What are the four types of symptoms that constitute anxiety?
- Cognitive - thoughts
- Behavioral - fidgeting fingers
- Emotional -
- Physical - sweaty palms
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.
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"
- fear of anxiety related to physical sensations.
- - exp. heart racing, shortness of breath
- LINKED TO DEVELOPMENT OF PANIC DISORDER.
Why do people have Anxiety Sensitivity?
because of the belief that these sensations have harmful somatic, psychological, or social consequences.
Drug Treatments for Panic Disorders
- Tricyclic Anti depressants
- SSPIs (Prozac, Zolof, Celexa)
What is Benzodiazepines?
- it is a downer for Panic Disorder
- it suppresses the central Nervous System
- Mute Alarm Response
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
What are some Cognitive Treatments?
- Cognitive Restructuring
- Exposure of some kind
- -alters maladaptive fear/anxiety
- --provides evidence against irrational thoughts
- --habituation to anxiety
- -exp. spinning in a chair, breathing into a bag, getting the heart rate up.
Relaxation is a Cognitive Treatment that entails what?
- Progressive Muscle Relaxation
- You cannot be both relaxed and scared at the same time.
Humanistic Theory Carl Rogers
when people develop negative regards about self they worry more
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.
What is distinct about Blood-Injection-Injury Type compared to the other three?
a Physiological Response, involves drop in blood pressure.
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.
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
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.
Who is Mary Cover Jones and what did she do?
- She did an extinction experiment on Peter.
- She paired candy with a fear.
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
What are some Behavioral Therapies that are used to threat phobias?
- Systematic Desensitization
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.
What is Flooding Therapy?
the client is saturated with fear-provoking stimuli until anxiety is extinguished.
What is Systematic Desensitization Therapy?
the client is gradually exposed to the stimuli.
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
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.
- Duration is 6 months minimum
- Not due to substance or another disorder (GMC)
What are the Sub-Types for Diagnosis Social Anxiety Disorder?
- Public Speaking
The Sub-Type for Social Anxiety, Generalized consist of what?
- fears related to the most social situations.
- most likely to present for treatment.
The Sub-Type for Social Anxiety, Public Speaking consist of what?
- most common non-clinical fear
- 20% of the populaion
Group Social Anxiety Treatment vs. Individual Anxiety Treatment
- By nature group treatment will be exposure to a social environment.
- Observational Learning
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.
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
General Anxiety Disorder
- Psychodynamic Theory
- Humanistic Theory
- Existential Theory
- Cognitive Theory
- Post Traumatic Stress Disorder
Psychodynamic Theory Consist of what type of Anxieties?
- Realistic Anxiety
- Neurotic Anxiety
- Moral Anxiety
Why does General Anxiety Disorder happen?
it happens when defense mechanisms can no longer contain impulses or anxiety that results from them.
Theories Associate General Anxiety Disorder to not having a warm upbringing.
Humanistic Theory Carl Rogers
- In the absence of unconditional positive regard people become too critical.
- Develop conditions of worth that way harsh self-standards.
- A universal human fear of the limits and responsibilities of one's existence
- Ennui - boredom
- The In authentic life - Failing to confront life issues
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.
- Exposed to trauma with
- -Events involving actual or threatening death, injury, or physical integrity of self or others.
- -Response involving fear, helplessness, or horror.
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.
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.
PTSD What are some persistent symptoms of increased arousal.
- Difficulty falling asleep
- Difficulty concentrating
- Exaggerated startle response
- Irritability of outburst
What is the MOST Potent predictor of PTSD?
- Severity duration and proximity of trauma.
- exp. frontline soldier vs. commander at base.
Adjustment Disorder is not categorized with what?
Depression or Anxiety
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.
Adjustment Disorder can be triggered by a stressor of any severity and may include a variety of other symptoms making it different from PTSD
What are Social Factors of PTSD
- Severity duration and proximity of trauma.
- Social support - the amount of support after event
What are some Psychological Factors of PTSD?
- Shattered Assumptions
- Preexisting Distress
- Coping Styles
- Eye Movement
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.
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.
What are Obsessions?
Recurrent and persistent thoughts images or impulses that are experienced as intrusive, inappropriate or cause anxiety/distress.
What are Compulsions?
Repetitive behavior or mental acts in response to obsession.
- Obsessions or compulsions
- Excessive or unreasonable
- Distress/Time consuming
- Restricted to Another Axis 1 disorder
- Not due to substance
66% of people with OCD are Depressed
What are the brain regions implicted with OCD
Thalamus and Caudate Nucleus
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.
Rational Motive Therapy
the therapist is the one that does all the questioning.
Behavior Therapy is often used to treat phobias
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.