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TULANE / Psychology / PSYC 3330 / What is the principle of equifinality?

What is the principle of equifinality?

What is the principle of equifinality?

Description

School: Tulane University
Department: Psychology
Course: Abnormal Psychology
Professor: Constance patterson
Term: Winter 2016
Tags: abnormal psych, Exam 1, and Study Guide
Cost: 50
Name: Abnormal Psych Exam 1 Study Guide
Description: These are the answers to the study guide she provided for us.
Uploaded: 02/14/2016
24 Pages 7 Views 11 Unlocks
Reviews

Chadd Skiles (Rating: )

You can bet I'll be grabbing Lauren studyguide for finals. Couldn't have made it this week without your help!



Review for Exam 1: Abnormal Psychology Spring 2016


What is the principle of equifinality?



Chapters 1 and 2 

• Concept of “normal” Understand the fallacies associated with of the concept of “normal” - autonomy consistent with culture, growth and development, attitude of self-acceptance,  accurate perfection of reality, environmental competence, positive interpersonal relations;  Fred’s concept of normal: to love and to work  

- normal may be different across cultures  

• Concept of “abnormality” and the four D’s  

- The features or elements of abnormal behavior are sometimes conceived as the following:  - Are any of the elements sufficient by themselves to determine abnormality? - How many elements have to be present to assure what we are observing is  abnormal?

- Deviance - behaviors occur infrequently and are an abnormal deviation from accepted  standards; is it problematic to the person?  

- Distress - extreme or prolonged emotional reaction; intensity and exaggeration interfere  with functioning; aware that they don’t fit, so insight about one's behavior is a  piece of that distress; it's not their personal distress but the fact that they make  others miserable  


What are the cultural limitations of our current concepts of ‘normal’ and ‘abnormal’ ?



- Dysfunction - interferes with the ability to perform usual/expected roles or perform at  potential; roles just can't be done; having a depressed mom is one of worst  indicators for dysfunction, parent affectively  

- Dangerousness - in some instances the problem includes danger to self or others; very  small numbers of mentally ill people make bad things happen

• What is the principle of equifinality?

- used in developmental psychopathology to indicate that we must consider a number of  paths to a given outcome; ex: delusional syndrome may be an aspect of schizophrenia but  it can also arise from amphetamine abuse; autism can sometimes occur in kids whose  moms are exposed to rubella during pregnancy, but it can also occur in children whose  moms experience difficulties during labor  

- There are many different early experiences that can lead to the same psychological  disorder.


What are the risks associated with making diagnoses?



We also discuss several other topics like eees notes

• What was the lesson in the research project “being sane in insane places”? - On being sane in insane places: interpretation bias  Don't forget about the age old question of pols 1337 uh exam 1

- Hard for professionals trained to look for problems to distinguish between behavior  and normal

- An experiment: 8 mentally healthy people (including several psychologists and  psychiatrists) posed as mental patients and admitted to mental  

hospitals  

- Complaints included hearing voices that repeated words like “empty,” “dull,” and  “thud” – NOTE: none of the subjects was genuinely mentally ill.  

- Once admitted, all behaved normally during the rest of the period of hospitalization  but behavior (e.g., art activities, taking notes, interacting with others) was  interpreted as part of a pattern of pathology  

• What are the cultural limitations of our current concepts of ‘normal’ and ‘abnormal’ ? - Statistical definitions (normal / abnormal) based on “typical” behaviors among the  dominant or most influential group in society  

- Behaviors all originate from a cultural context – whether normal or abnormal - Members of cultural groups share some characteristics but as a group are multifaceted  - Any society or group that shares a set of behaviors and transmits those behavioral  expectations to its members represents a culture  If you want to learn more check out propane forms a flame and emits heat as it burns

- Culture powerfully determines worldviews and affects how “normal” or “abnormal”  others’ behaviors appear  

• What are the risks associated with making diagnoses?

- Sociopolitical Influence  

- Healthy survival strategies : Higher numbers of ppl in minority who are  diagnosed with psychotic features such as paranoia because of people  

being biased and prejudiced toward them; can be misdiagnosed as deviant  - Bias in Diagnosis  

- Overpathologizing : risk of exaggerating severity of disorder among  

socioeconomic, racial, ethnic groups whose values or lifestyles may differ  markedly from those of the clinician

• Know the vocabulary associated with frequency of mental disorders (incidence, etc.). - Psychiatric epidemiology – the study of the prevalence of mental illness in a society  - Prevalence – the percentage of people in a population who have been diagnosed with  a disorder at a given point in time  

- Lifetime prevalence – the percentage of people in the population who have had a  disorder at some point in their life  

- Incidence – the onset or occurrence of a given disorder over some period of time 

• Review contemporary scientific method and its relationship to the integrative approach - Fads and superstitious interventions have been the result of not imposing scientific rigor  on methods, theory and interventionsWe also discuss several other topics like psych 340
If you want to learn more check out sarah hanusch

- Single theory approaches leave out important factors that distort understanding and  prevent recovery  

- Sophistication of methods and scientific tools allows better understanding  - Understanding that abnormal behavior is due to multiple influences  - integrative approach - embraces an attitude towards the practice of psychotherapy that  Don't forget about the age old question of which of the following statements is true about the dual court system?

affirms the inherent value of each individual; a unifying psychotherapy that responds  appropriately and effectively to the person at the affective, behavioral, cognitive, and  physiological levels of functioning

• Scientist practitioner and research ( from ppt)

- Consumes research

- Reads the literature to understand issues, learns about methods and how to apply  them, understands limits of methods (highly trained to understand  

- Evaluates research  

statistics and research methods  

- Tests hypotheses by gathering data about the Impact of Intervention/treatment,  compares research from different sources , may adjust intervention  

to serve particular populations based on data  

- Contributes to research  

- Formulates hypotheses, Conducts research, reports outcomes of applied  intervention/ treatment through publishing, presenting, training other  

- Evaluate  

professionals  

- What kinds of things work with what kinds of people; generally geared towards a  particular set of people; tweak to make effective for certain group  

• What are the limits of single theory interpretations of mental illness?

- leave out important factors that distort understanding and prevent recovery

• Know the integrative approach to explaining abnormal behavior.

- behavior is not the product of a single influence  

- thoughts, feelings, and actions impact our brains  

- body and brain involved in all our thoughts and feelings  

- development and the context of development are important  

- integrated model attempts to understand of the complex interaction of multiple influences  

• What is the focus of neuroscience?

- knowing how the nervous system and especially how the brain works is central to any  understanding of our behavior, emotions, and cognitive processes

- Brain structure and function are the basis of behavior, cognitive ability, and emotion  - Neurons or nerve cells in the brain communicate with each other through release and re uptake of neurotransmitters  

- Excesses and deficiencies of neurotransmitters are associated with psychological disorders

• What is the general function of neurotransmitters (you do NOT have to know specific  neurotransmitters)

- the biochemicals that are released from the axon of one neuron and transmit the  impulse to the dendrite receptors of another neuron are this  

- excesses or insufficiencies in some are associated with different groups of psych  disorders

• Is there a role for understanding mental illness by studying brain lesions and other brain  abnormalities?  

- Each part of the brain has specific functions  

- Damage (lesions) leads to changes / loss of function  

- General brain function is tied to personality traits and may be inherited (genetic)  - Personality traits may predispose some to developing problems

- OCD - increased brain activity in cerebral cortex  

- Lack of stimulation in infancy and early childhood leads to neuron atrophy and death  - Rich opportunities and stimulation can enhance brain function , increase cognitive ability,  promote cognitive flexibility  

- Stress produces changes in structure and changes the balance of neurotransmitters  - Trauma produces temporary changes to brain function and neurotransmitters; repeated  trauma or prolonged stress can cause permanent changes  

-• How does learned helplessness function as a basis of mental illness

- individuals learn to give up when encounter situations where they have no control  - this is a foundation for an individual to feel totally hopeless in situations and become  depressed

• How does social learning as a basis of mental illness  

- Albert Bandura - observed that organisms do not have to experience certain events in  their environment to learn effectively. rather, they can learn just as much by observing  what happens to someone else in given situations  

- modeling or observational learning

- this type of learning requires a symbolic integration of the experiences of others  with judgments of what might happen to oneself  

- Bandura expanded his observations into a network of ideas in which behavior,  cognitive factors, and environmental influences converged to produce the  complexity of behavior that confronts us  

• Females are more likely to have eating disorders (at least partially due to social pressures  to be thin?)  

 Social changes include :  

• Climate changes are forcing changes in work situations and roles  • Movement from rural to urban life  

• Famine  

• Political unrest  

• Quick introduction of technology  

 ->Leads to Stress, anxiety, depression, drug/alcohol abuse, family violence,  suicide  

• 10-20% of demands for health services are based on need for services due to mental  health problems  

• There is a severe lack of mental health resources

• Those with more connections have better health, longer lives and fewer psychological  problems  

• What is the role of genetics in Behavior/personality/Cognitive Ability  

- we learn to fear some objects more easily than others (fears and phobias are learned  selectively)  

- the genetic influence on much of our behavior, personality, and even IQ is polygenic -  influenced by many genes  

- this is assumed to be the case in abnormal behavior as well, although research is  beginning to identify specific small groups of sense that relate to some major  psychological disorders

• How do polygenic issues impact behavior

- multiple genes are involved in determining a trait  

• Know the Diathesis – Stress Model and its limitation

- individuals are assumed to inherit certain vulnerabilities that make them susceptible to  a disorder when the right kind of stressor comes along

• What is the impact of psychosocial factors on brain structure  

• What is the role of emotions:

• Role of emotion in anxiety and fear (focus on primitive flight or fight response)

• Role of cultural, social, interpersonal factors in mental illness especially social support  and gender

• What is the role of lifespan development in abnormal behavior?

- we incorrectly focus on a particular point in a person’s life and summer it represent s  the whole person  

- important development changes occur at all points in life  

- erik erikson suggested that we go through 8 major cases during life, each determine by  our biological maturation and the social demands made at particular times  - the complex and challenging environments increased the size and complexity of  neurons in the motor and sensory cortical regions in the adult  

- the influence of developmental stage and prior experience has a substantial impact on  the development and presentation of psych disorders  

Chapters 3 and 4 

• Pay attention to the key concepts in assessment from Powerpoint

• Be sure you understand parts of the assessment process (clinical interview; mental status  exam; physical exam; behavioral, psychological and neurological testing) • clinical interview  

 ◦ Face to face between clinician and client  

 ◦Covers various aspects of client’s current situation, behavior, and personality   ◦May include in-depth history of development over the lifespan (patterns)  

 ◦Crucial to an accurate diagnosis and effective treatment  

 ◦Unstructured

 • Flexible format  

 • Freedom to explore responses in depth  

 ◦Structured  

 • Clear goals  

 • Carefully constructed  

 • Demonstrated reliability  

 • Comprehensive symptom review  

 • Standard way to administer  

• mental status exam  

- Five Domains:  

- Appearance and behavior (dress/appearance/posture/overt behavior)  

- Thought processes (rate/flow of speech, clarity and content of speech/ideas  - Mood and affect (Predominant feeling/Appropriate? Inappropriate?)  

- Intellectual functioning (reasonable vocabulary, memory intact?)  

- Orientation (accurate knowledge of date, time, place, knowledge of self)

• physical exam  

- Assure physical health  

- Rule out or identify metabolic or biological problems that may impact abnormal  behaviors or account for them  

- Elicit support for healthy lifestyle choices and improved health  

- Note: May later need psychiatric referral  

• behavioral exam  

- Formal Observations:  

- Planned observation of behavior in particular setting  

- Goal may be to determine frequency, duration, intensity or other  

characteristics of behavior  

- A normative comparison (compare to others same age/gender) used to  determine ‘abnormality’  

- Informal Observations:  

- May include variety, such as interaction with others in waiting room,  

interaction with clinician, ways of approaching tasks, test taking  

behaviors and attitudes, style of problem solving, characteristics of  

physical appearance and actions  

- Medical – biological status of person being assessed  

- Interview – Development and behavior over lifespan (biological, psychological,  social )  

- Psychological assessment – abilities, coping style, personality

• psychological testing  

- must be reliable so that 2 or more ppl administering the same test to the same  person will come to the same conclusion about ht problem  

- must be valid so that they measure what they say they are measuring  

- tools to determine cognitive, emotional, or behavioral responses that might be  associated with specific disorder and also personality features  

• neurological testing  

- determines the possible contribution of brain damage or dysfunction to the  patient’s condition  

- measure abiliteis in areas such as receptive and expressive language, attention and  concentration, memeory, motor skills, perceptual abilites, and learning and  abstraction in a way that th elcinician can make educated guesses about the  person’s performance and the possible existence of brain impairment  

• What kind of information does each part of the assessment process contribute to understanding  mental illness?

• What is the difference between structured and unstructured interviews?

 ◦ Unstrucuted  

 • Flexible format  

 • Freedom to explore responses in depth  

 ◦ Structured  

 • Clear goals  

 • Carefully constructed  

 • Demonstrated reliability  

 • Comprehensive symptom review  

 • Standard way to administer  

• What are the five domains of a mental status exam?  

- Appearance and behavior (dress/appearance/posture/overt behavior)  - Thought processes (rate/flow of speech, clarity and content of speech/ideas  - Mood and affect (Predominant feeling/Appropriate? Inappropriate?)  - Intellectual functioning (reasonable vocabulary, memory intact?)  

- Orientation (accurate knowledge of date, time, place, knowledge of self) • What are potential limitations of interviews when diagnosing mental illness? - Can be subjective based on clinician’s bias  

- Clinician’s skills may limit usefulness of interview  

- Client may not be entirely truthful  

- Different questions may be asked of different clients  

- All symptoms and patterns of symptoms may not be explored  

- May take a long time; May be tiring for the client  

• What is the difference between objective and projective tests (projective usually used for  personality testing)?

• objective tests  

- Intent is to provide reliable and valid measures of personality characteristics - Questionnaires, self-report inventories, rating scales  

- Carefully constructed, based on research  

- Often items provide several alternative responses/choices

- Controlled format increases usefulness  

• projective tests  

- Uses psychodynamic concepts of “making the unconscious conscious” - Relies on interpretation of some “ambiguous stimulus”

- Clinician must be highly trained

- People project their thoughts, ideas, styles onto the stimulus  

- There is controversy about validity and reliability

• Why is a medical exam important in diagnosing mental illness?

- rule out biological/medical causes of problem  

• What is the contribution of neurological testing?

 • Eegs; look at funciton of brain in diff states  

 • 16 weeks of tutoring, put them back in machine, with practice, you see glucose being  burned in that area of the brain because it's being reorganized  

 • Electroencephalogram (EEG) – used to assess brain wave patterns while awake (resting /  with varied stimulation) or while sleeping  

 • Electrodes placed on scalp, brain waves amplified  

 • Can detect abnormal brain activity (dysrhythmia) which leads to more focused testing   • Computerized Axial Tomography (CAT scan) – uses  

 • X-ray technology to produce images of parts of the brain that may be abnormal,  damaged, or diseased  

• What contribution is there from blood, urine or saliva tests in diagnosing mental illness?  ◦ Blood tests for neurotransmitters can be helpful in supporting other findings for  diagnosis  

 ◦ Neurotransmitters (and precursors) are produced throughout the body - what is collected  in the urine does not reflect brain activity  

 ◦ Saliva testing is not a reliable method for assessing levels of neurotransmitters.  • What is data-based decision making (PPT)?

- All the assessment information (data) is put together to create a full picture of the  person’s strengths, needs and styles (personality)  

• What characteristics of the criteria for diagnosis are important in determining if a mental  illness is present (NOT diagnostic criteria)  

• What are the risks of stigma in labeling people as having a mental illness?  - stigma : a combination of stereotypic negative beliefs, prejudices, and attitudes  resulting in reduced life opportunities for the devalued group in question  • Your book says research starts with one thing, and your instructor says it starts with another  (look at the ppt) – pay attention to your instructor’s perspective.

- We start with what we know and move forward a step at a time; start with a theory  

- A theory provides a basis for organizing our assumptions and what is already known  (Your book has a slightly different perspective, what is it?)

- Based on what we know, we develop an hypothesis speculating on what we might  expect to find or research questions to guide our inquiry

- A research design is chosen to investigate the hypothesis based on what we want to  know

• Diagnostic criteria in the DSM-III shifted away from psychodynamic and biological medical  theories of etiology and took a different perspective. DSM-IV and DSM-IV-TR have  continued this transition  

- Use of DSM-5 is controversial BUT encourages use of “Cultural Formulation  Interview”* which attempts to tie diagnostic issues to cultural norms (see text)  and assess:  

- Level of acculturation to U.S. culture  

- Understanding of symptoms with patterns from primary culture  

- Acceptability of “disability” in primary culture

- * No research supports this method

• What are the basic characteristics of a science of psychology?

- what problems cause distress and impair functioning  

- the nature of the problems ppl report; we explore research strategies that help  answer this question  

- why do ppl behave in unusual ways  

- considers the causes (etiology) of abnormal bevhaior; we explore strategies for  discovering why a disorder occurred  

- how do we help them behave in more adaptive ways  

- want to help ppl who have disorders so describe how researchers evaluate  treatments

• What is the difference between quantitative and qualitative research? What is the most  important contribution from qualitative research in our contemporary world?  • qualitative  

- Research that seeks to understand the lived experiences of the people we study  (participants /subjects)  

- Start with research questions

- Informed by what we know BUT make no assumptions that researcher’s  concepts of reality are the same as those of the subjects  

- Excellent way to gather information about different cultural groups

• quantitative  

- Research intended to quantify concepts so that they can be expressed numerically  - Starts with the hypothesis  

- Assumes the ideas (“reality”) behind the hypothesis mean the same for  everyone  

- Useful for comparisons: ranges, averages, cause-effect determinations

• What is the difference between population and sample.

- sample subjects represent population and apply intervention; measure outcome • What is difference between practical/clinical significance and statistical significance of a  research finding?

• How important are findings?  

• Statistically: The probability of finding  

 the observed outcome by chance is very small  

• Clinically: Is the observed outcome important to those who might  

 have the findings applied to their lives?  

• Both are important  

• Effect size is used to determine how much difference there was for each  subject compared to control subjects  

• Social validity – what do subjects think?  

• Review the types of research methods

- case study method : investigating intensively one or more individuals who display the  behavioral and physical patterns  

- one way to describe is by notinng what it is not: doesn't use scientific method, few  efforts made to ensure internal validity, many confounding variables are present  that can interfere with conclusions  

- relies on a clinician’s observations of differences among one person or one group  with a disorder, ppl with other disorders, and ppl w/ no psych disorders  

- sometimes coincidences occur that are irrelevant to the condition under study  - correlation  

- statistical relationship b/t 2 variables  

- used to study phenomena just as they occur  

- positive corr : great strength or quantity in one variable is associated w/ great  strength or quantity in other variable ; ex: marital discord and child problems  (marital distress and more child disruptive behavior)  

- correlation coefficiant - represented as +1.00  

- negative corr : the more social supports that are preent, the less likely it is that a  person wil. become ill  

- directionality - a corr allows us to see whether a relationship exists b/t 2 variables  but not to draw conclusions about whether either variable causes the effects  - experiment  

- involves manipulation of an independent variable and the observation of its  effects; manip IV to answer the question of causality

- single case experimental designs  

- B.F. Skinner’s innovations in scientific methodology were important  

- he formalized concept  

- invovles the systematic study of individuals under a variety of experimental  conditions; thought much better to know lots about the behavior of one individual  than make a few observations of a large group  

- repeated measurement  

- withdrawal designs  

- multiple baseline  

• What is the function of a control group in a research project?

- people are similar to the experimental group in every way except that members of the  exp. group are exposed to the independent variable and those in control group are not;  help rule out alternative explanations for results, thereby strengthening internal validity  

• What is the function of a withdrawal design when conducting research? - a reseracher tires to determine whether the independent variable is responsible for  changes in behavior

• What is the importance of informed consent in research?

- came about from the war trials after WWII  

- basic components are competence, voluntarism, full info, and comprehension  • Genetic contributions to abnormality (PPT)

• Phenotype – observable characteristics or behavior of an individual; Physical  characteristics such as body type, hair color, etc.

• Genotype – unique genetic makeup of individual humans; Part of genetic makeup from  each parent; Genetic mutations  

• Endophenotypes – genetic mechanisms which contribute to the development of  problems, symptoms associated with psychopathology; Generally combinations of  genetic materials that confer vulnerability to developing problems

- Behavioral Geneticists study the genetics of behavior  

- Basic genetic epidemiology allows mapping of the genetic components of the problem  

- Advanced genetic epidemiology then explores deeper to determine how genetics affects  different aspects of the condition  

- Gene finding is a sophisticated effort to locate where the genetic materials are located in  the genome  

- Using biological studies, determining what the genes do and how the environmental  factors influence them.

• What methods of study suggest genetic influences on abnormal behaviors? - Family studies allow the identification of a pattern of problems across family members –  should see stronger influence with closer biological ties  

- When siblings are raised in different environments, we presume many of their similarities  are genetically based  

- Identical twins share identical genetic material and appear more likely to share similar  problems  

- Genetic linkage studies rely on identifying other inherited characteristics as well as  studying the problem behavior  

• What methods are used to study behavior over time?

- prevention studies:  

- promoting healthy practices  

- universal prevention practices  

- selected and targeted interventions (groups at risk)  

- indicated prevention strategies  

- cross sectional design  

- select cross section of the population  

- different age groups at same point in time  

- compare some characteristic(s)  

- longitudinal designs  

- follow one group over time to see how they change

Chapter 14  

• How do we determine what is normal and abnormal in childhood?

- the correct sequence in pattern of change in development stages

• What are the three key features of AD/HD? What are the three primary types? What impacts  does AD/HD have on children? What treatments are effective in alleviating the symptoms of  AD/HD?

- pattern of inattention, hyperactivity, impulsivity  

- ??  

- impacts on children  

- Frustration and sense of helplessness  

- Much more capable than typically demonstrate  

- Self esteem suffers  

- Lowered sense of efficacy  

- High risk of poor outcomes:

- Poor grades, lower achievement

- Vocational underachievement

- Disrupted work history

- Less stable relationships

- treaments  

- Traditionally, stimulant medication has been used; paradoxical effect allows the  brain to slow down and both behavior and attention are positively impacted  - A range of new medications are available that impact attention and over-activity  - *Noting and treating side effects is important  

- Both behavioral and cognitive behavioral interventions  

- are crucial to effective functioning

- Well practiced behaviors  

- Ineffective coping skills  

- Social skills (peers/adults)  

- Issues around self-esteem 

• In what areas of functioning (skills) are Learning Disabilities identified?  - Growing evidence that learning disabilities are based in ability to learn and use  language

- *Cognitive ability is average

- Reading Disability is most common (4-10% of population)

- decoding

- fluency

- comprehension

- Math Disability (1%)

- spatial orientation

- math reasoning

- math calculation

- written expression  

- less well documented  

- eye hand coordination  

- innaccurate figure copying  

- disorganization  

- rotations

• What are the communication disorders? What areas of the brain are associated with receptive  and expressive language?

- Speech Sound Disorder – lack of clear speech, forming words but very difficult to  understand  

- Stuttering –speech fluency is disrupted, repeated syllables or words, pauses (articulation  of words)  

- LANGUAGE DISORDER: DSM-5 combines expressive and receptive  - Expressive Language Disorder – limited ability to use language to express thoughts  - Receptive Language Disorder - limited ability to process spoken language (problems  with understanding what is heard)

- brain  

- broca - speech production  

- wernicke - understanding speech and written language  

• What distinct patterns of behavior are common to Autism Spectrum Disorders (ASD)? Why is  it important to treat family members of children with ASD?

- Distinct Patterns of Behaviors:  

- Communication is impaired  

- Restricted interests  

- Impaired social interactions  

- Symptoms vary from mild to severe across all behaviors

- Family Members  

- Support and education for the family members  

- Social and community support  

- Research supported interventions

- Early speech and language intervention is key concern

- Social skills training  

- Educational programming that addresses the whole child  

- Social programming that increases connections and communication  

- Early identification!

• Why are outlooks for those with brain damage more hopeful than has been traditionally  thought?  

Chapter 5 

• Know impact of stress

- stress is a normal part of life and can be useful; a moderate level of stress can have  productive outcomes; high levels can cause anxiety  

• What are the connections between lifestyle and stress

Lifestyle changes can help alleviate symptoms of stress and anxiety:  

• eating a balanced, healthy diet  

• limiting caffeine and alcohol consumption  

• getting enough sleep  

• getting regular exercise  

• meditating  

• scheduling time for hobbies  

• keeping a diary of your feelings  

• practicing deep breathing  

• recognizing the factors that trigger your stress and managing them  

• talking to a friend, keeping connected with those you care about (who care about you)   If frequent, uncontrollable bouts of stress and anxiety, a doctor may suggest a   mental health provider: talk therapy (CBT), relaxation training, medication

• All Anxiety disorders include…?

- A physiological response originating in the brain and resulting in a negative mood state characterized by physiological symptoms of muscle tension, elevated heart rate,  apprehension about controlling events in the future, a subjective sense of unease, and  behaviors that indicate discomfort.

• Know more common problems that are comorbid with anxiety disorders • Simultaneous occurrence of two or more psychological disorders in a single individual  

• In one large scale study, 55% of those studied who had principal diagnosis of a depressive or  anxiety disorder also had a secondary diagnosis of anxiety or depressive disorder at the time  of the study; lifetime incidence was 76%  

• Use or abuse of drugs or alcohol often implicated in relapses (self-medicating effects) • Unique and significant association with diseases including:  

– Respiratory disease  

– Gastrointestinal disease  

– Arthritis  

– Migraine headaches  

– Allergic conditions  

– Thyroid disease  

Generally, anxiety disorder occurs first.

The quality of life can be very poor with the combination of anxiety and a chronic  physical illness.

• What are the contributions of the different parts of the integrative model to anxiety? - biological, psychological, social contributions  

- integrated model  

- triple vulnerability theory  

- generalized biological vulnerability  

- gen. psych vul  

- specific psych vul

• Know about GAD and treatment

 • Excessive anxiety and worry (more days than not; over 6 months; worry over a number  of events/activities)  

 • Person has difficulty controlling the worry  

 • Anxiety associated with at least three factors (only one for children):   ◦ Restlessness, keyed up, on edge  

 ◦ Easily fatigued  

 ◦ Difficulty concentrating  

 ◦ Irritability  

 ◦ Muscle tension  

 ◦ Sleep disturbance  

 • Focus on the anxiety is not limited to panic, fear of embarrassment   • Significant distress  

 • Not due to physical causes  

 • Adults with GAD:  

 ◦ Life is dominated by worries  

 ◦ Most worries are about minor things  

 ◦ Possible misfortunes to their children  

 ◦ Major events can be debilitating  

 • Children with GAD  

 ◦ Worry about competence in everyday life (school/freiendships/sports)   ◦ Worry about family problems  

 ◦ Difficulty sleeping makes the anxiety worse  

About 3.1% of the U.S. population meets criteria for being diagnosed during a given year  About 5.7% are estimated to have diagnosable GAD during their lifetime  Incidence and prevalence are remarkably consistent across cultures *  

Few seek treatment

About 2/3 are female but females seek treatment more readily  

Earlier onset and more gradual development than other anxiety disorders  Usually onset with some life stressor  

Median age of onset is 31  

Has a chronic course over the lifetime; relapse after treatment is common Treatment for GAD  

 • Intervention with drugs is helpful – small doses of antidepressants found to be most  effective  

 • Psychological treatment is also effective using cognitive behavioral treatment   • Identify content of worry  

 • Confront worries in sessions  

 • Use thought controlling techniques  

 • Expand coping strategies and techniques  

 • NOTE: For most anxiety disorders long term follow-up shows CBT to be best  intervention  

 

• Know about panic attacks and panic disorders and treatment

Panic attack and panic disorder  

 • 12-14% of people will have one each year  

 • An abrupt and overwhelming reaction of intense fear or acute discomfort.   • Can be cued by a situation that causes anxiety (situationally bound)  

 • Don’t know when the next attack will occur so becomes vigilant to try to avoid it  (anticipates problem)  

 • May (or may not) occur in a setting where a panic attack has occurred before  (situationally predisposed)  

 

Panic Attack  

 • Panic has elements of conditioning and we create cognitive explanations  

 • Initial fear occurs under extreme stress; the emotional response becomes associated with  external and internal cues  

 • Cues evoke the fear response as though danger is actually present (when danger is  usually not present)  

 

Characteristics:  

 • Pounding heart  

 • Sweating

 • Trembling or shaking  

 • Feeling of choking  

 • Chest pain / discomfort  

 • Nausea or abdominal distress  

 • Dizzy, lightheaded, faint, unsteady  

 • Derealization (feelings of unreality)  

 • Depersonalization (feelings of detachment from self)  

 • Fear of losing control or going crazy  

 • Fear of dying  

 • Paresthesis (numbness or tingling)  

 • Chills or hot flashes  

 

Panic disorder  

 • About 2.7% of U.S. population in a one year period, and 4.7% sometime during their  lifetime  

 • Similarities in rates across cultures, but with some variations  

 • Two thirds are women – role of cultural issues?  

 • Men more likely to “self-medicate”  

 • Onset from early teens to about 40  

 • Children will rarely develop the disorder but there may be a bias toward not diagnosing    

 

Causes of panic disorder  

 • A vulnerability to stress, and over-reactivity to some events in daily life   • Panic disorder occurs at time of high stress  

 • Development of anxiety that another attack is likely (generalized psychological  vulnerability)  

 • Avoid situations where panic attacks may be likely  

 

What about people who Have Panic attacks but do not develop Panic Disorders?   • Approximately 8 to 12 % of people experience a panic attack , usually during intensely  stressful periods  

 • Many attribute the panic attack to stress or specific events, and do not develop the  expectation that they will have another panic attack nor do they attach their fears about  having another attack to a situation or a place  

 • May or may not experience others

 • Unlikely to over-respond to physical symptoms with catastrophic expectations or  consider it dangerous  

 

Treatment of panic disorder  

 • Combined Psychological and medication treatments  

 • CBT alone and drugs alone were not very different in outcome studies with short term  follow up  

 • Long term follow up studies of what works best: CBT combined with medication or  CBT alone without drug treatment? CBT demonstrated as more effective for long term  well-being.  

• Know about agoraphobia and treatment  

 • Commonly, a phobic avoidance of situations which evoke significant anxiety about a  repetition of a previous panic attack  

 • Have a group of enablers  

 • Telling themselves they'll have a problem if they leave the safety of their own home   • Often think the panic attack is a complete loss of control or impending death   • Panic disorder and agoraphobia often occur together but not always   • In rare cases, there is no history of panic attacks  

 • Some people are able to function to some extent (e.g., go to work) but do so with intense  dread  

 • Many spend their lives as recluses and do not leave their homes  

 • Effort to avoid situations which evoke strong emotional responses    

 

• treatment  

• drug and psychological  

• benzodiazepines prescribed for gen axiety, give short term relief  

• cognitive behavioral treatment (CBT) - puts evoke the worry process during therapy  sessions and confront anxiety provoking images and thoughts head on  

• we need more powerful treatments but recently there’s one that incorporates  procedures focusing on acceptance rather than avoidance of distressing thoughts and  feelings in addition to cognitive therapy (meditation)

• Specific phobias and treatment  

 • An irrational fear of a specific object or situation that markedly interferes with an  individual’s ability to function  

 • May work around a phobia  

 • Immediate exposure evokes an anxiety response so situation or object is either avoided or  endured with intense anxiety and discomfort

 • Almost unlimited variations of this disorder (see table 5.4 in your text)   • Four major subtypes:  

 • Animals – includes insects  

 • Natural environment – things that occur in nature (lightening)  

 • Situational– situations or activities (closed places/flying  

 • Other – situations that may lead to vomiting, choking, contracting an illness   • Note: blood-injury-injection phobia almost always differs from other types of phobic  responses  

 

 • Onset is not dependent on a frightening event, although this does happen (about 50%)   • Social learning about fear when exposed to an object/situation  

 • Information transmission = repeated warning about the danger posed by some situation or  object  

 • Inherited tendency to be fearful or anxious  

 • Cultural expectations often "forbid" males from expressing fears  

 • Treatment  

 ◦ Exposure based exercises with graduated levels of exposure to fear producing  event or stimulus  

 ◦ Therapeutic supervision  

 ◦ Blood-injury-injection phobia treatment requires extra attention to muscle tension  exercises which prevent fainting  

 ◦ Some treatments are completed in one day long session.  

 ◦ Follow up requires that the client spend time at home exposing him/herself to the  situation/object and periodically checking in with the therapist  

• Separation Anxiety Disorder and treatment

 • Use to think it was limited to children  

 • Those exposed to domestic violence have a higher likelihood of development   • Unrealistic and persistent fear that something will happen to a parent or other person  important to them  

 • May refuse to leave home or go to school  

 • May have nightmares, physical symptoms such as upset stomach, headaches   • Nightmares, and sleep disturbances  

 • May diminish over time, OR may persist into adulthood  

 • About 4.1% of children have diagnosable disorder  

 • About 35% of children continue to have severe problems in adulthood  • Social Anxiety Disorder and treatment

 • Previously called Social Phobia

 • Fear of social or performance situations  

 • Recognition that the response is unreasonable  

 • Avoid or engage in activity with high levels of anxiety  

 • Need to rule out substance use, medical causes  

 • As a child may have tendency to fear angry or threatening expressions   • Temperamental shyness  

 • Genetic tendency toward social inhibition or to become anxious   • When under stress, may have panic attack and attribute to social situation  

 • May have history of traumatic social situations  

 • About 12.1% of the population at some point in their lives (about 35 million in US)   • Second to specific phobia as most common anxiety disorder  

 • Females more likely to experience  

 • Onset most common in late adolescence to late 20s  

 • Younger age, lower SES, and lower education* are associated with Social Phobia  

 • Uncommon in those over 60  

• PTSD and changes from DSM-IV to DSM-V

Post Traumatic Stress disorder is now under “trauma and Stress related disorders” in Dsm-5   • Exposed to traumatic situation  

 • Develops ways of reliving the event (nightmares, flashbacks)  

 • Avoids reminders of the event (flight) OR engages in “fight responses”   • Restricted or numbed emotions  

 • Gaps in memory of the event  

 • Chronic over-arousal  

 • Irritable  

 • Exaggerated startle response  

 

 

Post traumatic stress disorder  

 • DSM-V now includes broader criteria for what constitutes a traumatic event   • Sexual assault is explicitly included  

 • Recurring exposure such as that of first responders  

 • Includes four clusters based on behavioral clusters:  

 • Re-experiencing – spontaneous memories, recurrent dreams, flashbacks, intense or  prolonged psychological distress

 • Avoidance – making efforts not to re-experience distressing memories, thoughts, feelings,  or external reminders  

 • Negative cognitions and mood – persistent and distorted sense of self blame, or blaming  others, estrangement from others, inability to recall event or key aspects of event   • Arousal – aggressive, reckless or self-destructive behaviors, sleep disturbances,  hypervigilance or related problems (“fight” aspect)  

 • Acute = diagnosed at one month after the event  

 • Chronic = continues more than 3 months <-removed from DSM-5   • Delayed onset = few or no immediate symptoms, and may take a year or more to develop  

 • Lasts at least a month  

 • Preschool Type for children who are younger than 6  

 • PTSD with prominent dissociative symptoms = feeling detached from one’s own mind or  body or experiences in which the world seems unreal, dreamlike or distorted   • Develops  

 • Close exposure to traumatic event  

 • Personal  

 • Biological vulnerability  

 • Family history of anxiety  

 • Easily stressed and anxious  

 • Less education  

 • Early exposure to stressful or traumatic events  

 • Family instability can be predisposing factor  

 • Social support is buffer (protective)  

 • High stress produces stress hormones (e.g., cortisol) which change brain structures   • Course is usually chronic  

• OCD and treatment

Obsessive Compulsive Disorder (OCD) is now under “Obsessive –Compulsive and  Related Disorders” in DSM-5

 • Very debilitating:  

 • Presence of recurring obsessions, compulsions or both

 • Time consuming, cause clinically significant distress or impairment   • Obsessions = intrusive and usually nonsensical thoughts that cannot be  controlled

 • Compulsions = thoughts or actions used to control or suppress obsessions and  provide relief

 • May experience sense of danger, severe generalized anxiety, repeated panic  attacks, and significant avoidance of events or objects that evoke anxiety

• Attachment disorders  

• Hoarding Disorder

• Generally begins early in life and goes on throughout adulthood  

• May be exacerbated in times of great stress  

• Difficulty with letting go of possessions  

• Problems with controlling their lives or possessions  

• Difficulty with decision making, especially about the value of their possessions • Generally begins early in life and goes on throughout adulthood  

• May be exacerbated in times of great stress  

• Difficulty with letting go of possessions  

• Problems with controlling their lives or possessions  

• Difficulty with decision making, especially about the value of their possessions • Tricotillomania

• HAIR PULLING  

• Arms, legs, eyebrows, scalp  

• Experience distress  

• Severe social responses  

• More females than males  

• Between 1-5% of college students

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