Monday September 23, 2019
Chapter 5: Anxiety
○ Response to an actual threat
○ Fear of something that hasn’t yet happened.
○ Activates systems that evolved to respond to actual threats
○ Anxiety dissolves when the threat didn’t actually occur
○ Can drive behavior
■ Being anxious to get an elevator so you miss an interview for a job you really like.
○ Has a genetic component, it runs in families, but it creates a vulnerability
● Cognitive Dissonance
● YerkesDodson Curve
○ Arousal and anxiety falls within a curve and depending on the task or person their optimal level will be different.
● Brain Structure involved in dealing with fear and stress
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● Generalized Anxiety disorder
○ Someone who’s anxiety is so strong that it interferes with their function but it’s not specific
■ Easily startled
■ Muscle Tension
■ Exaggerated Worry
■ Constant Worry
■ Difficulty sleeping
● Panic attack
○ If they think their panic attacks is caused by a specific thing or setting, they’ll start avoiding it.
○ Panic disorder symptoms
■ Racing or pounding heart
■ Chest pains
■ Difficulty breathing
■ Dizziness or lightheadedness
■ Fear of losing control
■ Fear of dying
■ Tingling or numbness
■ Overwhelming terror
○ It’s not necessarily the setting that is the problem but it’s how you think about the situation.
■ Can lead to phobias
■ Heart palpitations
■ Chills or hot flashes
■ Trembling or shaking If you want to learn more check out What are the total abatement cost functions of the two firms?
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■ Numbness and tingling
● Obsessive Compulsive Disorder
● Excessive, repetitive thoughts and behaviors
● Social Phobia
● Embarrassment and humiliation in social situations
● Posttraumatic stress disorder
● Thoughts and experiences of a horrible event
● Panic disorder
● Frequent, Spontaneous Attacks plus avoidance
● Generalized Anxiety Disorder
● Constant Worry and physical symptoms
○ Can be exaggerated
● The fear of spiders. Don't forget about the age old question of What is the difference between bacteriostatic and bacteriocidal?
● This phobia tends to affect women more than men.
● The fear of snakes.
● Often attributed to evolutionary causes, personal
experiences, or cultural influences.
● The fear of heights.
● This fear can lead to anxiety attacks and avoidance of
● The fear of situations in which escape is difficult.
● This may include crowded areas, open spaces, or
situations that are likely to trigger a panic attack. People
will begin avoiding these trigger events, sometimes to the
point that they cease leaving their home.
● Approximately one third of people with panic disorder
● The fear of dogs.
● This phobia is often associated with specific personal experiences, such as being bitten by a dog during
● The fear of thunder and lightning.
● Also known as Brontophobia, Tonitrophobia, or Ceraunophobia.
● The fear of injections.
● Like many phobias, this fear often goes untreated because people avoid the triggering object and situation. ■ Social Phobias:
● Social Anxiety
● Separation Anxiety
● The fear of social situations.
● In many cases, these phobias can become so severe that people avoid events, places, and people that are likely to trigger an anxiety attack.
● The fear of flying.
● Often treated using exposure therapy, in which the client is gradually and progressively introduced to flying. ■ Mysophobia:
● The fear of germs or dirt.
● May be related to obsessivecompulsive disorder. ■ Animal phobias
■ Natural environment phobias
■ Situational phobias
■ Bloodinjectioninjury phobia
■ Other Phobias
● Fear of choking
● Fear of illness
● Fear of death
● Fear of injury
● Fear of clowns
● Fear of public speaking
● Behavioral inhibition system (BIS)
○ Involves connections from the septum and hippocampus and frontal cortex and input from the amygdala. Involves serotonin and Norepinephrine. It is activated by unexpected threats and causes is to Freeze.
● Fight or flight connections start in the brain stem and connect to the brain stem, midbrain, amygdala & hypothalamus. Triggers alarm and involves decreased serotonin. May be impacted by early experience leading to increased anxiety sensitivity.
○ Catastrophizing is a way of thinking called a 'cognitive distortion.' A person who catastrophizes usually sees an unfavorable outcome to an event and then decides that if this outcome does happen, the results will be a disaster.
○ Catastrophic Misinterpretation Theory
● So how do we manage anxiety? We have to break the cycle of avoidance ○ Exposure Therapy
■ Systematic Desensitization
■ Cognitive Behavioral Therapy
■ Changing Perceptions
● What we think affects how we feel and act
● What we do affects how we think and feel
● What we feel affects how we think and act
● Treatment of Phobia
○ Medications with efficacy for SAD
○ Ativan, Xanax, VAllum
● Can produce dependence
● Often prescribed for chronic forms of anxiety
○ Obsession on thoughts
○ Obsession anxiety compulsions relief obsession
■ Constant thoughts about whether or not the oven was turned off, even after checking once
■ Obsessions cause strong uncomfortable feelings of anxiety. The person feels compelled to act and remove the discomfort
■ Repeatedly checking to confirm that the oven is off.Possibly going to great lengths to do so such as traveling home from work.
■ The individual experienced fleif from their anxiety. However, the obsessive response has been strengthened for the future.
○ Occurs when people can’t let go of that anxiety
○ Frontal Cortex
■ People with OCD can’t turn off the planning area of their brain ○ Treatment of OCD
■ OCD presents a wide range of severity and disability
■ Exposure and response prevention
● Graduated exposure to obsessional cues and strict
prevention of rituals
● Relaxation training may be used
■ Cognitive therapy
● Challenge errors in thinking
● SSRIs, tricyclics
■ Increased activity in the frontal lobe of brain
Monday September 30, 2019
● Body Dysmorphic Disorder
○ Perceived defect in appearance
○ May diet, seek plastic surgery
○ Influenced by culture
○ Responds to CBT and SSRIS
○ Acquisition and difficulty getting rid of things
○ Involves Decision making and responds to CBT
○ Hair pulling
○ Skin picking
○ Respond to Habit Reversal Training( Substitute Behaviors) and SSRIS ● PTSD
● WW1 shell shock ● WW2 combat fatigue ● Experience
something that would be traumatic to anybody, not just vets ○ Historically PTSD was believed to be a physical injury that lead to both physical and mental symptoms
● What is it
○ Recurring intrusive recollection of the traumatic event ○ Persistent avoidance of stimuli with the trauma or numbing of general responsiveness
○ Persistent symptoms of increased arousal physiological hyper reactivity
■ Core Symptoms
○ Physical assault (70%)
○ Other sexual trauma (64%)
○ Sexual assault/rape (57%)
○ Sudden death of loved on ( 43%)
○ Transportation ( 40%)
○ Illness/Injury ( 34%)
○ Weapon assault ( 32%)
○ Severe suffering (21%)
○ Accident (19%)
○ Natural disaster (14%)
● Brain component
○ A magnetoencephalography of the resting state brain shows hyperaroused amygdala in PTSD patient
● Prolonged Exposure (PE)
○ Involves talking about trauma with a provider and doing some of the things you have avoided since the trauma.
● Cognitive Processing Therapy (CPT)
○ Teaches you to reframe negative thoughts about the trauma ● EyeMovement Desensitization and Reprocessing (EMDR). ○ Helps you process and make sense of your trauma. It involves calling the trauma to mind while paying attention to a back
andforth movement or sound (like a finger waving side to side, a light, or a tone).
● Antidepressants (SSRIs and SNRIs)
○ Sertraline (Zoloft)
○ Paroxetine (Paxil)
○ Fluoxetine (Prozac)
○ Venlafaxine (Effexor)
● Michelle Groth
○ I did not ask for the things that I’ve been through and I certainly did not ask my mind to paint and repaint the pictures in
● Summary Treatment for Anxiety Disorders
○ Behavioral approaches
○ Cognitive Behavioral TX
○ Relaxation Training
○ Exercise, Sleep, Diet
Chapter 6: Somatic Disorder
● Somatic Symptom Disorders
○ Medically Unexplained Physical Symptoms
○ Or excessive response to symptoms
○ Often anxiety and depression compound symptoms
● Illness anxiety disorder
○ Used to be called Hypochondriasis.
○ Characterized by major concerns about physical symptoms even if they are normal sensations.
○ Also involves a “disease conviction” which makes it hard to convince people that they are not ill, even if there is no evidence. ● Somatic Disorder
○ Extreme concern about physical symptoms.
○ Associated with depression and anxiety
○ Tends to run in families and be more common in women ○ The more you focus on sensations the stronger they become. ○ Can be culturally influenced
○ CBT and medication such as SSRI’s can help
● Conversion Disorder
○ Physical malfunction which can involve vision, motor or other symptoms but lacks actual pathology
○ Associated with stress and trauma more common in women ○ May be influenced by culture
○ Not always distressed by loss
○ Freud thought it was due to unconscious conflict
○ Allows people to avoid conflict
○ May resolve quickly
● Faking Illness
■ Deliberately faking symptoms
○ Secondary Gain
■ Benefits from being sick
○ Factitious Disorder
■ Fake symptoms no clear gain
■ Factitious Disorder can be imposed on another
○ Rule out physical causes
○ Explore history of trauma
○ Cognitive therapy
○ Explore insight/ Suggestibility
○ Anxiety Meds
○ Family/Couples therapy
● Dissociative Disorders
○ Sense of detachment self or environment
○ Associated with extreme stress, sleep deprivation
○ Common immediately after a traumatic event
■ Lost sense of extreme reality.
■ Separate from reality may help is cope in the short run
■ Disrupted sense of self characterized by emotional inhibition ■ Attention processing and memory issues
■ Related to suggestibility and hypnosis
○ Organic Amnesia
■ Due to brain injury, irreversible
○ Dissociative Amnesia
■ Typically occurs in adults
○ Generalized Amnesia
■ Total loss of memory
○ Selective Amnesia
■ Failure to remember an event
● Dissociative Fugue
○ Memory loss for an event
○ Often associated with trauma
○ Can abruptly
○ In some cultures and belief systems dissociation may be described as possession, or a trance.
○ This illustrates why we have to be careful when labeling something “ abnormal”
● Dissociative identity disorder
○ Formerly known as multiple personality disorder
○ Typically have a strong history of severe abuse that happened when young ( below 9 years old)
○ Defining feature is dissociation of personality and adoption of new identities
○ Identities display unique, behaviors, voice, posture, handwriting ○ Even different brain wave activity
○ Person might not be aware of the different personalities and may consider them as blackouts.
○ DID often cooccurs with anxiety, depression, substance abuse and personality disorders
○ We can all dissociate under duress, but some people may be more prone.
○ Could also be PTSD with extreme dissociation
■ Identifying cues that provoke trauma
■ Have to confront memories and learn to control emotions much like PTSD and anxiety
● Real and false memories
○ Memory is not infallible, can be disordered or altered
○ People who are prone to false memory creation made more false recall errors on laboratory tasks, and were more suggestible, and depressed ○ Children are not reliable witnesses
○ Causes problems for therapy process