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by: Spencer Smitham


Spencer Smitham
GPA 3.97


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Class Notes
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This 59 page Class Notes was uploaded by Spencer Smitham on Saturday September 12, 2015. The Class Notes belongs to PSYC 4240 at University of Georgia taught by Miller in Fall. Since its upload, it has received 45 views. For similar materials see /class/202457/psyc-4240-university-of-georgia in Psychlogy at University of Georgia.




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Date Created: 09/12/15
Anxiety Disorders Nature of Anxiety and Fear Anxiety Future oriented mood state Characterized by marked negative affect Somatic symptoms of tensions Fear Present oriented mood state marked negative affect Immediate ght or ight response to danger or threat Strong avoidance escapist tendencies Abrupt activation of the sympathetic nervous system Anxiety and Fear are normal emotional states From normal to disordered anxiety and fear Characteristics of Anxiety Disorders Psychological disorders Pervasive and persistent symptoms of anxiety and fear Severe enough to cause stress and impairment Involve excessive avoidance and escapist tendencies Causes clinically significant distress and impairment Does impair ability The phenomenology of Panic Attacks What is a panic attack Abrupt experience of intense fear or discomfort Accompanied by severe physical symptoms DSMIV Subtypes of Panic Attacks Situationally bound cued panic Only when flying fear of flying Unexpected uncued panic Part of panic disorder Situationally predisposed panic more common in specific social phobias Doesn t mean everytime but more likely in setting Biological Contributions to Anxiety and Panic Diathesis Stress Inherit bulnerabilities for anxiety and panic not disorders Stress and life circumstances activate vulnerability Biological causes and inherent vulnerabilities Anxiety and brain circuits GABA noradrenergic and serotonergic systems Lower levels more anxiety Fight or flight Corticotropin releasing factor CRF and HPAC axis hypothalamic pituitaryadrenalcortical axis believed to be central to expression of anxiety Wide ranging effects Behavioral Inhibition System activated by signals from brain stem of unexpected events such as major changes in bodily functioning that might signal BIS thought to be distinct from circuit involved with Panic Fight or Fliqht system when system aroused it produces an immediate alarm and escape response May be related to serotonin deficiencies Environmental factors may change the sensitivity of brain circuits causing one to be more or less apt to develop an anxiety disorder Psychological Contributions to Anxiety and Panic Freud Anxiety is a psychological reaction to anger but tied to early infantchildhood fears Behaviorist views anxiety and fear result from classical and operant conditioning and modeling vicarious learning Psvcholoqical views Early experiences with uncontrollability and or unpredictability Parents can through their behavior pass on lesson that the child has some impact on their environment and the child can cope with a world that is unpredictable Social contributions Stressful life events trigger vulnerabilities Many stressors are familial or interpersonal Toward an integrated model of anxiety Integ rative view Triple vulnerability model 1 Generalized biological vulnerability tendency to be uptight nervous and high strung is heritable neurotic Generalized psychological vulnerability grow up with a belief that the world is dangerous and upredictable and doubt one s own coping ability gene heritability Specific psychological vulnerability learn potentially from early experiences that certain situations are fraught with dangeD Comorbidity of Anxiety Disorders Comorbidity is common across anxiety disorders Approximately 50 of patients with an anxiety disorder have another secondary diagnosis Major depression is most common secondary diagnosis ANXIETY TYPICALLY PRECEEDS DEPRESSION Comorbidity suggests common factors exist across anxiety disorders and possibly between anxiety and mood disorders Evidence suggests strong link between anxiety and depression The Anxiety Disorders An overview Generalized Anxiety Disorder Panic Disorder with and without Agoraphobia Specific Phobias PTSD OCD Social Phobia Posttraumatic Stress Disorder ObsessiveCompulsive Disorder Generalized Anxiety Disorder GAD The basic anxiety disorder Overview and Defininq Features Excessive uncontrollable anxious apprehension and worry worry about minor things Disability to stop worrying Coupled with strong persistent anxiety Somatic symptoms differ from panic eg muscle tension fatigue irritability sleep disturbance Persists for 6 months or more must occur more days than not Facts and Statistics GAD affects 4 of the general population may be more likely to seek treatment from primary care doctors Females outnumber males approximately 21 all anxiety disorders Onset is often insidious beginning in early adulthood Tends to have a chronic course Tendency to be anxious runs in families Appears to be more prevalent in older populations Causes of GAD Generalized bioloqical vulnerability Tendency to become anxious not GAD is heritable Autonomic restrictors less responsive on physiological measures unlike those With who experience panic Heart rate BP Skin Conductance Respiratory rate Distinguished from normal controls by muscle tension Cognitiver highly sensitive to threat especially threat that has personal relevance Appear to allocate more of their attention to these cues but in automatic manner Evidence of activity in left hemisphere but not right anxious thoughts but not anxiety provoking images Focus all attention on worry nothing left for visual images Problem this may make it hard for the patient to actually confront the feared situation and having a change to adapt to it Treatment of GAD Both drug and psychological interventions are effective Medications Benzodiazepines valium xanax help provide immediate short term relief lmpairs motor and cognitive functioning can produce dependence Abuse potential Antidepressants Proving useful in treatment of GAD Paxi effexor lower side effects Dcycloserine an antibiotic promising new drug Psychological Better longterm benefits CognitiveBehavioral Therapy evoke and confront anxiety provoking images and thoughts Challenge automatic irrational thoughts that lead to anxiety What is the likelihood that you are going to fail that test Let s review the data Works better than medication Panic Disorder with and without Agoraphobia Overview and Defininq Features Experience of unexpected panic attacks discrete period of intense fear or discomfort with four or more symptoms palpitations sweating trembling sensation of shortness of breath choking chest pain nausea feeling dizzy fear of dying A false alarm Anxiety worry or fear about having another attack or implications of attack Agoraphobia fear or avoidance of situationsevents where escape might be difficult or embarassing Symptoms and concern persists for 1 month or more Facts and Statistics Combines Anxiety Panic and Phobic Avoidance Panic disorder affects about 35 of the population Two thirds with panic disorder are female Onset is often acute beginning between ages 25 29 Agoraphobia can eventually exist independent of panic attacks lnteroceptive avoidance avoidance of internal physical symptoms Internal symbols Panic Disorder Associated Features and Treatment Associated Features Nocturnal panic attacks 60 of individuals with PD report noctournal panic attacks Happens in nonREM sleep delta sleep deepest slowest brain waves Some sensations of letting go when falling into deep sleep that is frightening to individuals with PD Bioloqical predisposition to be overreactive to life s events Some will have an emergency alarm reaction eg heart racing sweating breathing heavily as a response to a stressor Internally vigilant Situations get associated with internal cues hear racing and externals cues driving the car that were present during panic attack Predisposition to developing anxiety about the panic attacks and making catastrophic misinterpretations of symptoms of panic The intense focus on internal cues is followed by this misinterpretation which further exacerbates the internal symptoms Treatment of Panic Disorder Medication Treatment of Panic Disorder Target serotonergic noradrenergic and benzodiazepine GABA systems SSRls eg Prozac and Paxil Preferred drugs Relapse rates are high following medication discontinuation Psychological and Combined Treatments of Panic Disorder Cognitivebehavior therapies are highly effective Exposure for agoraphobia sometimes paired with relaxation strategies Panic create minipanic attacks in session as exposurepaired with cognitive therapy techniques challenging thought and perceptions about dangerousness of symptoms Spinning in chair Exercise Hypenentilate Breathe through a straw Should stop taking antianxiety meds during the process No longterm advantage for combined treatments Best longterm outcome Cognitivebehavior therapy alone Specific Phobias An overview Overview and Defining Features Extreme and irrational fear of a specific object or situation Markedly interferes with one s ability to function Recognize fears are unreasonable Still go to great lengths to avoid phobic objects Facts and Statistics Affects about 11 of the general population Females are again overrepresented Phobias run a chronic course Specific Phobias Associated Features and Treatment Associated Features and Subtypes of Specific Phobia Bloodiniurviniection phobia entirely different physiological response drop in blood pressure and heart rate Strongest heritability Situational phobia public transportation or enclosed places planes Natural environment phobia events occuring in nature heights storms Animal phobia animals and insects Other phobias do not fit into other categories fear of nhnkinn Inmitinn Specific Phobias Associated features Causes of Phobias Direct conditioning eg Dog bites child Experiencing a panic attack in a specific situation Observing vicarious learning someone ese s intense fear Being told about danger information transmission Biological and evolutionary vulnerability more likely to develop fear for certain objects an inherited tendency to fear things that have always been dangerous to humans snakes storms heiohts Specific Phobia Treatment Psychological Treatments of Specific Phobias Cognitivebehavior therapies are highly effective Exposure therapy Build anxiety hierarchy Start with least threatening and move to most threatening Can start at highest level works well but lowers treatment compliance Can use counterconditioning if necessary Modeling can help Social Phobia Overview Overview and Defining Features Extreme and irrational fearshyness Fears that heshe will act in a way thatwill be humiliating Involve evaluation Public speaking peeing in public Focused on social andor performance situations Markedly interferes with one s ability to function May avoid social situations or endure the with intense anxiety or distress Generalized subtype anxiety across many social situations Speaking eating using restroom writing typing Facts and Statistics Affects about 13 of the general population at some point Females are slightly more represented than males Onset is usually during adolescence Peak age of onset at about 15 years Social Phobia Associated Features and Treatment Causes of Phobias Evolutionary vulnerability evolved to fear disapproving faces Bioloqical vulnerability some individuals born with a shy inhibited temperament lntroverted individuals are chronically more aroused and thus need less stimulation Social performance experiences may cause overarousal Psychological factors taught that social evaluation is important and or dangerous Medication Treatment of Social Phobia Beta blockers ineffective Tricyclic antidepressants reduce social anxiety Monoamine oxidase inhibitors reduce anxiety SSRI Paxil FDA approved for social anxiety disorder Relapse rates high following medication discontinuation Psychological Treatment of Social Phobia Cognitivebehavioral treatment Exposure rehearsal roleplay in a group setting Therapists challenge underlying automatic thoughts regarding phobic activities eg If I misprounounce a word everyone will laugh at me If everyone laughs at me I ll never be able to show my face there again Goal is to reduce stress and impairment Cognitivebehavior therapies are highly effective Exposure portion appears to be most important component May actually change brain function Posttraumatic Stress Disorder PTSD An overview Overview and Defining Features Requires exposure to a traumatic event AND Person experiences extreme fear helplessness or horror Continue to reexperience the event eg memories nightmares flashbacks Avoidance of reminders of trauma and emotional numbing Avoid smells places Persistent symptoms of increased arousal difficulty sleeping hypervigilance exaggerated startle response Interpersonal problems are common PTSD diagnosis only 1 month or more posttrauma less than 1 month acute stress disorder Posttraumatic Stress Disorder PTSD An Overview cont Facts and Statistics Affects about 78 of the general population Most Common Traumas Sexual assault Accidents Combat Natural disasters Posttraumatic Stress Disorder PTSD Causes and Associated Features Subtypes and Associated Features of PTSD Acute PTSD may be diagnosed 13 months post trauma Chronic PTSD diagnosed after 3 months post traums Delayed onset PTSD symptoms begin after 6 months or more post traumas repression Acute stress disorder diagnosis of PTSD immediately post trauma Causes of PTSD Intensity of the trauma and one s reaction to it Uncontrollability and unpredictability Extent of social support or lack thereof post trauma Family history of anxiety increases likelihood PTSD Treatment Psychological Treatment of PTSD Cognitivebehavioral treatment involves graduated or massed imaginal exposure reexperience event in safe controlled environment Can challenge thoughts and emotions attached to the event Goal is to reduce the negative emotions involved such as shame guilt or anger Cognitive behavioral treatment involves graduated or massed imaginal exposure reexperience event in safe controlled environment Can challenge thoughts and emotions attached to the event Goal is to reduce the negative emotions involved such as shame guilt or anger Increase positive coping skills and social support Cognitive behavior therapies are highly effective Medications SSRls may be effective in reducing the anxiety and panic associated with PTSD ObsessiveCompulsive Disorder OCD An Overview Obsessions Persistent recurrent and intrusive thoughts images or urges that one tries to resist or eliminate Did I turn my stove off did I turn my stove off Common contamination doubts order aggressive or sexual imagery Ego dystonic feels intrusive and out of one s own control Not consistent with regular thought content Compulsions Repetitive thoughts or actions that person feels driven to perform or according to rigid rules goal of compulsions or to prevent or reduce distress associated with obse33ion Compu3ions are either not connected in a realistic way to what they are deSIgned to neutralize or are clearly excesswe Most persons with OCD display multiple obsessions Many cleaning washing or checking rituals Potentially devastating disorder Negative reinforcement ObsessiveCompulsive Disorder OCD Causes and Associated Features Facts and Statistics Affects about 26 of the population at some point Most persons with OCD are female although more males have the disorder in childhood OCD tends to be chronic Onset is typically in early adolescence or adulthood Causes of COD Parallel with other anxiety disorder Early life experiences and learning that some thoughts are dangerousunacceptable thoughts of sexaggression Thouqhtaction fusion having the thought becomes equated with the action I thought about hitting that woman with my car I did hit that woman with my car May be linked to excessive sense of responsibility and resulting guilt Belieft that some thoughts are unacceptable and must be suppressed may put one at risk for OCD eg Pink elephant ObsessiveCompulsive Disorder OCD Treatment Medication Treatment of COD Clomipramine and other SSRls benefit 50 Psychosurgery cingulotomy lesion a specific area Extreme cases Relapse is common with medication discontinuation Psychological Treatment of COD Cognitivebehavioral therapy Most effective for OCD CBT involves exposure and response prevention Combined treatments Not better than CBT alone Mood and Suicide An Overview of Mood Disorders Mood Disorders Types of DSMIVTR Depressive Disorders Types of DSMIVTR Bipolar Disorders Major Depression An Overview Maior Depressive Episode Overview and Defininq Features Extremely depressed mood Lasting at least 2 weeks Cognitive symptoms Disturbed physical functioning Anhedonia Thoughts of death Maior Depressive Disorder Single episode Highly unusual Recurrent episodes must be separated by two months during which criteria not met More common Dysthymia An Overview Overview and Defininq Features Milder symptoms of depression than major depression Persists for at least 2 years Facts and Statistics Double Depression An Overview Overview and Defininq Features Major depressive episodes and dysthymic disorder Facts and Statistics Bipolarl Disorder An Overview Overview and Defininq Features Essential feature occurrence of oneor more manic episodes or mixed episodes depreSSIon and mama W Distinct period of elevated or irritable mood 1 week Inflated selfesteem or grandiosity Decreased need for sleep More talkative pressured speech Flight of ideas racing thoughts Distractibility Increase in goaldirected behavior Excessive involvement in pleasurable activities Facts and Statistics Bipolar ll Disorder An Overview Overview and Defininq Features Alternating major depressive and hypomanic episodes like mania but causes less impairment Facts and Statistics Cyclothymic Disorder An Overview Overview and Defininq Features More chronic version of bipolar disorder Manic and major depressive episodes are less severe don t meet criteria for Major Depressive Episode or Manic Episode Manic or depressive mood states persist for long periods without remitting for greater than 2 months Pattern must last for at least 2 years for adults Facts and Statistics Additional Defining Criteria for Mood Disorders Symptom Specifiers Symptom Specifiers Atypical Melancholic Chronic Catatonic Psychotic Postpartum Additional Defining Criteria for Mood Disorders Course Specifiers Course Specifiers Longitudinal course Rapid cycling pattern Seasonal pattern Mood Disorders Additional Facts and Statistics Worldwide Lifetime Prevalence Sex Differences Prevalence of Depression Does not Vary Across Subcultures Relation Between Anxiety and Depression Mood Disorders Familial and Genetic Influences Family Studies Twin Studies Mood Disorders Neurobiological Influences Neurotransmitters The permissive hypothesis Endocrine System Sleep Disturbance Mood Disorders Psychological Influences Stress The Role of Stress in Mood Disorders Stress is strongly related to mood disorders The relation between context of life events and mood Reciprocalgene environment model Stress alone not necessarily enough to make us depressed stress interacts with psychological characteristics to affect the outcome Mood Disorders Psychological Influences Learned Helplessness The Learned Helplessness Theory of Depression Depressive Attributional Stvle Internal attributions Stable attributions Global attribution All three domains contribute to a sense of hopelessness but it is the hopelessness that leads to depression Mood Disorders Psychological Influences Cognitive Theory Aaron T Beck s Coqnitive Theory of Depression Types of Cognitive Errors Arbitrary inference Overqeneralization Dichotomous thinkinq Personalization Cognitive Errors and the Depressive Coqnitive Triad Mood Disorders Social and Cultural Dimensions Marriaqe and Interpersonal Relationships Gender lmbalances Social Suggort Integrative Model of Mood Disorders Shared Bioloqical Vulnerability Exposure to Stress Social and Interpersonal Relationships are Moderators Treatment of Mood Disorders Tricyclic Medications Widely Used Examples include Tofranil Elavil Block Reuptake Takes 2 to 8 Weeks for the Effects to be Known Negative Side Effects Are Common May be Lethal in Excessive Doses Treatment of Mood Disorders Monoamine Oxidase MAO Inhibitors Monoamine Oxidase MAO MAO Inhibitors block Monoamine Oxidase As or slightly more effective than tricyclics Must avoid certain foods containing Tyramine Can interact dangerously with other medicines Rarely used Treatment of Mood Disorders Selective Serotonergic Reuptake Inhibitors SSRls Specifically Block Reuptake of Serotonin Fluoxetine Prozac is the most popular SSRI Celexa Lexapro Luvox Paxil Zoloft SSRls Pose No Unique Risk of Suicide or Violence Side effects are common upset stomach insomnia physical agitation sexual dysfunction or lower sexual desire Treatment of Mood Disorders Lithium Lithium common salt mineral found in natural environment Side effects may be severe Mechanisms unclear Treatment of Mood Disorders Electroconvulsive Therapy ECT ECT ECT s effective for cases of severe depression Side effects Psychological Treatment of Mood Disorders Coqnitlve Therapy CBT Behavioral Activation Interpersonal Psychotherapy IPT Outcomes with Psychological Treatments CBT and IPT Prevention programs Teaching social and problemsolving skills Psychological Treatment for Bipolar Disorder The Nature of Suicide Facts and Statistics Eighth leading cause of death in the United States Overwhelmineg a White and Native American phenomenon Suicide rates are increasing particularly in the young Gender Differences lndices of Suicidal Behavior The Nature of Suicide Risk Factors Psychological Autopsies Suicide in the family Low serotonin levels Evidence of a preexisting psychological disorder Alcohol use and abuse Past suicidal behavior Experiencing of a shamefulhumiliating stressor Publicity About suicide and media coverage


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