Chapter 4 Notes and Vocab
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Date Created: 09/27/16
Chapter 4 Notes Anxiety and obsessive-compulsive and related disorders Understanding anxiety disorders Anxiety is an emotional state that produces tension, worry, and physiological reactivity Anxiety can range from mild to terrifying, and form an attack to an ongoing state Thoughts range from vague worries to the fear that death is imminent Anxiety disorders produces significant distress and interfere with daily functioning Stress vs. anxiety Stress results from external factors Anxiety can occur without external factors and can be due to maladaptive learning Anxiety disorders All anxiety disorders share features of excessive fear and anxiety and related behavioral disturbances Fear - an emotional response to real of perceived threat; associated with fight or flight response Anxiety - anticipation of future threat; associated with tension and avoidance behaviors List of anxiety disorders Developmental order (by age of onset): o Separation anxiety disorder o Selective mutism o Specific phobia o Social anxiety disorder (social phobia) o Panic disorder o Agoraphobia o Generalized anxiety disorder o Substance/medication-induced anxiety disorder o Anxiety disorder due to another medical condition OCD and related disorders Categorized separately from the other anxiety disorders: o OCD o Body dysmorphic disorder o Hoarding disorder o Trichotillomania - hair pulling o Excoriation disorder - skin picking o Substance/medication induced OCD disorder o Other OCD disorder Biological aspects of anxiety Need to rule out physical causes of anxiety: hyperthyroidism, cardiac arrhythmias, stimulants, asthma medications Two neural pathways involved in anxiety: o Stimulation of the amygdala activates the HPA axis to reach to danger - fight or flight o Sensory signals are also processes by the hippocampus and prefrontal cortex - evaluate danger and decided to top the HPA response Decreased levels of serotonin are linked to depression and anxiety Research has focused on variation in serotonin transporter gene, 5-HTTLPR, short alleles of this gene are associated with low level of serotonin activity and increased anxiety Numerous genes affect vulnerability; behavior is the result of certain environmental factors interacted with genetic predisposition Psychological and social aspects of anxiety Negative appraisal - interpreting events as threatening Anxiety sensitivity - interpreting physiological changes as signs of danger - leads to anxiety Environmental stress can produce anxiety (poverty, trauma, adverse working conditions, limited social support, and acculturation) Culture can influence how anxiety is expressed Generalized anxiety disorder An anxiety state of chronic free-floating anxiety and hyperactivity of the autonomic nervous system within a broad range of normally nonthreatening situations Develops gradually, often beginning in childhood or adolescence Essential feature is a physiological stress syndrome known as chronic ANS over-activity: sweating, heart palpitations, etc. The autonomic nervous system controls cardiovascular, digestive and respiratory functions; divided into the sympathetic and parasympathetic divisions GAD is fairly common: prevalence is about 3%; twice as common in women GAD tends to be chronic, but fluctuating; worsens during times of stress Diagnostic criteria: o Excessive anxiety and worry, more days than not, for at least 6 months, about several activities o Difficulty controlling the worry o At least 3 of the following symptoms: Restlessness, felling keyed up on edge Easily fatigues Difficulty concentrating or mind going blank Irritability Muscle tension Sleep disturbance (insomnia, restlessness) Etiology of GAD Biological causes: o Small but significant heritability factor o May disrupt prefrontal cortex modulation of response to threatening situations Psychological causes (cognitive perspective): o Dysfunctional thinking and beliefs o Viewing many situations with apprehension o Worry is used to cope with stressful events o Constantly generate solutions to "what it" scenarios o Worry about worry Mothers with anxiety may be less engaged with their infants; associated with increased likelihood of child developing GAD Stressors that influence GAD: o Poverty, poor housing, prejudice, and discrimination o Peer relationship conflicts Treatment of GAD Drug therapy: o Benzodiazepines - issues with dependence - Xanax, Valium o Antidepressants - safer alternative - SSRI's Cognitive-behavioral therapy: o Effective for GAD; 60% showed significant symptom reduction that persisted 12 months after treatment Phobic disorders Phobic disorders are patterns in which chronic avoidance behaviors occur with an irrational fear of a particular object or situation o Extreme anxiety is expressed when phobic stimulus is encountered o Prevalence - 8.7% of population; twice as common in women than men, but depends on phobia o Phobias are intense, persistent, and disproportionate fear o Two types of phobic disorders: Specific phobias Social phobia Specific phobias Involve marked fears of specific objects or situations Learned through classical conditioning Onset is usually childhood or early adolescence Categories: living creatures, environmental conditions, blood/needles or injury, situational factors Diagnostic criteria for specific phobia The object or situation: o Provokes immediate fear or anxiety o Is actively avoided or endured with intense anxiety The fear, anxiety, or avoidance: o Is persistent (6 months or more) o Causes distress in social, occupational, or other areas of functioning Social anxiety disorder - social phobia Fear of embarrassment in social situations; avoidance of situations where one is the focus of attention Fear is out of proportion and persistent, causing significant distress; can be chronic and disabling Typical situations - eating/speaking in public, small group discussions, being observed, using public restrooms, performing in front of others Often comorbid with major depressive disorder and substance-use disorders Prevalence is about 8%; twice as common in women than in men - onset: mid-teens Etiology of phobias Phobias have made moderate genetic contribution (31% heritability) Most likely a result of learning through classical conditioning or observational learning Parental behaviors that may influence development of social anxiety in children: o Overproduction o Lack of support for independence o Punitive maternal parenting style o Negative family interactions and family stress Treatment of phobias Medications: o Benzodiazepines (like Ativan, Xanax, Valium) o SSRI's (for chronic anxiety) o Beta-blockers Behavior therapy of CBT: o Systematic desensitization o Exposure o Cognitive restructuring: identifying and changing irrational thoughts o Modeling therapy Panic disorder Anxiety state characterized by random episodes of intense anxiety (panic attacks), accompanied by a sense of doom Panic attacks are sudden and unpredictable; cold sweats, dizziness, trembling, sensations of fainting, and feelings of impending doom Anxiety is free-floating and has no external cause Prevalence is about 2-3% twice as common in women, but this may be due to under-diagnosis in men Average age of onset is late adolescence/early adulthood; may begin in childhood or over age 45, but that is more unusual Causes include biochemical, genetic, and psychosocial factors Most common treatment is medication (benzodiazepines and SSRI's) and cognitive-behavior therapy Diagnostic criteria of panic attack Four or more of the following symptoms: o Palpitations, pounding heart, or accelerated heart rate o Sweating o Trembling or shaking o Sensations of shortness of breath or smothering o Feelings of chocking o Chest pain or discomfort o Nausea or abdominal distress o Feeling dizzy, unsteady, light-headed, or faint o Chills or heat sensation o Parasthesias (numbness or tingling) o Derealization or depersonalization o Fear of losing control or "going crazy" o Fear of dying Panic disorder Attacks last from a few minutes to several hours At least one attack has been followed by one month (or more) of one or both of the following: o Persistent concern about having another panic attack o A change in behavior related to the attacks Occasional panic attacks are not that unusual in normal adults Agoraphobia Intense fear of at least two of the following: o Being outside of the home alone o Traveling via public transportation o Being in open spaces (parking lots, bridges) o Being in enclosed spaces (stores or theaters) o Standing in line or being in a crowd Situations are feared because escape or help may not be readily available Often accompanies panic disorder; rarely occurs on its own (prevalence 1.7%) Etiology of panic disorder Biological o Heritability is 32% o Decreased levels of serotonin and GABA o Amygdala over-reactivity Psychological o Heightened fear responses to bodily sensations o Catastrophic thoughts o Conditioned response (effect of learning) Social o Anxiety provoking social environment o Peer victimization o Relationship separation or loss Sociocultural o Asian American and Latino/Hispanic adolescents are less likely to have panic attacks, but report higher anxiety sensitivity (compared to European Americans) o Cultural differences in expression Medication o Benzodiazepines, antidepressants (SSRI's), beta-blockers o High relapse rates after cessation of drug therapy Cognitive-behavior therapy o Promotes self-efficacy o Involves educating the client about panic disorder, identifying and correcting catastrophic thinking, encouraging client to face the symptoms Obsessive-compulsive disorder Anxiety state characterized by: o Obsessions - persistent or uncontrollable anxiety-producing thoughts or images o Compulsions - an irresistible impulse to perform certain actions repeatedly to counteract anxiety or prevent a dreaded event Does not include compulsions that people find pleasurable (overeating) People with OCD may be embarrassed, but are reluctant to give up symptoms They see behavior and thoughts as distressing, but do no experience panic May be linked to cultural factors; less common in less complex and advanced societies, more common in suburbs than in rural or urban areas Prevalence or 1-2% (fairly rare); equally common in men and women Average age of onset is 20 years, but can begin in childhood (25% before age 14) Etiology of OCD Biological o Heredity is 4x higher in close relatives o Over-activity in orbitofrontal cortex (increased interpretation of danger) o Decreased levels of serotonin Behavioral o OCD behaviors develop to reduce anxiety Cognitive o Exaggerated estimates of probability of harm, control, intolerance of uncertainty Family o Controlling parenting styles, low parental warmth Culture may affect how symptoms are expressed Treatment of OCD OCD is difficult to treat Highly resistant to psychotherapy, but behavior therapy and CBT can be very effective Medication (SSRI's and clomipramine) is helpful for about 60% of patients Best outcome is medication combined with behavior treatments (flooding, response prevention) Hoarding disorder The essential feature is persistent difficulties discarding or parting with possessions, regardless of value o Due to a perceived need to save the items and distress associated with discarding them o Results in the accumulation of possessions that clutter living areas o Causes significant distress or impairment Prevalence estimate is 2-6%; more common in older people, but is universal in all cultures Onset in late adolescence; worsening by age 30 Individuals with hoarding disorder believe that the items collected are valuable and resist having them removed, even when the possessions are worthless or unsanitary or create a fire danger. Body dysmorphic disorder A strong belief in the absence of evidence, that a body part is defective or deformed in some way Appears early adolescence to early adulthood; may persist for years Affected by culture; equally common in men and women Prevalence is about 2.4%; difficult to assess Trichotillomania (hair pulling disorder) The essential feature is the recurrent pulling out of one's own hair (scalp, eyebrows, eyelids) Repeated attempts to stop; significant distress Prevalence: 1-2%; 10 times more common in adult women; equal in young boys and girls Onset by age 17 Causes - not entirely known; most likely biological Treatment - habit reversal training (HRT); redirecting the impulse to pull hair Excoriation (skin picking disorder) The essential feature is recurrent picking at one's own face, arms, hands, or multiple body sites, resulting in lesions Prevalence is about 1.4% more common in women; usually begins in adolescence Cause - may be a coping mechanism to deal with anxiety (compulsion) Treatment - habit reversal training, CBT, and other behavior treatments that try to change behavior Chapter 4 Vocabulary Anxiety - an anticipatory emotion that produces bodily reactions that prepare us to "fight or flight" Fear - an intense emotion experienced in response to a threatening situation Anxiety disorder - fear or anxiety symptoms that interfere with an individual's day- to-day functioning Etiological model - model developed to explain the cause of a disorder Amygdala - the brain structure associated with the processing, expression, and memory of emotions, especially anger and fear Hippocampus - the part of the brain involved in forming, organizing, and storing memories Prefrontal cortex - the outer layer of the prefrontal lobe responsible for inhibiting instinctive responses and performing complex cognitive behavior such as managing attention, behavior, and emotions Neurotransmitter - any of a group of chemicals that help transmit messages between neurons Serotonin - a neurotransmitter associated with mood, sleep, appetite, and impulsive behavior Polymorphic variation - a common DNA mutation of a gene Alleles - a gene pair responsible for a specific trait Predisposition - a susceptibility to certain symptoms or disorders Behavioral inhibition - shyness Negative appraisal - interpreting events as threatening Anxiety sensitivity - a trait involving fear of physiological changes within the body Phobia - a strong, persistent, and unwarranted fear of a specific object or situation Social anxiety disorder (SAD) - an intense fear of being scrutinized in social or performance situations Specific phobia - an extreme fear of a specific object (such as snakes) or situation (such as being in an enclosed place) Agoraphobia - an intense fear of being in public places where escape or help may not be readily available Panic attack - an episode of intense fear accompanied by symptoms such as a pounding heart, trembling, shortness of breath, and fear of losing control or dying Exposure therapy - treatment that involved introducing the client to increasingly difficult encounters with a feared situation Systematic desensitization - a treatment technique involving repeated exposure to a feared stimulus while a client is in a competing emotional or physiological state such as relaxation Cognitive restructuring - a cognitive strategy that attempts to alter unrealistic thoughts that are believed to be responsible for phobias Modeling therapy - a treatment procedure involving observation of a non-phobic individual successfully coping with the phobic object or situation Panic disorder - a condition involving recurrent, unexpected panic attacks with apprehension over future attacks or behavior changes to avoid attacks Comobid - existing simultaneously with another condition Concordance rate - the degree of similarity between twins or family members with respect to a trait or disorder Generalized anxiety disorder (GAD) - a condition characterized by persistent, high levels of anxiety and excessive worry over many life circumstances Schema - the mental framework for organizing and interpreting information Obsessive compulsive disorder (OCD) - a condition characterized by intrusive, repetitive anxiety-producing thoughts or a strong need to perform acts or dwell on thoughts to reduce anxiety Obsession - an intrusive, repetitive thought or image that produces anxiety Compulsion - the need to perform acts or mental tasks to reduce anxiety Hoarding disorder - a condition involving congested living conditions due to the accumulation of possessions and distress over the thought of discarding them Body dysmorphic disorder (BDD) - a condition involving a preoccupation with a perceived physical defect or excessive concern over a slight physical defect Delusion - a firmly held false belief Muscle dysmorphia - the belief that one's body is too small or insufficiently muscular Trichotillomania - recurrent and compulsive hair pulling that results in hair loss and causes significant distress Excoriation (skin-picking) disorder - a distressing and recurrent compulsive picking of the skin resulting in skin lesions Orbitofrontal cortex - the brain region associated with planning and decision making Flooding - a technique that involved inducing a high anxiety level through continues actual or imagined exposure to a fear-arousing situation Response prevention - treatment in which an individual is prevented from performing a compulsive behavior
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