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Chapter 4 Notes

by: priitad

Chapter 4 Notes 01:830:340

Marketplace > Psychlogy > 01:830:340 > Chapter 4 Notes
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Abnormal Psychology
Dr. Karlin

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Chapter 4 notes with lecture and reading combined!
Abnormal Psychology
Dr. Karlin
Class Notes
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This 7 page Class Notes was uploaded by priitad on Tuesday February 24, 2015. The Class Notes belongs to 01:830:340 at a university taught by Dr. Karlin in Spring2015. Since its upload, it has received 44 views.

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Date Created: 02/24/15
Anxiety Disorders green something that is noted specifically from professor and not in the book from his bold key terms Important Concepts When Studying Anxiety Disorders The importance of exposure 0 anxiety is often curable with unreinforced exposure to the feared stimulus or when the fear is associated with something that is safe or positive the anxiety can be extinguished o On the other hand exposure bad experience can sensitize and make things worse rather than extinguish the response The small mouse to dragon theory of running away from perceived threat 0 When you are afraid it is a good idea to run away we have been prey a lot longer than we have been predators 0 However most fears get worse if you run away from threat so face the fear and it will disappear and mostly stay away Gender Differences and Their Meaning 0 More women have gt GAD gt Agoraphobia gt Specific phobias gt Depression 0 More men are alcoholics 31 menwomen 0 An equal number of men and women have OCD bipolar disorder and schizophrenia o Dissociate Identity Disorder 91 ratio of womenmen incidence gt According to Karlin large gap of women and men incidence only in disorders we make up The worse the disorder is or the more defined it is the less likely there are gender differences In Class movie about snake phobia 0 He claims he can reduce phobia in just 3 hrs there is a 3hr program and 1 week program 0 The therapist treats Mariam39s phobia by exposing her to her fear the snake 0 He says quot if you stay exposed to a situation long enough anxiety levels will go down quot 0 There is positive reinforcement and modeling in Osts39 Research 0 Osts39 Research shows 80 improvement in phobias 0 Recommendation gt watch nature shows gt go to zoo o 2 months after treatment gt She had dreams with snakes and no anxiety gt She39s able to watch movies and see pictures with no anxiety as well Dr Karlin Anxiety Disorders 0 PTSD 0 Panic attack 0 OCD gt Has been moved in the DSM to another category not necessarily anxiety anymore 0 Social anxiety disorder gt Starts usually in adolescence a lot of social factors that can bring about this anxiety The Complexity of Anxiety Disorders Anxiety Fear and Panic Some Definitions 0 anxiety is a negative mood state characterized by bodily symptoms of physical tension and by apprehension about the future future oriented mind state gt Surprisingly anxiety is good for us at least in moderate amounts We perform better when we are a little anxious gt What happens if we have too much anxiety Harmful effects on performance because of lack of concentration and distraction from the discomfort and worried state of mind gt Anxiety should lead to preemptive coping 0 fear is an immediate alarm reaction to danger immediate flight or fight response to danger present oriented mind state gt fear can be good for us because it works to protect us gt this is an immediate emotional reaction to a current danger characterized by strong escapist tendencies An abrupt activation of the sympathetic nervous system adrenaline shut down of digestive system etc o panic is a sudden ovenNhelming reaction to a fearful stimulus might exist or might not gt panic attack is an abrupt experience of intense fear accompanied by unpleasant and even dangerous physical symptoms Natural and can be managed at one point necessary because panic means RUN to avoid danger Will go away if one learns how to deal with them Subtypes o Situationally bound cued if you39re scared of heights and know you39re scared you have a panic attack when you know you are about to go somewhere tall 0 Unexpected uncued no clue when and where a panic attack will occur or whether one will at all 0 Situationally predisposed when you might have an attack because of previous experience but you might not as well Causes of Anxiety Disorders 0 Pervasive and persistent symptoms of anxiety andor fear 0 lnvolves excessive avoidance and escape 0 Cause clinically significant distress and impairment 0 Biological contributions gt No single gene seems to cause anxiety or panic but it does show to run in families gt Anxiety also associated with specific brain circuits and neurotransmitter systems depleted levels of GABA are associated with increased anxiety attention is increasing on the role of the corticotropinreleasing factor CRF o CRF activates the HPA axis 0 it also has wide ranging effects on various parts of the brain limbic system locus coeruleus in brain stem prefrontal cortex and dopaminergic system 0 CRF also directly related to GABA 5HT and NE systems as well gt Part of brain most associated is Limbic System mediator between brain stem and cortex behavioral inhibition system BIS is a circuit that leads from the petal and hippocampal area of limbic system to frontal cortex 0 activated by signals from brain stem of unexpected events such as major changes in body functioning o BIS also receives boost from amygdala 0 When BIS is activated we freeze experience anxiety and evaluate situation apprehensively to confirm if danger is present fightflight system FFS is the circuit that originates in the brain stem and travels through midbrain 0 involved in panic 0 produces an immediate alarmandescape response 0 activated partly by deficiencies in serotonin o Psychological Contributions gt A general sense of uncontrollability and unpredictability may develop through a function of experiences in early childhood gt Most accounts of panic unlike anxiety invoke conditions and cognitive explanations If there is an initial strong fear toward a situation this emotional response will be closely associated with that situation and the fear response can be provoked even if the danger is not actually present These cues can be unconscious gt Interpretation of threat plays a role in how you panic Panic attacks are normal and the problem occurs when you overreact and think you are dying versus taking it lightly and understanding it39s natural 0 Social Contributions gt Stressful life events trigger our biological and psychological vulnerabilities to anxiety gt The way we react to stress seems to run in families 0 An Integrated Model gt The Triple Vulnerability Theory Generalized Biological Vulnerability tendency to be uptight might be inherited Generalized Psychological Vulnerability based on early experiences view of worlds and fears might give you this kind of vulnerability to anxiety Specific Psychological Vulnerability when you learn from early experience that a specific object or situation is dangerous whether by parents or firsthand experience Comorbidity of Anxiety Disorders 0 High rates of comorbidity emphasizes how all of these disorders have the common features of anxiety and panic they also shares same vulnerabilities listed above 0 The most common additional diagnosis for all anxiety disorders was major depression Generalized Anxiety Disorder GAD Clinical Description 0 Excessive and uncontrollable apprehensiveness and worry makes one irritable o This excessive worry is unproductive distressing and accompanied by physical symptoms of tenseness and restlessness 0 at least 6 months of persistency to be diagnosed 0 Physical symptoms gt muscle tension mental agitation susceptibility to fatigue irritability and difficulty sleeping o varies from other anxiety disorders because 100 of GAD patients responded quotyesquot when asked if they worry about minor everyday things Statistics 0 Affects about 31 of the general population in one year and 57 over span of lifetime gt Large numbers one of most common anxiety disorders 0 Prevalent among older adults and females by 21 ratio gt Gender makes a difference remember what Karlin said about the differences in disorders where gender makes a difference vs not People worry about things that don39t matter to avoid worrying about things that do matter People KNOW they are worrying about inconsequential stuff gt Women in our culture have more permission to be immobilized by fear to not do things because they are afraid Causes insert Figure 43 o Onset is often insidious beginning in early adulthood o GAD tends to run in families twin studies show that what is inherited is tendency to become anxious not GAD itself 0 What sets GAD apart gt Show less responsiveness to stressors than other anxiety disorders gt When compared to those without anxiety though people with GAD consistently showed chronic muscle tension known as automatic restrictors 0 Individuals with GAD are acutely aware of danger especially threats with personal relevance gt This acute awareness seems to unconscious and automatic Treatment 0 Treatment of GAD is generally weak 0 Benzodiazapines gt Most commonly prescribed gt Provides shortterm relief usually but not much long term therapeutic effects gt In older patients these drugs seem to be associated with falling and impaired driving gt Produces dependence making it difficult for people to stop even if it isn39t helping o Antidepressants gt Seem to be better choice than benzodiazepines o Psychological interventions cognitivebehavioral therapy gt About the same benefit as drugs but produces more long term effects gt Approach where patients confront anxietyprovoking images and the worry process head on to learn coping techniques 0 Meditation therapy gt Teaches patients to be more tolerant of these anxious and worried feelings so they are not thought of as negative and avoided but rather accepted and dealt with 0 Combined treatments gt Drugs therapy most effective approach Panic Disorder with and without Agoraphobia Clinical Description 0 Panic disorder with agoraphobia PDA is where individuals experience severe unexpected panic attacks gt agoraphobia is the fear and avoidance of situations in which they feel unsafe in the event of a panic attack or symptoms fear of being in a place where escape might be difficult gt A few develop agoraphobia even though textbook says many 0 Unexpected panic attacks along with anxiety over the possibility of having another attack 0 The Development of Agoraphobia gt based on the expectation of panic attack or thinking you39ll have a panic attack regardless of whether you really have one or not can be years without an attack and the fear can still remain gt People will either avoid these anxious situations or will face them head on with great distress example riding a train to work everyday can be dreadful but some will suck it up and go on the ride anyway with fear every single day gt interoceptive avoidance is the avoidance of behaviors that will cause internal changes that can cue a panic attack or remind someone of a panic attack example exercise can be avoided because fast heart rate reminds an individual of a panic attack Statistics 0 Approximately 27 of general population give 1 year and 47 throughout lifetime 0 23rds of patients are women 0 Onset is often acute generally between ages 2024 gt Most initial unexpected panic attacks being at or after puberty 0 Prevalence of PD or PDA at ages 3044 is 57 and goes down to 20 or less after age 60 0 Cultural Influences gt In third world countries somatic symptoms physical symptoms are emphasized gt Very similar rates of incidence in a lot of developed countries when compared to US 0 Nocturnal Panic gt When a panic attack occurs in the middle of the night as the patient is going into deep sleep delta waves gt Possible reason the body is quotletting goquot which might be fearful to a person with panic disorder so they wake up and feel like they are dying since the panic attack came about from no where Might cause fear of sleeping gt isolated sleep paralysis occurs when a person is transitioning from REM to wakefulness and results in temporary paralysis and vivid hallucinations which can bring on a panic attack and fear African Americans seem to have a much higher rate of this and it is hypothesized that it is due to a history of trauma and diagnoses of panic disorder and PTSD Causes 0 Panic attack and panic disorders are more related to biological influences and psychological influences gt Whether agoraphobia develops or not and how severe it is depends on social influences gt learned alarms name for the panic and fear that is brought on by conditioning and learning of stimuli and environment from previous panic episodes 0 Panic disorder is specific to those people who have a fear of the panic attack and feel like something bad will happen to them because of the attack they are fearful of another attack gt This is extremely important to diagnosis panic disorder Treatment 0 Medication gt Target noradrenergeric serotonergic or GABAbenzodiazepine systems gt SSRls eg Prozac and Paxil currently the indicated drug for panic disorder gt Approximately 60 free of panic if maintained on an effective drug Relapse rates are high once medication is stopped o Psychological Intervention gt Gradual exposure exercises sometimes combined with anxietyreducing coping mechanisms have proved effective in helping patients overcome agoraphobic behavior gt Panic control treatment PCT concentrates on exposing patients with panic disorder to the cluster pf interoceptive sensations that remind them of their panic attacks Most patients who receive this remain better after at least 2 years gt best longterm outcome is with cognitivebehavioral therapy alone 0 Combined Psychological and Drug Treatments gt Combined treatment shows no evidence to be better than individual treatments gt A study suggests that a quotsteppedcarequot approach might be better This is where a psychological treatment PCT is administered Then a second treatment a drug for those who did not respond enough to the first treatment will be administered Specific Phobia Clinical Description 0 specific phobia is an irrational fear of a specific object or situation that interferes with an individual39s ability to function 0 Persons will go to great lengths to avoid phobic objects 0 Most people with this realize that the fear and avoidance are unreasonable but can39t help it 0 Four subtypes gt Bloodinjuryinjection type Differ in their physiological reaction from other types of phobias decrease in heart rate and blood pressure causes people to faint peaks around age 7 gt Situational type Characterized by fear of public transportation or enclosed places peaks around mittens to mid twenties like panic disorder gt Natural environment type Natural events heights storms and water peaks around age 7 gt Animal type Fears of animals and insects peaks around age 7 0 Separation Anxiety Disorder gt children39s 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 cause separation like that episode of Super Nanny where the boy would freak out if the mom left his side gt Common in children but must be judged by professional to see if how far past normal it is and will she grow out of it 35 extend into adulthood Statistics 0 Females are overrepresented WHY o Affects about 125 of the general population 0 Once a phobia develops it tends to last a lifetime 0 Influenced by cultural Causes 0 Direct experience a true alarm gt Experiencing a false alarm panic attack gt Observing someone else experience it vicarious experience gt Being told about danger under right conditions 0 Evolutionary vulnerability biological factor likely to run in families 0 Prepared tendency fear situations that seem to be harmful and dangerous to you 0 Social and cultural factors Treatment 0 Cognitive behavioral therapy Structured and consistent exposurebased exercises gt The treatments seem to quotrewirequot the brain Social Phobia Social Anxiety Disorder Clinical Description 0 social phobia is an irrational and unexplained fear of social situations 0 markedly interferes with one39s ability to function 0 Often avoid social situations or deal with them but with great distress Statistics 0 Affects about 68 in one year span and 121 of general population over a lifetime 0 Slightly greater in females than males not as much as phobias 0 Second most prevalent phobia in the anxiety disorders 0 Peak age onset at 13 years 0 More prevalent in young 1829 yrs undereducated single and of low socioeconomic class Causes 0 Similar learning pathway as specific phobias three pathways gt a generalized biological vulnerability gt generalized psychological vulnerability ex idea that stressful events are uncontrollable an experience associated with the vulnerability seals the deal gt had to learn early on that social acceptance is either dangerous or important in some way Treatment 0 Cognitive behavioral therapy 0 Cognitive behavioral group therapy gt Success rates are overrated for this form of therapy according to Karlin despite what the book says 0 Drug treatments gt Some that work MAO inhibitors Paxil but have high relapse rate 0 Both together did not have better results than each individually however drug treatment had higher relapse than cognitive therapy Posttraumatic Stress Disorder PTSD Clinical Description 0 post traumatic stress disorder is an anxiety that follows a particularly severe and traumatic experience or incident 0 victims reexperience the event through memories and nightmares 0 they avoid things that reminds them of the trauma 0 markedly interferes with one39s ability to function 0 Acute PTSD gt Occurs 1 month after the event happened 0 Chronic PTSD gt Is if the symptoms last 3 months or longer 0 Delayed onset gt Onset six months or more posttrauma 0 Acute stress disorder gt PTSD occurring within the first month new in DSMlV TR gt this characterizes the severe reaction some people get immediately Statistics 0 Combat torture and sexual assault are the most common traumas resulting in PTSD gt Strong connection to proximity of traumatic event the closer you are to development of PTSD 0 General rule too much adrenaline for too long and you39ll wind up with PTSD 0 Life treat and injury 45 lifetime prevalence o No life treat or injury 19 lifetime prevalence Causes 0 The more severe the trauma the higher the chance of developing PTSD but does not mean that everyone with that intensity of trauma will develop PTSD 0 Biological vulnerabilities genetic predisposition to anxiety or family history of anxiety 0 Learn alarms conditioning and learning 0 Uncontrollability and unpredictability psychological vulnerability 0 Big factor social support gt When looking at subjects where they were exposed to same trauma and comparing those who had PTSD with those who did not develop it social support group was a huge difference gt Social support reduces HPA axis activity 0 Maybe change in brain where hippocampus is damaged due to trauma hippocampus in charge of learning and memory Treatment 0 Psychological Treatments gt Cognitive behavioral therapies are highly effective gt psychoanalytic therapy reliving emotional trauma to relieve the suffering is called catharsis Here the therapist will work to rearrange the reexposure so that it is therapeutic and not distressful gt imaginal exposure the content of the trauma are worked through systematically and then emotions associated with trauma are retrained 0 Drug treatment gt SSRls Prozac and Paxil Obsessive Compulsive Disorder OCD Clinical Description 0 obsessive compulsive disorder OCD is characterized a devastating culmination of many anxiety disorders gt Obsessions are intrusive nonsensical thoughts images or urges gt Compulsions are the thoughts or acts used to suppress the obsessions and provide relief often bear no logical relation to the obsession 0 Types of Obsessions and Compulsions gt Symmetry 267 Keeping things in perfect order or doing something in a specific way gt Forbidden thoughts 21 feel they are about to yell in church or about to do something disruptive so they avoid situation completely may lead to checking rituals they serve to prevent an imagined disaster gt Cleaning and contamination 159 obsession with contamination lead to cleaning rituals gt Tic Disorder and OCD Tic disorder characterized by involuntary movement to cooccur in patients with OCD o In some cases might not be tics but might be compulsions The obsessions in Tic related OCD are almost always symmetry gt Hoarding 154 Hold on to things even 10 year old newspapers because of a fear that if they throw it away they might immediately need it During teenage years people start collecting and enjoy this and make it sort of quotretail therapyquot but have problems throwing anything useless away Statistics 0 Affects less than 1 in a given year and 16 of general population over a lifetime 0 Having moderately and mild obsessions and compulsions is normal as long as it doesn39t interfere with daily tasks and relationships 0 5560 with OCD are female in adults 0 In children boys have a higher percentage boys usually develop OCD earlier gt Males peak age 1315 gt Females peak age 2024 0 Remarkable similar across cultures worldwide Causes 0 Same as others biological psychological and social 0 Psychological gt Thoughtaction fusion is when OCD patients equate thoughts with the specific action of the thought this could be conditioned from childhood if person was taught that thinking something could cause it to happen and it would be hisher fault Treatment 0 Drug treatment gt Clomipramine and other SSRls benefit up to 60 of patients gt Relapse is common with medication discontinuation o Psychological treatment gt Cognitive behavioral therapy is most effective gt exposure and ritual prevention ERP is a type of CBT where patient is slowly exposed to feared thoughts or situations by preventing ritual behavior Once it is clear to patient that thoughtfear is irrational then cognitive element plays little part 0 Combining treatments did not show greater results than each individually o Psychosurgery cingulotomy is used in extreme cases gt Surgical lesion to the cingulate bundle gt Approximately 30 benefited substantially


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