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PSYC 3082: Chapter 4

by: Meghan Davis

PSYC 3082: Chapter 4 3082

Meghan Davis
Developmental Psychology

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About this Document

Chapter 4: Anxiety Disorders
Developmental Psychology
One Day of Notes
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This 4 page One Day of Notes was uploaded by Meghan Davis on Friday September 19, 2014. The One Day of Notes belongs to 3082 at Louisiana State University taught by Gros in Fall2014. Since its upload, it has received 54 views. For similar materials see Developmental Psychology in Psychlogy at Louisiana State University.

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Date Created: 09/19/14
Chapter 4 Weolnesolay September 17 2 14 338 PM 0 Nature of anxiety and fear 0 Anxiety I Somatic symptoms of tension I Future oriented mood state characterized by marked negative alfect I Apprehension about future danger or misfortune 0 Fear I Immediate ght or ight response to danger or threat I Involves abrupt activation of the sympathetic nervous system I Present oriented mood state marked negative alfect O From normal to disordered anxiety and fear 0 Characteristics of anxiety disorders I Psychological disorders Pervasive and persistent symptoms of anxiety and fear I Involve excessive avoidance and escapist tendencies I Symptoms and avoidance causes clinically signi cant distress and impairment 0 The phenomenology of panic attacks 0 What is a panic attack I Abrupt experience of intense fear or discomfort I Accompanied by several physical symptoms e g breathlessness chest pain 0 DSMIV Subtypes of Panic Attacks I Situationally bound cued panic Expected and bound to some situations I Unexpected uncued panic Unexpected out of the blue without warning I Situationally predisposed panic May or may not occur in some situations 0 Panic is Analogous to Fear as an Alarm Response 0 Biological contributions to anxiety and panic O Diathesis stress I Inherit vulnerabilities for anxiety and panic not anxiety disorders I Stress and life circumstances activate the underlying vulnerability 0 Biological Causes and Inherent Vulnerabilities I Anxiety and brain circuits GABA I Limbic amygdala and the septalhippocamp al systems I Behavioral inhibition BIS and ght ight FF systems 0 Psychological contributions to anxiety and fear 0 Began with Freud I Anxiety is a psychic reaction to fear I Anxiety involves reactivation of an infantile fear situation 0 Behavioral Views I Anxiety and fear result om direct classical and operant conditioning and modeling 0 Psychological Views I Early experiences with uncontrollability and unpredictability 0 Social Contributions I Stressful life events as triggers of biologicalpsychological vulnerabilities I Many stressors are familial and interpersonal 0 An integrated model 0 Biological vulr1erability interacts with psychological experimental and social variables to produce an anxiety disorder 0 Consistent with diathesis stress model 0 Common Processes The Problem of Comorbidity O Comorbidity is common across the anxiety disorders 0 Major depression is the most common secondary diagnoses 0 About half of patients have two or more secondary diagnoses 0 The anxiety disorders 0 Generalized anxiety disorder I Overview and De ning Features III Excessive uncontrollable anxious apprehension and worry about life events III Coupled with strong persistent anxiety III Persists for 6 months or more III Somatic symptoms dilfer om panic eg muscle tension fatigue irritability I Statistics I 4 of the general population meet diagnostic criteria for GAD III Females outnumber males approximately 21 III Onset is often insidious beginning in early adulthood Psychology 3082 Page 1 III Tendency to be anxious runs in families I Associated Features III Persons with GAD have been called autonomic restrictors III Fail to process emotional component of thoughts and images I Treatment of GAD III Benzodiazapines Often Prescribed Xanax Valium Buspar III SSRI s SSNIR s Prozac Zoloft Paxil Effexor celexaPsychologica1 interventions Cognitive Behavioral Therapy 0 Panic disorder with and without agoraphobia I Overview and De ning Features III Experience of unexpected panic attack ie a false alarm III Develop anxiety worry or fear about having another attack or its implications III Agoraphobia Fear or avoidance of situationsevents associated with panic III Symptoms and concem about another attack persists for 1 month or more I Facts and Statistics III 35 of the general population meet diagnostic criteria for panic disorder III Two thirds with panic disorder are female 9 Why III Onset is often acute beginning between 25 and 29 years of age I Associated Features III Interoceptiveexteroceptive avoidance catastrophic misinterpretation of symptoms I Medication Treatment of Panic Disorder III Target serotonergic noraadrenergic and benzodiazepine GABA systems III SSRIS SSNRI s eg Prozac and Paxil Effexor are currently the preferred drugs III beta blockers III Relapse rates are high following medication discontinuation I Psychological and combined treatments of panic disorder III Cognitivebehavior therapies are highly effective 9 exposure based 0 panic control treatment III Combined treatments do well in the short term III Best longterm outcome is with cognitivebehavior therapy alone 0 Speci c phobias I Overview and De ning Features III Extreme irrational fear of a speci c object or situation III Markedly interferes with one s ability to function III Persons will go to great lengths to avoid phobic objects while recognizing that the fear and avoidance are unreasonable I Facts and Statistics III Females are again overrepresented III About 11 of the general population meet diagnostic criteria for speci c phobia III Phobias run a chronic course with onset begirming between 15 and 20 years of age I Associated Features and Subtypes of Speci c Phobia III Bloodinjuryinjection phobia blood injury or injection III Situational phobia Public transportation or enclosed places eg planes III Natural Environment phobia Events occurring in nature eg heights storms III Animal phobia Animals and insects III Other phobias Do not t into the other categories eg fear of choking vomiting I Causes of Phobias III Biological and evolutionary vulnerability direct conditioning observational learning information transmission I Psychological Treatments of Speci c Phobias III Cognitivebehavior therapies are highly effective III Structured and consistent graduated exposurebased exercises 0 Social phobias I Overview and De ning Features III Extreme and irrational fearshyne ss in social and performance situations III Markedly interferes with one s ability to function III Often avoid social situations or endure them with great distress III can occur across numerous social situations or relatively few I Facts and Statistics III About 13 of the general population meet lifetime criteria for social phobia III Prevalence is slightly greater in females than males III Onset is usually during adolescence with a peak age of onset at about 15 years I Causes of Social Phobia III Biological and evolutionary vulnerability Psychology 3082 Page 2 III Direct conditioning observational learning information transmission Psychological Treatment of Social Phobia III Cognitivebehavioral treatment Exposure rehearsal roleplay in a group setting III highly elfective Medication Treatment of Social Phobia III Tricyclic antidepressants and monoamine oxidase inhibitors reduce social anxiety III SSRI Paxil is FDA approved for treatment of social anxiety disorder III Relapse rates are high following medication discontinuation 0 Separation anxiety disorder Excessive fear or anxiety when separating om home primary caregivers or attachment gures May involve thoughts of harm occurring to primary caregivers or attachment gures May involve re isal to attend school or elsewhere without caregivers May involve excessive reluctance to be alone Occurs primarily in childhood 0 Posttraumatic stress disorder Overview and De ning Features III Requires exposure to an event resulting in extreme fear helplessness or horror Person continues to reexperience the event eg memories nightmares ashbacks Avoidance of cues that serve as reminders of the traumatic event Emotional numbing and interpersonal problems are common Markedly interferes with one39s ability to mction III PTSD diagnosis cannot be made earlier than 1 month posttrauma Statistics III Combat and sexual assault are the most common traumas III About 78 of the general population meet criteria for PTSD Subtypes and Associated Features of PTSD III Acute PTSD May be diagnosed 13 months post trauma III Chronic PTSD Diagnosed after 3 months post trauma III Delayed onset PTSD Onset of symptoms 6 months or more post trauma III Acute stress disorder Diagnosis of PTSD immediately posttrauma Causes of PTSD III Intensity of the trauma and one39s reaction to it ie true trauma III Uncontrollability and unpredictability III Extent of social support or lack thereof posttrauma III Direct conditioning and observational learning Psychological Treatment of PTSD III Cognitivebehavior therapies CBT are highly elfective III CBT may include graduated or massed eg ooding imaginal exposure EIEIEIEI O Obsessive compulsive disorder Overview and De ning Features III Obsessions Intrusive and nonsensical thoughts images or urges that one tries to resist or eliminate III Compulsions Thoughts or actions to suppress the thoughts and provide relief III Most persons with OCD present with cleaning and washing or checking rituals Statistics III About 26 of the general population meet criteria for OCD in their lifetime III Most people with OCD are female III Onset is typically in early adolescence or young adulthood III OCD tends to be chronic Causes of OCD III Parallel the other anxiety disorders III Early life experiences and learning that some thoughts are dangerousunacceptable III Thoughtaction 1SlOI1 Tendency to view the thought as similar to the action Medication Treatment of OCD III Clomipramine and other SSRIs seem to bene t up to 60 of patients III Relapse is common with medication discontinuation III Psychosurgery cingulotomy is used in extreme cases Psychological Treatment of OCD III Cognitivebehavioral therapy is most elfective with OCD CBT involves exposure and response prevention III Combining medication with CBT does not work as well as CBT alone 0 Summary of anxiety related disorders 0 Anxiety Disorders Represent Some of the Most Common Forms of Psychopathology O From a Normal to a Disordered Experience of Anxiety and Fear Psychology 3082 Page 3 I Requires consideration of biological psychological experiential and social factors I Fear and anxiety persist to bodily or environmental nondangerous cues I Symptoms and avoidance cause signi cant distress and impair Iunctioning O Psychological Treatments are Generally Superior in the LongTerm I Most treatments for diiferent anxiety disorders involve similar components I Suggests that anxietyrelated disorders share common processes Psychology 3082 Page 4


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