clinical 4 final

Generalized Anxiety disorder:

• Experience excessive anxiety under most circumstances and worry about practically anything. 

  • Described as free-floating anxiety (no specific reason necessarily- worry about anything)

• Common symptoms of GAD:

  • Restless, muscle tension, difficulty concentrating, irritability, sleep problems, worry about multiple matters. (must experience at least 3 for diagnosis.)

  • Symptoms last: 6 months 

  • Symptoms lead to a reduced quality of life. 

  • Women are twice as likely as men to have GAD. 2:1.

  • White people are more likely to have GAD.

  • Poor people are more likely to have GAD. 

• Psychodynamic perspective:

  • Freud believes all children experience some anxiety, and their ego defense mechanisms help control it. For children with particularly high levels of anxiety, it means that their defense mechanisms are inadequate, so they may develop GAD.

  • Ex: if a boy is hit whenever he cries for milk (the natural id impulse) then he will feel anxious whenever he has natural impulses. 

  • Overprotected children dlack the ability to develop effective defense mechanisms

  • Poor childhood relationships with parents can lead to GAD

• Psychodynamic therapies:

  • Free association

  • Transference, resistance, dream interpretation

• Biological Factors for GAD: People with anxiety disorders have lower GABA levels, and increased activity of fear circuit 

• CBT therapy is the best treatment for GAD

• Humanistic perspective of GAD: occurs when people stop looking at themselves honestly and acceptingly. 

• This can occur when you lack unconditional positive regard

• Rogers believes client-centered therapy with unconditional positive regard is helpful 

• Cognitive behavioral perspective: 

  • Focuses more on the cognitive aspect for GAD.

  • Albert Ellis believed people had maladaptive assumptions - irrational beliefs leading people to act a certain way. 

  • Aaron Beck: thinks people have anxiety from the mindset of assuming the worst.

• Meta-cognitive theory: Adrian Wells: Thinking about thinking 

• Thomas Borkovec believes in the avoidance theory: worrying reduces arousal rate - physical anxiety symptoms. 

• CBT for GAD: changing maladaptive assumptions 

• Breaking down worrying 

• Biological perspective: do relatives have it? 

• Benzos help anxiety 

• Disturbed brain circuits cause anxiety. Fear circuit - prefrontal cortex, anterior cingulate cortex, insula and amygdala.

• Phobias: 

  • Persistent and unreasonable fear. Brings dread when encounters or thinks about the object, activity for situation

  • Causes avoidance 

  • May interfere with daily lives

• Specific phobia checklist:

  • Specific, persistent fear lasting at least 6-months

  • Exposure to object causes immediate fear

  • Avoidance of situation

  • Significant distress 

• Agoraphobia: Pronounced or repeated fear in at least two of the following situations:

  • Public transit

  • Parking lots, brides, other open spaces

  • Shops, theaters, other confined spaces

  • Lines or crowds

  • Away from home unaccompanied.

• Cause of fear of these situations: it would be hard to escape if panicking, embarrassment. 

• Symptoms usually continue for at least 6 months. 

• Significant distress or impairment 

• Cognitive-behavioral theorists offer the most research support in what causes phobias. 

• Fears come from conditioning.

• Classical conditioning: when multiple events occur close together in time, they become strongly associated in the person’s mind. If one triggers a fear response, they other may also. 

• Unconditioned stimulus (what feeling naturally causes the fear) EX: entrapment 

• Unconditioned response: Fear

• Conditioned stimulus: What you associate with the feeling of fear. -then causes the conditioned response of fear. 

• Behavioral-evolutionary explanation: preparedness. 

• Treatments for specific phobias: 

  • Exposure treatment

  • Joseph Wolpe: systematic desensitization: learn to relax when exposed to phobia

• Treatments for agoraphobia: support group - does exposure sessions together

  • Home-based self-help programs.

• Social anxiety disorder: 

  • Checklist: 

  • Excessive anxiety about social situations in which the individual could be exposed to possible scrutiny by others. Lasting at least 6 months. 

  • More female than male.

  • Poor people are more likely

  • White people are more likely than black or asian people

  • Tends to begin late childhood/adolescence and may continue into adulthood

  • Dysfunctional cognitions and behaviors lead to SAD. 

  • Traumatic childhood experiences and overprotective parents can increase likelihood for SAD.

• Meds can help SAD. 

  • Benzos, antidepressants

  • These improve functioning in the brain’s fear circuit which tends to be hyperactive for people with SAD. 

  • CBT is very helpful with SAD

• Panic Disorder: 

  • Panic attacks - periodic short bouts of panic that occur suddenly, reach a peak within minutes and gradually pass. 

  • People who have repeated panic attacks for no apparent reason may have panic disorder. 

  • Dysfunction in thinking or behavior: am I losing my mind? Am I going to die?  

  • At least a month of fear of attacks or dysfunctional behavior is panic disorder. 

• Biological perspective: 

  • In the 1960s they realized antidepressants help. 

  • Lack of Norepinephrine can cause panic. (Norepinephrine causes relaxation.)

  • Abnormal activity in the brain circuit Locus Coeruleus can cause panic as it has a lot of neurons that use norepinephrine.

  • Amygdala is stimulated when confronting fear. It stimulates the other brain circuits (setting alarm and escape response)

  • Amygdala is part of each circuit 

  • Antidepressants increase serotonin and norepinephrine 

  • Cognitive Behavioral theorists think misinterpretation of physical anxiety symptoms causes panic. 

  • Biological challenge test: evaluates how people respond to physical symptoms of anxiety.

• Obsessive compulsive disorder: 

• Obsessions: persistent thoughts, ideas, impulses or images that invade a person’s consciousness. 

• Compulsions: repetitive and rigid behaviors or mental acts that people with OCD feel they must perform to reduce anxiety. 

• OCD is the only anxiety related disorder that is equally common in men and women and different racial backgrounds.  

• Psychodynamic perspective of OCD: 

  • When children fear their own id impulses. 

  • Ego comes in the form of counter thoughts for OCD

  • Freud traced OCD to anal stage - shame from trouble potty training 

  • They are taught they should control their impulses

• Cognitive behavioral perspective: counteract disturbing thoughts

  • Ex: deliberately thinking good thoughts, checking for danger, washing hands. 

  • Brings out temporary reduction of discomfort.  

• CBT for OCD: 

  • Exposure and response prevention. 

  • Exposed to anxiety that produces an urge for compulsions, and then they have to withhold from doing it.

• Biological perspective: 

  • Serotonin, glutamate and dopamine impact OCD. 

  • The brain circuit, Cortico-striato thalamo-cortical circuit is hyperactive in ppl with OCD, making it hard for them to turn off their impulses and related thoughts. 

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