PSYC 2300 Week 5 Notes
PSYC 2300 Week 5 Notes PSYC 2300
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This 8 page Class Notes was uploaded by Liana Sandell on Thursday September 29, 2016. The Class Notes belongs to PSYC 2300 at University of Connecticut taught by Dr. Inge-Marie Eigsti in Fall 2016. Since its upload, it has received 10 views. For similar materials see Abnormal Psychology in Psychology (PSYC) at University of Connecticut.
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Date Created: 09/29/16
Abnormal Psychology Exam Two Notes September 29, 2016 Anxiety Disorders Overview 1. anxiety disorders a. generalized anxiety disorder b. panic disorder and agoraphobia c. speciﬁc phobias d. social anxiety disorder 2. trauma and stress related disorders a. PTSD, adjustment disorder b. attachment disorder 3. obsessive compulsive and related disorder a. OCD b body dysmorphic disorder c. hoarding, trichotillomania Focus on the contrast between fear versus anxiety Fear 1. state of alarm about a known threat 2. Example a. imagine that a tiger comes into your class (heart rate, blood pressure, sweating, breathing rate, digestion stops, pupils dialate. there are many physiological changes in this high state of arousal. extra functions are stopped so we are able to focus on the main concern) Anxiety 1. alarm about a vague sense of a threat (generalized state of apprehension) 2. this is not adaptive Panic attacks 1. abrupt onset of fear and discomfort 2. peak in 10 minutes 3. at least FOUR of these symptoms to be experiencing this a. palpitations, pounding heart and rapid heart rate b. sweating c. trembling/shaking d. sensation of smothering e. feeling of choking f. chest pain g. nausea h. dizziness, lightheadedness and fainting i. parathesia (numbness, tingling) j. chills or hot ﬂashes k. derealization (feeling of unreality), depersonalization (detached from self) l. lear of losing control, being crazy m. fear of dying Physiological changes during a panic attack (slide with graphs) 1. changes in muscular activity in frontal (EMG) 2. heart rate (BMP) 3. body temperature Panic disorder and agoraphobia 1. prevalence is 2.7% (year); 4.7% (lifetime) 2. unexpected panic attacks 3. anxiety, worry, or fear of another attack 4. persists for one month or longer 5. agoraphobia a. fear or avoidance of situations or evens b. concern, about being unable to escape or get help in the event of panic symptoms or other unpleasant physical symptoms (incontinence (go to the bathroom but not in the bathroom) vomiting, falling) c. common learned situations (bus, tunnel, train, elevator, waiting in line, restaurant, theatre, crowds…) 6. the root of agoraphobia is (agora) marketplace a. originally meant fear of the marketplace (being in open spaces and not being able to escape it) Both panic and agoraphobia are characterized by similar things, however you can have one or another HPAAxis Activation and Negative Feedback (chapter one) 1. hippothalimus, adrenal and pituitary 2. set by cortisol (stress hormone) 3. to end process rely on inhibitory neurotransmitters Biological contributions to anxiety 1. poly genetic inﬂuences a. corticotropin releasing factor: when this turns on this affects the HPA axis and ﬁght or ﬂight responses are turned on 2. Brain circuits and neurotransmitters a. GABA (inhibitory system, can be thought of as the breaks) 1. less GABA leads to more anxiety (broken breaks, keep going) b. Noradrenergic (norepinephrine) and serotonergenic system (systems that are cleaning that is too strong) 1. less of these chemicals equals more anxiety 3. Limbic system a. behavioral inhibition system (BIS) 1. brain stem (sense changes in bodily functions, sends danger signals to the cortex) 2. septum and hippocampus b. ﬁght/ﬂight (FFS) system 1. panic circuit 2. alarm and escape responses People who experience panic disorders show markedly different results in each of these components (not all) An integrated model 1. biological vulnerability (heritable contribution to negative affect a. glass is half empty (not enough chemicals) b. irritable c. driven 2. Speciﬁc psychological vulnerability (physical sensations are potentially dangerous) a. anxiety about health b. non clinical panic? 3. generalized psychological vulnerability (sense that events are uncontrollable/unpredictable) a. tendency towards lack of self conﬁdence b. low self esteem c. inability to cope there is a correlation between teen cigarette smoking and later panic attacks (nicotine is altering the operation of your lungs and heart, because you are getting different amounts of oxygen. it also includes changes in brain) Etiology of Panic Disorders 1. misinterpreting slight changes in bodily changes 2. feeling scared and anxious 3. feeling scared elicits physiological effects of pounding of heart, shortness of breath 4. “i’m having a panic attack??” 5. panic attack 6. fear of future panic attacks 7. next time they experience these slight bodily changes they are more anxious People who have panic attacks 1. attend to bodily sensations 2. misinterpret these sensations 3. “snowballing” assumptions How to deal with this? “Whistle a happy tune” song which states that you should help convince your body that there is no need to be afraid 1. cognitive behavioral treatmetns a. challenge/change, maladaptive, irrational assumptions 1. daily diary (example of slide) 2. piece of paper with headings that clients can ﬁll in (“situation, what was the negative automatic thought, initial level of anxiety, what was the alternative thought, subsequent level of anxiety) b. exposure paired with relaxation (note that this does seem to require the help of a mental health professional, it is hard to do it on your own) 1. “pretend” to be brave while encountering fear stimulus (teaches you and your body not to be afraid in this context) 2. learn how to relax yourself (making positive statements etc) c. stress inoculation (small amount of stress that you can handle successfully to help patients learn how to handle this outside of the ofﬁce) 1. prepare for feared situation, respond to bodily sensations Treatment of Panic Disorder 1. cognitive scheems a. identify catastophizing cognitions about bodily sensations b. understand ﬁght/ﬂight response 2. relaxation techniques a. deep breathing b. progressive muscle relaxation 3. interoceptive challenge 4. medication to target multiple systems a. SSRIs (prozac, paxil) to target serotonergic system) b. SNRIs (cymbalta, effexor) to target soradrenergic system) c. bexodiazepines (ativan, valium) to enhance GABA 1. be careful they are very powerfully effective for the ﬁrst week but then drop off 2. can be addictive d. but there are very high relapse rates once drugs are stopped Interoceptive exposure (biological challenge) 1. shake head side to side for thirty seconds 2. run in place for 30 seconds 3. spin in a chair 60 seconds 4. body tension for 60 seconds 5. hyperventilate for 60 seconds 6. straw breathing 120 seconds 7. hot stuffy room for 5 minutes Generalized anxiety disorders (GAD) 1. 3.1% (year) of population; similar rates worldwide 2. excessive anxiety and uncontrollable worry (duration 6mo or more) 3. hard to control their worrying it feels out of their control 4. associated with at least three symptoms a. restlessness b. fatigue c. difﬁculty to concentrate (mind thinking about worries) d. irritability e. muscle tension f. sleep disturbance 5. clinical features a. move from crisis to crisis b. heightened worry about minor and every day concerned (job, family, chores, appointments c. accompanied by sleep disturbance irritability d. leads to behaviors like procrastination or over preparation 6. GAD children a. need only one physical symptom b. worry center on academic, social or athletic performance 7. GAD in the elderly a. worry about failing health, loss b. up to 10% prevalence c. use of minor tranquilizers overprescribed (17-50%) 1. sometimes prescribed for medical problems or sleep problems 2. increase risk for falls and cognitive impairments (make people more clumsy) Model of risk process for GAD (post picture) 1. generalize biological vulnerability or generalized psychological vulnerability can be triggered due to stress 2. leading to anxious apprehension (increased muscle tension and vigilance are) 3. worry process (a failed attempt to cope and problem solve) 4. leads to… 1. intense cognitive processing 2. avoidance of imagery 3. inadequate problem solving skills 4. restricted autonomic response 5. combine to generalized anxiety disorder Similarities between GAD and panic disorders however, they are not the same process Anecdote about GAD Family comes in because daughter has many tantrums. Meets with family asks daughter to go outside. Father begins asking questions (can you go outside? are you okay? I can walk you there). She was 11 and she did not need that attention. Findings that madeline and her father struggled with this