Psyc 3560 (abnormal psyc) Chapter 6 Notes
Psyc 3560 (abnormal psyc) Chapter 6 Notes PSYC 3560
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This 13 page Class Notes was uploaded by Kennedy Finister on Saturday June 4, 2016. The Class Notes belongs to PSYC 3560 at Auburn University taught by Dr. Fix in Spring 2016. Since its upload, it has received 10 views. For similar materials see Abnormal Psychology in Psychlogy at Auburn University.
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Date Created: 06/04/16
Chapter 4: Anxiety Disorder Outline • Fear and Anxiety • Specific Phobias • Social Anxiety Disorder • Panic Disorder & Agoraphobia • Generalized Anxiety Disorder • Obsessive Compulsive Disorder • Body Dysmorphic Disorder Fear and Anxiety • Fear and Anxiety: Two Different Emotions? – Fear • Basic emotion (shared by all animals) • Involves activation of the “fight or flight” response of the autonomic nervous system • Cognitive/Subjective • “omg I’m going to die” • Physiological • heart rate increase, release of adrenaline • Behavioral • response, whatever it takes to stay alive • Panic attack fear response in the absence of actual threats – Anxiety • Complex blend of unpleasant emotions and cognitions • Is more oriented to the future and more diffuse than fear. • Cognitive/Subjective • “What if I embarrass myself?” • Physiological • some adrenaline but not as much as fear response • Behavioral • plan to avoid the situation, or having a plan of action if situation does arise • Anxiety can be adaptive – problem occurs when it is excessive. What makes it an anxiety disorder? • Out of proportion to dangers truly faced • Severe enough to cause distress and/or impairment • Fear response exists even when stimulus is not present Specific Phobias Chapter 4: Anxiety Disorder Characterized by a strong and persistent fear triggered by the presence of a specific object or situation plus avoidance of that object or situation Subtypes • Animal • Dogs, birds, snakes and spiders are very common • Natural environment • Hurricane, lightning, floods • Blood injection injury • Blood pressure drops and person faints • Seeing blood or an injury, receiving an injection • Situational • Fear of flying, tunnels, elevators, bridges • Other • Choking, throwing up • Lifetime Prevalence ≈ 12% • Gender ratio (varies) – Most (90-95%) animal-type cases are women – ~2:1 ratio for blood-injection-injury • Comorbidity – 75% have at least one other specific fear • Age of onset (varies) – Animal and blood-injection types = early childhood – Others = adolescence or early adulthood Causal Factors – Psychological • Behaviorism/Learning • Classical conditioning • fear response can readily be conditioned to previously neutral stimuli when these stimuli are paired with traumatic or painful events • phobic fears generalize to other, similar objects or situations • observational learning • watching a phobic person behaving fearfully with his or her phobic object can be distressing to the observer and can result in fear being transmitted from one person to another thru vicarious or observational classical conditioning • media can also play a role in this • individual differences in life experience • some life experiences may serve as risk factors and make certain people more vulnerable to phobias than Chapter 4: Anxiety Disorder others and other experiences may serve as protective factors for the development of phobias • a person who has had good experiences with potentially phobic stimulus, such as a girl playing with her dog, is likely to be immunized from later acquiring a fear of dogs even if she has a traumatic encounter • evolutionary preparedness • evolutionary history has affected which stimuli we are most likely to come to fear. Primates and humans seem to be evolutionarily prepared to rapidly associate certain objects such as snakes, spiders, water, enclosed spaces with frightening or unpleasant events • prepared fears are not inborn or innate but rather are easily acquired or especially resistant to extinction • Treatment – exposure therapy • behavioral technique • best treatment option • involves controlled exposure to the stimuli or situations that elicit phobic fear • clients are gradually placed symbolically or increasingly under “reallife” conditions in those situations they find the most frightening • flooding • one prolonged session • example 56 hour session with a snake, push thru all stages at once • Medications • Not very effective, can interfere with exposure Social Anxiety Disorder o Characterized by disabling fears of one or more specific social situations (public speaking, urinating in a public bathroom, or eating or writing in public) o Person may fear that they may be exposed to the scrutiny and potential negative evaluation of others or that they may act in an embarrassing/humiliating manner o Subtypes Performance situations such as public speaking Nonperformance situations such as eating in public • Lifetime Prevalence ≈ 12% • Gender ratio – 3:1 to 2:1 (female to male) Chapter 4: Anxiety Disorder • Comorbidity – >50% another anxiety disorder in lifetime – ≈50% major depression – ≈33% abuse alcohol – Higher unemployment, lower SES • Age of onset – Typically mid to late adolescence – early adulthood • Causal Factors Psychological Causes (including evolutionary perspectives) o Behavioral o Direct and observational learning Social trauma not fitting in, bullying, etc o Cognitive biases o Uncontrollable, unpredictability Being exposed to uncontrollable and unpredictable stressful events such as parental separation and divorce, family conflict, or sexual abuse Perceptions of uncontrollability and unpredictability often lead to submissive and unassertive behavior which is characteristic of socially anxious or phobic people People with social phobia have a diminished sense of personal control over events in their lives o Misperceive ambiguous stimuli (neutral faces) o People with social phobias tend to expect that other people will reject or negatively evaluate them which leads to a sense of vulnerability when they are around people who might pose Biological Causes o Genetic and temperamental factors o Behavioral inhibitions share characteristics with both neuroticism and introversion Example infants who are easily distressed by unfamiliar stimuli and who are shy and avoidant are more likely to become fearful during childhood and by adolescence show increased risk of developing social phobia o Modest genetic contribution About 30% of the variance in the liability to social phobia is due to genetic factors Even larger proportion of variance in who develops social phobia is due to nonshared environmental factors which is consistent with a strong role for learning Treatment o Exposure therapy Chapter 4: Anxiety Disorder o Cognitive restructuring o Therapists attempts to help client with social phobia identify their underlying negative autonomic thoughts (“ive got nothing to say” or “ no one is interested in me”). Then they help change these inner thoughts and beliefs thru logical reanalysis (challenge the autonomic thoughts. Look for evidence for and against such a thought). Then they reframe thoughts to be less biased and more accurate. o Medication o Antidepressants SSRIs [serotonin reuptake inhibitors] (example Paxil) Fairly effective but not long term Panic Disorder Recurrent panic attacks that “come out of the blue” AND fears of having additional panic attacks Agoraphobia Fear of situations in which escape might be difficult if you have a panic attack (or other embarrassing symptoms) Panic Attack – A discrete period of intense fear in which 4 of the following symptoms develop abruptly and peak within 10 minutes: • Palpitations of pounding heart • Sweating • Trembling of shaking • Shortness of breath • Feelings of choking • Chest pain or discomfort • Nausea or abdominal distress • Feeling dizzy, lightheaded, or faint • Derealization or depersonalization • Fear of losing control • Fear of dying • Numbness or tingling sensations • Chills or hot flashes • Timing of a first panic attack – Frequently follows feelings of stress or highly stressful life circumstance – Many adults with a single panic attack do not develop panic disorder – Heart attack concerns Chapter 4: Anxiety Disorder • Agoraphobia – Anxiety about being in places from which escape might be difficult/embarrassing, or in which help may not be available in the event of a panic attack (or other embarrassing symptoms) – Situations are avoided or endured with distress or a panic attack. – Common Situations • Crowds • Theaters • Malls • Parking lots • Cars • Bridges • Standing in line • Elevators • Airplanes • Home alone • Panic Disorder – Lifetime Prevalence ≈ 5% – Gender ratio • 2:1 (female to male) – Comorbidity (~83%) • Other anxiety disorders, substance use disorders • 50-70% major depression – Age of onset • Early adulthood – Course • Chronic and often disabling • Symptoms can wax and wane – Causal Factors • Psychological o Cognitive theory o Disorder may develop in people who are prone to making catastrophic misinterpretations of their bodily sensations, a tendency that may be related to preexisting high levels of anxiety sensitivity o Anxiety sensitivity o A traitlike belief that certain bodily symptoms may have harmful consequences o Example “when I notice that my heart is racing, I worry that I might have a heart attack” o Perceived Control Chapter 4: Anxiety Disorder o If the person feels like they’re in control they have less attack/symptoms o Safety behaviors o Example a person who has 34 attacks a week for 20 years; each time believing they’re having a heart attack yet they never do. One would think that this catastrophic thought would diminish but evidence shows that it doesn’t because people with this disorder engage in safety behaviors such as carrying around a bottle of pills to pop before or during a panic attack. Then mistakenly tend to attribute the lack of catastrophe to their having engaged in the safety behavior rather than panic attacks don’t lead to heart attacks o Cognitive biases that maintain panic o The way people perceive what’s going on will determine whether the symptoms heighten or subside Treatment Medications o Benzodiazepine (Xanax, Klonopin) Pros Quick acting, useful in acute situations of intense panic or anxiety Cons Can become dependent Side effects such as drowsiness, sedation, impaired cognitive and motor performance o Antidepressants (tricyclic & SSRIs) Pros Do not create dependence Can alleviate any comorbid depressive symptoms or disorders Cons Takes about 4 weeks before the have beneficial effects Not useful in acute situations CognitiveBehavioral o Exposure therapy Interoceptive deliberate exposure to feared internal sensations people are asked to engage in various exercises that bring on various internal sensations and to stick with those sensations until they subside, thereby allowing habituation of their fears of these sensations o Cognitive restructuring Chapter 4: Anxiety Disorder Teach people to look at evidence for what their thoughts are Generalized Anxiety Disorder • Characterized by excessive and unreasonable anxiety or worry about many different aspects of life. Prevalence 3% in any 1-year period, 6% lifetime Course Tends to be chronic Gender differences 2:1 ratio (female to male) Age of onset Varies Comorbidity Other anxiety or mood disorders • Causal Factors Psychological Causal Factors o People may have a history of experiencing many important events in their lives as unpredictable or uncontrollable o Role of worry o Worrying is good. Superstitious avoidance of catastrophe “worrying makes it less likely that the feared event will occur” Avoidance of deeper emotion topics “worrying about most of the things I worry about is a way to distract myself from worrying about even more emotional things, things that I don’t want to think about Coping and preparation “Worrying about predictive negative events helps me to prepare for its occurrence” o Actually increases the sense of danger and anxiety o Cognitive biases for threat o People seem to have danger schemas about their inability to cope with strange and dangerous situations that promote worries focused on possible future threats Biological Causal Factors o Functional deficiency in the neurotransmitter GABA, which is involved in inhibiting anxiety in stressful situations, the limbic system is the area most involved o CRH hormone Chapter 4: Anxiety Disorder Treatment – Medications o Benzodiazepines May relieve physical symptoms but not cognitive ones o Antidepressants Help cognitive symptoms – Cognitive Behavioral Treatment o Muscle relaxation o Cognitive restructuring Aimed at reducing distorted cognitions and information processing biases, as well as reducing catastrophizing about minor events Obsessive-Compulsive Disorder • Characterized by the recurrence of unwanted and intrusive obsessive thoughts or distressing images; often accompanied by compulsive behaviors to cope with such thoughts. • Obsessions are defined by: – Recurrent and persistent thoughts, impulses or images that are • intrusive and inappropriate • cause marked anxiety or distress – Not simply excessive worries about real-life problems – Attempts to ignore, suppress, or neutralize them – Recognition they are a product of own mind (different from psychotic thoughts) – Common obsessions • Contamination fears • Fears of harming oneself or others • Pathological doubt • Need for symmetry • Sexual obsessions – Compulsion are defined by: • Repetitive behaviors or mental acts • driven to perform acts in response to an obsession • 15 min-hours long • Aimed at preventing or reducing distress or some dreaded event or situations • Common Compulsions • Cleaning • Checking • Repeating Chapter 4: Anxiety Disorder • Ordering/Arranging • Counting – Prevalence: 1-2% (lifetime and 1 year) – Gender Differences • 1.4 to 1 ratio (female to male) – Age of onset • Late adolescence/ early adulthood – Course • Gradual onset, tends to be chronic • symptom severity waxes and wanes – Comorbidity • Frequently co-occurs with other mood and anxiety disorders • Elevated rates of divorce and unemployment – Causal Factors Psychological Causes Mowrer’s two process theory of avoidance learning o Neutral stimuli becomes associated with frightening thoughts or experiences thru classical conditioning and come to elicit anxiety Example touching a doorknob or shaking hands can lead to the scary idea of contamination. Once having made this association the person may discover that anxiety produced by those stimuli can be reduced by handwashing o Once learned, such avoidance responses are extremely resistant to extinction. Any stressors that raise anxiety levels can lead to a heightened frequency of avoidance that responses in animals or compulsive rituals in humans Cognitive Factors o Thought suppression Attempting to suppress unwanted thoughts actually increases thoughts later o Appraisals of responsibility for intrusive thoughts Simply having a thought about doing something is morally equivalent to actually having done it. Or that thinking about committing a sin increases chances of actually doing so May motivate compulsive behaviors o Cognitive behaviors/distortions People with OCD are drawn to disturbing material relevant to their obsessive concerns. Chapter 4: Anxiety Disorder Also have difficulty blocking out negative, irrelevant input or distracting information so they may attempt to suppress negative thoughts stimulated by this info. Have low confidence in their memory ability which ma contribute to their repeating of ritualistic behaviors over and over again Biological Causes o Evidence from twin studies reveals a moderately high concordance rate for monozygotic twins and a lower rate for dizygotic twins o Neurotransmitter abnormalities Treatment o Behavioral and cognitive behavioral o Exposure and response prevention OCD clients develop a hierarchy of upsetting stimuli and rate them on a scale from 1100 according to their capacity to evoke anxiety, distress, or disgust. Then theyre asked to expose themselves repeatedly to the stimuli that will provoke their obsession. Following each exposure they are asked not to engage in the rituals they would normally do to reduce the anxiety/distress. Preventing the rituals is essential so that they can see that If they allow enough time to pass the anxiety created by the obsession will dissipate naturally down to atleast 4050 on the 100 scale even if it takes hours. Very intense on clients, high drop out rates Studies suggest 5070% reduction in symptoms 75% maintain gains long term o Medication o Medications that affect serotonin systems (SSRIs) Minor improvements in symptoms but many nonresponders When discounted symptom relapse is high Body Dysmorphic Disorder • Characterized by obsessions about some perceived or imagined flaw or flaws in one’s appearance to the point one firmly believes one is disfigured or ugly. • Imagined Defects in those w/ BDD Associated features Chapter 4: Anxiety Disorder Typically focused on a specific body part Compulsive checking behaviors common Avoidance of activities Reassurance seeking Comparing self to others obsessively Engagement in activities to cover up their perceived flaw e.g. excessive grooming, makeup Interference w/ functioning Prevalence 1-2% of general population Gender Ratio men = women Age of onset Usually adolescence Comorbidity High rates of comorbid depression (50%), suicidal behavior Relationship to eating disorders, OCD, psychosis (delusions) Prevalence by race/ethnicity – 79% European American – 11% African American – 5% Native American/American Indian – 3% Asian American – 8% Latino Causal Factors o Personality predisposition (neuroticism) o Differences in visual processing of faces o Sociocultural context o Cognitive style o Biased attention and interpretation of information relating to attractiveness Treatment o High doses of antidepressants o Cognitive behavioral therapy o Focus on distorted perceptions, exposure and response prevention Example: wear something that highlights their perceived flaw rather than hides it prevent checking responses (looking in the mirror) Chapter 4: Anxiety Disorder
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