Psychopathology (PSYC 4240) Day 6
Psychopathology (PSYC 4240) Day 6 PSYC 4240
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This 5 page Class Notes was uploaded by Selin Odman on Monday May 23, 2016. The Class Notes belongs to PSYC 4240 at University of Georgia taught by Miller in Summer 2016. Since its upload, it has received 19 views. For similar materials see Psychopathology in Psychology (PSYC) at University of Georgia.
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Date Created: 05/23/16
Psychopathology (PSYC 4240) Day 6 5/23/16 Anxiety Disorders (Anxiety, OCD, trauma-and-stressor-related disorders) Nature of Anxiety and Fear Anxiety -Future oriented mood state (“How is this date going to go?”) -Described with a negative affect; takes away from good experience -Somatic symptoms of tensions like sweating and heavy breathing -Worried about future and bad things that can come from it Fear -Present oriented mood state (“There’s a snake here”) -Described with a negative affect as well -Immediate flight or fight response -Fear makes you develop avoidance behaviors -Activation of the sympathetic nervous system (happens instantly) Anxiety and Fear are normal emotions we experience Characteristics of Anxiety Disorders Psychological disorders: excessive and persistent symptoms of anxiety and fear -avoidance and escapist tendencies start adding dysfunction into your life -there is clinically significant distress in your life Phenomenology of Panic Attacks What’s a panic attack? -A rapid onset of intense fear with physiological and psychological symptoms -Physiological: heartrate, sweating, nausea (feels like you’re dying or having a heart attack) DSM-5 types of Panic Attacks -Expected: you’re expecting that certain stimuli will cause an attack (“obvious cue or trigger”) connected more to phobias -Unexpected: happens in a situation where you’re not expecting and stimuli (“devoid of clear cue or trigger”) *Both occur in Panic Disorder DSM-5 includes specifiers for diagnosis -i.e Depression with panic attacks -Common condition: 11% of population has panic attacks Biological Contributions to Anxiety and Panic Diathesis – Stress -Some people are more vulnerable for anxiety and panic, but it’s not a disorder -Stress and life events can activate the disorder Biological causes and inherent vulnerabilities -Anxiety and brain circuits: GABA, noradrenergic and serotonergic systems -Lower levels of GABA and serotonin leads to more anxiety -higher levels of noradrenaline leads to more anxiety Behavioral Inhibition System -Activated by brain signals which draw our attention to unexpected events like changes in body function which signals danger -i.e. rabbits have high BIS levels while criminals may have low levels -We have a “freeze” reaction and have anxiety which forces us to reevaluate the environment we’re in for signs of danger -BIS is different from the panic system Fight or Flight system -Exciting the system produces an immediate “alarm and escape” response Environmental factors can change sensitivity of the brain Psychological Contributions to Anxiety and Panic Freud -Anxiety is a psychological reaction to danger tied to early childhood fears like castration or penis envy Behaviorist views -Anxiety results from classical and operant conditioning and modeling which is vicarious learning Psychological views -Learned from early experience with a trait of uncontrollability or unpredictability -Parents can pass on this neurotic behavior OR teach their children that they CAN cope with the world and they can influence their environment (these people are not helpless in their environment) Social Contributions -Stressful life events (many from familial or interpersonal events) trigger our vulnerabilities Toward and integrated model of anxiety Integrative view -Triple vulnerability model 1. Generalized biological vulnerability: tendency to be uptight, nervous and high strung is heritable (neurotic) -doesn’t necessarily lead to a disorder, but it may make you more susceptible to one day developing them. 2. Generalized psychological vulnerability: have the belief that the world is dangerous and unpredictable and we can’t cope with that reality 3. Specific psychological vulnerability: this is learned through early experiences; some experiences are surrounded by danger Comorbidity of Anxiety Disorders Very common with anxiety disorders; you’re likely to have multiple anxieties and phobias -About 50% of patients with anxiety disorders have a secondary diagnosis like major depression -Comorbidity suggests there are common factors across anxiety disorders - and maybe mood disorders – and that all of these conditions are not actually unique -Strong correlation between anxiety and depressed (Most depressed people are anxious, but not most anxious people are depressed) Generalized Anxiety Disorder (GAD) Overview and Defining Features -Excessive, uncontrollable anxious worrying about multiple events and activities; worry and anxiety interfere with ability to function and causes distress -Persists for 6 months or more that occurs most days than not -3 or more of following symptoms: restlessness, easily fatigued, difficulty concentrating/mind going blank, irritability, muscle tensions, sleep disturbance -This is different from a “normal” worry which is more distressing and lasts longer -Occurs without triggers -Comes with physical symptoms like G.I distress and exaggerated startle response Facts and Statistics -Affects 3% of general populations -Females suffer from it twice as much as men -Onset is often insidious -Median age of onset: 30, but has a lot of variability -Prevalence peaks during the middle age, and declines in later life -Symptoms wax and wane throughout life and full remission is rare; there’s no real cure and stressors can always bring it back -Earlier onset causes a more intense disorder and higher comorbidity rate Causes of GAD Genetic factors -Genetic factors account for 30% Temperamental factors -High behavioral inhibition; neuroticism Environmental factors -Not really clear; overprotection? Childhood adversities? Cognitive factors -Highly sensitive to threat, especially If it’s personal. They allocate more attention to cues automatically. Treatment of GAD Both drugs and psychological interventions help symptoms get better Medications -Benzodiazepines (i.e. valium, Xanax) can provide immediate relief, but these drugs are very addictive and have many side effects -Impairs cognitive and motor functioning with high abuse potential - Anti depressants work best for GAD since they have less side effects Psychological -Best for long-term effects -Cognitive-Behavioral Therapy: evokes and helps confront anxiety provoking images and thoughts. This is to challenge automatic, “irrational” thoughts that lead to anxiety -Looks at past experiences to collect “data” to help predict future occurrences Panic Disorder Overview and Defining Features -Recurrent unexpected panic attacks with our or more symptoms (choking, dizzy, nausea, fear of dying, heat/chills, numbness, chest pain, sweating, shortness of breath, trembling) -1 attack must be followed by at least a month of one or more of: 1. Persistent worry about having more attacks or worrying about their consequences (social concerns; physical illness) 2. Significant maladaptive change in behavior related to attacks (i.e. avoidance of situations where you think you’ll be triggered) Facts and Statistics -12 month prevalence: 2-3% -2/3 of patients are female -Onset is acute, beginning between ages 20-24 -Symptoms wax and wane but is a chronic disorder if left untreated Associated Features -Nocturnal panic attacks: waking up from sleep with physical symptoms of panic attacks – not related to having bad dreams -Many have general physical or health concerns -Sensitive to medication side effects -Substance use is a common way to control their panic -They avoid any activity that can lead to cues like exercise or sex increasing heart rate Biological predisposition to overreact to life events. Some people may have an “emergency alarm reaction” as a response to a stressor (i.e. heart racing, sweating, breathing heavily) -Fearful of physiological changes -Develops anxiety about having panic attacks and they end up making catastrophic misinterpretations about their symptoms (i.e. “I’m dying” “This will be so embarrassing, I can never leave the house again”) -Intense focus on internal cues leads to misinterpretations which makes the internal symptoms even worse (A cycle or worrying) Treatment of Panic Disorder Medication Treatment -Target serotonergic, noradrenergic, and benzodiazepine GABA systems -SSRIs (i.e. Prozac and Paxil) are the preferred drugs -Relapse rates are high when medication is discontinued Psychological and Combined Treatments of Panic Disorder -Cognitive-behavior therapies are highly effective -Exposures to Agoraphobia (sometimes paired with relaxation strategies) -Panic: create mini-panic attacks in sessions with the hope that the exposure paired with cognitive-therapy treatment changes the way they think about their symptoms (i.e. spinning in chair, exercise, hyperventilation, breathing through a straw) Stop taking anti-anxiety medication during therapy process -No long-term advantage from combining medicine and therapy -Cognitive-behavior therapy works best from long-term outcomes
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