Test 2 Study Guide!
Test 2 Study Guide! CLP4143
Popular in Abnormal Psychology
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This 15 page Study Guide was uploaded by Julia Marcinak on Sunday October 11, 2015. The Study Guide belongs to CLP4143 at Florida State University taught by Jesse Cougle in Summer 2015. Since its upload, it has received 270 views. For similar materials see Abnormal Psychology in Psychlogy at Florida State University.
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Date Created: 10/11/15
Anxiety and Panic 1 Anxiety Test 2 Study Guide Ch 5 a Anxiety is a negative mood characterized by physical tension and apprehension about the future We get anxious because it is an adaptive alarm system that prepares our body for a ght or ight reaction 1 ii iii iv V vi vii viii ix xi xii xiii xiv Panic Disorder Speci c Phobia Social Anxiety Disorder Generalized Anxiety Disorder Post Traumatic Stress Disorder 1 Trauma and stressor related disorders Obsessive compulsive disorder Hoarding Disorder Excessive acquisition of things dif culty discarding anything and living with excessive clutter under conditions best characterized as gross disorganizations Treatment is not very successful Body dysmorphic disorder A person who looks normal but is obsessively preoccupied with an imagined defect in appearance or imagined ugliness Some seek plastic surgery as a remedy Trichotillomania Hair pulling Excoriation Skin picking Emetophobia Fear of vomiting Adjustment Disorders Developing anxiety or depression in response to a stressful but not traumatic event Anxiety prone individuals are more likely to experience this Attachment Disorders Common in children experiencing inadequate abusive or absent caregiving and fail to develop normal relationships with caregivers This results in two different disorders 1 Reactive attachment disorder is when children that are inhibited emotionally withdrawn and unable to form attachment with caregivers 2 Disinhibited social engagement disorder describes children who inappropriately approach all strangers as if they had a strong and loving relationship Many more 2 There are 3 Components of Anxiety i Cognitive Symptoms ii Behavioral Symptoms iii Physiological or Somatic Symptoms b Adaptive vs Maladaptive Fears i Are the concerns realistic given the circumstances ii Is the amount of fear in proportion to the threat iii Does the concern persist in absence of the threat iv Anxiety disorders involve maladaptive fear c Fear vs Diagnosis of Anxiety Disorder i Anxiety is a futureoriented state where a person focuses on the possibility of uncontrollable dangermisfortune while fear is a present oriented state in response to current danger ii Distress and Impairment is Present for Anxiety Disorders 1 Severe enough to lower quality of life 2 Chronic and frequent enough to interfere with functioning iii Anxiety is a mood state of apprehension because we can not control the future fear is an immediate emotional reaction to current danger 3 Features of Anxiety Disorders i Prevalence Commonness 1 25 lifetime prevalence 31 in females 19 in males 2 Some recent estimates put lifetime prevalence at 495 ii Chronicity 1 7 080 of people do not seek professional help a Reasons 2 1730 experience spontaneous remission iii High Rates of Comorbidity 1 Comorbidity is the simultaneous presence of more than one disorder 2 557 6 iv Linked to Suicide Attempts 1 Rates similar to depression in PTSD and MDD 4 Vulnerabilities i Generalized Biological Vulnerability 1 We inherited a tendency to be tense and uptight Panic seems to run in families 2 Multiple genes contribute to making us more vulnerable 3 Stress factors in environment turn on these vulnerable genes to cause anxietypanic 99 89 11 ii 1 9599 iii 1 2 3 5 Panic Disorders a Panic Attack Speci c brain circuits and neurotransmitter systems are associated with increased anxiety GABA Noradrenergic system has also been implicated in anxiety Heredity contributed to negative affect Glass is half empty IrritableDriven CRF system The limbic system is the area of the brain that is most related to anxiety Behavioral inhibition system involved in apprehensively evaluating a situation with potential danger Generalized Psychological Vulnerability Sense that events are uncontrollable and unpredictable Tendency toward lack of selfconfidence Low selfesteem Inability to cope Early life experiences Actions of parents affect Whether a child develops a sense of control Specific Psychological Vulnerability Focused on particular events or circumstances Development of specific anxiety disorders Specific focus of stress and anxiety that leads to a specific diagnosis a ie Social Phobia i Discrete period of intense fear and discomfort ii danger iii 1 WWNQP PP N Represents the alarm response of real fear but there is not actually any Four or more of these symptoms develop and peak Within 10 minutes Pounding Heart Sweating Trembling Shaking Shortness of Breath Feeling of Choking Chest Pain Nausea or Abdominal Distress Dizziness Derealization or depersonalization 10 Fear of losing control 11 Fear of Dying 12 Numbness or Tingling 13 Chills or Hot Flashes iv 283 Lifetime prevalence V 23X more common in women vi Onset lateadolense to mid30 s b Panic Disorder i Recurrent unexpected panic attacks ii At least one panic attack has been followed by one month of any of these 1 Persistent concern of additional attacks 2 Worry about the implications of the attacks 3 Signi cant change in behavior iii 47 Lifetime prevalence iv 23X more common in women V Onset lateadolense to mid30 s 6 Cognitive Perspective 1 Panic disorders are a misinterpretation of bodily senses ii They involve maladaptive beliefs including cardiac loss of control going crazy social consequences iii Trigger stimulus gt Perceived threat gt Apprehension gt Body sensations gt Interpretation of sensations as catastrophic gt Cycle repeats iv Safety Behaviors l 2 7 Treatments Avoiding anxiety provoking situations Maintain fear by avoiding disconfirming evidence or having a false attribution of evidence Slow breathing sit down drink water grab hold of something or distract themselves during a panic attack Taking XanaX i Tricyclic Antidepressants ii SSRI s iii Benzodiazepines downers 1 These suppress the central nervous system to mute the alarm response They are addictive and interfere with cognitive and motor functioning They are a form of avoidance and panic attacks occur when you stop taking them 8 Agoraphobia iv V Cognitive Behavioral Therapy 1 Includes cognitive restructuring and exposure treatment 2 Exposure reduces maladaptive fear anxiety by providing evidence against irrational thoughts and allowing new associations to form between the feared context and safety Interoceptive Exposure 1 Controlled exposure to the symptoms in order to show the patient that the symptoms are tolerable 2 Brings on symptoms carefully and then reduces them through techniques 3 Decreases the cognitive interpretations of symptoms a ie hyperventilating a A fear of places or situations that might caused panic helplessness or b 1 ii iii iv v c d Specific Phobias embarrassment Fear or Anxiety of at Least Two of the Following Open Spaces Enclosed Spaces Public Transportation Standing in Line Being in a Crowd Being Outside the Home Alone Fear or avoidance of these situations because thoughts of escape are difficult Commonly Linked to Panic Disorder Anxiety about having another panic attack develops in absence of panic while anticipating another panic attack 1 Fear vs Phobia a b c A phobia causes impairment and distress Almost everyone is afraid of something Diagnostic Criteria for Phobias 1 ii iii iv v Excessive and unreasonable fear cued by a specific object or situation The feared objectsituation always evokes anxiety Object situation is either avoided or endured with intense anxiety Persisted for more than 6 months Causes impairment and distress Phobias are adaptive fears that are expressed in a maladaptive manner Fear is focused on a speci c event or object and that event is avoided They can be caused by a traumatic event or even be taught 76 of people with one phobia have another 24 of people only have one phobia 2 Four Categories of Speci c Phobias a Animal Type i Speci c animals or insects 1 ie snakes spiders 2 Snakes are the most common in the US ii 222 have fear of animals 57 have phobia Natural Environment Type i Naturally occurring situations such as storms heights or water 1 204 have fear of heights 53 have phobia Situational Type i A speci c situation such as bridges public transportation ying driving elevators tunnels enclosed places Bodily InjectionInjury Type i Seeing blood an injury or receiving an injection ii Often results in fainting l 70 of blood phobia results in fainting 2 56 of injection phobia results in fainting Gender Differences i Large gender difference in snake spider lightning darkness and closed space fears ii Small gender difference in heights ying injections dentist and injuries 3 Behavior Therapy a b c Learned patterns of behaviors can develop into psychological disorders Classical conditioning Rewards and punishments in uence behavior i Avoidance behavior is rewarded with a reduction in anxiety John Watson tested learned phobias on Little Albert Fear could be acquired through observation Mineka s Monkeys Preparedness We learn certain associations quicker than others if they are related to our survival Joseph Wolfe developed systematic desensitization for phobias i Relaxation component was abandoned ii SUDS scale Subjective Units of Distress 1 Measures the amount of anXiety being eXperienced 2 010 scale h Basic concepts of classical conditioning could be used to treat psychological disorders without complex theories and lengthy therapy i Three Types of Behavior Therapies i Modeling Therapist models the behavior that is most feared by client in order to show them it is not harmful This is based off the observational learning theories ii Flooding Client is presented with fear provoking stimuli until anxiety is extinguished iii Gradual Exposure Client is gradually presented with stimuli iv Other treatments 1 Image exposure 2 Cognitive restructuring 4 Cognitive Perspective a Stimulus gt Belief that it is dangerous gt Anxiety b Stimulus gt Belief that it is harmless gt No Anxiety Social Anxiety 1 Social Phobia Called Social Anxiety Disorder since DSM IV a Social phobia is not a specific phobia b It severely disrupts daily life c Highly comorbid with substance abuse and depression 2 Diagnostic Criteria a Marked and Persistent fear of being humiliated in a social or performance situation b Fears that they will act in a way or show anxiety that will be negatively interpreted Exposure invariably evokes panic sometimes situationally bound panic attack Social situations are either avoided or endured with extreme distressanxiety Fear is out of proportion to the actual threat Duration is at least 6 months Not due to substance abuse or another disorder P qorwvgp Causes distress and impairment y n Diagnostic Specification Performance Only DSM V i The fear is restricted to public speaking or performance ii Public speaking is the most common non clinical fear 20 of population 3 Social Anxiety Disorder a Prevalence i The most prevalent anxiety disorder ii 133 155 in women 111 in men Course i For 50 is is chronic with an onset prior to adolescence ii Causes social and occupational impairment Risk Factors i Childhood shyness ii Social inhibition iii Peer Victimization iv Sociometric Status how much you are liked by peers V Rejection Sensitivity vi ParentChild Relationship Safety Behaviors i Overprepare for a speech ii Wear makeup to hide a blush iii Avoid eye contact iv Alcohol or marijuana use Attentional Biases The tendencies of our perceptions are affected by recurring thoughts ie If we think a lot about the clothing we wear than we pay more attention to other people39s clothing i Selffocused attention ii Rejection Cognitive Theory i Focus on exaggerated likelihood of negative evaluation and exaggerated costs of negative evaluation 4 Cognitive Behavioral Therapy a Small groups can be treated together which adds the benefit of observational learning and contains exposure b Exposure Works in Four Ways C 1 Shortcircuits avoidance ii Allows practice of behavioral skills iii Opportunity to test dysfunctional beliefs iv Habituation of fear v Examples include Initiating a conversation asking for a date public speaking eatingdrinking in front of others workingplaying while being observed job interviews making mistakes in front of others interaction with authority gures expressing opinions revealing personal information Cognitive restructuring i Identify Maladaptive Behaviors gt Challenge Logically gt Develop a Rational Response d 5070 respond to CBT i Meds do not add any bene t ii People who receive CBT show improvement at follow up while those taking meds show relapses Generalized Anxiety Disorder GAD l CD gt C Is the basic anxiety disorder Focuses on minor everyday events not one major one Worry is the cognitive component of anxiety anxious anticipation 56 of general population Twice as common in women Highly comorbid with other anxiety disorders Associated with depression and substance abuse P qorwvgpgrgw 50 report onset in childhood or adolense y n Course is chronic but uctuating and worse during times of stress 80 of people with GAD worry about family 55 worry about money 50 Q worry about work W GAD worry lasts much longer 300 minutes vs 50 minutes of normal worry 1 Threatrelated reassuranceseeking is uniquely associated with pathological worry m Markers i Biological l Irrelevant levels of neurotransmitter 2 Generalized biological vulnerability to anxiety is inherited ii Enviormental 1 Trauma history 2 Interpersonal problems 3 Attachment issues 2 Diagnostic Criteria a Anxiety and worry occurring more days than not for 6 months about a number of events and activities b Worry is difficult to control c Experienced at least three of the following for more days than not for at least six months i ii iii iv V vi Restlessness or on edge feeling Easily fatigued Difficulty concentrating or mind going blank Irritability Muscle Tension Sleep disturbance d Focus is not confined to features of axis 1 disorders 6 i Axis I disorders are all psychological diagnostic categories except mental retardation and personality disorders Causes impairment andor distress f Not due to substance abuse and does not occur exclusively during mood psychotic or pervasive developmental disorders 3 Cognitive Theory People with GAD think about potential threat constantly Overestimate the likelihood and cost of aversive outcomes a b c d Under predict their ability to deal with the outcome The function of worry is to be used as a coping strategy to deal with negative material and to be used as negative reinforcement by allowing the individual to cognitively avoid dealing with the negative affect 4 Cognitive Behavior Therapy a Cognitive reconstructing 1 ii iii iv v vi vii Focuses on exaggerated threat appraisals Revaluations of beliefs of worry Tolerance of uncertainty Peel back the layers of worry by asking questions like than what would happen and how would you deal with that Ask 6Looking back 10 years from now will it matter Ask What s another way of looking at it Self monitor worry and schedule worry time b Relaxation Procedures i ii iii Diaphragmatic breathing Progressive muscle relaxation These are also effective for treating chronic pain 5 Biological Treatments a Benzodiazepines Xanax and Valium i ii iii Short term relief Many side effects Addictive b Buspirone i Less addictive ii Fewer side effects iii Stimulates serotonin release c Tricyclic Antidepressants d SSRI s e Pharmacotherapy and CBT both had positive short term effects The effect of CBT lasted even after treatment ended There is not a great effect from combining both Posttraumatic Stress Disorder PTSD 1 Diagnostic Criteria a Exposure to actual or threatened death serious injury or sexual violence in one or more of these ways i Directly experiencing the event ii Witnessing in person events occurring to others iii Learning that a violent or accidental event occurred to a family member or friend iv Repeated or extreme exposure to aversive details of the event b Traumatic event is persistently reexperienced in one or more of the following ways i Recurrent intrusive distressing memories of the event ii Distressing dreams iii Acting or feeling that the traumatic event is reoccurring iv Distress when exposed to cues that resemble an aspect of the event v Psychological reactivity when exposed to cues that resemble an aspect of them event c Avoidance of Stimuli associated with the trauma i Efforts to avoid thoughts feelings and conversations about the event internal reminders ii Avoids people places activities objects and situations that evoke memories thoughts or feelings about the event external reminders d Negative alterations in cognitions and mood associated with the trauma evidenced by at least two of the following i Inability to recall important aspects of the trauma ii Persistent and exaggerated negative beliefsexpectations about self others and or world iii iv V vi vii Persistent distorted cognitions about causes or consequences of event leading to the individual blaming themselves or others Persistent negative emotional state Fear anger guilt shame etc Diminished interest or participation in activities Detachment andor estrangement from others Inability to experience positive emotions e Marked alterations in arousal or reactivity associated with trauma indicated by at least two of the following i ii iii iv v vi Irritable behaviorAngry outbursts Reckless or destructive behavior Hypervillaglance Exaggerated startle response Concentration problem Sleep disturbance f Duration for more than one month g Impairment andor distress that is not caused by substance abuse or GMC 2 PTSD a Focuses on avoiding thoughts or images of past traumatic events b Gender differences i ii iii Women are twice as likely to develop it 104 in women 5 in men Men are more likely to have comorbid substance abuse Women are more likely to have comorbid panic disorders agoraphobia c Combat Related PTSD i ii Up to 30 in vietnam vets 1220 in soldiers returning from Iraq d Risk Factors 1 ii iii iv 607 of Americans have experienced a traumatic stressor in their lives but only 8 develop PTSD History of previous trauma preexisting mental disorder perceived threat to life lower IQ Dissociation at time of trauma hyperresponsive amygdala and reduced hippocampal volume are all increased risk factors Social support can reduce risk Intensity of trauma biological vulnerabilities social and cultural factors also play a role in whether or not an individual develops PTSD e Prolonged Exposure i Treatment rationale l Avoidance maintains PTSD symptoms 2 Confronting fear cues helps process distressing memories leads to cognitive change and helps reduces PTSD symptoms ii Two major treatment components 1 Imaginal Exposure relive memory repeatedly audio record 2 Invivo Confront situations they have been avoiding since the trauma 3 PTSD Treatments a Eye Movement Desensitization and Reprocessing b Exposure including lateral eyemovement i Shapiro suggested that eye movements facilitate cognitive processing of trauma c CBT Drug Treatments i SSRI s and tricyclic antidepressants ii Limited effectiveness iii May relapse after discontinuation e Imagery rescripting treatment of traumatic nightmares i Write out nightmare with a positive twist ii Read and imagine for several minutes right before bedtime iii Deep breathing and relaxation exercises f Prevention Studies i Psychological debriefing ii Some say this does more harm than good OCD 1 Diagnostic Criteria a Either obsessions or compulsions b Recognized at some point as excessive and unreasonable c Distress Consumes more than one hour per day causes impairment d Content of obsessions andor compulsions is not restricted to another axis 1 disorder e Not due to substance use 2 Obsessions a Recurrent and persistent thoughts images and impulses that are experienced as intrusive inappropriate or causes anxietydistress b Not excessive worry about real life problems Attempts to ignore suppress or neutralize with some other thought or action 90 Recognized as a product of their own mind 6 Most common obsessions are aggression 687 contamination 577 symmetry 532 hoarding religious and sexual 3 Compulsions a Repetitive behavior or mental acts that the person performs in response to an obsession or according to rules that must be rigidly applied Aimed at preventing or reducing distress or preventing a dreaded event or situation but not connected in a realistic way or clearly excessive Most common compulsions are checking 807 cleaning 637 repeating 555 ordering arranging counting and hoarding Focuses on avoiding frightening or repulsive intrusive thoughts obsessions andor neutralizing these thoughts through the use of ritualistic behaviors compulsions 25 lifetime prevalence No gender differences i Onset usually occurs earlier for males than females Onset is in adolescence or early adulthood Tends to be chronic if no treatment is received but goes through phases of intensity 50 of individuals with OCD do not receive a salary 70 reported problems in their family relationships Associated with depression anxiety disorders sleep disturbances eating disorders motor tics and tourette syndrome i 2550 of those with tourette39s have OCD Subtypes i Washers Illness expectancies disgust ii Checkers Poor memory or lack of confidence in memory iii Not just right experiences asymmetry concerns 1 Internal state of imperfection 2 Non cognitive sensations relevant to ordering and arranging compulsions 3 Occurs across sensory modalities 4 Also relevant to perfectionism checking and washing 5 Perspectives a b C Biological theory Psychological perspectives i 90100 of population have unwanted intrusive thoughts Cognitive factors i ThoughtAction Fusion ii Perfectionism iii Overestimation of threat 6 Treatment a Psychological Treatments i Exposure and Response Prevention 1 Exposes to situation that provokes obsession and prevents compulsion as a response 2 ie Having a washer touch toilet seats and door knobs Without washing or having a checker turn the oven on and off once and then immediately leave Without checking ii 76 response to treatment but not all symptoms are treated b Anafranil i A tricyclic antidepressant ii Relapse rates are higher gt Suggested Reading Pages 125128 143148 and 155172
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