psy240 test two

anxiety

emphasis on potential future events, threatened by the potential occurrence of a future negative event (can become debilitating, lead to fear and panic)

fear

more basic emotion and occurs in response to a real or perceived threat, happens in the here-and-now

panic

false alarm that is triggered in the absence of a concrete, identifiable threat

history

neurosis + Freud’s focus on the difference between objective fears and neurotic anxiety (thought something unconscious/unexpressed was making its way to the surface)

panic attacks

abrupt surge of intense fear or discomfort that reaches a peak within minutes; accompanied by at least four symptoms out of thirteen

symptoms of a panic attack

need at least four; palpitations, pounding heart, accelerated heart rate, trembling/shaking, chest pain or discomfort, fear of losing control or going crazy, fear of dying, etc

panic disorder

recurrent and unexpected panic attacks, at least one followed by a month or more of persistent concern about the meaning of it or result in significantly changed behaviour to prevent another one

agoraphobia

situations are actively avoided, require the presence of a companion, or are endured with intense fear/anxiety that’s out of proportion; concern they won’t be able to escape or get help in the event of a panic attack, concern they’ll experience other incapacitating or embarrassing symptoms,

agoraphobia diagnosis criteria

active, persistent (six months or more) avoidance of situations + two or more of the following: using public transit, being in open paces, being in enclosed spaces, standing in line or being in a crowd, being outside of the home alone

etiology + treatment (panic disorder and agoraphobia)

trigger —> perceived threat —> apprehension —> body —>

~ anxiety sensitivity, physical/cognitive —> (misinterpretation) —> panic

~ catastrophic misinterpretation, physical/mental —> panic

panic self-efficacy

perceived ability to cope with panic attacks, replace thoughts related to not coping

exposure therapies (panic disorder and agoraphobia)

exposure to bodily changes (dizziness, heart palpitations, shortness of breath), exposure to situations without experience of a panic attack

specific phobia

marked and persistent (six months or more) of fear and anxiety of a specific object or situation, excessive and disproportionate fear, actively avoided or endured with intense fear or anxiety

five specifiers of specific phobias

animal, natural environmental, blood-injection-injury, situational, other

etiology + treatment specific phobias

associative model, non-associative model, disgust sensitivity

treatment: exposure and cognitive restructuring

associative model

your association with it can be changed (like fear of dog); limitation: each neutral stimulus has an equal potential of becoming a phobia

non-associative model

biological predisposition for acquiring certain phobias; limitation: not all fears involve major threats

disgust sensitivity

phobias develop because the phobic object is disgusting and possibly contaminated

social anxiety disorder

marked and persistent (six months or more) fear or anxiety of social situations in which there is exposure to possible scrutiny by others, fear of acting in a way that will be negatively evaluated, fear or anxiety out of proportion (usually aware)

etiology social anxiety

genetic factors ~40% (not necessarily genetic, but tendencies are), behavioral inhibition (temperament: avoid going outside, social situations), interactions among brain structures, environmental factors, cognitive factors

brain (social anxiety)

brain structures involved in fear, recognition, and conditioning (amygdala), HPA axis, monitoring of negative affect (prefrontal and orbitofrontal cortex), dysregulation of serotonin, norepinephrine, and other neurotransmission symptoms during stress responses

environmental factors (social anxiety)

being victimized (bullying, teasing) during childhood (dysregulation of HPA axis), critical, intrusive, or overprotective parents

cognitive factors (social anxiety)

negative view of the self, self-focused attention, dishonest self-disclosure, public self-consciousness

treatment (social anxiety)

exposure, cognitive restructuring, and social skills training

generalized anxiety disorder (GAD)

chronic, excessive, and uncontrollable anxiety and worry about a number of events or activities, occurs more days than not for at least six months

gad symptoms

must have three out of six; restlessness/feeling on edge, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances

etiology (gad)

beck’s model, cognitive avoidance theory, metacognitive model, emotion dysregulation model, intolerance of uncertainty model

beck’s model

exaggerated threat appraisals, individuals believe they can’t cope with dangerous situations

cognitive avoidance theory

verbal aspects of worry dampen uncomfortable anxious arousal, push away (consciously or unconsciously) to escape distressing thoughts

metacognitive model

negative beliefs about worry become prominent, leading to a tendency to worry about how much the person is worrying

emotion dysregulation model

anxious people have trouble regulating their emotions

intolerance of uncertainty model

discomfort with ambiguity and uncertainty, problems are seen as threatening and therefore avoided, worry is viewed positively (as a way to help motivate problem solving)

treatment (gad)

often involves cognitive restructuring

obsessions

thoughts, images, or urges that are persistent, unwanted, and markedly distressing (uncertainty, sexuality, violence, contamination); feel embarrassed about them, try to conceal them

compulsions

repetitive behaviours (checking) or mental acts (counting) that a person does in response to obsession or to align with rigid rules; to prevent anxiety/distress or to prevent a feared outcome (handwashing, bathing/cleaning, obsessive tapping, placing objects in a specific order, counting)

moral thought-action fusion (TAF)

the belief that thinking it is just as bad as doing it, characterize themselves as a bad person

likelihood thought-action fusion (TAF)

the belief that having a particular thought about a feared situation will increase the likelihood that the situation will happen

etiology (ocd)

mild genetic contribution, neurobiological model, cognitive-behavioural model

neurobiological model (ocd)

basal ganglia, thalamus, and frontal cortex; serotonin hypothesis (treatment involves SSRIs), glutamate hypothesis

cognitive behavioural model

obsessions are caused by the person’s catastrophic misinterpretation of their own intrusive thoughts, unhelpful efforts to control the intrusions, rebound effect with thoughts (more), with avoidance, there’s no chance to learn thoughts are not correct, rewarding consequences that can maintain the compulsion

treatments (ocd)

exposure and response prevention (ERP): clients are asked not to engage in a compulsion when an obsession is experienced (have the compulsion, feel the anxiety, don’t do it, learn that they can cope with the anxiety and stress)

post-traumatic stress disorder (PTSD)

exposure to actual or threatened death, serious injury, or sexual violence in one or more ways: directly experiencing, witnessing it, learning that it happened to someone close, experiencing repeated or extreme exposure to details of it

intrusion symptoms (PTSD)

one or more; recurrent, involuntary, and intrusive distressing memories, recurrent distressing dreams, dissociative reactions (flashbacks), intense or prolonged psychological distress at exposure, marked physiological reactions to internal/external clues

symptoms (PTSD)

intrusion symptoms, persistent avoidance of stimuli, marked alterations in arousal and reactivity,

persistent avoidance of stimuli

avoidance of distressing memories, thoughts, or feelings, or avoidance of external reminders that arouse these

negative alterations in cognitions and mood (ptsd)

dissociative amnesia, persistent and exaggerated negative beliefs or expectations about oneself, others, or the world, the cause or consequences of the traumatic events that lead the individual to blame themselves or others, persistent negative emotional state, diminished interest or participation in significant activates, feelings of detachment or estrangement from others, persistent inability to experience positive emotions

marked alterations in arousal and reactivity (ptsd)

irritable behaviour and angry outburst, reckless or self-destructive behaviour, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbance

etiology (ptsd)

risk factors (pre-event and post-event), alterations in brain, cognitive and behavioural theories, eye movement desensitization and reprocessing

risk factors (ptsd)

pre-event: lower socio-economic status, lower education, lower tested intelligence, previous psychopathology, childhood history of abuse, people with jobs where they’re prone to experience/witness trauma

post-event: severe triggering events, lack of social support, presence of stressful experiences after the traumatic events, interpersonal traumas

alterations in brain (ptsd)

changes in brain volume (hippocampus) and endocrine function (the stress hormone cortisol)

cognitive and behavioural theories

storing and retrieving of memories: non-verbal, sensory-based traumatic memories —> verbal form (non-traumatic memories)

perceptions of meaning of the traumatic event

eye movement desensitization and reprocessing (EMDR)

not recommended by APA, considered second-line; research showing its effective, but more needed; don’t have to discuss trauma to see benefits (less stressful, hold a memory in your mind instead)

smaller disorders in relation to stress

acute stress disorder (shorter time frame), adjustment disorder (emotional, ongoing stressors)

treatment (ptsd)

medication: benzodiazepines (short-term, infrequent), antidepressants

neural fear circuit (ptsd)

thalamus —> amygdala, areas of the hypothalamus via the mid-brain to the brain stem —> spinal cord

neurotransmitters (ptsd)

GABA, norepinephrine, and serotonin

research (ptsd)

two antidepressants (paroxetine and sertraline) are approved by the US FDA, small effect on patients when vs a placebo, therapy still first treatment

hippocrates humoral theory

“ealtatation” (mania) due to excess warmth and dampness, “melancholia” (depression) due to excess of black bile, treated through draining

Robert Burton

Anatomy of Melancholy (1621)

Emil Kraepelin

“manic-depression,” influences current DSM criteria

Freud’s conflict model

depression due to grief related to a loss (including imagined loss), internalized anger, needs were not met or excessively met during oral stage —> more prone to experience depression

Aaron Beck

cognitive therapy for depression, cognitive factors instead of grief and loss

major depressive disorder (MDD)

higher rates in women, typically onset in mid-twenties, often comorbidity with other psychopathology

diagnostic criteria (mdd)

a) five or more symptoms for the same two week period, one must be depressed mood or loss of interest or pleasure

single episode vs recurrent

severe enough to be noticed by others

symptoms (mdd)

depressed mood, diminished interest or pleasure, significant weight loss or weight gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive/inappropriate guilt, diminished ability to think or concentrate, recurrent thoughts of death (suicidal ideation)

psychomotor agitation

inability to sit still, pacing, hand-writing, pull or rubbing on the skin, clothing, or other objects

psychomotor retardation

slowed speech, thinking, body movements, increased paused before answering, speech that is decreased in volume, inflection, amount, variety or content, or muteness

Beck’s Depression Inventory

scores between 17-21; rank scale 0-3 that detail symptoms

criteria for persistent depressive disorder

consolidation of chronic MDD and dysthymic disorder for DSM-IV

a) chronic low/depressed mood, lasting for at least two years

b) presence, while depressed of two (or more) of the following: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness

childhood —> may not remember a time where they weren’t depressed

criteria for mania

a) distinct period of abnormally persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy (lasts at least one week, pretty much every day)

b) during this, at least three symptoms are met

c) marked impairment in social/occupational function or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features

d) the episode isn’t because of a substance or other mental condition

symptoms (mania - bipolar)

inflated self-esteem or grandiosity, more talkative than usual or pressure to keep talking, decreased need for sleep, flight of ideas or subjective experiences that thoughts are racing, distractibility, increase in goal-directed activity or psychomotor agitation, excessive involvement in activities that have a high potential for painful consequence

hypomania

shorter, milder (a: four consecutive days, c: change in functioning that’s uncharacteristic, d: disturbance in mood and change are observable, e: not severe enough to cause marked impairment in social or occupational functioning)

bipolar I

at least one manic episode, can be preceded or followed by hypomanic or major depressive episodes, can be mixed features (depressive at the same time as manic symptoms)

bipolar II

at least one manic episode, can be preceded or followed by hypomanic or major depressive episodes, can be mixed features (depressive + manic)

cyclothymic disorder

chronic but less severe form of bipolar disorder; history of at least two years of alternative numerous periods of hypomanic and depressive episodes that don’t meet full criteria

seasonal affective disorder

changing recurrent episodes that are tied to the changing seasons, must go on for two years, melatonin (doesn’t really help)

etiology (mood disorders)

pre-existing vulnerability, heritability, biological factors, psychological factors

pre-existing vulnerability (mood disorders)

family history, poor relationships with caregivers, personality patterns

biological factors (mood disorders)

genetics (MDD: 0.36, bipolar: 0.75), neurotransmitters (norepinephrine, serotonin, dopamine), HPA axis (cortisol release, chronic stressors sustained release and breakdown), corticolimbic brain activity (lower functional relationship between amygdala and higher cortical structures in depression)

psychological factors (mood disorders)

depression: higher neuroticism, higher scores on behavioural inhibition system (regulates avoidance); bipolar: higher extraversion and openness, higher scores on the behavioural activation system (regulates approach)

Beck’s cognitive model (diathesis-stress model)

negative view of the self —> negative view of the future —> negative view of the world —> loop

cognitive distortions (mood disorders)

all-or-nothing thinking, overgeneralization, magnification, catastrophizing, jumping to conclusions

treatments (MDD)

psychotherapy (cognitive behaviour therapy, interpersonal psychotherapy), medication selective serotonin reuptake inhibitors and norepinephrine reuptake inhibitors), neurostimulation (electroconclusive therapy, transcranial magnetic stimulation)

treatments (BPD)

medication (lithium, anticonvulsant, antipsychotic drugs, antidepressants), psychotherapy (family-focused therapy, interpersonal and social rhythm therapy, cognitive therapy), neurostimulation

research (MDD)

immediate therapy vs waitlisted, no differences between the two

suicide

mental health disorders are the leading cause of suicide, decriminalized, interpersonal theory of suicide

interpersonal theory of suicide

thwarted belongingness (I am alone) + perceived burdensomeness (I am a burden —> hopelessness (will never change) —> suicidal desire (capability) —> lethal or near-lethal attempt

schizophrenia diagnostic criteria

a) two or more symptoms during a one month period

b) for a significant portion of time since onset, level of functioning one one or more major areas is below previously achieved

c) continuous signs of symptoms persist for at least six months

d) schizoaffective, depressive/bipolar with psychotic features have been ruled out

e) and f) rule out substance and medical conditions

symptoms (schizophrenia)

delusions, hallucinations, disorganized speech, grossly disorganized or cationic behaviour, plus negative symptoms

negative symptoms (schizophrenia)

avolition, affective flattening, anhedonia, asociality, alogia, impairment in memory, learning, attention, etc

delusions

implausible beliefs that are resisant to change even in the face of disconfirming or contradictory evidence

persecutory (paranoid) delusions

believe they’re being harmed, harassed, targeted, ridiculed, or deceived by others

referential delusions

believes certain gestures, comments, or cues are directed at them

delusions of grandeur

belief in having divine or special powers

hallucinations

perceptual experiences that occur without an eternal stimulus (auditory most common, then visual)

disorganized speech

nonsensical speech that often signals the presence of thought disorder (pervasion, neologisms, paraphasia, word salad)

grossly disorganized or catatonic behaviour

problems starting or sustaining appropriate goal-directed behaviours; unpredictable movements/agitation, lack of self-care, catonia

avolition

decreased motivation for self-initiated purposeful activities

affective flattening

diminished emotional expression

anhedonia

difficulty experiencing pleasure