PSYC 2300 Week 6 Notes
PSYC 2300 Week 6 Notes PSYC 2300
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This 11 page Class Notes was uploaded by Liana Sandell on Thursday October 6, 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 6 views. For similar materials see Abnormal Psychology in Psychology (PSYC) at University of Connecticut.
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Date Created: 10/06/16
Class Notes October 4, 2016 Treatment for GAD 1. learning to confront worries “head-on” (rather than avoiding them) 1. cognitive behavior theory (trained relaxation techniques) 2. acceptance of distressing thoughts and feelings 3. meditation/mindfulness techniques potentially helpful 4. speciﬁc anxiety diagnosis (not talking about whole class of anxiety( Phobias (5 categories) 1. persistent and intense fears, impacts functioning 1. natural environmental (heights, storms, swimming) 2. animals (snakes or dogs) 3. situational (claustrophobia, public transportation) 4. blood injury injection 5. other 2. exposure leads to intense and excessive anxiety 3. exposure provokes a fear response 4. person recognizes that the fear is excessive (children” not necessary) 5. situation is avoided, or endured with intense distress 6. symptoms cause impairment in functioning (often at this point where individuals come in for help) Preparedness 1. we fear spiders and snakes more than busses (latter are more dangerous; why?) 2. through evolution we have been “prepared” to handle Phobias and classical conditioning 1. neurural object paired with frightening situation which produces fear of the neutral object 2. dog bites girl (US), girl experiences fright/pain (UR) 3. dog (US) is associate with fright and pain (UR) 4. dog (CS) leads to dog phobia (CR) Phobias and operant conditioning (avoidance) 1. when they have developed this conditioned response the person avoids or escapes the conditioned stimulus (if you see a dog, stay away) 2. escaping the conditioned stimulus provides relief 3. negative reinforcement for avoidant behavior 4. therefore, the avoidance of CS makes extinguishing it hard Treatment: fear hierarchy 1. least feared item: ______ 2. __________ 3. __________ 4. __________ 5. most feared item: ______ *similar to how we help those with panic attacks Snake example 1. start with a black and white drawing of a snake (not particularly scary or threatening) 1. meditate while looking at this picture 2. look at photograph of a real snake 1. help the individual endure this 3. look at a real snake in the cage 1. help them practice staying calm 4. look at a snake, 3 feet away (out of cage) 5. touch a live snake Video in class: elevator phobia Separation anxiety disorder 1. 4.1% of children meet criteria, 6.6 for adults 2. unrealistic, persistent worry that something will happen to loved ones when apart (kidnapping, accident) 3. anxiety about leaving loved ones Social anxiety disorder (social phobia) 1. 12% o population will experience it in their lives; 6.8 in year 2. extreme, irrational worry of being negatively evaluated by others 1. can manifest as shyness 3. signiﬁcant impairment and /or distress 4. avoid feared situations or endure with great distress 5. subtype, performance anxiety: anxiety only in performance situation (public speaking) 6. in Japan— taijin kyofusho 1. fear of ordering others or making them uncomfortable due to aspects of personal appearance (stuttering, blushing, body contact 2. more common in males Treatment of social anxiety disorder 1. medications 1. beta blockers 2. benzodiazepines (enhance GABA) 3. SSRI (paxil, zoloft, effexor) 4. d-cycloserine antibiotic originally treated tuberculosis; sometimes called cognitive enhancer (potentially effective new treatment) 2. psychological 1. cognitive behavioral treatment 1. challenging of anxious thoughts about the consequences if sick judgement 2. exposure to anxiety provoking situations 3. rehearsal 4. role play 3. highly effective CBT for social anxiety seems like the best cure Selective mutism 1. rare childhood disorder characterized by lack of speech 2. duration of >1 most (not ﬁrst month of school) 3. high comorbidity (sick with two things at same time) with the separation anxiety *50% 4. treatment 1. CBT is the most efﬁcacious, similar to treatment for SAD Post traumatic stress disorder (PTSD): originally shell shock syndrome 1. exposure to a traumatic event (involving possible injury, death) 2. trauma is re-experienced via ﬂashbacks, dreams, high physiological arousal and distress when cued) 3. avoidance of stimuli is associated with the trauma via, forgetting, social withdraw 4. increase arousal (hypervigilance) 5. most people who experience traumatic events do not develop PSD (4% of troops do, 7% with combat experience 1. history of repeated sexual issue (2-3x increase in PTSD) 2. proximity: more likely to develop PTSD if it is closer to the trauma Vietnam vets 1. almost 30 years after the war (experienced more communication) 2. Iraq vets: lesser prevalence in PTSD (more recent) 1. 1 of 3 vets seek care for mental heard concerns (PTSD, anxiety, depression) 2. second duty 1 out of 5 (20% on second tour of study to experience anxiety disorer) 3. 10 oer 100,000 suïcide in 2005 4. rates increasing: some data suggesting 30 for Risk Factors: PTSD 1. biological responsitivity (bang on desk) the more you had a reaction, the mire biological responsivity 2. risk factors are heavily monitored by social support sources and coping skills 3. severity of trauma 4. degree of exposure 5. passive vs. active coping style 6. social support 7. additional stresses Treatment 1. cognitive behaioral treatment 1. imagine exposure to memories of traumatic event 2. graduated or massed 3. increase positive coping skills 4. increase social support 5. highly effective 2. group therapy 3. social skill training 4. SSRIs can be helpful 1. receive heightened anxiety and panic attacks that are common to PTSD Cannot diagnose someone with PTSD unless it has been 6 mo Adjustment disorders 1. anxious or depressive reactions to life stress 2. milder than PTSD/acute stress disorder 3. occur in reaction to life stressors like moving, new job, divorce 4. clinically signiﬁcant distress or impairment 5. distinguish normal responses for life events with unexpected responses 6. clinical signiﬁcant degree of impairment 7. clinically signiﬁcant degree of stress Attachment disorders 1. disturbed and developmentally inappropriate behaviors in children 2. child is unable or unwilling to form normal attachment relationships with caregiving adults 3. occurs as a result of inadequate or neglectful care in early childhood Class Notes October 6, 2016 Obsessive compulsive disorder (OCD) 1. obsessions are intrusive and reoccurring thoughts 1. need for symmetry 2. forbidden thoughts or actions 3. cleaning and contamination 2. compulsions are repetitive behaviors or mental actions that are repeated over and over in order to reduce anxiety 3. prevalence: 1.6% to 2.3% (life); 1% (year) Example: think you left door unlocked, you can go check the door multiple times Common Compulsions 1. cleanliness 2. avoiding particular objects (ex. cracks in the sidewalk) 3. performing repretitive, magical, protective practices 4. checking (is the door locked, is the gas off, is there a kid behind my car?) 5. performing a particular act (ex. chewing slowly, tapping a glass against your teeth in a particular way) Move in class about OCD 1. obsession around son jake (she must look at him at stop lights because she is scared he will be taken) 2. when she is driving she doesn’t have to do it because she doesn’t think they could get him 3. scared of contamination either 4. scared of AIDS or something contracted through bodily ﬂuids Risk factors 1. thought-action fusion: “if i think it, it will occur” 2. inﬂated responsibility: I can cause this event by doing XY and Z Treating OCD 1. cognitive behavior therapy 1. exposure and ritual prevention (ERP) 2. highly effective 1. one study found that 86% of patients beneﬁt 3. no added beneﬁt from combined treatment with drugs 4. SSRIs: 60% of patient beneﬁt 1. high relapse rate when discontinued Summary 1. anxiety and related disorders occur when natural and adaptive processes (anxiety, fear and panic) become disproportionate to the environment 2. these disorders occur as the result of generalized biological vulnerabilities, generalized psychological vulnerabilities and speciﬁc psychological vulnerabilities 3. the most effective treatment for most anxiety disorders is cognitive behavioral therapy 1. medications may also be helpful Affective and Mood disorders Mood 1. “I am troubled; I am bowed down greatly; I go mourning all the day long… i am feeble and sore broken… my hearth panteth, my strength faith me; as for the light of mine eyes it also is gone from me” (King Solomon) 2. talks about some troubles of depression Mood disorders 1. Hippocrates (400 BC): melancholia due to imbalance of humors, particularly the overbalance of black bile 1. there are four humors, blood, phlegm, black bile and yellow bile 2. Robert Burton (1621): Wrote the “anatomy of melancholia” 1. hypothesized etiology included 1. position of saturn 2. melancholy parents 3. intense love 4. ruddy complection 3. Emil Kraepelin (1800): separated schizophrenia from bipolar 4. Karl Leonhard (1957): argued for bipolar vs. unipolar Bad news: extraordinarily disabling The good news: responds well to treatment Overview (affective disorders) Unipolar 1. major depressive disorder 2. persistent depressive disorder Bipolar 1. Bipolar 1 and 2 (manic depression) 2. cyco International epidemiology 1. disease burden in economically developed countries (% of burden) 1. unipolar major depression (6.8) 2. schizophrenia (2.3) 3. bipolar mood disorder (1.7) 4. obsessive compulsive disorder (1.5) 5. panic disorder (.7) 6. PTSD (.3) 7. self inﬂicted injuries (ex. suicide) (2.2) 8. ex. ﬁnancial cost, mortality, morbidity or other indicator Unipolar mood disorders 1. typical variation (stays on the positive side of the neutral x axis, don’t dip too far into the negative side) 2. persistent depressive disorder (most time there is a constant on the bottom side of the x axis) 3. major depression (constantly changing; person sits in a sad mood state for a while, just going between very sad and sad) Epidemiology 1. rates of depression 1. increasing over last 5 decades (from 5.2% to 16% 2. women are twice as likely to develop symptoms of depression (very interesting and puzzling phenomenon) 1. responsible for taking care of children, more role related stress 3. higher rates in young adults, and individuals with lower economical status, and elderly when compared to general population 1. stress for students, elderly struggle with uncertainty and stress Features of Depression 1. emotional symptoms 1. low mood (how are you feeling today? not good) 2. crying, tearfulness 3. irritability 2. behavioral symptoms 1. loss of experience of pleasure in life: anhedonia 2. social withdraw 3. loss of motivation (“i don't care”) 3. cognitive symptoms 1. self esteem 2. self blame, guilt, shame 3. hopelessness 4. ineffectual, indecisive 5. poor concentration 6. suicide 4. bodily (vegetative) symptoms 1. psychomotor retardation: people move more slowly (“walking through jello”) 2. low energy, fatigue 3. sleep changes (increase or decrease) 4. appetite changes (increase or decrease) Depression and positive effect 1. usually we feel happier seeing a positive face 2. depressed individuals 1. display fewer positive expressions: smile study 2. report experiencing less pleasant emotion in response to pleasant stimuli 3. physiologically less responsive to positive but not negative stimuli 4. do get the same response for negative stimuli Diagnosing a Major Depressive Episode 1. depressed mood or 2. anhedonia 1. must have one of these 3. change in appetite/weight 4. insomnia, hypersomnia nearly every day 5. agitation, motor retardation (lethargy) 6. fatigue, loss of energy 7. feeling worthless or guilty 1. must have 5 or more Major Depressive Disorder 1. 2+ major depressive episodes 2. no history of manic episodes 3. in 5-10% of people with MD epidote, the episode lasts 2 years or more Risk factors for depression 1. gender (role stress) 2. age 3. sociocultural factors 4. life events 5. social supports 6. seasonal factors (S.A.D) 1. no sunlight sometimes From Grief to Depression 1. in previous editions of the DSM, depression could not be diagnosed during periods of mourning 2. now recognized that major depression may occur as part of the grieving process 3. acute grief: occur immediately after loss 4. integrated grief: eventual coming to terms with meaning of the loss 5. complicated grief: persistent acute cried and inability to come to terms with the loss (continue to experience acute grief for extended periods of time, they are unable to come to terms with their loss)
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