Abnormal Psych Notes
Abnormal Psych Notes Psyc 3330 - 01
University of Louisiana at Lafayette
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This 12 page Class Notes was uploaded by Lauren Notetaker on Saturday February 13, 2016. The Class Notes belongs to Psyc 3330 - 01 at Tulane University taught by Constance Patterson in Winter 2016. Since its upload, it has received 14 views. For similar materials see Abnormal Psychology in Psychlogy at Tulane University.
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Date Created: 02/13/16
Week 4 Notes Anxiety, TraumaRelated, Stressor Related and ObsessiveCompulsive Disorders Stress is a normal part of life and can be useful • A moderate level of stress can have productive outcomes • High levels of stress can cause anxiety When does stress become anxiety? Signs of severe stress: • Stress and anxiety can both produce physical and psychological symptoms : • Physical symptoms can include stomach ache, muscle tension, headache, rapid breathing, fast heartbeat, sweating, shaking, dizziness, frequent urination, diarrhea, fatigue • Mental or emotional symptoms can include: • Feelings of impending doom, panic or nervousness, especially in social settings, difficulty concentrating , irrational anger, restlessness, frequent worry about small, inconsequential things Taking steps to reduce stress can be very protective of personal wellbeing and prevent more serious Problems • 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 Study of anxiety: • Everyone experiences it • It is helpful to study anxiety early in the study of psychopathology: many other disorders also include some element of anxiety • Common human experience based on threat, but usually short term • Duration, intensity, and degree of impact differentiates patterns of typical and ‘pathological’ anxiety Fear • A present oriented response, based on a reaction to something that evokes a fightorflight response. • Alarm function that signals danger is present • Physiological effect: automatic and strong response from the sympathetic nervous system • Experienced as negative affect Anxiety • 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. • Each anxiety disorder has distinct characteristics but all include: ◦ Cognitive components – self talk that reflect our thoughts ◦ Emotional components – how we feel about the experience ◦ Behavioral components – includes • Overt behaviors that others can observe (trembling, facial expression, sweat, flushing) • Covert behaviors that are physiological (heightened arousal, butterflies in stomach<>nausea) Comorbidity of Anxiety Disorders with other psychological problems • 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 (selfmedicating 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. Risk of suicide with anxiety disorders • Having any anxiety disorder increases the risk of suicide • Most do not want to die, but want the acute and pervasive discomfort that comes with anxiety to stop • About 20% of those with panic disorder have been documented as having made suicide attempts • Rate of substances use is high; this compromises judgment and is known to increase suicide risk Biological Factors in anxiety Disorders • If you take good care of yourself, less likely to get anxiety • Tendency to experience high levels of anxiety is biologically based and seems to run in families (genetic or learned?) • Tendency to panic also seems to be inherited • Polygenetic influences lead to vulnerability but genetic background does not cause anxiety or panic directly • Brain structure: Limbic system • Mediates the flow of information between the brain stem which senses and monitors bodily functions and relays the information to higher cortical functioning • Cortex can also send message of threat to septalhippocampal system • Panic attacks include activation of more midbrain structures, including the amygdala, ventromedial nucleus of the hypothalamus, and the central grey matter. What determines who develops significant Problems with anxiety? • Factors in our environment can change or sensitize brain circuits to make brain more vulnerable to anxiety (e.g., smoking among youthnicotine has sensitizing impact that appears to make people more prone to anxiety symptoms) • Events in the environment also trigger anxiety responses which can create chronic problems (e.g., trauma) Psychological factors in anxiety • Multiple psychological factors are implicated in anxiety • Sense of control / uncontrollability based on having basic needs met as a child; • Parents provide “secure home base” versus unsafe or chronically uncomfortable/unpredictable home • Freedom to explore within limits with rules that create/promote safety during development versus lack of boundaries that allow the child to be unsupported (“on their own”) Social contributions to Anxiety (and Panic) • Highly stressful times engender anxiety • Interpersonal events such as graduation, marriage, divorce, birth of a child • Losses, such as death of a family member • Pressures at work, to excel at school or job • Injury or illness • Traumatic experience (s) Triple VuLnerability model • Generalized biological vulnerability ◦ Driven quality in approach to life ◦ Easily irritated ◦ Attitudes (glass is half empty) • Generalized psychological vulnerability ◦ Overattentive to health? ◦ Hypochondriasis? ◦ Nonclinical panic • Specific psychological vulnerability ◦ May have low selfconfidence ◦ Low selfesteem ◦ Inadequate ability to cope with stress Generalized Anxiety Disorder (GAD) • 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 *physiological basis is strong? Triple Vulnerability model in GAD • GAD tends to run in families suggesting heritability of biological vulnerability (based on twin studies) but vulnerability appears to tendency to be anxious • Anxiety is unfocused, and often people with GAD do not react to actual sources of anxiety like those with other anxiety disorders suggesting physiological response is different: chronic tension • Highly sensitive to threat, especially personal threat • See the world as generally threatening, and do not focus on any specific threat as predominant • They do not adapt to source of anxiety resilience does not develop 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 followup shows CBT to be best intervention Panic attack and panic disorder • 1214% 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 “selfmedicate” • 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 overreactivity 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 overrespond to physical symptoms with catastrophic expectations or consider it dangerous Agoraphobia • 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 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 wellbeing. Why? Specific phobias • 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: bloodinjuryinjection 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 • Bloodinjuryinjection 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 • 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 (sad) • 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 Post Traumatic Stress disorder is now under “trauma and Stress related disorders” in Dsm5 • 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 overarousal • Irritable • Exaggerated startle response Post traumatic stress disorder • DSMV 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: • Reexperiencing – spontaneous memories, recurrent dreams, flashbacks, intense or prolonged psychological distress • Avoidance – making efforts not to reexperience 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 selfdestructive 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 DSM5 • 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 Obsessive Compulsive Disorder (OCD) is now under “Obsessive –Compulsive and Related Disorders” in DSM5 • 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
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