Psych 3331 Class Notes Week 7
Psych 3331 Class Notes Week 7 PSYCH 3331
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This 8 page Class Notes was uploaded by Casey Kaiser on Sunday October 9, 2016. The Class Notes belongs to PSYCH 3331 at Ohio State University taught by Brittney Schirda in Spring2015. Since its upload, it has received 8 views.
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Date Created: 10/09/16
Psych 3331 Abnormal Psych 10/3 Phobias - persistent unreasonable fears Can be to specific objects or more broadly (agoraphobia) We often see avoidance in both Compared to normal fear, phobias give more intense elongated fear, intense distress Specific phobia - Severe persistent fear of a specific object or situation Most common - specific animals or insects, heights, enclosed spaces, thunderstorms, and blood Criteria used for diagnosing a phobia: Marked fear or anxiety about a specific object or situation The phobic object or situation almost always provokes immediate fear or anxiety The phobic object or situation is actively avoided or endured with intense fear or anxiety The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning Disturbance is not better explained by the symptoms of another mental disorder How often do we see this condition? It is typically comorbid with other disorder, likely paired with other specific phobias Average individual with specific phobia will fear three objects or situations o About 75% of individuals with a specific phobia fear more than one thing The context will also determine how impairing the phobia is Females more commonly experience this than males - 2:1 The age of onset varies There is prevalence in African Americans and Hispanic Americans than in White Americans, but only those born in America not those who emigrate 19% of people are currently in treatment Agoraphobia Talking about a particular type of fear, the person will be afraid to be in public situations where escape may be difficult or help would be unavailable if panic- like, incapacitating, or embarrassing symptoms were to occur o Marked fear or anxiety about two or more, of a set of five different situations 1- using public transportation 2- being in open spaces 3- being in enclosed spaces 4- standing in line or being in a crowd 5- being outside of the home alone o Individual fears or avoids these situations because of their thoughts that escape may be difficult or help may be unavailable o These situations almost always provoke fear or anxiety o They are actively avoided, and require the presence of a companion, or are endured with intense fear or anxiety o The fear or anxiety is out of proportion to the actual danger o It is persistent and lasts for 6 months or more o Causes clinically significant distress or impairment in situations o If another medical condition is present the fear, avoidance, anxiety is clearly excessive o If the symptoms fit another disorder this diagnosis is not the best diagnosis 1.7% US prevalence Twice as common in the poor than in the wealthy Typical age of onset is 15-35 20.9% are currently in treatment Common features: Intensity often fluctuates Can place severe limitations on life - people can become virtual prisoners in their own homes Often accompanies panic disorder Evidence tends to support behavioral explanation for the cause of these phobias If someone has a phobia they most likely learned to fear this item or situation Classical Conditioning Before conditioning o UCS Entrapment ---> UCR Fear Conditioning o Running water + UCS entrapment ---> UCR Fear After conditioning o CS Running water ---> Fear Modeling Phobias may develop through observation and imitation o Seeing others being afraid of something may develop fears of the same thing Maintenance of Phobia After an onset of phobia, avoidance of the feared object or situation will maintain this phobia o Because of this avoidance the individual will never learn that their fear is out of proportion and therefore it will be maintained Phobias leading to GAD? Behaviorists propose that phobias may develop into GAD if there is a large number of phobias 10/5 Behavioral explanations: They have received some empirical support Classical conditioning study - Little Albert study, conditioning a baby to fear a bunny or something by using loud sounds that were then associated with the sight of something Bandura's modeling study - participants who watched confederates get shocked every time a buzzer sounded began to show a fear response to the buzzer Important to realize the caveate Just because it appears that you can gain a phobia in this way does not mean that is how it happens in the real world. You may be able to show it in the lab but it is different in real life o Many case studies trace phobias to incidents of classical conditioning or modeling, but quite a few fail to do so Behavioral-Evolutionary Explanation: Some phobias are much more common than others - the idea is that some symptoms come about because of an adaptive component We have a built in preparedness to develop certain fears (like snakes, spiders) rather than other things (like meat, grass, houses) Theorists argue there is a species-specific biological predisposition to develop certain fears Called "preparedness" because human beings are theoretically more prepared to acquire some phobias than others Treatments for specific phobias Behavioral interventions, particularly exposure treatments, are most widely used and tend to be most effective o Exposure treatment - people are exposed to the objects or situations that they dread Systematic desensitization Treatment where you teach a client relaxation skills Then create a fear hierarchy (list of stimuli ranked from least fear to most fear and client will provide a specific rating for the things on the list) Then pair relaxation with the feared objects and situations until you eventually reach the top of the list Can do this in vivo desensitization (live in person) Or covert desensitization (imaginal, facing them in your head) With this you are trying to get the client to associate the object they fear with relaxation rather than associating it with fear Flooding Repeatedly exposing the client to the most feared object or situation - no relaxation skills are taught and no build up May be in vivo or covert also It works! Modeling Therapist confronts the feared object in the presence of the patient so that they can see nothing bad is happening May also use participant modeling - the therapist would interact with the feared object and try to get the patient to participate with them o Research shows that exposure treatments are pretty effective in treating specific phobias The key to success is in vivo exposure to the feared object or situation Although more therapists are using virtual reality as a useful exposure tool Treatments for Agoraphobia Behaviorists favor exposure therapy with additional features: o Support groups - patients who all have agoraphobia go out together for exposure sessions that last for several hours, these group members encourage each other. The goal is to eventually get them to go out alone but this is a good start o Home-based self-help - clinicians give clients and their families instructions for at home exposures About 60-80% who receive exposure therapy find it easier to enter public places o Improvements last for years but relapses are common (about 50%) Thankfully if those who relapse go through therapy again, improvement comes more quickly o If agoraphobia is paired with panic disorder then exposure therapy is not as effective because it becomes more complicated Social Anxiety Disorder A severe and persistent fear of social situations in which ebarrassment may occur DSM-5 criteria A marker fear or anxiety about 1 or more social situations The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (humiliating or embarrassing) Social situations almost always provoke fear or anxiety The social situations are avoided The fear will be out of proportion to the actual threat The fear, anxiety, or avoidance is persistent Must be clinically significant distress or impairment in social situations Is not attributable to the physiological effects of a substance or other medical condition Social fears may be narrow (talking, performing, more specific) or more broad (general functioning fear) In both cases people rate themselves as performing less competently than they actually do Can interfere greatly with ones life Reluctance to interact with other or speak in public, can lead to failure to carry out important responsibilities and reject important social offerings Others may interpret social reluctance as snobbery, lack of interest, or hostility o This can cause people to treat those with social anxiety differently, so the person will then feel more crappy about themselves and they will feel more socially incompetent and then feel more anxious Symptoms of disorders (social anxiety and GAD) are not always listed in the criteria, because they are not necessary to establish the disorder How often do we see this? One-year US prevalence - 7.4% Female to male ratio 3:2 Typical age of onset - 10-20 years 24.7% are currently in treatment Cognitive theorists would say this disorder is all about their thoughts - irrational beliefs and expectations that are working against them Examples: o View themselves are unattractive social beings o View themselves are socially unskilled and inadequate o Believe they are always in danger of behaving incompetently in social situations o Constantly anticipating that something bad will happen and take safety precautions (things like applying a ton of makeup to cover their face so others cannot tell they are embarrassed, or using alcohol to get through a social situation) o Etc.. Following social events these individuals often review the event, and they usually overestimate how poorly things went and the negative things that may arise because of how poorly things went These thoughts increase the fears about future social situations Research shows that individuals with this disorder often have the social beliefs and expectations mentioned What factors cause this? o Genetic predispositions o Trait tendencies - different temperaments may influence it o Biological abnormalities - in neurotransmitters o Traumatic childhood experiences o Overprotective parent-child interactions 10/7 Social Anxiety Disorder Tyically use the cognitive perspective to determine causes of this disorder Treatments Reducing social fears o Medication - antidepressants work better than benzodiazepines or other antianxiety medication o Psychotherapy - exposure therapies, or cognitive therapies At least as effective as medication, with added benefit of a lower chance of relapsing More commonly using a group setting than an individual setting - because of the social skills aspect Improving social skills o Social skills training - using various behavioral techniques to help them improve in interacting with others Therapist may model appropriate social behaviors and clients may try them out Clients could role-play with therapist, they would rehearse behaviors and receive feedback on their actions Social skills training groups and assertiveness training Panic Disorder Panic is an extreme anxiety reaction - can result when a real threat suddenly emerges Experience of panic attacks are different o They are periodic, short bursts of panic that occur suddenly, reach a peak, and then pass o Happen without actual threat, there is an absence of threat o The people experiencing this fear they will die, go crazy, or lose control More than 1/4 of all people have one or more panic attacks at some point in their lives, but some have them repeatedly, unexpectedly, etc.. Criteria Recurrent unexpected panic attacks - characterized by a set of symptoms o Heart palpitations o Racing heart o Sweating o Trembling or shaking o Shortness of breath o Chest pain of discomfort o Feelings of choking o Nausea, abdominal distress o Feeling dizzy, unsteady, light-headed, or faint o Chills or heat sensations o Paresthesias (numbness or tingling) o Derealization or depersonalization Must have at least four of these symptoms At least one or more of the attacks has been followed by: o persistent concern or worry about additional attacks o A significant maladaptive change in behavior - maybe avoiding certain things because of this Cannot be attributable to the physiological effects of a substance or another medical condition If someone is experiencing these criteria, but missing certain points that would determine it as a panic disorder does not mean they will not receive treatment, it could be attributable to another disorder or be label NOS How often do we see this? 2.4% one-year prevalence U.S Lifetime prevalence 5% Female to male ratio 5:2 More common in poor versus wealthy More prevalent among white Americans than minority groups Age of onset about 15-35 years Can set the stage for development of agoraphobia Biological views Neurotransmitter involved is norepinephrine o The locus coeruleus in the brain has a lot of receptors for norepinephrine - when you electrically stimulate this region in monkeys, they have panic attacks. Leads us to believe that the same would happen for humans o If you inject humans with chemicals that increase norepinephrine activity it leads to panic attacks We also see correlations with brain networks including structures like - locus coeruleus, amygdala, hippocampus, hypothalamus, central gray matter o In any person when faced with something scary there is activation in the amygdala, which will activate other regions of the brain In panic attacks this circuit goes crazy o This circuit does not function correctly in those with panic disorder Can be hereditary, the more genetic material one shares with someone who has panic disorder the more likely they are to develop it Treatments - biologically Antidepressants are effective o Effects the norepinephrine in the brain circuit to regulate it o Brings improvement to about 80% of patients o To keep improvements it requires maintenance of drug therapy o Some benzodiazepines have also been helpful Treatments - cognitive Cognitive therapists view full panic attacks as experienced by people who misinterpret physiological events taking place within their bodies - they say the people who are prone to this thinking are prone to panic attacks o Cognitive therapist say correcting these maladaptive interpretations will helpl The people who are panic-prone and sensitive to certain bodily sensations may misinterpret them as signs of medical catastrophe - which could lead to panic Whatever the cause, panic-prone people typically have a high degree of "anxiety sensitivity" Cognitive approach will typically start by educating the client - what brings out the sensations and panic o Then teach them to apply more accurate interpretations, especially when they are feeling stressed o Then teach them relaxation and breathing skills for coping with the anxiety May also use "biological challenge" o Where you induce physical sensations that cause feelings of panic during therapy o So that you can expose them to the physical sensations that cause them fear so that they can practice coping strategies and dampen the effects over time Combination therapy may be the most effective - but it is still being researched
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