exam 2: psychopathology chapter 5

fear

central nervous system's physiological and emotional response to a serious threat to one's well-being

anxiety

central nervous systems physiological and emotional response to a vague sense of threat or danger

generalized anxiety disorder (GAD)

disorders marked by persistent and excessive feelings of anxiety and worry about numerous events and activities

most common disorders in US

-19% of us adults experience one of six DSM-5-TR anxiety
disorders
-around 31% develop one of the disorders at some point in their lives
-about 42% of these individuals seek treatment

GAD diagnosis

1. 6 months or more, person experiences disproportionate uncontrollable, and ongoing anxiety and worry about multiple matters
2. symptoms include at least 3 of: edginesss, fatigue, poor concentration, irritability, muscle tension, sleep problems
3. significant distress or impairment

sociocultural perspective (GAD)

-GAD is most likely to develop in people faced with dangerous ongoing social conditions or highly threatened environments (supported by research)
-societal stress: poverty, race and ethnicity, widespread illness

separation anxiety disorder

-individuals feel extreme anxiety, and often panic, whenever they are separated from key people in their lives
-most common among young children
-DSM-5-TR determined it can develop in adults
-new categorization is tan anxiety disorder is controversial

separation anxiety disorder diagnosis

-developing inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached as evidenced by 3 of: fear, anxiety, or avoidance is persistent at least 4 weeks in children and adolescents and 6 months or more in adults and the disturbance causes clinically significant distress or impairment

Freud on GAD

-all children experience some degree of anxiety and use ego mechanisms to control this
-GAD occurs with high anxiety levels or inadequate defense mechanisms

todays psychodynamic theorists (GAD)

-disagree with some Freudian GAD explanations, but agree GAD Cana be traced to early parent-child relationships
-research testing psychodynamic explanations (GAD and defense mechanisms, repressed memories, harsh punishment, overprotectiveness)

psychodynamic therapies (GAD)

-free association
-therapist interpretations of transference, resistance, and dreams to reduce fear of id impulses and control
specific treatment: Freudians focus less on fear and more on control of the id
-object-relations therapists attempt to help patients identify and settle early relationship problems
-short term psychodynamic therapy is more effective than longer treatments

humanistic perspective (GAD)

-GAD arises when people stop looking at themselves honestly and acceptingly
-Carl Rogers: lack of unconditional positive regard in childhood leads to conditions of worth
-threatening self judgements break through an cause anxiety setting the stage for GAD to develop

humanistic treatment approach (GAD)

client-centered therapy: used to show unconditional positive regard for clients and empathize with them
-despite optimistic case reports, controlled studies shave failed to offer strong support
-only limited support for Roger's explanation of GAD and other forms of abnormal behavior

cognitive behavioral perspective (GAD)

-problematic behaviors and dysfunctional thinking often cause psychological disorders
-treatment focus involves the nature of behavior and throughs
-early approach: maladaptive or basic irrational assumptions, silent assumptions
-newer explanations: metacognitive theory, intolerance of uncertainty theory, avoidance theory

cognitive behavioral therapies (GAD)

-changing maladaptive assumptions (Ellis rational-emotive therapy)
-breaking down worrying: mindfulness-based cognitive behavioral therapy
-acceptance and commitment therapy- mindfulness meditation

biological perspective (GAD)

-caused chiefly by biological factors, supported by family pedigree studies and brain researchers, and challenged by competing explanations of shared environment
-fear reactions are tied to brain circuits

biological explanations (GAD)

-everyday fear reactions are tied to brain circuits- fear circuit hyperactivity may be tied to the development of GA
-benzodiazepines provide anxiety relief-: benzodiazepine receptors ordinarily receive neurotransmitter gamma-aminobutyric acid
-GABA carries an inhibitory message that ends the firing of neuron receptors- low GAB could help produce excessive brain circuit communication and contribute to GAD development

drug therapies (GAD)

-early 1950's: barbiturates (sedative-hypnotics)
-late 50's: benzodiazepines (significant problems)
-more recently: antidepressants that increase serotonin and norepinephrine neurotransmitter activity, antipsychotics

phobias vs. fear

-more intense and persistent fear
-greater desire to avoid a feared object or situation
-create distress that interferes with functioning

specific phobias

-yearly symptoms exist in 9% of US population
-13% experience symptoms during lifetime
-women 2 to 1 for men
-32% at most seek treatment

specific phobia diagnosis

-marked, persistent, and disproportionate fear of a particular object or situation; usually lasting 6+ months
-exposure to an object produces immediate fear
-avoidance of the feared situation
-significant distress or impairment

agoraphobia diagnosis

-pronounce, disproportionate, or repeated fear about being in the act least two delineated situations
-avoidance of agoraphobic situations
-symptoms usually continue for at least 6 months
-significant distress or impairment

agoraphobia

-yearly symptoms exist in around 1% of US population
-1.3% experience symptoms during lifetime, gender differences
-around 46% seek treatment

causes for specific phobias

-cognitive-behavioral theories receive most research support
-focus primarily on the behavioral dimension
-first fear of certain objects, situation, or events are learned through conditioning
-once fears are acquired, individuals avoid dreaded object or situation and permit fears to become entrenched

phobia research

-early laboratory studies of classical conditioning fear (little Albert)
-modeling: bandora
fear reactions are not always conditioned: disorders no ordinarily acquired through classical conditioning or modeling

behavioral-evolutionary explanation (PH)

-some specific phobias are much more common than others
-species biological predisposition to develop certain fears (preparedness)
-explains why some phobia are more common than other

phobias treatments

-actual contact with the feared object or situation is key to greater success in all forms of exposure treatment
-systematic desensitization: relaxation training, fear hierarchy, in vivo or overt desensitization, virtual reality
-flooding, modeling

agoraphobia treatment

-variety of exposure therapy approaches (support groups, home-based self-care programs)
-successful in around 70% of agoraphobic clients (as many as half relapse)

social anxiety disorder

-pronounced repeated anxiety about the social situation in which an individual could be exposed to scrutiny by others (6 months or longer)
-fear of being negatively evaluated by or offensive to others
-exposure to the social situation almost always produces anxiety
-avoidance of feared situations
-significant distress or impairment

cause of social anxiety disorder

cognitive behavioral perspective: a group of social realm dysfunctional beliefs and expectations help; the anticipation of social disasters and dread social situations
-avoidance and safety behaviors performed to reduce or prevent disasters
-tied to genetic predispositions, trait tendencies, biological abnormalities, trauma, overprotective parents

treatment for social anxiety disorder

overwhelming social fears
-- medications: benzodiazepine or antidepressents
--cognitive behavioral therapy: exposure and systematic therapy discussions
lack of social skills
--social skills and assertiveness training

social media jitterss

computer and mobile device use can produce more common forms of anxiety including generalized and social
-instagram, snapchat, TikTok, Facebook
-fomo, nomophobia

panic attacks

-periodic short bouts of panic that occur suddenly, reach a peak within minutes and gradually pass
-fears at least 4 of the following: heart palpitations, tingling in hands or feet, shortness of breath, sweating, hot or cold flashes, trembling, chest pain, choking sensation, faintness, dizziness, feeling of unreality

panic disorder

-unforeseen panic attacks occur repeatedly
-one or more of the attacks preceded either: at least a month of continual concern about future attacks
or a month of dysfunction behavior changes associated with attacks

biological perspective of panic disorder

initial theory: panic attacks caused by abnormal norepinephrine activity in locus ceruleus
more recent: brain circuits and amygdala are the more complex root of the problem, may be inherited predisposition to abnormalities

biological factors contributing to panic disorder

-hyperactive panic circuit: amygdala, hippocampus, ventromedial nucleus of hypothalamus, central gray matter, locus coerulues

drug therapies for panic disorder

-various antidepressants bring some improvement to more than 2/3 of patients
-drugs function in norepinephrine receptors in the panic brain circuit
-improvements require maintenance of drug therapy
-some benzodiazepines (Xanax) have proved helpful

cognitive behavioral perspective on panic disorders

-biological factors are only part of the cause of panic attacks
-bodily sensations are misinterpreted as signs of medical catastrophe and controlled by avoidance and safety behaviors
-anxiety sensitivity may exist

-biological challenge test: procedure used to produce panic and assess panic disorder

cognitive behavioral therapy for panic disorder

-seeks to correct people's misinterpretations of their bodily sensations
-educate about nature of panic attacks
-teach applications of more accurate interpretations
-teach skills for coping with anxiety, including biological challenge procedures

obsessions

persistent thoughts, ideas, impulses, or images that seem to invade a person's consciousness
-features: though feel both intrusive and foreign, attempts to ignore or resist them trigger anxiety, awareness the thoughts are excessive
-basic themes: dirt/contamination, violence and aggression, orderliness, religion, sexuality

compulsions

repetitive and rigid behaviors or mental acts that people feel they must perform to prevent or reduce anxiety
-features: various forms of voluntary behaviors or mental acts, feeling mandatory/unstoppable, recognition the behaviors are unreasonable, performing behaviors that reduce anxiety for a short time, behaviors often develop into rituals
-themes: cleaning compulsions, checking compulsions, order or balance, touching, verbalizing and/or counting compulsions

OCD

-occurrence of repeated obsessions, compulsions, or both
-obsessions or compulsions take up considerable time
-significant distress or impairment

psychodynamic perspective for OCD

theory: battle between id and ego defense mechanisms lessens anxiety in overt thoughts and actions
-freud: oct related to anal stages of development
-not all psychodynamic theorists agree
treatment: classical techniques of free association and therapist interpretation; have little research support
-short term psychodynamic therapies are more direct and action-oriented

cognitive behavior perspective of OCD

disorder grows from human tendencies to have unwanted, intrusive, unpleasant though
-to avoid negative outcomes individuals attempt to neutralize their thoughts with actions
-reduction in anxiety after neutralizing strategies
-exceptionally high standards of conduct; thought-action fusion

cognitive behavior therapy for OCD

focus on cognitive processes that help to produce and maintain obsessive thoughts and compulsive acts
-use exposure and response prevention exercises: set example, videoconferencing in recent years, between 50%-70% see improvement with therapy

biological perspective of OCD

early research: genetic focus- family pedigree and twin studies, heritability estimates 26%- 33%
recent research: brain circuit hyperactive in people with OCD
-abnormal serotonin activity, abnormal brain structure and functioning, some research evidence suggests these two lines may be connected

biological treatment of OCD

-serotonin-enhancing antidepressants: clomipramine and similar drugs, improvement within 50%-80%-- relapse occurs if medication is stopped
-research suggests that combination therapy may be most effective

religious OCD

-fear of not having enough faith, fear of hell, fear of being unclean or contaminated according to rules of one's religion, fear of committing immoral behavior

OCD related disorders

-hoarding disorder
-trichotillomania (pulling hair)
-excoriation (skin-picking)
-body dysmorphic disorder

epidemiology of OCD

OCD- lasts an average of 8.9 years
-mean time consumed by symptoms
-obsessions 5.9 hours
-compulsions 4.6 hours