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Abnormal Psych Week 4 Notes (Getzfeld)

by: Willow Frederick

Abnormal Psych Week 4 Notes (Getzfeld) Psych-UA 51

Marketplace > New York University > Psychology (PSYC) > Psych-UA 51 > Abnormal Psych Week 4 Notes Getzfeld
Willow Frederick

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About this Document

This is the last of what we covered and will be on our first exam! (Week 1-4 study guide coming soon) Topics include: Phobias, Anxiety, PTSD, Agoraphobia, GAD, Social Anxiety Disorder, and more
Abnormal Psychology
Dr. Andrew Getzfeld
Class Notes
anxiety, agoraphobia, phobias, PTSD, GAD, psych, treatment
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This 8 page Class Notes was uploaded by Willow Frederick on Wednesday September 28, 2016. The Class Notes belongs to Psych-UA 51 at New York University taught by Dr. Andrew Getzfeld in Fall 2016. Since its upload, it has received 94 views. For similar materials see Abnormal Psychology in Psychology (PSYC) at New York University.


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Date Created: 09/28/16
ABNORMAL PSYCH­ WEEK 4  CYBERTHERAPY : has come to complement or even replace face­to­face therapy  Computer software therapy  E­mail therapy  Visual e­therapy   Virtual support groups  HUMANISTIC­EXISTENTIAL MODEL  o Combo model humanistic view  o People are good­ finding the good within, self­actualization  o human­centered therapy similar to reality therapy­ they are responsible for doing something about it       existential view  emphasis on self­determination, choice, individual responsibility,  authenticity o unconditional positive regard­ self­regard (if not, conditions or worth) o Rogers’ client­centered therapy  therapist creates a supportive climate  unconditional positive regard—Rogers believes in the human need for this  if not, leads to conditions of worth—incapable of self­actualization  accurate empathy, genuinity   little research support but positive impact on clinical practice  ANXIETY DISORDERS  Anxiety: a mood state characterized by negative affect & somatic symptoms of tension o A person with anxiety apprehensively anticipates future dread or misfortune— afraid of the future & convinced it will be bad o Anxiety is less reality­based than fear  o May cause subjective unease in humans  Worry  Physiological symptoms  Enhances physical & intellectual functions, but too much anxiety disrupts  function o Neurotic paradox­severe anxiety does not dissipate even when no threat is present o Too much anxiety can lead to ‘choking’ o Ppl w/anxiety have a higher rate of suicidal ideation & suicide attempts  o Neurotic Paradox: When severe anxiety does not dissipate even when no threat  is present! o Average age of onset in the US is 22­23  FEAR (different than anxiety) o Fear is a response to an immediate threat (reality­based) o Present­oriented mood state  o Characterized by strong avoidance & sometimes fleeing o Not diagnosable like panic/panic attacks, anxiety  PANIC (also different): an extreme anxiety reaction  o Can result when a real threat emerges o PANIC ATTACKS: abrupt feeling of intense fear or discomfort (reach a peak n  then pass)  Short, periodic, & occur suddenly   Happen in the ABSENCE of real threat   Expected: ex. Before a game or going to the doctor   Unexpected: ex. teacher has an attack mid­lecture  Nocturnal panic attack: wake up in state of panic (happens to about 40% w/panic disorder)  Often feel like they will die, go crazy or lose control   Accompanied by at least 4 symptoms   Shortness of breath  Dizziness  Heart palpitations  Chest pain   Trembling or shaking  Feelings of choking  Nausea   Chills  Fear of dying  Paresthesia’s­ pins n needles, numbness  De­realization  Depersonalization o DSM Panic Disorder  1. Unforeseen panic attacks occur repeatedly  2. One or more of the attacks preceeds:  at least a MONTH of continual concern about having more attacks  at least a MONTH of dysfunctional behavior changes associated  w/attack (ex. Avoiding new experiences) o hard to differentiate bw heart attack & panic attack o Panic Disorder is often comorbid w/depressive disorder, bipolar disorder,  substance abuse   AVOIDANCE: becomes a vicious, self­perpetuating cycle—reinforcing, but causes relief o must last at least 6 months—along with patterns of regularity & onset to make  diagnoses   AGORAPHOBIA: fear or anxiety about 2 or more: o Using public transport o Being in open places –like to stand near doors, easy exit o Being in enclosed spaces o Standing in line or being in a crowd o Being outside of the home ALONE  o –they fear escape from these situations will be difficult or impossible situations  are avoided, require a companion, or are dealt with while having extreme fear or  anxiety o –lasts at least 6 months  o can have agoraphobia without panic disorder o comorbid w/: anxiety disorder, depression, PTSD, alcohol use disorder o affects only about 1.7% of ppl  GAD (Generalized Anxiety Disorder): a catch­all  Albert Ellis’ irrational assumptions of ppl w/GAD: o Dire need for an adult to be loved or approved of by virtually every person in their life o Catastrophic when things are not the way they want them to be o GAD may develop when these assumptions are applied to everyday life  Biological theorists believe that GAD is caused mainly by biological factors—the closer  the relative, the greater chance of having it   New cognitive explanations: o Metacognitive theory o Developed by Wells; suggests that the most problematic assumptions in GAD are  the individual's worry about worrying (meta­worry) o Intolerance of uncertainty theory o Certain individuals consider it unacceptable that negative events may occur, even  if the possibility is very small; they worry in an effort to find “correct” solutions o Avoidance theory o Developed by Borkovec; holds that worrying serves a “positive” function for  those with GAD by reducing unusually high levels of bodily arousal  DSM5 Symptoms o Excessive anxiety & worry, occurring more days than not for at least 6 months o Difficult to control the worry o Associated w/3 or more symptoms (1 in kids):  Restlessness or feeling on edge  Easily fatigued   Difficulty concentrating or mind going blank  Irritability   Muscle tension (benzodiazepines, such as valium)  Sleep disturbance  Sociocultural Perspective   Psychodynamic Perspective: Freud believed all children experience: realistic anxiety,  neurotic anxiety when prevented from expressing ID impulses, moral anxiety when  punished for expressing ID impulses  o Freudians focus less on fear & more on control of ID  Humanistic Perspective: client­centered approach­doesn’t work very well   Cognitive Perspective: “musterbation” –everyone must like me, etcsetting impossible  standards  o Studies suggest modest relief from this treatment   Biological Perspective: GABA inactivity   One of the most powerful forms of societal stress is poverty (live in greater risk), but  GAD is common in Western society   GABA inactivity o 1950s – Benzodiazepines (Valium, Xanax) found to reduce anxiety  o Why? o Neurons have specific receptors (like a lock and key) o Benzodiazepine receptors ordinarily receive gamma­aminobutyric acid (GABA, a common neurotransmitter in the brain) o GABA carries inhibitory messages; when received, it causes a neuron to stop  firing  Do physiological events CAUSE anxiety? Or other way around? We don’t know  Biological treatments  o Antianxiety drug therapy o Early 1950s: Barbiturates (sedative­hypnotics) o Late 1950s: Benzodiazepines o Provide temporary, modest relief o Rebound anxiety with withdrawal and cessation of use o Physical dependence is possible o Produce undesirable effects (drowsiness, etc.) o Mix badly with certain other drugs (especially alcohol)  Malfunctions in the feedback system are believed to cause GAD o Possible reasons: Too few receptors, ineffective receptors  Biological treatments  o Biofeedback o Therapist uses electrical signals from the body to train people to control  physiological processes o Electromyograph (EMG) is the most widely used; provides feedback about  muscle tension o Found to have a modest effect but has its greatest impact when used as an adjunct  to other methods for treatment of certain medical problems (headache, back pain,  etc.) PHOBIAS: an unreasonable fear about a situation or object   Have to consider age appropriate behavior in children (fear might be expressed in  tantrums, freezing or clinging)  The phobic situation almost always provokes immediate fear or anxietyis actively  avoided   Fear is out of proportion to the actual danger/situation   Persistent (lasts at least 6 months)  Causes significant distress or impairment in social life, work, school  Can have multiple phobias   Develop thru conditioning, modeling, observation/imitation –supports behavioral  explanations  o MAINTAINED thru avoidance   A lot of them can develop into GAD if person has a bunch of phobias  o Stimulus generalization: responses to a stimulus are also elicited by similar  stimuli  Prevalence rate of ~9% in USA—most of them do NOT seek treatment  Most common: animal phobias, insects, heights, tight spaces, thunderstorms, blood  Ppl w/a phobia often avoid the object or thoughts about it  Social phobia: ‘stage fright,’ specific to performance  More intense & persistent than fear­more avoidance & life­disturbing distress  PHOBIA Treatment o Joself Wolpe: teach relaxation skills, create fear hierarchy  Pair relaxation w/feared objects or situations—relax response should  substitute fear response  In vivo desensitization (live)  Covert desensitization (imaginal) o Other behavioral treatments:  Flooding: forced, non­gradual exposure  Modeling: therapist faces feared object while phobic person observes o Key to success is ACTUAL contact w/feared object/situation o Virtual reality! Can be really helpful w/PTSD  Phobias are usually categorized as specific, but the 2 more broad kinds are: agoraphobia  & social anxiety disorder AGORAPHOBIA: fear of being in public places or situations where escape could be difficult or help unavailable, should they panic or become incapacitated  Treatments o Exposure therapy o Support group o Home­based self­help SOCIAL ANXIETY DISORDER­ marked, disproportionate & persistent fears about 1 or more social situations  AKA SOCIAL PHOBIA OR STAGE FRIGHT lasts at least 6 months  Talking, performing, eating, writing/speaking in public  General fear of functioning poorly in front of others   In both forms, ppl rate themselves as less competent than they actually  arerelated to self­esteem  Treatment success past 15 yrs   2 components  1) overwhelming social fear (exposure)  2) lack of social skills (assertiveness training)     social media jitters   Behavioral inhibition: genetic component & anxious modeling by parents   1  degree relatives have a 2­6x greater chance of having social phobia!  SOCIAL PHOBIA IS NOT o School phobia: the environment is negative, not the building o Separation anxiety disorder: ppl who avoid social settings bc of fear of being  separated from, for ex., mom & dad –requires parents to stick around in situations that are not socially appropriate Cognitive theorists contend that people with this  disorder hold a group of social beliefs and  expectations that consistently work against them, including:    OBSESSIVE­CUMPULSIVE DISORDER (OCD)  1­ obsessions: persistent thoughts, ideas, impulses, or images that seem to invade a  person’s consciousness  2­ compulsions: repetitive & rigid behaviors or mental acts that ppl feel they must do to  prevent or reduce anxiety o provide a form of relief  unlike phobias, the ‘dangerous event’ is INTERNAL   may have connection w/anorexia or autism  typically comorbid w/anxiety, MDD, maybe schizo   treatment:  o exposure & response prevention o thought­stopping o hospitalization o meds ­­­ what kind?  PTSD  trauma & stressor  symptoms begin within 4 weeks of event & last more than a month  different from ACUTE STRESS DISORDER o normal stress reaction to trauma­­ lasts less than a month! o As much as 80% of all cases of acute stress disorder develop into PTSD  Symptoms:  must last more than a month o Depersonalization­ feeling detached, like you’re living in a dream o flashbacks, dreams o de­realization­ world around you is unreal/distorted o w/delayed expression: full criteria aren’t met until 6 months after event   Children younger than 6 may get PTSD  If so, witnessing traumatic events does not include those only seen via electronic media,  tv, movies, or pictures.  This means they need to witness the events in person  This indirect exposure (seeing horrors on tv etc.) also applies to those older than 6 up to  and including adults  Must meet all 6 criteria:


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