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What are the four types of symptoms that constitute anxiety?
- Cognitive - thoughts
- Behavioral - fidgeting fingers
- Emotional -
- Physical - sweaty palms
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What questions should be asked to determine wether fear is Adaptive or Maladaptive?
- Are concerns realistic given the circumstances?
- Is the amount of concern in proportion to the concern?
- Is the fear still persistent after threat is gone?
- If yes, maladaptive.
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Criteria for Panic Disorder
- Recurrent unexpected panic attacks.
- On panic attack has been followed by 1 month of
- - persistent concerns of more attacks
- - concerns of what the attack implies (Emotional, Physical Mental)
- - a major change in behavior "Fear of Fear it's Self"
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Anxiety Sensitivity
- fear of anxiety related to physical sensations.
- - exp. heart racing, shortness of breath
- LINKED TO DEVELOPMENT OF PANIC DISORDER.
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Why do people have Anxiety Sensitivity?
because of the belief that these sensations have harmful somatic, psychological, or social consequences.
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Drug Treatments for Panic Disorders
- Tricyclic Anti depressants
- SSPIs (Prozac, Zolof, Celexa)
- propazocel
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What is Benzodiazepines?
- it is a downer for Panic Disorder
- it suppresses the central Nervous System
- Mute Alarm Response
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What are the disadvantages for Panic Disorder drug treatments?
- They are like band-aids
- once you are off attacks begin again
- Addictive and needs increasing dosages
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What are some Cognitive Treatments?
- Cognitive Restructuring
- Exposure of some kind
- -alters maladaptive fear/anxiety
- --provides evidence against irrational thoughts
- --habituation to anxiety
- Introspection
- -exp. spinning in a chair, breathing into a bag, getting the heart rate up.
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Relaxation is a Cognitive Treatment that entails what?
- Progressive Muscle Relaxation
- You cannot be both relaxed and scared at the same time.
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Humanistic Theory Carl Rogers
when people develop negative regards about self they worry more
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What are the Four Types of specific phobias diagnosed by the DSM IV TR?
- Animal Type - specific animals, insects, most common snake.
- Natural Environment Type - Events and situations in the environment exp. storms, heights, or water.
- Situation Type - Specific situations exp. flying, elevators, bridges or driving.
- Blood-Injection-Injury Type - Seeing blood or an injury or receiving an injection.
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What is distinct about Blood-Injection-Injury Type compared to the other three?
a Physiological Response, involves drop in blood pressure.
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Behavioral Therapy Tenants
What does Evolutionary Phobias mean?
Humans are prepared through evolutionary history to develop phobias to objects or situations that are ancestrally dangerous.
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What does Classical Conditioning lead to?
- It leads to fear of an objet or situation when paired with a naturally frightening event.
- Exp. Little Albert
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What did John B. Watson believe and do?
- Ha believed in Blank Slate- Tabula Rasa
- He Classically Conditioned Little Albert to be afraid of white fluffy things.
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Who is Mary Cover Jones and what did she do?
- She did an extinction experiment on Peter.
- She paired candy with a fear.
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Who is Joseph Wolpe and what did he do?
- he is a Behavior Therapist
- He came up with Subject Units of Distress Scale (SUDS) 1-5
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What are some Behavioral Therapies that are used to threat phobias?
- Modeling
- Flooding
- Systematic Desensitization
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What is Modeling Therapy?
- it is based on theories of observational learning/modeling
- The Therapist models behaviors most feared by clients before asking them to engage.
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What is Flooding Therapy?
the client is saturated with fear-provoking stimuli until anxiety is extinguished.
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What is Systematic Desensitization Therapy?
the client is gradually exposed to the stimuli.
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What is Social Anxiety that Specific Phobia is not?
- not a fear of a specific thing.
- Severely disrupts daily life
- highly co-morbid with Substance Use Disorder, Depression and Anxiety.
Social Phobia = Social Anxiety Disorder
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What are the diagnostic Criteria's for Social Anxiety?
- Persistent fear of being humiliated or embarrassed.
- Exposure provokes anxiety, situationally bound panic attacks.
- Avoidance or endured with intense anxiety.
- Impairment/Distress
- Duration is 6 months minimum
- Not due to substance or another disorder (GMC)
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What are the Sub-Types for Diagnosis Social Anxiety Disorder?
- Generalized
- Public Speaking
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The Sub-Type for Social Anxiety, Generalized consist of what?
- fears related to the most social situations.
- most likely to present for treatment.
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The Sub-Type for Social Anxiety, Public Speaking consist of what?
- most common non-clinical fear
- 20% of the populaion
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Group Social Anxiety Treatment vs. Individual Anxiety Treatment
- By nature group treatment will be exposure to a social environment.
- Observational Learning
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What are the three mechanisms of actions for Exposure Therapy in Social Anxiety Disorder (SAD)?
- Short -Circuits Avoidance
- Allows Practice of behavioral skills.
- Opportunity to empirically test dysfunctional beliefs.
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Criteria for General Anxiety Disorder
- Six or more months of worry or Anxiety
- Focus is not confined to features of Axis 1 disorders.
- Not due to substance use, GMC, or does not occur exclusively during mood, psychotic or pervasive developmental disorders
- Impairment and or distress
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General Anxiety Disorder
- Psychodynamic Theory
- Humanistic Theory
- Existential Theory
- Cognitive Theory
- Post Traumatic Stress Disorder
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Psychodynamic Theory Consist of what type of Anxieties?
- Realistic Anxiety
- Neurotic Anxiety
- Moral Anxiety
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Why does General Anxiety Disorder happen?
it happens when defense mechanisms can no longer contain impulses or anxiety that results from them.
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Theories Associate General Anxiety Disorder to not having a warm upbringing.
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Humanistic Theory Carl Rogers
- In the absence of unconditional positive regard people become too critical.
- Develop conditions of worth that way harsh self-standards.
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Existential Theory
- A universal human fear of the limits and responsibilities of one's existence
- Death
- Ennui - boredom
- The In authentic life - Failing to confront life issues
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Cognitive Theory Wells and Butler, Broskovec
- People thin about threat constantly
- Worrying is an attempt to suppress negative images
- Worry prevents bad things from happening
- Worrying is dangerous to your health
- - Negative reinforcement exp. seat belt beep.
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PTSD
- Exposed to trauma with
- -Events involving actual or threatening death, injury, or physical integrity of self or others.
- -Response involving fear, helplessness, or horror.
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PTSD Traumatic events are experienced in what ways?
- Intrusive thoughts or perceptions
- Distressing dreams
- Feelings that traumatic events were recurring.
- Distress at exposure to internal or external cues that symbolizes or resemble an aspect of the traumatic event.
- Physiological reactivity on exposure to internal or external cues that symbolized an aspect of the trauma.
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PTSD Avoidance of stimuli associated with the trauma and numbing of general responsiveness are?
- Efforts to avoid thoughts, feelings, or conversations.
- Avoid activities, people, places.
- Inability to recall important traumas.
- Diminished interest in activities.
- Detachment of estrangement of others.
- Restricted range of affect (emotion).
- Sense of shortened future.
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PTSD What are some persistent symptoms of increased arousal.
- Difficulty falling asleep
- Hyper-vigilance
- Difficulty concentrating
- Exaggerated startle response
- Irritability of outburst
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What is the MOST Potent predictor of PTSD?
- Severity duration and proximity of trauma.
- exp. frontline soldier vs. commander at base.
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Adjustment Disorder is not categorized with what?
Depression or Anxiety
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Adjustment Disorder Criteria
- Emotional or behavioral symptoms in response to and identifiable stressor occurring within 3 months of the onset of the stressor.
- Symptoms/ behaviors clinically significant either of the following
- -Marked distress, beyond what would be expected
- -Impairment if social or occupational/academic
- Does not meet criteria for another specific Axis 1 disorder, not an exacerbation of preexisting Axis 1 or 2 disorder
- Not Bereavement
- After stressor has terminated, symptoms doe not persist for more than an additional 6 months.
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Adjustment Disorder can be triggered by a stressor of any severity and may include a variety of other symptoms making it different from PTSD
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What are Social Factors of PTSD
- Severity duration and proximity of trauma.
- Social support - the amount of support after event
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What are some Psychological Factors of PTSD?
- Shattered Assumptions
- Preexisting Distress
- Coping Styles
- Eye Movement
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What are Shattered Assumptions of Psychological PTSD?
- Personal invulnerability - sexual assault at young age.
- Just would Belief
- Bad things don't happen to good people.
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What are Eye Movement of Psychological PTSD?
- Exposure including lateral eye movements (Francine Shapiro)
- No difference in outcomes when compared to other treatments with all of the same components except eye movement.
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What are Obsessions?
Recurrent and persistent thoughts images or impulses that are experienced as intrusive, inappropriate or cause anxiety/distress.
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What are Compulsions?
Repetitive behavior or mental acts in response to obsession.
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OCD Crideria
- Obsessions or compulsions
- Excessive or unreasonable
- Distress/Time consuming
- Restricted to Another Axis 1 disorder
- Not due to substance
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66% of people with OCD are Depressed
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What are the brain regions implicted with OCD
Thalamus and Caudate Nucleus
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Why can't people with OCD "turn-off their thoughts?"
- Depression or general anxiety makes even minor. events likely to invoke thoughts.
- Rigid moralistic thinking and feelings of responsibility.
- Believe they should be able to control thoughts.
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Rational Motive Therapy
the therapist is the one that does all the questioning.
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Behavior Therapy is often used to treat phobias
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Cognitive Behavioral Therapy
- Includes components of behavioral Theory
- Emperical approach to problems
- Form of Manualized, "Talk" Therapy exp. Zumba
- *Highly Effective than SSRIs in short term and 6 month follow-up.
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