Obsessive-Compulsive Disorder (OCD)

Presence of obsessions, compulsions, or both that are time-consuming or cause clinically significant distress or impairment.

Obsessions

Recurrent and persistent thoughts, urges, or images that are intrusive, unwanted, and may cause anxiety or distress.

Response to Obsessions

Attempts to ignore or suppress intrusive thoughts or neutralize them with another thought or action.

Compulsions

Repetitive behaviors or mental acts performed in response to obsessions or according to rigid rules.

Purpose of Compulsions

To prevent anxiety, distress, or a dreaded event, although the behaviors are excessive or not realistically connected.

OCD Time Criterion

Obsessions or compulsions take more than 1 hour per day or cause clinically significant distress or impairment.

OCD Insight Specifiers

Good or fair insight, poor insight, or absent insight/delusional beliefs.

OCD Tic-Related Specifier

Used when OCD is associated with a tic disorder.

Cognitive-Behavioral Explanations of OCD

Obsessional intrusive thoughts, dysfunctional beliefs, and negative reinforcement of compulsions and avoidance.

Inflated Responsibility

Belief that one has the power to cause or prevent negative outcomes.

Overestimation of Threat

Belief that negative events are likely and would be unmanageable.

Exaggerated Importance of Thoughts

Belief that the mere presence of a thought means it is significant.

Need to Control Thoughts

Belief that complete control over one's thoughts is necessary and possible.

Perfectionism in OCD

Belief that mistakes and imperfection are intolerable.

Intolerance of Uncertainty in OCD

Belief that it is necessary and possible to be 100% certain that negative outcomes will not occur.

Negative Reinforcement of Compulsions

Compulsions and avoidance continue because they temporarily reduce anxiety or distress.

OCD Identical Twin Concordance

Approximately 53%.

OCD Fraternal Twin Concordance

Approximately 23%.

OCD Neurobiological Models

Genetics, abnormal serotonin activity, and brain circuit abnormalities.

OCD Neurotransmitters

Serotonin, with possible involvement of glutamate, GABA, and dopamine.

OCD Medication

SSRIs.

OCD Psychotherapy

Cognitive-behavioral therapy, exposure and response prevention, and cognitive therapy.

Exposure and Response Prevention (ERP)

A CBT treatment involving exposure to feared stimuli while preventing compulsive responses.

OCD-Related Disorders

Body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder.

Body Dysmorphic Disorder

An obsessive-compulsive-related disorder involving preoccupation with perceived appearance flaws.

Hoarding Disorder

An obsessive-compulsive-related disorder involving persistent difficulty discarding possessions.

Trichotillomania

Hair-pulling disorder.

Excoriation Disorder

Skin-picking disorder.

Acute Stress Disorder

Trauma-related symptoms persisting for 3 days to 1 month after trauma.

Posttraumatic Stress Disorder (PTSD)

Trauma-related symptoms lasting more than 1 month and causing significant distress or impairment.

PTSD Qualifying Trauma

Exposure to actual or threatened death, serious injury, or sexual violence.

PTSD Four Exposure Routes

Direct experience, witnessing, learning about trauma to a close family member or friend, or repeated or extreme exposure to aversive details.

PTSD Four Symptom Clusters

Intrusion, avoidance, changes in cognition or mood, and changes in arousal or reactivity.

PTSD Intrusion Symptoms

Intrusive memories, dreams, and flashbacks related to the traumatic event.

PTSD Avoidance

Persistent avoidance of stimuli associated with the traumatic event.

PTSD Duration

More than 1 month.

PTSD Dissociative Specifier

Persistent or recurrent depersonalization or derealization.

Depersonalization

Feeling detached from oneself.

Derealization

Feeling that surroundings are unreal.

PTSD Delayed Expression

Full diagnostic criteria are not met until at least 6 months after the trauma.

PTSD Projected U.S. Lifetime Risk

8.7% according to the lecture slides.