Test 2 Exam Review

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Generalized Anxiety Disorder:

Definition: A disorder marked by persistent and excessive feelings of anxiety and worry about numerous events and activities. Sometimes described as free-floating anxiety

Symptoms: See Checklist -->

Criteria Time / Duration: at least 6 months, about two or more events

Co-morbidities:

Treatment:

Medications:

Cognitive Behavioral Therapy

Exposure Therapies / Systematic Desensitization

Exposure and Response Prevention:

Bolded Definitions:

Anxiety: The central nervous system's physiological and emotional response to a vague sense of threat or danger

Fear: The central nervous system's logical and emotional response to a serious threat to one's well-being

Generalized Anxiety Disorder:

experience general and persistent feelings of worry and anxiety

Specific Phobias:

experience a persistent and irrational fear of a particular object or situation.

Agoraphobia:

fear traveling to public places such as stores or movie theaters

Social Anxiety Disorder:

intensely afraid of social or performance situations in which embarrassment may occur

Panic Disorder:

have recurrent attacks of terror

DSM-5 Checklist

Generalized Anxiety Disorder:

1. Excessive or ongoing anxiety and worry, for at least six months, about two or more activities or events

2. At least three of the following symptoms: restlessness

fatigue

poor concentration

irritability

muscle tension

sleep disturbance

3. Significant distress or impairment

Epidemiology:

gender: Female 2: Male 1

socioeconomic classes: Low Income- Higher Prevalence

ethnicity: African American- Higher Prevalence, Hispanic- Same

Ranges / Patterns: One-year prevalence- 4%,

Age at Onset: 0-20 years

Prevalence among close relatives: elevated

Percent receiving clinical treatment: 25.5%

Etiology:

Psychodynamic Perspective:

Freud:

Child comes to believe that is id impulses are very dangers and may experience overwhelming anxiety whenever he has such impulses

Child's ego defense mechanisms may be too weak to cope with even normal levels of anxiety- overprotected by parents don't give child opportunity to develop defense mechanisms

Today:

GAD can be traced to inadequacies in the early relationships between children and their parents

defense mechanisms- quickly forget (repress) what they had been feeling

extreme punishment for id impulses

Overprotectiveness

Example:

Boy is spanked every time he cried for milk as an infant, messes his pants as a 2 year old, and explores his genitals as a toddle.

He may eventually come to believe that his various id impulses are dangerous

Child

Biological Perspective:

Socio-cultural Perspective:

Behavioral Perspective:

Cognitive Perspective:

Treatment:

Psychodynamic Perspective

Freudian Psychodynamic Therapists

Free Association- use these methods to help clients with GAD become less afraid of their id impulses and more successful in controlling them.

Object Relations Therapists:

use Free Association to help anxious patients identify and settle the childhood relationship problems that continue to produce anxiety in adulthood

Studies found that psychodynamic treatment only modest help to GAD

Exception: Short-term Psychodynamic Therapy

Biological Perspective:

Generalized Anxiety Disorder:

People with generalized anxiety disorder experience excessive and worry about a wide range of events and activities.

Sociocultural View:

Societal dangers, economic stress, or related racial and cultural pressures may create a climate in which cases of generalized anxiety disorder are more likely to develop.

African Americans are 30% more likely to suffer from GAD than white Americans

Hispanics born in the United States suffer from Nervios, a similar culture-bound disorder marked by extreme distress and tension headaches

Treatment: Psychodynamic

use Free Association, interpretation, and related psychodynamic techniques to help people overcome this problem

Moderate success rate, exception for Short-term Psychodynamic Therapy

Psychodynamic View:

Freud said that GAD may develop when anxiety is excessive and defense mechanisms break down

GAD can be traced to inadequacies in the early relationships between children and their parents

Humanistic View:

Arises when people stop looking at themselves honestly and acceptingly.

Carl Rogers

Believed that people with GAD fail to receive unconditional positive regard from significant others during their childhood and so become overly critical of themselves

Treatment: Humanistic

He treated such individuals with client-centered therapy

Shows unconditional positive regard and empathize with clients

hopes that atmosphere of genuine acceptance and caring will help clients feel secure enough to recognize their true needs, thoughts, and emotions

Only sometimes superior to placebo therapy

Low success rate

Cognitive View:

caused by dysfunctional ways of thinking

Believe that GAD is caused by maladaptive assumptions and beliefs that most life situations are dangerous.

Metacognitive View:

Implicit beliefs about the both positive and negative beliefs about worrying.

Negative- can lead to metaworries which is a predictor for GAD

Intolerance of Uncertainty Theory:

certain individuals cannot tolerate the knowledge that negative events may occur, even if the possibility of occurrence is very small

worry and worry to find "correct" solutions but can never find one, which leads to uncertainty, and more worry to find solution

Avoidance Theory:

greater bodily arousal (higher heart rate, perspiration, respiration) than other people and that worrying actually serves to reduce this arousal by distracting from unpleasant physical feelings

Treatment: Cognitive

Ellis and Beck

help clients change the maladaptive assumptions

Rational-emotive Therapy: point out irrational assumptions , suggest more appropriate assumptions, and assign homework that gives the individuals practice at challenging old assumptions

Educating about the role of worrying in their disorder

observe bodily arousal and cognitive responses across life

see the world as less threatening

Mindfulness-based Therapy:

apart of Acceptance and Commitment Therapy (ACT): learn to accept thoughts as events of the mind

Help clients to change thinking and to find more effective ways of coping during stressful situations

Biological View:

Family Pedigree Studies: determine how many and which relatives of a person with disorder have the same

15% of the relatives of people with GAD display it and Closer the relative, the higher the chance.

Low activity of GABA which is an inhibitor

Have problems in their anxiety feedback system- too few GABA receptors, or GABA receptors do not readily capture the neurotransmitter

Circuit that produces anxiety reactions is broken- prefrontal cortex, anterior cingulate cortex, and amygdala

Treatments: Biological

Drug Therapy

Benzodiazepines (sedative-hypnotic-drugs): Increase GABA (inhibitory) drugs that calm people in low doses and help them fall asleep in higher doses

may lead to tolerance and dependence

Antidepressant Medications: SNRIs- Increase serotonin and norepinephrine

Antipsychotic Medications

Relaxation Training

physical relaxation will lead to a state of psychological relaxation.

Meditation-

When combined with Cognitive therapy or with biofeedback- most effective

Biofeedback

electrical signals from the body to train people to control physiological process such as heart rate or muscle tension

connected to monitor, start controlling seemingly involuntary physiological processes

Electromyograph (EMG) clients see or hear when their muscles tension lessens

DSM-5 Checklist

Generalized Anxiety Disorder:

1. Excessive or ongoing anxiety and worry, for at least six months, about two or more activities or events

2. At least three of the following symptoms: restlessness

fatigue

poor concentration

irritability

muscle tension

sleep disturbance

3. Significant distress or impairment

Specific Phobia:

A persistent and unreasonable fear of a particular object or situation.

People with a phobia become fearful if they even think about the object or situation they dread, but they usually remain comfortable as long as they avoid it or thoughts about it

9% of all people in the United States have the symptoms of a specific phobia.

More that 12% of individuals develop such phobias at some point during their lives.

Many develop more than 1 disorder

Women outnumber men 2:1

African and Hispanic Americans who were born in the U.S. had 50% more that white

DSM-5 Checklist

Specific Phobia:

1. Marked, persistent, and disproportionate fear of a specific object or situation, typically lasting six months or more

2. Immediate anxiety is usually produced by exposure to the object.

3. Avoidance of the feared situation.

4. Significant distress or impairment

Agoraphobia:

An anxiety disorder in which a person is afraid to be in public places or situations from which escape might be difficult (or embarrassing) or help unavailable if panic-like symptoms were to occur.

2.2% of the adult population experience this problem

Women twice as likely as men

Twice as common among poor people

1/5 of individuals with agoraphobia are currently in treatment

develop in 20s and 30s

panic attacks

Comorbidity: Panic Disorder

DSM-5 Checklist

Agoraphobia:

1. Marked, disproportionate, and immediate fear about being in at least two of the following situations:

Public transportation (e.g., auto travel)

Open Spaces (e.g., parking spaces)

Shops, theaters, or cinemas

Lines or crowds

outside at home alone

2. Fear of agoraphobic situations is related to concern that escape might be hard or help unavailable if one were to experience panic or become incapacitated

3. Avoidance of agoraphobic situations

4. Symptoms typically last six or more months

5. Significant distress or impairment

Causes of Phobias:

Behaviorists:

Classical conditioning- specific phobias

entrapment (US) --> fear response (UR)

running water(CS) --> fear response (CR)

Behavioral Modeling:

Observation and Imitation:

boy watches mother be afraid of illnesses, doctors, and hospitals

boy expresses fears of those things as well

learned fears will blossom into GAD when a person acquires a large number of short encounters with the fear.

Stimulus Generalization: responses to one stimulus are also elicited by similar stimuli

phobias can be acquired by classical conditioning- but not ordinarily

Behavioral-Evolutionary Explanation:

Preparedness- predisposition to develop certain fears

Genetically through an evolutionary process

How are Phobias Treated?

Behavioral models are more widely used than the rest, particularly for specific phobias

Treatment: Specific Phobia

Exposure Treatments:

Behavioral treatments in which persons are exposed to the objects or situations they dread

1. Systematic Desensitization:

A behavioral treatment that uses relaxation training and a fear hierarchy to help clients with phobias react calmly to the objects or situations they dread

in vivo, or imaginal

2. Flooding

A treatment for phobias in which clients are exposed repeatedly and intensively to a feared object and made to see that it is actually harmless

in vivo, or covert

3. Modeling

The therapist who confronts the feared object or situation while the fearful person observes

Participant modeling- client is actively encouraged to king in with the therapist

Each Exposure Treatment helps people with specific phobias.

Virtual Reality- 3D computer graphics that simulate real-world objects and situations

Treatment: Agoraphobia

Exposure Treatments:

Not very successful for agoraphobia.

Use Systematic exposure methods

Support, Reasoning, and coaxing to get clients to confront the outside world

Support groups:

a small number of people with agoraphobia go out together for exposure sessions that last for several hours

support and encourage one another, and eventually coax one another to move away from group and go on their own

Home-based Self-help Programs:

Clinicians give clients and their families detailed instructions for carrying out exposure treatments themselves

Social Anxiety Disorder:

A severe and persistent fear of social or performance situations in which scrutiny by others and embarrassment may occur

Judge themselves as performing less competently than they actually do

Not called Social Phobia anymore.

Often interpreted as snobbery, lack of interest, or hostility

Cognitive theorists believe that the disorder is particularly likely to develop among people who hold and act on certain dysfunctional social beliefs and expectations

7.1% of people in the U.S and other Western countries (60% women) experience social anxiety disorder in any given year

12% develop this disorder at some point in their lives

Late childhood or adolescence and continues into adulthood

1/4 of individuals with disorder are currently in treatment

poor people are 50% more likely

African American and Asian American more likely

Not Hispanic Americans

Culture-bound disorder: Taijn Kyofusho- fear of making other people uncomfortable

DSM-5 Checklist:

Social Anxiety Disorder:

1. Marked, disproportionate, and persistent fear or anxiety about one or more social situations in which individual is exposed to possible scrutiny by others, typically lasting six months or more.

2. Fear of being negatively evaluated by or offensive to others

3. Anxiety is almost always produced by exposure to the social situation

4. Avoidance of feared situations

5. Significant distress or impairment

Treatment: Social Anxiety Disorder:

Sufferers have overwhelming social fears, and they often

lack skill at starting conversations, communicating their needs, or meeting the needs of others

Training in Social Skills:

model appropriate social behaviors for clients and encourage the individuals to try them out

Role-play with the therapists

rehearsing their new behaviors until they become more effective

Therapists provide feedback and reinforce (praise) the clients for fictive performances

Medication:

Antidepressant medication-

Psychotherapy:

less likely to relapse than those with medication alone

Exposure Therapy:

Behavioral intervention

encourage clients with social fears to expose themselves to the dreaded social situations and to remain until their fears subside

Cognitive Therapy:

often used in combination with behavioral techniques

rational-emotive therapy to help a man who fears he will be rejected if he speaks up at gatherings

Panic Disorder:

Anxiety takes the form of a smothering, nightmarish panic in which people lose control of their behavior and, in fact, are practically unaware of what they are doing.

Panic Attacks: periodic, short bouts of panic that occur suddenly, reach a peak within 10 minutes, and gradually pass

-palpitations of the heart

tingling in the hands or feet

shortness of breath

sweating

hot and cold flashes

trembling

chest pains

choking sensations

faintness

dizziness

nausea

feeling of unreality

fear of losing control

fear of dying

DSM-5 Checklist:

Panic Disorder

1. Recurrent unexpected panic attacks

2. A month or more of one of the following symptoms after at least one of the attacks:

Persistent concern or worry about having additional attacks

Significant maladaptive change in behavior related to attacks

GAD

GAD2

Phobias

Social Anxiety

PANic Disorder