Abnormal Psychology Ch.5 notes
Abnormal Psychology Ch.5 notes Psych 433
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This 11 page Class Notes was uploaded by Derek Schrick on Sunday February 21, 2016. The Class Notes belongs to Psych 433 at University of Missouri - Kansas City taught by K. Harry in Spring 2016. Since its upload, it has received 72 views. For similar materials see Abnormal Psychology in Psychlogy at University of Missouri - Kansas City.
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Date Created: 02/21/16
Ch. 5 - Anxiety Disorders, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders The Complexity of Anxiety Disorders Fear Immediate, presentoriented Sympathetic nervous system activation Anxiety Apprehensive, futureoriented Somatic symptoms = tension Both: Negative affect Anxiety, Fear, and Panic: Some Definitions Panic attacks –abrupt experience of intense fear Symptoms: palpitations, chest pain, dizziness Two types Expected Unexpected Diagnostic Criteria for Panic Attack Has to reach a peak within minutes Have to experience 4 of the sympotoms People can feel nauseous, sweating, detached for ones self, etc. (Table 5.1) Biological Contributions Increased physiological vulnerability; *Sends signal to motion senses of brain Polygenetic influences Corticotropin releasing factor (CRF) Brain circuits and neurotransmitters GABA, Noradrenergic, Serotonergic systems CRF and the HPAC axis Limbic system* signal that sends for fear or danger; accessing danger and what needed to do to get out of danger Behavioral inhibition system (BIS) Brain stem Septalhippocampal system Amygdala Fight/flight (FFS) system Panic circuit & alarm and escape response 1An Integrated Model Triple vulnerability Generalized biological vulnerability Diathesis Generalized psychological vulnerability Ch. 5 - Anxiety Disorders, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders Beliefs/perceptions Specific psychological vulnerability Learning/modeling Biological vulnerability heritable contribution to negative affect “Glass is half empty” Irritable Driven Specific Psychological vulnerability physical sensations are potentially dangerous Anxiety about health, dogs, world is dangerous place Nonclinical panic Generalized psychological vulnerabilitysense that events are uncontrollable/unpredictable Tendency toward lack of selfconfidence Low selfesteem Inability to cope Comorbidity of Anxiety and Related Disorders High rates of comorbidity 55% to 76% Commonalities Features Vulnerabilities Links with physical disorders Physical disorders Suicide Suicide attempt rates Similar to major depression 20% Increases for all anxiety disorders Comorbidity with depression? Generalized Anxiety Disorder (GAD) Clinical description Shift from possible crisis to crisis Worry about minor, everyday concerns Job, family, chores, appointments Problems sleeping GAD in children Need only one physical symptom Worry = academic, social, athletic performance Ch. 5 - Anxiety Disorders, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders Diagnostic Criteria for GAD Occur for more days than not for at least 6 months Difficulty to control worry Has to cause clinical distress of impairment Can not be because of alcohol, drug, or other general medical condition Generalized Anxiety Disorder (GAD) Statistics 3.1% (year) 5.7% (lifetime) Similar rates worldwide Insidious onset Early adulthood Chronic course GAD in the elderly Worry about failing health, loss Up to 10% prevalence Use of minor tranquilizers: 1750% Medical problems? Sleep problems? Falls Cognitive impairments Causes Inherited tendency to become anxious “Neuroticism” Less responsiveness “Autonomic restrictors” Threat sensitivity Frontal lobe activation Left vs. right Treatments Psychological Cognitivebehavioral treatments Exposure to worry process Confronting anxietyprovoking images Coping strategies Acceptance Meditation Similar benefits Better longterm results Pharmacological Ch. 5 - Anxiety Disorders, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders Benzodiazepines Risks versus benefits Antidepressants Panic Disorder and Agoraphobia Clinical description Unexpected panic attacks Anxiety, worry, or fear of another attack Persists for 1 month or more Agoraphobia Fear or avoidance of situations/events (mall, tains, buses, restaruants, planes, crowds, etc.) Clinical description Avoidance can be persistent Use and abuse of drugs and alcohol Interoceptive avoidance Statistics 2.7% (year) 4.7% (life) Female: male = 2:1 Acute onset, ages 2024 Special populations Children Hyperventilation Cognitive development Elderly Health focus Changes in prevalence Social/gender roles ~75% of those with agoraphobia are female Similar prevalence rates Variable symptom expression Somatic symptoms Nocturnal Panic 60% with panic disorder experience nocturnal attacks nonREM sleep Delta wave Caused by deep relaxation, Sensations of “letting go” Sleep terrors Ch. 5 - Anxiety Disorders, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders Isolated sleep paralysis Causes Generalized biological vulnerability Alarm reaction to stress Cues get associated with situations Conditioning occurs Generalized psychological vulnerability Anxiety about future attacks Hypervigilance Increase interoceptive awareness Treatment Medications Multiple systems serotonergic noradrenergic benzodiazepine GABA SSRIs (e.g., Prozac and Paxil) High relapse rates Psychological intervention Exposure based Reality testing Relaxation Breathing Panic control treatment (PCT) Exposure to interoceptive cues Cognitive therapy Relaxation/breathing High degree of efficacy Combined psychological and drug treatments No better than individual CBT = better long term Specific Phobias Clinical description Extreme and irrational fear of a specific object or situation Significant impairment Recognizes fears as unreasonable Avoidance Bloodinjectioninjury phobia Decreased heart rate and blood pressure Ch. 5 - Anxiety Disorders, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders Fainting Inherited vasovagal response Onset = ~ 9 Situational phobia Fear of specific situations Transportation, small places No uncued panic attacks Onset = early to mid 20s Natural environment phobia Heights, storms, water May cluster together Associated with real dangers Onset = ~7 Animal phobia Dogs, snakes, mice, insects May be associated with real dangers Onset = ~7 Statistics 12.5% (life); 8.7% (year) Female : Male = 4:1 Chronic course Onset = ~ 7 Treatment Cognitivebehavior therapies Exposure Graduated Structured Relaxation Separation Anxiety Disorder Clinical Description Characterized by children’s unrealistic and persistent worry that something will happen to their parents or other important people in their life or that something will happen to the children themselves that will separate them from their parents (for example, they will be lost, kidnapped, killed, or hurt in an accident) 4.1% meet criteria for children, 6.6% for adults Social Anxiety Disorder (Social Phobia) Clinical description Extreme and irrational fear/shyness Ch. 5 - Anxiety Disorders, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders Social/performance situations Significant impairment Avoidance or distressed endurance Generalized subtype Statistics 12.1% (life); 6.8% (year) Female : Male = 1:1 Onset = adolescence Peak age of 13 Young (18–29 years), undereducated, single, and of low socioeconomic class, 13.6% Over 60, 6.6% Treatment Medications Beta blockers SSRI (Paxil, Zoloft, and Effexor) Dcycloserine Psychological Cognitivebehavioral treatment Exposure Rehearsal Roleplay Highly effective one study 84% improvement Selective Mutism (SM) Clinical description Rare childhood disorder characterized by a lack of speech Must occur for more than one month and cannot be limited to the first month of school Comorbidity with SAD Treatment CognitiveBehavioral like the treatment for social anxiety best Trauma and StressorRelated Disorders Attachment disorders Posttraumatic stress disorder Posttraumatic Stress Disorder (PTSD) Clinical description Trauma exposure Extreme fear, helplessness, or horror Ch. 5 - Anxiety Disorders, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders Continued reexperiencing (e.g., memories, nightmares, flashbacks) Avoidance Emotional numbing Reckless or selfdestructive behavior Interpersonal problems Dysfunction One month Statistics 6.8% (life); 3.5% (year) Prevalence varies Type of trauma Proximity Most common traumas Sexual assault 2.4 to 3.5 increase Accidents Combat Causes Trauma intensity Generalized biological vulnerability Twin studies Reciprocal geneenvironment interactions Generalized psychological vulnerability Uncontrollability and unpredictability Social support Neurobiological model Threatening cues activate CRF system CRF system activates fear and anxiety areas Amygdala (central nucleus) Increased HPA axis activation Cortisol Treatment Cognitivebehavioral treatment Exposure Imaginal Graduated or massed Increase positive coping skills Increase social support Highly effective Psychoanalytic therapy, catharsis Medications Ch. 5 - Anxiety Disorders, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders SSRIs Adjustment Disorders Anxious or depressive reactions to life stress that are generally milder than one would see in acute stress disorder or PTSD but are nevertheless impairing in terms of interfering with work or school performance, interpersonal relationships, or other areas of living Attachment Disorders Disturbed and developmentally inappropriate behaviors in children, emerging before five years of age, in which the child is unable or unwilling to form normal attachment relationships with caregiving adults Reactive Attachment Disorder The child will very seldom seek out a caregiver for protection, support, and nurturance and will seldom respond to offers from caregivers to provide this kind of care Disinhibited Social Engagement Disorder A pattern of behavior in which the child shows no inhibitions whatsoever to approaching adults ObsessiveCompulsive Disorder (OCD) Clinical description Obsessions Intrusive and nonsensical Thoughts, images, or urges Attempts to resist or eliminate Compulsions Thoughts or actions Suppress obsessions Provide relief Obsessions 60% have multiple obsessions Need for symmetry Forbidden thoughts or actions Cleaning and contamination Hoarding Compulsions Four major categories Checking Ch. 5 - Anxiety Disorders, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders Ordering Arranging Washing/cleaning Association with obsessions Tic disorder Tic disorder is characterized by involuntary movement (sudden jerking of limbs, for example), to cooccur in patients with OCD ObsessiveCompulsive Disorder (OCD) Statistics 1.6% to 2.3%(life); 1% (year) Female = Male Chronic Onset = childhood to 30s medial 19 Causes Similar generalized biological vulnerability Specific psychological vulnerability Early life experiences and learning Thoughts are dangerous/unacceptable Thoughtaction fusion Distraction temporarily reduces anxiety Increases frequency of thought Treatment Medications SSRIs 60% benefit High relapse when discontinued Psychosurgery (cingulotomy) 30% benefit Cognitivebehavioral therapy Exposure and ritual prevention (ERP) Highly effective 86% benefit No added benefit from combined treatment with drugs Body Dysmorphic Disorder (BDD) A preoccupation with some imagined defect in appearance by someone who actually looks reasonably normal Comorbid with OCD 10% Course lifelong Ch. 5 - Anxiety Disorders, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders Onset – early adolescence through 20s Reaction to a horrible or grotesque feature Two treatments SSRIs Exposure and response prevention Plastic Surgery and Other Medical Treatments Fully 76.4% had sought this type of treatment and 66% were receiving it 8% to 25% of all patients who request plastic surgery may have BDD Hoarding Disorder Estimates of prevalence range between 2% and 5% of the population, which is twice as high as the prevalence of OCD Men = women Individuals usually begin acquiring things during their teenage years and often experience great pleasure, even euphoria, from shopping or otherwise collecting various items OCD tends to wax and wane, whereas hoarding behavior can begin early in life and get worse with each passing decade Trichotillomania (Hair Pulling Disorder) and Excoriation (Skin Picking Disorder) The urge to pull out one’s own hair from anywhere on the body, including the scalp, eyebrows, and arms, is referred to as trichotillomania Excoriation (skin picking disorder) is characterized by repetitive and compulsive picking of the skin, leading to tissue damage 1 5% Habit reversal training, show best results Exam Questions 1. For GAD, the typical pharmacological treatment of choice has been the bategory of drugs known as? Benzodiazepines 2. what would be the most affective treatment for anxiety disorders? Cognitive behavior disorder 3. An individual who suffers from panic disorder might become anzious about climbing stairs, exercising or being in hot rooms because these activities produce sensations similar to those accompanying a panic attack. In psychological terms, the exercise and hot rooms have become? a. Conditioned stimuli
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