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Abnormal Psychology Exam 1 Study Guide
psychopathology - psyche - soul pathos - suffering logos - science of what is a psychological disorder? - behavioral, psychological, or biological dysfunctions that are: deviance: unexpected in their cultural context distress: associated with present distress dysfunction: impairment in functioning danger: increased risk of dangers such as death (self or others) studying psychological disorders -
- clinical description: the unique combination of behaviors, thoughts, and feelings that makes up a specific disorder
- causation (etiology): the study of origins, or why a disorder begins
- treatment and outcome CHAPTER 2: INTEGRATIVE MODELS - models of abnormality - model/paradigm: perspective used to explain events
- influence how things are observed, questions asked, information sought, and interpretation of events one-dimensional model -
- single cause, operating in isolation
- ignores critical information multidimensional models -
- interdisciplinary, eclectic, and integrative
- "system" of influences that cause and maintain suffering
- draw upon information from several sources THEORIES - Biological Approaches -
- changes in brain structure can impact behavior, memory, emotion... example: Phineas Gage, Henry Molaison Henry Molaison:
- hippocampus: the role in retaining learned facts, (replacing the notion that memories are scattered throughout the brain) how do biological theorists explain abnormal behavior? (brain chemistry) -
brain chemistry
- neurotransmitters 'transmit' information between nerve cells (or neurons) example: serotonin, dopamine, glutamate, norepinephrine, GABA
- studies suggest that abnormal activity in neurotransmitters are involved in mental disorders endocrine system - the system of glands that produces chemicals called hormones
- released directly into the blood
- carries messages throughout the body, potentially affecting a person's moods, levels of energy, and reactions to stress
- hypothalamic-pituitary-adrenal axis (or HPA axis) -- fight or flight response
- integration of endocrine and nervous system how do biological theorists explain abnormal behavior? (genetics) - genetics
- each cell in the human body has 23 pairs of chromosomes, each with numerous genes that control the characteristics and traits a person inherits
- we do not know the extent to which genetic factors contribute to disorders
- appears that in most cases several genes combine to produce our actions and reactions polygenics -
- many genes contribution only tiny effect (many = hundreds)
- most likely the case for most complex phenomena (behavior, personality, IQ)
- environmental and/or social influences can determine what genes are expressed state of genetics -
- the pathway from genes to behavior is now known to incorporate multiple opportunities for modulation of risk, including epigenetic modification of gene activity gene expression and epigenetics
- study of changes in gene expression without change in gene sequence example: nicotine and tumor suppressor gene methylation--silencing the gene's activation evidence for environmental influence on genes -
- Rat studies (Francis et al 1999)
- Increase maternal grooming of pups = less fearful & physiologically reactive adults (in both biological & adoptive pups)
- Grooming releases hormones in the pup
- Hormones impact gene expression in the hippocampus (stress response)
- Monkey Studies (Suomi, 1999)
- Emotionally reactive monkey raised by calm parents for the first 6 months of life was calm
- These monkeys also became calm parents
- Human studies (Tienari et al, 2006 )
- Finnish Adoption Study: 36.8% of high-genetic risk adoptees living in a dysfunctional family environment were found to have developed a schizophrenia-spectrum disorder, compared to only 5.8% of those in a healthy family environment
- Kids significantly more likely to develop schizophrenia if they were adopted into dysfunctional families
genes: the short story - genetic influences on trait development cannot be separated from their environmental context immune system // inflammation -
- Inflammation is the body's natural response to infection or wounding
- defends you against microbial infections.
- The first line of defense against invasion by microorganisms such as bacteria and viruses
- activated rapidly after infection how do biological theorists explain abnormal behavior? (viral infections) - sources of biological abnormalities: viral infections
- another possible source of abnormal brain structure or biochemical dysfunction example: schizophrenia and prenatal viral exposure the human microbiome -
- the human gut microbiome is home to 100 trillion bacteria - 10x the number of cells in the human body
- around 8 million protein-coding genes, 360x as many as in the human genome
- vast viral populations also live in the human gut microbiome-gut-brain axis -
- bacteria in the gastrointestinal (GI) tract can activate neural pathways and central nervous system (CNS) signaling systems
- psychological stress suppresses beneficial bacteria (bidirectional relationship) assessing the biological model - strengths:
- considerable respect in the field
- constantly produces valuable new information
- may bring relief weaknesses:
- Can limit, rather than enhance, our understanding
- Too simplistic
- Evidence is incomplete or inconclusive
- Treatments produce significant undesirable (negative) effects BEHAVIORAL MODELS -
- operant conditioning
- classical conditioning
- modeling
operant conditioning - define as: a learning process in which the consequences which follow a response determine whether the behavior will be repeated
- the behavior will likely be repeated when reinforced
- and tend not to be repeated with punishment how do behavioralists explain abnormal functioning? - Classical conditioning
- learning by temporal association
- when two events repeatedly occur close together in time, they become fused in a person's mind; before long, the person responds in the same way to both events Father of classical conditioning: Ivan Pavlov (1849 - 1936) modeling: observational learning - individuals learn responses by observing and repeating behavior assessing the behavioral model - Strengths:
- Powerful force in the field
- Can be tested in the laboratory
- Significant research support for behavioral therapies Weaknesses:
- Too simplistic
- Behavior therapy is limited
- Downplays role of cognition THE COGNITIVE MODEL -
- examines the manner in which the person attends to, interprets, and uses available information
- asks questions about assumptions, attitudes, and thoughts of a client -- concerned with internal processes -- present-focused nocebo effects with antidepressant clinical drug trial placebos -
- A 26-year-old male took 29 inert capsules, believing he was overdosing on an antidepressant.
- Subsequently, he experienced hypotension (low blood pressure) requiring intravenous fluids to maintain adequate blood pressure.
- The nature of the capsules was revealed and the adverse symptoms then rapidly abated. assessing the cognitive model - Strengths:
- Very broad appeal
- Clinically useful and effective
- Focuses on a uniquely human process
- Theories lend themselves to research
- Therapies effective in treating several disorders
Weaknesses:
- Precise role of cognition in abnormality has yet to be determined
- Singular, narrow focus
- Overemphasis on the present
- Limited effectiveness equifinality - a basic principle of developmental psychopathology that holds that one symptom can have many causes multifinality - a basic principle of developmental psychopathology that holds that one cause can have many (multiple) final manifestations CHAPTER 3: CLINICAL ASSESSMENT AND DIAGNOSIS - classifying and diagnosing psychological disorders - classical (or pure) categorical approach
- strict categories dimensional approach
- classification along dimensions (e.g., different people have varying amount of anxiety in social situations) prototypical approach
- combines classical and dimensional views
- DSM-5 is based on this approach
- identifies essential features of a psychological disorder so that it can be classified, but allows for nonessential variations that do not necessarily change the classification -- (e.g., there are several ways one could meet criteria for major depression or panic disorder, but still get the diagnosis) International Classification of Diseases - global standard in diagnostic classification for health reporting and clinical applications for all medical diagnoses, including mental health disorders. Diagnostic and Statistical Manual of Mental Disorders - only mental disorders listed but in great detail including epidemiology and associated features. diagnosis - symptom:
- a sign of the existence of something, especially of a potential problem diagnosis:
- the identification of the nature of an illness or other problem by examination of the symptoms -- based on observed clinical features that are consistent with the known body of literature for symptoms classification of disorders
differential diagnosis:
- the process of differentiating between two or more conditions which share similar signs or symptoms example: schizophrenia, alcohol withdrawal, cocaine intoxication, major depressive disorder with psychotic features clinical judgement -
- the informal and subjective method of arranging information about the client in order to establish a diagnosis and formulate treatment plans
- good clinical judgement includes not only an understanding of the diagnostic and pathophysiological aspects of an illness, but the setting in which that illness has occurred
- diagnosis and clinical judgement come together in order to facilitate a treatment plan criticism: the problem of comorbidity -
- defined as two or more disorders for the same person
- are we attaching multiple labels to differing manifestations of the same underlying condition?
- having more than one disorder doesn't mean that each is independent of one another, or that they require separate treatments
- multiple diagnoses may reflect one underlying etiology and may respond to one treatment goals for improving the DSM - clinical changes should be based on empirical research rather than clinical consensus
- behavioral science
- neuroscience
- molecular genetics move towards a classification based on etiology CHAPTER 4: RESEARCH DESIGN - pyramid of evidence - goals of research - description
- what is the symptom presentation? understanding
- example: what part of CBT has the most impact on alleviating depression? prediction
- example: what predicts relapse? control
- example: can changing family communication patterns result in better outcomes? the case study -
- Detailed, interpretative description of a person's life and psychological problems
- Can be a source of new ideas about behavior
- May offer tentative support for a theory
- May challenge current assumptions -- disconfirm allegedly universal aspects of a particular theoretical proposition
- May inspire new therapeutic techniques
- May offer opportunities to study unusual problems case-study example -
- 25-year-old man who had recently given up heroin, cocaine and marijuana had a sudden attack of nausea and vomiting so severe that he had to go to the hospital
- nausea and vomiting eased when he took a hot shower
- regularly used an herbal product that he bought in a neighborhood store called Spice, said to be synthetic marijuana.
- urine toxicology screen that showed he had no cannabinoids in his system cannabinoid hyperemesis -
- First described in 2004: syndrome of nausea and vomiting, compulsive bathing and marijuana use.
- patient repeatedly admitted to the hospital with psychogenic cyclic vomiting. Oddly, the patient was also constantly showering.
- symptoms improved during hospitalization with no intervention and recurred once the patient was sent home the case study (limitations) - Has limitations:
- Reported by biased observers
- Relies on subjective evidence
- Has low internal validity (the number of confounding variables found in your experiment)
- Provides little basis for generalization
- Has low external validity (the extent to which results of a study can be generalized to the world at large) •These limitations are addressed by the two other methods of investigation... the correlational method -
- The correlational method examines the relationship between or among two or more variables
- The variables are assessed as they exist in nature (no experimental manipulation)
- Correlational studies seek to determine the magnitude and direction of a relationship among variables correlation does not imply causation -
- no, correlation does not imply causation, but it sure does provide a hint
- if it can frame the question, then our observation sets us down the path toward thinking through the workings of reality example: smoking and mortality the correlational method - Advantages of the correlational method:
- Has high external validity (can generalize finding)
•Can repeat (replicate) studies on other samples Difficulties with correlational studies:
- Lack internal validity
- Results describe but do not explain a relationship epidemiological research - Epidemiology
- the study of the frequency and distribution of a disorder in a population
- Prevalence = proportion of a population that has a disorder at any given time
- Incidence = number of new cases that occur during some time period
- Risk factors = conditions that increase the likelihood of developing the disorder
- Protective factors = conditions that decrease the likelihood of developing the disorder the experimental method -
- A variable is manipulated (example: drug vs placebo) and the manipulation's effect on another variable is observed
- Manipulated variable = independent variable
- Variable being observed = dependent variable
- Allows researchers to ask questions such as: Does a particular therapy relieve the symptoms of a particular disorder?
- Causal relationships can only be determined through experiments the experimental method (continued) -
- Seeks to reduce the presence of confounds - variables other than the independent variable that may influence the outcome
- Three features are included in experiments to guard against confounds:
- A control group or comparison group
- Random assignment
- Blind design
- Randomized Clinical Trials
- a research investigation in which people volunteer to test new treatments, interventions or tests as a means to prevent, detect, treat or manage various diseases or medical conditions
- Human Lab-Based Studies (Analogue Studies)
- participants closely resemble the target population evaluating human laboratory studies - advantages
- Researcher has more control over variables.
- Participants can be randomly assigned to groups.
- Appropriate control groups can be created to rule out alternative explanations of important findings. Disadvantages
- Results may not generalize to outside the laboratory
meta-analysis -
- sits at the very top of the pyramid of evidence
- involves looking at lots of different studies on the same topic and comparing the results from all the studies.
- brings together the data of many scientists in order to identify patterns across all the different studies, which may not have been noticed before.
- Compilation or generation of effect sizes
- Only as good as the data collected/studies published CHAPTER 8: SLEEP-WAKE DISORDERS - Sleep-Wake Disorders - -Dyssomnias
- Quantity
- Quality
- Circadian rhythm disorders
- Parasomnias
- Sleep walking
- Sleep eating,
- Sleep paralysis
- REM sleep behavior disorder
- Nightmares Sleep Staging in Adults - sleep: a behavioral definition -
- rapid reversibility
- place preference/specific position
- increased arousal threshold (decreased responsiveness to sensorial stimuli)
- homeostatic regulation (need for recovery after deprivation)
- circadian regulation typical assessment -
- Polysomnographic (PSG) evaluation
- Detailed history
- Sleep hygiene
- Electrooculogram: eye movements
- Electromyogram: muscle movements
- Electrocardiogram: heart activity •Actigraphy (monitoring human rest/activity cycles) Two Process Model (Borbely, 1983) - Process S:
the accumulation of sleep-inducing substances in the brain. It's an internal biochemical system that generates a homeostatic sleep drive or the need to sleep after a certain amount of time awake. -the longer you've been awake, the stronger your desire for sleep becomes Process C: the regulation of the body's internal biological processes and alertness levels. This is what controls the timing of sleep and it coordinates the light-dark cycle of day and night.
- regulates your body's sleep patterns, feeding patterns, core body temperature, brain wave activity, and hormone production over a 24-hour period circadian -
- Our internal clock is highly synchronized to external cues, the strongest of them being the light-dark cycle. -Timing of meals
- Physical activity
- Social interactions sleep needs change with time - newborns/infants
- 0-2 months: 10.5-18 hours
- 2-12 months: 14-15 hours toddlers/children
- 12-18 months: 13-15 hours
- 18 months - 3 years: 12-14 hours
- 3-5 years: 11-13 hours
- 5-12 years: 10-11 hours adolescent/young adults
- 9 hours adults/older persons
- 7-9 hours women typically have a more difficult time sleeping, due to - hormones, pregnancy, and children popcorn sleep - poor sleep quality throughout the duration of the night how partial sleep deprivation happens -
- Lack of sleep consolidation (disruption of sleep stages such as untreated sleep disordered breathing)
- Selective sleep stage deprivation (when medications, alcohol, or drugs impact certain stages of sleep)
- Reduced sleep duration (most common, by choice or via insomnia disorder)
finals week - the combination of cramming for tests, increased stress, bright light exposure, and excessive caffeine/stimulant use less to variable sleep durations and "all-nighters" 8 hour challenge -
- The students who opted to take the challenge averaged 8.5 hours of sleep.
- On the final exam, students who slept more than 8 hours nightly performed better than those who opted out or slept less than 7.9 hours. •Worth noting: one student who had a D-plus grade before the final but slept more than 8 hours a week during finals week, remarked that it was the 'first time my brain worked while taking an exam'. semester performance -
- Sleep quality, longer duration, and greater consistency of sleep correlated with better grades. •No relationship between sleep measures on the single night before a test and test performance -- sleep duration and quality for the month and the week before a test correlated with better grades. (Okana et al., 2019) Sleep Deprivation & Decision Making (Venkatramen et al.,2011 J. Neuro) -
- More sensitive to positive rewards while diminishing sensitivity to negative consequences. •Men = more risky •Women = more risk averse; less altruistic Sleep Deprivation and False Confessions (Frenda et al., 2016 PNAS) -
- Complete series of lab tasks but do not press esc key (data will be lost)
- 18% rested and 50% sleep deprived participants signed on first request sleep as prodrome - prodrome: an early symptom indicating the onset of a disease or illness
- when sleep starts changing, it could imply a larger disorder is coming Is it a bad thing to be awake when reason sleeps?(Perlis, ML et al. (2016)) Sleep Med Rev -
- Suicide may occur disproportionately in individuals who are awake at night.
- Being awake when one is not biologically prepared to be so may result in impaired decision-making.
- Lack of social support at night.
- Increased risk for any behavior that requires impulse control; eating, addictive, self-harm behaviors. insomnia disorder -
- One or more of:
- Difficulty initiating sleep
- Difficulty maintaining sleep
- Waking up earlier than desired
- One or more of:
- Fatigue/malaise
- Concentration or memory impairment
- Impaired social, family, occupational, or academic performance
- Reduced motivation/energy/initiative
- Proneness for errors/accidents
- Concerns about or dissatisfaction with sleep
- Complaints not explained by inadequate opportunity or circumstances
- Sleep disturbance and associated daytime symptoms occur at least 3 times/week
- Short-term -Present for ≤ 3 months
- Chronic -Present for ≥ 3 months diathesis-stress model: acute and chronic insomnia - perpetuating factors:
- behavioral choices that causes somebody to continue experiencing insomnia precipitating factors:
- stressful events that occur throughout one's life that effects sleep predisposing factors:
- predisposition to insomnia
- vulnerability of development (pre-morbid) signs of sleep deprivation -
- needing an alarm clock to wake up
- falling asleep within five minutes of hitting the pillow
- napping easily medications -
- the first and only FDA prescribed guideline for different genders//10 mg for males and 5 mg for females •Lunesta •Belsomra •Sonata •Sedating antidepressants (trazadone, mirtazapine)
- could inhibit aurousal •Melatonin
- promotes process S only when activated •Cannabis all sleep medication fails eventually
- preferable for acute insomnia Cognitive Behavioral Therapy for Insomnia (CBT-I) -
- Recalibrates body's ability to sleep via behavior change
- Addresses core problems - challenging people's thinking around sleep.
- Equivalent to medications in the short term
- Outperforms medications in the long term
- Breaks the cycle of chronic insomnia irregular sleep schedule:
- wake up and go to bed at the same time every day regardless of sleep quality the night before
- stay up later if the quality of sleep is poor (activates process S)
- limit naps healthy sleep (RU SATED) -
- Regularity
- Satisfaction
- Alertness
- Timing
- Efficiency
- Duration CHAPTER 5: ANXIETY DISORDERS - anxiety - alarm in response to a vague sense of threat or danger fear - immediate alarm in response to a serious, know threat to well-being anxiety disorders -
- Severe enough to lower quality of life
- Chronic and frequent enough to interfere with functioning
- Out of proportion to the dangers that they truly face anxiety disorders (continued) -
- Most frequent diagnoses in general population
- Co-morbid with depression 50% of the time
- Most individuals with one anxiety disorder also suffer from a second disorder
- Women 2x more likely than men to develop anxiety disorders Unified Model of Anxiety Disorders: Shared Components - Stimulus/trigger
- Anxiety is almost always cued Misinterpretation of threat (1) Overestimating the likelihood of negative outcomes
(2) Catastrophizing Avoidant coping
- Primary avoidance - avoiding triggers altogether
- Secondary avoidance - engaging in safety behaviors when complete avoidance is not possible Absence of corrective learning
- New learning does not occur and the fear is maintained (and often strengthened) Panic -
- Panic, an extreme anxiety reaction, can result when a real threat suddenly emerges The experience of "panic attacks," however, is different
- Panic attacks are periodic, short bouts of panic that occur suddenly, reach a peak, and pass
- Attacks happen in the absence of a real threat Panic Attacks: Defined by 4 or more of the following 13 symptoms - 11 Somatic Symptoms:
- Increased heart rate
- Shortness of breath
- Chest pain
- Dizzy/unsteady/lightheaded or faint
- Choking sensation
- Trembling
- Sweating
- Nausea
- Numbness/Tingling
- Hot flashes or chills
- Depersonalization or derealization 2 Cognitive Symptoms: •Fear of dying •Fear of losing control Panic Disorder -
- Recurrent unexpected panic attacks Criterion B •Worry about future attacks •Worry about the consequences of the attack (i.e., having a heart attack) •Substantial behavioral changes in response to the attacks Panic Disorder Statistics -
- Around 2.8% of U.S. population affected in a given year -- Close to 5% of U.S. population affected at some point in their lives (lifetime point prevalence)
- Women are twice as likely as men to be affected
- The prevalence is the same across cultural and racial groups in the U.S. and seems to occur in cultures worldwide. Agoraphobia - Experience fear or anxiety about >2 of the following situations:
- Public transportation
- Open spaces (public parks, bridges, large parking lots)
- Enclosed spaces (theater, plane, supermarket)
- Being in a crowd (malls, concerts, sporting events)
- Being outside of the home or a certain distance from home
- Avoidance of places where there may be trouble escaping or getting help with anxiety or panic attack.
- Fear of embarrassment if others see their symptoms or efforts to escape during an attack. Epidemiology of Agoraphobia -
- Lifetime prevalence in the general US population is about 2%
- The prevalence is higher (10.4%) in adults over 65 years old
- Twice as likely to occur in women than in men
- Average age of onset is between 25 and 30 Panic Disorder: The Biological Perspective - An increase in norepinephrine from the sympathetic nervous system increases the rate of contractions in the heart
- Along with epinephrine, norepinephrine also underlies the fight-or-flight response, directly increasing heart rate •Misfiring of fight-flight system Biological Perspective: Brain Structure -
- Brain circuits involving the amygdala
- critical role in the circuits that control the experience of fear, both instinctive fear (like being afraid of snakes or large carnivores) and fear that is learned from life experiences. pH -
- One of the most consistent findings in people with panic disorder is that they are unusually sensitive to carbon dioxide inhalation and other laboratory procedures that increase brain acidity.
- Most patients with panic disorder will experience a panic attack when they inhale air containing 35% carbon dioxide, while most healthy volunteers will not. Bed Nucleus of the Stria Terminalis (BNST): Threat Monitoring -
- Helps detect a potential threat and maintain hypervigilance until threat encounter or situational resolve
- Amygdala preferentially responds to the actual presence of an aversive stimulus, mediating instantaneous responses during acute danger.
- Therefore, given that human anxiety is largely driven by future-oriented hypothetical threats that may never occur, studies involving the BNST stand at the forefront of essential future research. Panic Disorder: The Biological Perspective - If a genetic factor is at work, close relatives should have higher rates of panic disorder than more distant relatives:
- Monozygotic (MZ, or identical) twins = 24-31% concordance rate
- Dizygotic (DZ, or fraternal) twins = 11% A significantly higher concordance was found for CO2-induced panic attacks among monozygotic than dizygotic twins (55.6% versus 12.5%). Panic Disorder: The Biological Perspective - SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. FDA approved: fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft). Serotonin and norepinephrine reuptake inhibitors (SNRIs).
- FDA approved: venlafaxine hydrochloride (Effexor XR)
- Medications bring at least some improvement to 80% of patients with panic disorder
- Approximately 50% of people with panic disorder will recover markedly or fully
- Improvements require maintenance of drug therapy The Cognitive Model -
- Interoceptive awareness -pay close attention to bodily sensations
- Anxiety sensitivity
- belief that bodily sensations are harmful
- changes in body interpreted negatively
- fear of symptoms of anxiety Common Catastrophic Thoughts in Panic Disorder -
- Fears of death or disability
- Am I having a heart attack?
- I am having a stroke!
- I am going to suffocate!
- Fears of losing control/insanity
- I am going to lose control and scream
- I am having a nervous breakdown
- If I don't escape, I will go crazy
- Fear of humiliation or embarrassment
- People will think something is wrong with me
- They will think I am a lunatic
- I will faint and be embarrassed Cognitive-Behavioral Model of Panic Disorder - Panic Disorder: Cognitive behavioral therapy - Step 1: Psychoeducation
- Panic in general
- Causes of bodily sensations
- Tendency to misinterpret the sensations
- Role of escape and avoidance in maintaining fear Step 2: Practice generating multiple interpretations for bodily sensations Step 3: Teach coping strategies
- Examples: relaxation, breathing Interoceptive Exposures (exposures to internal sensations) - Method:
- Engage in systematic exercises that induce feared internal sensations (i.e., dizziness, increased heart rate). Rationale for exposure:
- Provides opportunities to examine negative predictions about internal sensations.
- Provides opportunities to increase tolerance to and acceptance of internal sensations. Panic Disorder: Continuation Treatment - Panic Disorder: Post-Imipramine Discontinuation - Integrated Model -
- Biological vulnerability to hypersensitive fight/flight response
- Catastrophic thinking, hypervigilant for other signs of panic Phobias - We all have some fears at some points in our lives; this is a normal and common experience
- How do phobias differ from these "normal" experiences?
- More intense and persistent fear
- Greater desire to avoid the feared object or situation
- Distress that interferes with functioning
- Persistent and unreasonable fears of particular objects, activities, or situations
- People with a phobia often avoid the object or thoughts about it
Specific Phobias -
- A persistent fear that is excessive or unreasonable, that occurs by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
- Exposure to the feared item or situation almost always leads to an immediate anxiety response, which may take the form of a panic attack.
- The phobic situation(s) is avoided or endured with intense anxiety or distress.
- The avoidance, anxious anticipation, or distress during the feared situation(s) interferes significantly with the person's normal routine, work (or school) functioning, or social activities or relationships, or there is marked distress about having the phobia.
- The fear, anxiety, or avoidance is persistent, typically lasting for >6 months. Specific Phobias - Animal type Natural environment type Situational type Blood-injection-injury type Likely to run in families Hypotension and bradycardia Treatment implications Specific Phobias - Each year 8.7% of all people in the U.S. have symptoms of specific phobia
- More than 12% develop such phobias at some point in their lives Many suffer from more than one phobia at a time Women outnumber men 2: Vast majority of people with a specific phobia do NOT seek treatment Social Anxiety Disorder - A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating. -performance only - talking, performing, eating, or writing in public -broad - general fear of functioning poorly in front of others Social Anxiety Disorder Statistics - Can greatly interfere with one's life Often kept a secret 7.1% of people in the U.S. experience social anxiety disorer in any given year Women outnumber men 3: Phobias often begin in childhood and may persist for many years
Concordance rates: MZ 24.4% & DZ 15.3% Etiology - Behavioral Models Predominate Direct learning: Specific phobias can sometimes begin following a traumatic experience in the feared situation. Observational learning: Some people may learn to fear certain situations by watching others show signs of fear in the same situation learn to fear heights himself. Informational learning: Sometimes, people develop specific phobias after hearing about reading about a situation that may be dangerous. What Causes Specific Phobias? - A behavioral-evolutionary explanation
- Model explains why some phobias (snakes, spiders) are more common than others (faces, houses)
- Preparedness = inherited tendency to fear situations that have always been dangerous to the human race -- Threat from wild animals -- Trapped in small spaces Treatments for Specific Phobias - Systematic desensitization:
- Teach relaxation skills
- Create fear hierarchy (stimulus hierarchy)
- Pair relaxation with the feared objects or situations
- Since relaxation is incompatible with fear, the relaxation response is thought to substitute for the fear response Several types:
- In vivo desensitization (live)
- Covert desensitization (imaginal) Treatments for Specific Phobias - Other behavioral treatments: Flooding
- nongradual exposure Modeling
- Therapist confronts the feared object while the fearful person observes
- Clinical research supports each of these treatments
- The key to success is ACTUAL CONTACT with the feared object or situation Treatments for Social Anxiety Disorder - Medications
- SSRIs
-- Sertraline (Zoloft) -- Paroxetine (Paxil)
- SNRIs -- venlafaxine (Effexor XR) Exposure therapy, either in an individual or group setting Treatment (Mayo-Wilson et al (2014)) Lancet Psychiatry - meta-analysis: N= 101 clinical trials comparing multiple types of medication & CBT
- CBT best initial treatment option, because its effects are well-maintained at follow-up -- selective serotonin-reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors associated with high relapse rates.
- no evidence that combined therapy was better than talk therapy alone Brain Volume post-CBT Månsson et al (Feb 2016) Translational Psychiatry - N = 26
- link between hypersensitivity of the amygdala and the volume of grey matter - one of the two main tissues of the central nervous system - in this part of the brain.
- brain volume and activity in the amygdala decrease as a result of 9 weeks of CBT (internet delivered) Generalized Anxiety Disorder (GAD) -
- Characterized by excessive anxiety under most circumstances and worry about practically anything -Often called "free-floating" anxiety
- Worry is a cognitive process involving repetitive, verbal-linguistic thoughts about possible negative outcomes for future events (Borkovec, Alcaine, & Behar, 2004) GAD Symptoms - A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The person finds it difficult to control the worry. The anxiety and worry are associated with > (1) restlessness or feeling keyed up or on edge (2) being easily fatigued (3) difficulty concentrating or mind going blank (4) irritability (5) muscle tension (6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) Generalized Anxiety Disorder (GAD) -
- Shift from possible crisis to crisis
- Worry about minor, everyday concerns •J ob, family, chores, appointments
Statistics
- 3.1% (year); 5.7% (lifetime)
- Similar rates worldwide
- Insidious onset
- Early adulthood -Chronic course GAD: The Cognitive Perspective - Aaron Beck (cognitive theorist), argued that those with GAD constantly hold silent assumptions that imply imminent danger:
- A situation/person is unsafe until proven safe
- It is always best to assume the worst GAD: Cognitive Therapy - Role of worry - problem solving (?) Learn to distinguish between "useful" and "useless" worry, mistimed worry
- Modify need for certainty
- Diminish reassurance seeking