Psych Disorders Exam 1

The Four D’s + 1

• Deviance: standard deviations away from the mean/norm; the person’s symptoms are outside the normal range of experience

  • This is based, a lot, on context. Where you are in the world, your age range, culture; this allows for what is considered deviant to be varied. 

• Distress: person is experiencing distress; uncomfortable

  • Considered to be hallmark feature

  • Central criteria for almost all disorders, but not all; because not all report being in distress(ex: personality disorders, anorexia, substance use)

• Dysfunction: impairment in daily functioning

• Danger: danger to self

  • The vast majority of people with psych disorders are not dangerous to other people. 

    • Exceptions: substance use, antisocial personality disorder

  • 10x more likely to be victims of violence than to be perpetrators.

• Added D - Duration: certain amount of time for disorders to be diagnosable.

Classical conditioning

Pavlov’s dog example

Neutral stimuls - something that doesn’t cause the response yet

• Bell → no salivation

Unconditioned stim - something that naturally causes a response; no learning required

• food

Unconditioned response - the natural, automatic response to the US

• food → salivation

Food(US) → Salivation (UR)

During conditioning you repeatendly put the NS with the US

• bell + food → salivation

• eventually the dog learns the food is coming

after learning, now the bell alone makes the dog salivate

• the bell has changes from the NS → CS

Conditioned Stim = the previously neutral stim that now causes a learned response

conditioned response = the learned response to the CS

• salivation when hearing the bell

To what did they attribute disordered behavior? 

What was trephination and why was it used?

Attributed abnormal behavior to supernatural causes - evil spirits, demons, possession. Mental illness could be interpreted as a sign that supernatural forces had entered or were influencing a person.

Trephination - procedure where a hole was cut or drilled into a person’s skull.

• described to have been used to release evil spirits believed to be causing abnormal behavior, although archaeological evidence doesn’t establish that this was always its purpose.

Ancient Views and Treatments of Abnormality - Greek and Roman 500 B.C.E to 500 C.E.

Hippocrates believed that physical and mental illnesses had natural causes in the four humors: yellow bile, black bile, blood, phlegm

• significant because it challenged the common belief that abnormal behavior was caused by supernatural forces - gods, demons, possession.

• He treated mental disorders as illnesses that could be understood and treated through natural methods.

Treatment examples:

• quiet life

• vegetable diet

• celibacy

• vomiting

• bleeding

• exercise

Ancient Views and Treatments of Abnormality - Europe in the Middle Ages 500-1350 C.E.

Church rejected scientific forms of investigation and controlled all education.

Mental disorders seen as having demonic causes.

Treatment:

• exorcism

• torture

Ancient Views and Treatments of Abnormality - The Renaissance

Demonological views of abnormality declined

John Weyer(first mental health physician) believed the mind was as susceptible to sickness as the body.

• Care improved

• Human and caring treatment

Mid 16th century

• improvements in care began to fade - asylums

  • People were just housed; they were more like inmates instead of patients.

  • Kept away from everyone else

  • Filthy; chained

  • People would pay admission to walk through asylums - tourist attraction

• rise of asylums because more people with mental illness were institutionalized, and overcrowding and lack of resources led to poor conditions and treatment

• bedlam: chaotic; way they said Bethlehem was Bedlam

  • early mental asylum known for overcrowding and cruel/inhumane conditions

Ancient Views and Treatments of Abnormality - 19th century + American reformers

care of people with mental disorders began to improve

Benjamin Rush(father of American psychiatry): patients deserve moral and humane care

• Staff work closely with patients; walks, talking

• Restraint chair - he theorized that the device would slow the pulse, reduce blood flow to the head, and "tranquilize" the agitated mind

Dorothea Dix(Boston schoolteacher) - visited asylum like place and say horrible conditions

• promoted moral treatment in the US

• made humane treatment a public and political concern; new laws, greater funding, state hospitals

movement disintegrated by the end of the 19th century; mental hospitals warehoused inmates and provided minimal care, due to:

• overcrowing

• money and staff shortages

• poor recovery rates

• emergency of prejudice

Reversal → overcrowding, staff shortages, and lack of funding/resources

Ancient Views and Treatments of Abnormality - early 20th century

Somatogenic(body) perspective: psychopathology has psychical causes

• 2 factors responsible for the rebirth of this perspective

1. Emil Kraepelin

   1. Physical factors(fatigue)

   2. First system for classifying “abnormal” behavior

2. New biological discoveries

   1. Syphilis - general paresis

• Medical treatments were developed

  • tooth extraction, tonsillectomy, hydrotherapy, lobotomy

• results were disappointing until effective medication was developed in the 1950s

• in some circles eugenic sterilization was proposed

• gained momentum when scientists discovered that syphilis could infect the brain and cause psychological symptoms, showing that a physical disease could case abnormal behavior

Psychogenic(psychi) Perspective: psychopathology has psychological causes

• Rise in popularity based on work with hypnotism

  • Mesmer: hysterical disorders; mesmerism

  • Breuer: caused and cured symptoms

  • Freud: psychoanalysis; initially used hypnosis to treat patients with hysteria(symptoms such as paralysis or loss of senesation without an identified cause). he later developed psychoanalysis/free association

• Psychoanalytic theory and treatment became widely accepted

• gained momentum → hypnosis and psych treatments appeared to improve symptoms without treating a physical disease

How are people with Severe Disturbances Treated?

New psychotropic medications discovered in 1950s

• antipsychotic drugs

• antidepressant drugs

• antianxiety drugs

led to deinstitutionalization

• outpatient care and community mental health approach fell short of meeting the needs; resulted in homelessness and imprisonment for many

How are people with Less Severe Disturbances Treated?

Outpatient care is primary mode of treatment; most insurance coverage

Less than half of people with a psych disorder receive treatment.

1 in 5 people who enter therapy do so for milder problems in living

Ancient Views and Treatments of Abnormality - today

Prevention approach strategies

• correction of social conditions

• help individuals at risk for developing emotional problems

• utilizing positive psych to teach coping skills

  • what do happy people do

Deinstituitonlization

Deinstitutionalization - movement of people with mental illness of out large psychiatric hospitals and into community-based care

• began in the 1950s accelerating in the 60s - 70s

• Why? new psychiatric medications, concerns about inhumane institutions, and belief that community treatment would be better and less restrictive.

• Consequences - fewer people lived in psychiatric hospitals, but community services were often inadequate, contributing to problems such as homelessness, incarceration, and lack of treatment for some people

Multicultural psych

how culture, race, ethnicity, gender, and similar factors affect behavior and thought

how people of different cultures, races and genders may differ psychologically

Positive psych

study of well-being, happiness, strengths, and factors that help people thrive, rather than focusing only of psych disorders

Factors that relate to happiness:

• strong relationships/social connections

• meaningful activities

• optimism

• gratitude

• physical health/exercise

• sense of purpose

The Biological Model(medical perspective)

Malfunctioning physical parts of the organism

Points to problems in brain and nervous system

1. Anatomy(structures)

2. Chemistry(neurotransmitters, hormones)

3. Circuitry(interconnections, communication between)

What can go wrong?

• genetic factors(mutations/inheritance)

• accidents

• physical illness/disease

The Biological Model - How do biological theorists explain psychopatholgy?

How do biological theorists explain psychopatholgy?

• brain anatomy - neurons and glial cells; brain structures

• brain chemistry

  • neuron-to-neuron transmission

  • dendrites

  • axons

  • nerve endings

  • synapses

  • neurotransmitters

    • over 100 - serotonin, dopamine, GABA

    • abnormal activity in certain NTs can lead to specific psych disorders

    • depression linked to low levels of Serotonin, Norepinephrine, Glutamate

  • receptors

• Chem activity

  • abnormal activity in the endocrine system(hormones) is also related to psych disorders

  • Cortisol linked to anxiety and mood disorders

• Brain circuits

  • interconnectivity among circuit structures

• Genetics

  • abnormalities in brain anatomy or chemistry are sometimes the result of genetic inheritance

  • Genes - mutations, inheritance

  • Evolutionary theorists suggest

    • the result of normal evolutionary principles(fear)

      • genes contribute to adaptation and survival

      • may make some people more prone to psych problems

Biological Treatments

identify the physical source of dysfunction to determine tx

1. Pyschotropic meds (1950s)

   1. most common bio tx

2. Brain stimulation

   1. Direct or indirect brain stimulation

      1. Electroconvulsive therapy(ECT)

      2. Transcranial magnetic stimulation (TMS)

      3. Vagus nerve stimulation (VNS)

      4. Deep brain stimulation (psychosurgery)

3. Psychosurgery (neurosurgery)

   1. Deep brain stimulation

Strengths and Weaknesses of the Bio Model

Strengths

• well respected methods, insights, and results

• valuable new info

• treatments can bring great relief

Weaknesses

• may produce significant undesirable effects

• excludes nonbiological factors(limits understanding of psychosocial influences)

The Psychodynamic Model - Freud

Freud (1856-1939) Theory of psychoanalysis

• behavior determined

  • underlying unconscious, dynamic, psychological forces

• psychopathological symptoms are the result of unconscious conflict among these forces

• Abnormal vs Normal Functioning

  • 3 unconscious forces shape personality

    • Id - pleasure principle, instinctual needs

    • Ego - reality principle, rational thinking

    • Superego - morality principle

  • Conflicts - healthy personality = balance; dysfunction = excessive conflict

  • Proposed developmental stage

    • new events and pressures require adjustment in the id, ego, and superego at each stage.

    • Oral, Anal, Phallic, Latent, Genital

      • If successful → personal growth

      • If unsuccessful → fixation at early developmental stage leading to psychological abnormality

• Defense Mechanisms

  • Repression

  • Denial

  • Projection

  • Rationalization

  • Displacement

  • Intellectualization

  • Regression

The Psychodynamic Model - dynamic (interacting) forces + treatment

Self theorists

• emphasize the unified personality

Object-relations theorists

• emphasize the human need for relationships, especially between children and caregivers

Psychodynamic Therapists

• seek to uncover past trauma and inner conflict with the therapist acting as a guide

• Techniques

  • free association

  • therapist interpretation: resistance, transference, dream interpretation

  • catharsis

  • working through

The Psychodynamic Model - Strengths and Weaknesses

Strengths:

• First to recognize the importance of psych theories and systematic treatment for disorders

Weaknesses

• Unsupported ideas; difficult to research

• non-observable concepts, inaccessible(unconscious)

Congnitive-Behavioral Model

Focuses on maladaptive cognitions (thoughts) and behaviors associated with psych disorders.

Differences from previous models

• present-focused

• directive

• action-oriented

• structured therapies

• coping skills training

Behavioral basis of CB Model

Learning

• using conditioning

  • classical conditioning, Pavlov(association/pairings)

  • Operant conditiong, Skinner(consequences)

    • reinforcement or punishment

  • Modeling, Bandura (observation)

• identify and replace problematic behaviors with more appropriate behaviors.

Operant Conditioning

Positive(applies something)

• reinforcement: increases the frequency of a behavior

• punishment: decreases the frequency of a behavior

Negative(removes something)

• reinforcement: increases the frequency of a behavior

• punishment: decreases the frequency of a behavior

The Cognitive Basis of CB Model

Cognitive dimension

• Aaron Beck and Albert Ellis

• Focuses on maladaptive thinking processes

  • inaccurate/disturbing assumptions and attitudes

  • illogical thinking

• therapists help clients recognize, challenge, and change problematic thinking

• goal = new ways of thinking in daily life

New wave of cognitive - behavior therapies

Newer approaches

• acceptance and commitment therapy (ACT)

  • accept problematic thoughts rather than judge them, act on them, or change them

• mindfulness meditation

Cognitive-Behavioral Model Strengths and Weaknesses

Strengths:

• powerful force in clinical field; broad appeal

• clinically very useful

• theories lend themselves to research

• therapies are effective in treating many disorders

Weaknesses

• not successful with all clients

• may limit needed attention to the influence of early life experiences and relationships

The Humanistic-Existential Model

Humanist View

• people are basically good; driven to self actualize

  • fulfill potential for goodness and growth

  • recognition of strengths and weaknesses

  • establish satisfying personal values

Existential view

• self-determination; people have:

  • choice

  • individual responsibility

  • authenticity

• accurate awareness of self

• meaningful, authentic lives

• total freedom from birth negative or positive outcomes

• self-deception; psychological dysfunction

The Humanistic-Existential Model - Carol Rogers

Basic human need for unconditional positive regard

• if received → unconditional self-regard(self-worth)

• if not → conditions of worth

Rogers’ client-centered therapy

• Therapist creates a supportive climate

  • unconditional positive regard

  • accurate empathy

  • genuineness

• little research support but positive impact on clinical practice

The Humanistic-Existential Model - Gestalt theory

Guide clients toward self-recognition and self-acceptance

Techniques

• challenge and frustrate clients

• role playing, embrace and express real emotions fuly

  • own and accept feelings

• rules: “here and now” and “I” language

Little research support; subjective experiences and self-awareness can’t be objectively measured

The Humanistic-Existential Model - strengths and weaknesses

Strengths

• taps into domains missing from other models

• emphasizes the individual

• non-deterministic and optimistic

• emphasizes on health

Weaknesses

• focuses on abstract issues

• difficult to research

• weakened by disapproval of scientific approach; may be changing

The Sociocultural Model - Family Social Perspective

Social and cultural forces - norms and roles in society

Family Social Perspective

• how do family-social theorists explain abnormal functioning?

  • forces that operate directly on an individual(both normal and psychopathological behavior)

    • family, social interactions, community conditions

    • social labels and roles; diagnostic labels

      • Rosenhan study, power of labels

      • social connections and supports

    • Family systems theory

      • enmeshed or disengaged structures

• Treatments

  • family and social settings

  • group therapy(support group, self-help group, peer group, mutual-help group)

  • family therapy

  • couple(marital)therapy

  • community treatment

The Sociocultural Model - Multicultural perspective

behavior and treatment best understood in the context of culture, cultural values, and external pressures

• ethnic and racial minority groups, groups such as economically disadvantages persons, LGBTQ individuals, and women

prejudice and discrimination may impact psychological functioning

Intersectionality - group membership may overlap

The Sociocultural Model - strengths and weaknesses

Strengths

• Increased awareness of family, cultural, social and societal issues and roles

• Have sometimes been successful when other treatments have failed

Weaknesses

• research is difficult to interpret

• models are unable to predict why dysfunction develops in some individuals but not others under the same pressures.

The Developmental Psychopathology Perspective

Integrates factors from many models

Equifinality

• Unfavorable genetics → difficult temperament → ineffective parenting → conduct disorder

• low self esteem → high need for approval → delinquent peer group → conduct disorder

• In the end, people from two very different sets of circumstances end up in the same place with disorder. 

Multi-finality

• Unfavorable genetics → Difficult temperament → ineffective parenting → conduct disorder

• Unfavorable genetics → Difficult temperament → effective parenting → well adjusted

• One overcomes the risk factor and the other grows to have a disorder. 

Case Study

Detailed description of an individual person’s life and psychological problem.s

• Source of new ideas about behavior and discoveries

• Can provide tentative support for a theory; or may challenge a theory’s assumptions

• Intro of new therapeutic techniques

• Can study unusual problems that don’t occur often enough to permit a large scale study

• Ex: Freud (Little Hans)

  • Hans was in love with his mother and wanted to get rid of his father to have his mother to himself. 

  • Recognized that he was a small boy and couldn’t overpower his father. 

  • Instead of having this internal conflict with his father, displaced the fear of his father to horses. 

Limitations

• Biased observed and biased subjected

• Subjective evidence - low internal validity

  • Accuracy, one factory caused the other

• Little basis for generalization(low external validity)

Correlational Method

Correlation - degree to which events or characteristics vary with each other

Correlational method - research procedure used to determine how much events or characteristics vary along with each other

Subjects/participants

• people chosen for a study are collectively called a sample

• Sample must be representative of the larger population(for external validity)

Describing Data

• positive correlation (slope is upward and to the right) - variables change in the same direction

• Negative correlation(downward slope) - variables change in the opposite direction

• Unrelated(no slope) - no consistent relationship

Correlational Method - advantages and limits

Advantages

• high external validity(can generalize findings)

• can repeat(replicate) studies with other samples

Limitations

• lack high level of internal validity - describe, but don’t explain, a relationship or causation

The Experimental Method

Preferred when possible

Researcher manipulates one variable to see whether it causes a change in another variable.

limitation - some variables cannot ethically or practically be manipulated and laboratory results may not perfectly reflect real life

Manipulated variable = independent variable

Variable being observed = dependent

• expected to change as the IV is manipulated

Cofounds - variable(s) other than the independent variable that may also be affecting the dependent variable.

Experimental method - important features

• control group - doesn’t receive the experimental treatment; provides comparison

• random assignment - participants randomly assigned to groups; increases internal validity(accuracy of findings) because all potential factors should be evenly distributed between both groups.

• masked(blind) design - participants don’t now what group they are in; placebo therapy

Double-masked design: both participants and experimenters are unaware of the groups to which participants are assigned

Alternative experimental designs used when a traditional experiment would be unethical, impossible, or impractical

Placebo effect - when people experience a change because they expect a treatment to work, even though they didn’t receive the active treatment.

• researchers control for it by giving the control group a placebo(fake treatment) and ideally use a masked design

Protecting Human participants

Researchers’ primary obligation - avoid physical or psychological harm for human participants

Institutional Review Board(IRB) - Ethics committee to protect the rights and safety of human research participants

Research Participant Rights

• voluntarily enlist

• adequately informed about what the study entails; informed consent

• stop at any time

• benefits of the study outweigh the costs/risks

• protected from physical and psychological harm

• access to info about the study

• privacy of participants is protected; confidentiality or anonymity

Research Issues

WEIRD Participants

• Western

• Educated

• Industrialized

• Rich

• Democratic

Psych research often uses WEIRD participants, especially college students, so findings may not generalize to people from different cultures, backgrounds, ages, or socioeconomic groups

Concerns:

• small/unrepresentative samples

• Positivity bias - significant/interesting results are more likely to be published

• Replication - repeating a study to see whether the same or similar results occur again

  • increase confidence that a finding is reliable and wasn’t just due to chance or features of one particular study

Statistically significant

• typically p < .05

Statistical vs classical significance

• S - is the observed effect unlikely to be explained by chance alone under the null hypothesis?

• C - is the effect large or meaningful enough to make a real difference in someone’s symptoms or everyday functioning?

Projective Tests

Client interpretation of vague or ambigious stimuli

Low reliability and validity

ex: drawings, sentence-completion test

Personality Inventories

Designed to measure broad personality characteristics

Most widely used: Minnesota Multiphasic Personality Inventory (MMPI-3)

335 T/F self-statements

Scales

• self-doubt

• worry

• aggression

• psychoticism

Scale scores - 0-120

• above 70 = deviance

• graphed to create a profile

greater reliability and validity than projective tests

often limited in assessing culturally diverse samples

Response Inventories

self-report measures of one specific area of functioning

• affect (emotion) beck depression inventory (BDI)

• social skills

• cognitive processes

Clinical Interviews

Basic background data - gathered with specific theoretical focus

Unstructured, Semi-, and Structured

• SCID-5-RV

Limitations:

• may lack validity

• interviewer bias or mistakes in judgements

• may lack reliability

Psychophysiological tests

Measure physiological response as an indication of psychological problems

• Includes heart rate, blood pressure, body temp, galvanic skin response, and muscle contraction(EMG)

• Polygraph

• Biofeedback

Neuroimaging and Neuropsychological tests

Neuroimaging

• directly assess brain abnormalities by assessing brain structure and activity/function

• Structures: CT/CAT scans, MRI

• Activity: EEG, PET scans, fMRI

Neuropsychological tests

• indirectly assess brain function by measuring congnitive, perceptual, and motor functioning

Advantages of Diagnosis

Pattern is basically the same as other people

Client feels less alone

Has been investigated in many studies

Has possibly responded to particular treatments

DSM-5-TR

Based on Emil Kraeplin’s system - helped establish classification of mental disorders based on symptoms and patterns

Clinicians evaluate a person’s symptoms, duration, severity, distress/impairment, and exclusion criteria, then determines whether they meet the criteria for a disorder.

Over 500 diagnoses; symptom descriptions

requires both categorical and dimensional info

• categorical: you either meet the criteria for a disorder or you don’t

• dimensional: a rating of the severity of a client’s symptoms and dysfunction

Primarily categorical, but incorporates dimensional/severity measures too

Has greater validity and reliability than previous editions, but it is still a concern

DSM changes

asperger’s disorder incorporated into Autism spectrum disorder

OCD moved out of anxiety disorders into its own related category

ptsd moved out of anxiety disorders into traums/stressor-related disorders

problems with diagnosis DSM

stigma and stereotypes

labels can affect how others perceive someone

risk of misdiagnosis

different disorders can have overlapping symptoms

labels may oversimplify an individuals experiences

Hierarchical Taxonomy of Pyschopathology(HiTop)

Dimensional terms only

Identifies lower levels of patholgy

Attempts to control for symptom overlap across diagnoses

ICD-11

used in most other countries

Some differences, but most matching diagnoses and codes with DSM-5-TR

Disadvantages to Diagnoses

Misdiagnosis and reliance on clinical judgment are concerns

Labeling may lead to stigmatization and a self-fulfilling prophecy

• many Americans say they wouldn’t seek help because of the stigma of mental health problems (1 in 5); being labeled as mentally ill (1 in 3); half would hesitate to get help if a diagnosis is required.

Treatment decisions

Begin with assessment info and diagnostic decisions to determine a treatment plan.

Other factors

• therapists theoretical orientation

• current research; guide to practice

• general state of clinical knowledge: currently focuses on empirically supported, evidence based treatment

Approximately what percent of people in the US will experience a psychological disorder in their lifetime?

One disorder - 18.7%

Two - 10.4%

three or more: 17.3%

Fear vs. anxiety

Fear - CNS’s physiological and emotional response to a serious immediate threat to one’s well being

Anxiety - CNS’s physiological and emotional response to a vague sense of threat or danger

• Anticipated threat

• similar reaction, although may be less intense

Anxiety disorders

most common psych disorders in US

In any given year, about 19% of the US adult population experiences.

Lifetime prevalence = about 31%

High comorbidity rate

Generalized Anxiety Disorder

1. For 6 months or more person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about several events/activities/domains

2. The symptoms include at least 3 of the following

   1. restlessness

   2. fatigue

   3. poor concentration

   4. irritability

   5. muscle tension

   6. sleep problems

3. significant distress or impairment

Persistent and excessive anxiety experienced under most circumstances; worry about practically anything

• reduced quality of life

affects 4% of US population yearly; 6% lifetime prevalence

Psychodynamic view and treatment for Generalized Anxiety Disorder

Freud

• all children use ego defense mechanisms to control anxiety

• early developmental experiences may predispose one GAD

• GAD occurs with high anxiety levels and inadequate defense mechanisms

Today’s psychodynamic theorists

• Agree GAD can be traced to early parent-child relationships

• Some research support that GAD related to harsh punishment, overprotectiveness, possibly greater use of defense mechanisms

Psychodynamic therapies

• free association, interpretations of transference, resistance, dreams

• Freudians focus less on the fear and more on control of id impulses.

Humanistic view of and treatment for GAD

GAD arises when people stop looking at themselves honestly and acceptingly

Carl Rogers - lack of unconditionally positive regard in childhood leads to conditions of worth

• Threatening self-judgements break through and cause anxiety

Client-centered therapy

• Unconditional positive regard for clients and genuine empathy

CBT View and Treatment for GAD

Anxiety is caused by problematic behaviors and dsyfunctional thinking(maladaptive or irrational assumptions)

• Metacognitive theory(meta-worries)

• Intolerance of uncertainty

• Avoidance theory

CB Therapies - change maladaptive assumptions

• identify irrational assumptions

• form more appropriate assumptions

• coping skills and relaxation training

• Mindfulness-based CBT: acceptance and commitment therapy (ACT), mindfulness meditation

Biological view of GAD

GAD has several biological factors supported by

• family pedigree studies

• genetic studies

• animal studies

• brain imaging studies

fear circuit hyperactivity or dysfunction may be tied to development of GAD

Medication Therapies for GAD

early 1950s - barbiturates (sedative-hypnotics)

late 1950s - benzodiazepines enhance GABA(NT), especially in the amygdala - slows down the nervous system

• side effects (rebound anxiety, dependence, drowsiness, memory loss, depression, aggression; poss lethal interaction with alchohol)

More recently: antidepressants that increase serotonin and norepinephine activity (may impact fear circuit)

• anitpsychotic medications help some with more sever and treatment resistant GAD

How do phobias differ from general fear?

more intense and persistent

greater desire to avoid the feared object or situation

create distress that interferes with functioning

Categories of phobias

Specific

• animals

• environmental

• situational

• body-based

• other

Agoraphobia

• intense fear of being in public places, open spaces, or crowded situations where escape might be difficult or help unavailable

Specific phobias

9% yearly prevalence in the US; 13% lifetime

Women to men: 2:1

Symptom criteria:

• excessive, persistent, and disproportionate fear of a particular object or situation; lasting at least 6 months

• exposure to the object produces immediate fear

• avoidance of the feared situation

• significant distress or impairment

Agoraphobia

1% US/yearly; 1.3% lifetime prevalence more common in women

Symptom criteria

• pronounced, disproportionate, or repeated fear about being in at least two situations:

  • public transportation

  • parking lots, bridges, or other open spaces

  • shops, theaters, or other confined places

  • lines or crowds

  • away from home unaccompanied

• fear derives from a concern that escape or getting help would be hard if panic, embarrassment or disabling symptoms were to occur.

• Avoidance of the agoraphobic situations

• Symptoms usually continue at least 6 monts

• Significant distress or impairment

What causes specific phobias?

3 P’s

Predisposing factors

• biopsychosocial

• Bio factors such as a strong fear response, overactive circuit, differences in fear conditioning, generalization, and habituation

• Psych - beliefs, childhood stress

• Social - parenting style, modeling

Precipitating factors

• scary event initiates fear response.

• fear of certain objects, situations, or events are first learned through classical conditioning.

Perpetuating

• once fears are acquired, individuals avoid dreaded object or situation(negative reinforcement; operant conditioning) and fears become entrenched (lack of safety learning/habituation)

Learning Models - Phobias

Fears are learned through classical conditioning(little Albert)

• US loud noise

• UR fear

• initially, white rat was a NS but after pairings with US: CS = white rat, CR = fear

• Modeling

  • observation

Fears are maintained through operant conditioning

• avoidance is negatively reinforcing - perpetuates phobia

Behavioral - Evolutionary Explanation

Preparedness

• Biological Predisposition / innate tendency for people (and some animals) to be much more easily conditioned to fear certain objects and situations.

• Genetically transmitted via an evolutionary process.

• Explains why some phobias are more common than others(snakes, spiders, heights, darkness)

Treatments

CBT Exposure treatment

• systematic desensitization(J Wolpe)

  • relaxation training

  • create fear hiearchy - highly and specifically individualized for each client

  • exposure with paired relaxation

    • in vivo desensitization

    • covert desensitization

    • virtual reality

• flooding, no relaxation, no gradual buildup

• modeling

DSM-5 Criteria for Social Anxiety Disorder

Pronounced, disproportionate, and repeated anxiety about social situations in which the individual could be exposed to scrutiny by others, typically for 6 months or more

fear of being negatively evaluated by, or offensive to, others

exposure to the social situation almost always produces anxiety out of proportion to the actual threat.

avoidance of feared situations, or endured with intense anxiety

the fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning

7% of US yearly ; 12% lifetime prevalence

Treatment for Social Anxiety Disorder

overwhelming social fears

• cognitive-behavioral therapy - exposure therapy, and reexamine and challenge maladaptive beliefs

• medications - benzodiazepines or antidepressans

lack of social skills

• social skills and assertiveness training

• CBT as effective as medication, less likely to relapse

Social Media

Social networks are increasingly being used for research studies

Contributions

• access to large data bases

Concerns

• without consent

• direct and secret manipulation of social media by researchers without informed consent; potential for affecting clinical depression in some studies; psychological targeting(personalized ads)

Panic Attacks

Periodic, short bouts of panic that occur suddenly

1/3 of people have 1 or more at some point in their lives

Feature a least 4 of the following symptoms

• heart palpitations

• faitness

• shortness of breath

• dizziness

• sweating

• derealization

• hot/cold flases

• fear of going crazy

• trembling

• losing control, or dying

• numbness or tingling

• chest pains

• choking sensations

Panic Disorder - Criteria

Unforeseen panic attacks occur repeatedly

One or more of the attacks precede either

• at least 1 month of continual concern about possible repeat attacks

• at least 1 month of dysfunctional behavioral changes

3% of US/yearly; 5% lifetime prev

Often begins in late adolescence or early adulthood

Women: Men 2:1

May be accompanied by agoraphobia

Biological view of panic disorder

Caused by a hyperactive panic circuit

Drug Therapies for Panic Disorder

Antidepressant drugs bring some improvement to more than 2/3s

Regulates norepinephrine and serotonin in the panic circuit

Improvements require maintenance of drug therapy

Some benzodiazepines (especially Xanax) have proved helpful. but problems

CBT view of Panic Disorder

Biological factors are only part of the cause

bodily sensations are misinterpreted as signs of medical catastrophe

Anxiety sensitivity - overly focus on bodily sensations, see as harmful

Avoidance and safety behaviors are engaged to prevent sensations - negatively reinforce - no habituation/extinction - fear is maintained

Role of Cognitions in panic attacks

Internal or External stressor → perception of unpleasant bodily sensations heart palpatations, difficulty breathing, dizziness, sweating, trembling → catastrophizing throughts → increased bodily sensations → more catastrophizing thoughts → leads back to “perception…

CBT for panic disorder

educate about nature of panic attacks

teach more accurate interpretations of bodily sensations

teach skills for coping with anxiety, relaxation and breathing techniques

exposure - biological challenge test

• procedure used to produce panic-like symptoms

• ride it out

OCD

routines are not signs of OCD

Obsessions - persistent intrusive thoughts, ideas, impulses, or images

• intrusive thoughts

• attempts to ignore or resist them trigger anxiety

• awareness that thoughts are excessive

• Ex: dirt, orderliness, religion

Compulsions - repetitive and rigid behaviors (or mental acts) people feel they must perform to prevent

• various forms of voluntary behaviors or mental acts

• feel mandatory/unstoppable

• recognition that behaviors are unreasonable

• performing behaviors reduces anxiety for a short ime

• behaviors often develop riturals

• Ex: cleaning, checking, touching, counting

Criteria

• occurrence of repeated obsessions, compulsions or both more than 1 hr a day

• significant distress or impairment

1-2% of US yearly

2.3% lifetime

begins in childhood or early adulthood

CB view of OCD

Natural to have unwanted, intrusive, unpleasant thoughts, but most people dismiss/ignore them

to avoid negative outcomes, individuals attempt to neutralize their thoughts with actions(washing, checking) or other thoughts(good thoughts)

neutralizing strategies are reinforced(reduce anxiety)

Characteristics of people who develop OCD

• exceptionally high standards of conduct

• thought-action fusion - believe that intrusive thoughts are equivalent to actions and can cause harm

• believe they should have control over all thoughts and behaviors

CBT for OCD

focus on the cognitive processes that help to produce and maintain obsessive thoughts and compulsive acts

Exposure and Response Prevention (ERP)

• repeatedly exposed to anxiety-provoking stimuli and told to resist responding with compulsions

Biological view and treatment of OCD

early research: genetic focus

• family pedigree and twin studies

recent research: brain circuit(cortico-striato-thalamo-cotrical circuit) hyperactive in people with OCD

• abnormal serotonin activity(also glutamate and dopamine)

• abnormal brain structure and functioning

Treatment

• serotonin-enhancing antidepressants

  • improvement in 50-60% of those with OCD

  • relapse occurs if medication is stopped

• research suggests combination therapy (medication + CBT approaches)

Psychodynamic perspective on OCD

The id and ego are in conflict → the ego tries to manage that conflict using defense mechanisms → when those defenses don’t fully work, anxiety becomes noticeable in the person’s thoughts and behaviors.

Freud - OCD related to the anal stage of development

• Not all psychodynamic theorists agree

Treatment

• free association and therapist interpretation; have little research support

OCD related disorders

hoarding disorder

Trichotillomania - hair pulling

excoriation disorder - skin picking

body dysmorphic disorder