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Anxiety v. Fear
A: general worry about future (diffuse)
F: reaction to immediate danger
Criteria for specific and social phobia
1) Persistent, unreasonable fear of a situation or object
2) the situation/object is avoided or else endured with anxiety
3) the person recognizes that the fear is unreasonable
4) the phobia causes personal distress (interferes with the person’s life)
Symptoms of a panic attack.
A feeling of the world not being real
A feeling of being outside one’s body
Anxiety about situations in which it would be embarrassing or difficult to escape if panic symptoms occurred
Major symptom of Generalized Anxiety Disorder
Cannot control one’s worries
Intrusive and recurring thoughts, impulses, and images that are irrational and uncontrollable
What are common obsessions?
Contamination, self-doubt, symmetry, aggressive or horrific impulses, and sexual imagery.
A repetitive behavior or mental act that the person feels driven to perform in order to reduce the distressed caused by obsessions
Cleaning rituals, performing repetitive, “magically” protective acts, and repetitive checking
Maybe more likely to report their symptoms, social roles (men may feel more pressure to face fears), difficult life circumstances (women more likely to be assaulted-less control of environment)
A tendency by some infants to become agitated and cry when faced with novel toys, people, or other stimuli.
30% of infants with behavior inhibition develop anxiety disorders by adolescence
Personality trait defined by the tendency to react to events with greater-than-average negative effect.
Relationship between neuroticism and anxiety disorders?
People with high levels of neuroticism were more than twice as likely to develop an anxiety disorder.
Common feature of anxiety disorder treatment
Common problems with anxiolytics (benzodiazepines)
Memory lapses, difficulty driving, and addiction
Mowrer’s two-factor model
1) Through classical conditioning, a person learns to fear a neutral stimulus (the CS) that is paired with an intrinsically aversive stimulus (the UCS)
2) Through operant conditioning, the person gains relief from the conditioned fear by avoiding the CS, the avoidant response is maintained by its reinforcing consequence of reducing fear.
Does a person have to directly interact with the phobic object in order for a phobia to develop?
No, can be acquired through modeling or verbal instruction
“Prepared” by evolution to learn fear of certain stimuli
Why is it difficult to condition phobias to modern objects?
When an ongoing exposure occurs the stimuli is no longer fearful
How does the theory of prepared classical conditioning explain how humans have developed phobias to a select group of objects?
During the evolution of our species, people learned to react strongly to stimuli that could be life-threatening.
In general, how does social phobia develop?
A person could have a negative social experience (directly through modeling or through verbal instruction) and become classically conditioned to fear similar situations, which the person then avoids. Through operant conditioning, this avoidance behavior is maintained because it reduces the fear the person experiences.
Thoughts and actions that are performed to protect against feared consequences.
Role of cognitive factors and negative self-evaluation in the development of social phobia
Tend to think more negatively about other things in life and thus pay attention to more negative cues in their environment and perceive a lack of control of their environment
The Relationship between the misinterpretation of bodily sensation and the development of panic disorder
Panic attacks develop when a person interprets bodily sensations as signs of impending doom, which produces more of these sensations due to anxiety.
What is the goal of panic control therapy?
Person learns to stop seeing internal sensations as signals of loss of control and instead learns to see them as harmless and controllable.
According to Borkovec et al, why do people worry?
If cannot tolerate uncertainty.
Exposure with response prevention therapy
In which people expose themselves to situations that elicit the compulsive act and then refrain from performing the compulsive ritual.
In treating PTSD with exposure
Ask the client to replay the situation and first come to terms with it and then develop a positive alternative story.
Eye Movement Desensitization and Reprocessing is controversial as the patient first retells trauma, when reaches traumatic part, holds image and follows professional’s finger until image is less negative. Tell negative feelings and positive thoughts. Works because it activates part of the brain responsible for storing pain memories (there is not a lot of support for this theory)
Eye movement component necessary?
Is Critical Incident Stress Debriefing effective?
No, actually makes PTSD more likely
Bipolar v Major Depressive Disorder
MDD only has depressive part, bipolar sometimes has manic
Sx of Bipolar?
When manic: Elevated, expansive, or irritable mood, 3 or more: increase in goal-directed activities, talkativeness, racing thoughts or flight of ideas, less sleep needed, inflated self-esteem, distractibility, excessive involvement in pleasurable activities AND when depressed: depressed mood, anhedonia (lack of enjoyment in things once pleasurable), hypersomnia or insomnia, psychomotor retardation, changes in appetite, loss of energy, worthlessness, hopelessness, concentration problems, amotivation, and thoughts of suicide
Why is MDD an episodic disorder?
Symptoms tend to be experienced for two weeks to 6 months
What is dysthymic disorder? To diagnose how long must symptoms last?
Chronic mild depression (can function, but feel empty); Symptoms lasting 2 years
Factors proposed as explanation for gender differences in depression.
Socioeconomic (no free time, stress, support system, insurance, people not as close to immediate family
Why have the rates of depression increase in the past century?
Correlations between girls who do drugs and have sex are more depressed OR girls who are depressed do drugs and have sex (self-medication).
Age of onset of bipolar disorder? More common in men or women?
Early 20s, equally effects men and women
“Flight of ideas”
During mania, individual talks excessively, shifting rapidly from topic to topic
Light mania (not delusional, need seep, but elevated and irritable moods)
How strong of a genetic heritability have?
.9 (very strong) for identical twins
Why is the idea of depression being cause by too little serotonin overly simplistic?
Because it takes days for the medicine to take effect and by then mood has already risen.
Serotonin-receptor dysfunction theory
Those that are predisposed to be depressed have low sensitivity in the receptors.
Precursor of serotonin, if depleted, serotonin levels will drop.
The process by which neurons are generated
Relationship between depression and cortisol.
High levels of cortisol in the brain tend to show depressive moods
What are cognitive biases according to Beck?
Negative schemata that exist in depressed individuals as they may be overly sensitive to negative feedback and are more likely to remember such negative info compared to others
An individual who feels inept will remember instances that confirm this and ignore those that go against.
Has cognitive therapy been shown to be an effective treatment of depression?
Yes, standard treatment
Learned helplessness theory in regards to depression
Depressed individuals attribute negative events due to internal, stable, and global causes, so bad events and moments will keep occurring
Cause of depression?
Combination of neurobiological factors (neurotransmitters and brain abnormalities) as well as psychological (negative thoughts, learned helplessness, and attributional theory)
What is the focus of Interpersonal therapy? Effective for depression?
Role transitions, interpersonal conflicts, bereavement, and interpersonal isolation. Effective in preventing relapse in MDD
ECT? Effective? Worst risk?
Electroconvulsive therapy is effective for treating depression. The worst risk is the cognitive functioning deficits following treatment.
Treatment that seeks to increase participation in positively reinforcing activities so as to disrupt the spiral of depression, withdrawal, and avoidance
Positive v negative symptoms of schizophrenia.
P: the presence of unusual perceptions, thoughts, or behaviors, additional experiences or thoughts beyond the norm
N: the absence of usual emotion and behavioral responses
Examples of each?
P: delusions, hallucinations (auditory)
N: blunted or flat affect, alogia, avolition, anhedonia, and asociality
What symptoms are present during the acute phase?
Most common type of delusion in individuals with schizophrenia?
1) Re-experiences of the traumatic event
2) Avoidance of stimuli associated with the event and numbing of responsiveness
3) Increased arousal
A factor that is associated with the development of a disorder
Risk factors of PTSD?
3) Early separation from parents
4) Childhood trauma
5) Family history of anxiety disorder
6) Preexisting anxiety or depressive disorder
7) Greater exposure to trauma
8) Low level of social support
Criteria for MDD:
Either for 2 weeks
· depressed mood or anhedonia
At least four:
· Insomnia or hypersomnia
· Psychomotor retardation or agitation
· Changes in appetite loss of energy
· Worthlessness, hopelessness
· Concentration problems, amotivation
· Thoughts of suicide
One biological treatment of MDD?
Antidepressants- Rx but takes a while to act on mood.
Those likeliest at risk for suicide
1) Living alone
2) Age (50+ use weapons)
3) Sex (women attempt more, men “succeed” more
4) Marital status- divorced, widowed, separated, never married have higher rates
5) Lower SES
6) Ethnicity-Native Am, white male 50+, inner city Afr Am 15-24 highest success rate
2) Depressive Symptoms
3) Verbal Cues
4) Behavioral Clues (previous attempt, giving away possessions, procuring a weapon, organizing personal affairs, sudden unexplained improvement in mood, plan of action)
5) Family history, psychiatric history, impulsivity, perfectionism
2) Specifically identify what events led to the person feeling suicidal
3) Identify what the person is trying to say with suicidal behavior
4) Explore when the person feels better
5) Identify what is still meaningful to the person
6) Give the person hope that the situation will improve
7) Discuss spirituality/religion
8) Develop a specific plan for managing suicidal thoughts (crisis line or 5 support members)
10) If can contract for 24 hours, call 911or take to ER
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