PSYC 2011 GW Ch 5-8

Cognitive anxiety

Expectations of harm in the future

Classical conditioning

Association learning and involuntary reactions to stress

Operant conditioning

a type of learning in which behavior is strengthened if followed by a reinforcer or diminished if followed by a punisher

Escape responding

escape from frightening situation while it is occurring

Avoidance responding

leave before harmful event occurs

3 components of anxiety

physiological, cognitive, behavioral

Continuum of anxiety

Worry, anxiety, fear

Worry

Potential threat, little arousal, very cognitive, little avoidance, slow reaction

Anxiety

Approaching threat, moderate arousal, moderately cognitive, moderate avoidance, focused and quicker reaction

Fear

Imminent threat, severe arousal, scarcely cognitive, severe avoidance, focused and fast reaction

Multipath model of anxiety disorders

biological, psychological, social, and sociocultural dimensions

Psychological dimension overview

Anxiety sensitivity follows cognitive appraisals

Social dimension overview

Daily stressors and childhood trauma

Sociocultural dimension overview

Gender differences and cultural factors

Biological Dimensions

include causal factors from the fields of genetics and neuroscience; medical and physical causes of anxiety symptoms

Fear Circuitry

pre-frontal cortex shuts down (due to cortisol), focus is on survival, amygdala ramps up and its tissues grow to take up more brain area, connections and overall size of the hippocampus are reduced

Amygdala

A limbic system structure involved in memory and emotion, particularly fear and aggression.

HPA activity

Triggers fight or flight response

What does the amygdala do for the fear circuitry

Triggers anxiety

HPA

Set of direct influences and feedback interactions among 3 endocrine glands

3 endocrine glands for HPA

Hypothalamus, pituitary gland, adrenal glands

Hypothalamus

A neural structure lying below the thalamus; it directs several maintenance activities (eating, drinking, body temperature), helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward.

Pituitary gland

The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands.

Adrenal glands

a pair of endocrine glands just above the kidneys. the adrenals secrete the hormones epinephrine (adrenaline) and norepinephrine (noradrenaline), which help to arouse the body in times of stress.

Process of HPA

Sensory signals travel to hippocampus and prefrontal cortex. The sensory input is processed and evaluates danger. A higher level mental processing stops the HPA response.

Genetic influences for anxiety

Serotonin linked to depression and anxiety

Psychological Dimension

Personality, cognition, emotions, learning, coping skills, self-esteem, self-efficacy, values, early experiences that interact with biological predispositions

Negative appraisals

Interpret events as threatening

Anxiety sensitivity

Interpret physiological changes as signs of danger, which lead to anxiety

Sense of control and mastery

Reduces anxiety

Social and Sociocultural Dimensions

Daily environmental stress can produce anxiety; People with biological or psychological vulnerabilities are most likely to be affected

Factors for Sociocultural Dimensions

Poverty, traumatic events, adverse working conditions, limited social support, and acculturation; Culture can influence how anxiety is expressed

Phobias

irrational fears of specific objects or situations

Anxiety demographics

Affects 8.7% of population, and 2x more common in women

Primary types of phobias

Living creatures, environmental conditions, injury, situational factors

Social Anxiety Disorder (SAD)

Fear of being scrutinized or doing something embarrassing in front of others

SAD associations with other disorders

MDD or substance use disorders

Motivating factor for SAD

Avoidance of anxiety

Agoraphobia

Can't escape or get help

Aspects of Agoraphobia

Being outside of home while alone, traveling on public transport, being in open spaces, being in stores, standing in a line or crowd

Panic attacks

Intense fear with physiological symptoms (sweat or heart palpitations) (people don't leave their homes because of this)

Etiology of Phobias

Generalized Biological Vulnerability (heritable tendency to be "prepared" to associate fear with objects or situations that have been dangerous to the human species, and low threshold for specific defensive reactions).

Phobia aspects

1. Stress>> False Alarm OR Direct/ Vicarious Experience>> True Alarm

2. False alarm AND true alarm lead to LEARNED ALARM.

3. Specific Psychological Vulnerability and Learned alarm lead to Generalized Psychological Vulnerability.

4. Learned alarm and GPV lead to Specific Phobia.

Predisposition of anxiety is inherited

Heritability of phobia subtypes

31%

Psychological dimension of phobias

Classical conditioning, observational learning, negative information, cognitive-behavioral response

Social Dimension

Parental behaviors and negative family interactions develop SAD in children

Parental behaviors for SAD

Overprotection, lack of support for independence, punitive material parenting style

Cultural factors for SAD

Common in females, collectivist cultures (reflect on entire family)

Benzodiazepines

Short term; increase GABA levels; creates dependence, takes away worry

Types of Benzodiazepines

Ativan, Xanax, Valium

SSRIs

For chronic forms of anxiety; increases serotonin levels

Beta Blockers

Controls rapid heartbeat, shaking, trembling, and blushing in anxious situations; blocks norepinephrine effects

Norepinephrine

A neurotransmitter involved in arousal, as well as in learning and mood regulation

Cognitive Behavioral Treatment

A varied combination of verbal interventions and behavioral modification techniques used to help clients change maladaptive patterns of thinking

Exposure Therapy

Gradual introduction to the feared situation; based on classical conditioning, extinct response, more exposure leads to less fear

Systematic desensitization

A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias. Exposure techniques with relaxation.

Cognitive Restructuring

Finding and changing irrational thoughts by finding realistic fears

Modeling Therapy

Viewing another person's successful interactions with the subject of the phobia (model must be similar to us and motivated and educated)

Panic Disorder

An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Behavior changes are created to avoid having another attack. 2.7% prevalence rate.

Biological dimension of panic disorder

32% heritability; fewer serotonin receptors; effective SSRIs; increased serotonin

Psychological dimension of panic disorder

People show increased fear responses to bodily sensations

Role of cognitions in panic attacks

Overthink internal thoughts, stressors, perception of unpleasant bodily sensors, catastrophic thoughts, increased bodily sensations

Contributing factors of panic disorder

Separation anxiety, family conflicts, school problems, loss of loved ones

Cultural differences of panic disorder

Asian American and Latino/Hispanic youth report higher anxiety sensitivity but don't have panic attacks much

Medicines for panic disorder

Benzodiazepines, antidepressants, beta blockers

Cons of medicines for panic disorder

High relapse rates after cessation of drug therapy; must consider realistic lifestyle

Cognitive behavioral treatment of panic disorder

•Promotes self-efficacy

•General steps

-Educating the client about panic disorder

- Identifying and correcting catastrophic thinking

-Teaching client to self-induce physiological symptoms in order to extinguish the conditioning

-Encouraging the client to face symptoms

Generalized Anxiety Disorder (GAD)

Persistent, high levels of anxiety and excessive worrying over life circumstances

DSM-5 diagnostic criteria for GAD

-symptoms must be present on the majority of days for six months

-causes significant impairment in life activities

Psychological dimension of GAD

Negative schemas; cope with stress, create solutions to "what if", worry about worrying

Medicine for GAD

Benzodiazepines and antidepressants for lowering dependence

Cognitive behavioral therapy for GAD

-confront most common worries

-challenge catastrophizing thoughts

-develop coping strategies

OCD

Consistent, anxiety-producing thoughts or images; Overwhelming need to engage in activities or mental acts to counteract anxiety or prevent occurrence of dreaded event; Stereotypical behavior is not unique to OCD; Counting counteracts anxiety or prevents fear of occurrence; Aware that thoughts are irrational; Obsession of thought, compulsion of behavior; Alleviate anxiety; Stop person, they start again

Hoarding disorder

Inability to discard items regardless of value

Effects of stress

Negatively affects behavior, increases bodily tension, unexpected mood swings, snap out of anger

Stressors

External stimuli that place physical or psychological demands on us

Stress

Internal psychological or physiological response to stress

Symptoms of stress

Irritability or anger, fatigue, nervousness, headaches, depression, muscle tension

Adjustment disorder

Involves the reactions to a specific stressor that is disproportionately severe and intense

Criteria for adjustment disorder

Exposure to identifiable stressor; symptoms out of proportion to the severity of the stressor and results in significant impairment; symptoms don't last longer than 6 months

ASD and PTSD

exposure/threat of violence, death, serious injury, or traumatic event.

-reoccurring memories

-dreams of event

-flashbacks

-psychological distress

-physiological distress

-hypervigilance

ASD develops directly after & PTSD can develop w/ or w/o ASD

ASD and PTSD development

Type of trauma; degree of perceived threat; magnitude of event; extent of exposure to stressor; risk and protective factors

Symptoms of ASD and PTSD

Intrusion; Avoidance; Negative alterations in mood/cognition; Arousal and changes in reactivity

Intrusion

Intrusive thoughts; distressing recollections; nightmares/flashbacks; psychological distress triggered by reminders; physical symptoms of heart beats or sweat

Avoidance

Avoidance of thoughts, feelings, or physical reminders associated with the traumas, places, events, or objects that trigger distressing memories of the experience

Negative alterations in mood or cognition

difficulty remembering details of the event; persistent negative views about oneself or the world; distorted cognitions leading to self-blame or blaming others; frequent negative emotions; limited interest in important activities; feeling emotionally numb, detached, or estranged from others; persistent inability to experience positive emotions

Arousal and changes in reactivity

feelings of irritability that may result in verbal or physical aggression; engaging in reckless or self-destructive behaviors; hypervigilance involving constantly remaining alert for danger; heightened physiological reactivity such as exaggerated startle response; difficulty concentrating; sleep disturbance

ASD diagnosis

At least 9 symptoms; at least 3 days and no longer than 1 month

PTSD diagnosis

1-2 symptoms from each cluster

ASD prevalence

20% for traumatic events

PTSD prevalence

8.7% and year prevalence is 3.5%

Biological dimension for racial trauma

HPA axis dysfunction; amygdala reactivity; SS genotypes; lack of fear extinction

Psychological dimension for racial trauma

Anxiety/depression; severity of trauma; interpersonal trauma; negative emotions; catastrophic thinking

Social dimension of racial trauma

History of child maltreatment; lack of social support; social isolation

Sociocultural dimension of racial trauma

Female gender; immigrant/refugee status; exposure to prior trauma; discrimination

Medical treatment for racial trauma

Antidepressant medication

Antidepressant medication

Alters serotonin levels, decreases reactivity of amygdala, desensitizes fear network

Types of antidepressant medication

D-cycloserine, prazosin, propranolol

Psychotherapy

Prolonged exposure therapy